Department of Psychiatry and Behavioral Sciences (Scott Wetzler, Schwartz, Counts) and Department of Epidemiology and Population Health (Patel), Albert Einstein College of Medicine, Bronx, New York; Department of History and Science, Harvard University, Cambridge, Massachusetts (Sara Wetzler).
Psychiatr Serv. 2020 Aug 1;71(8):789-795. doi: 10.1176/appi.ps.201900392. Epub 2020 Apr 23.
This study investigated service use by individuals with serious and nonserious mental illness receiving mental health care in medical and mental health settings.
Claims data from the New York State Medicaid Data Warehouse were examined for 8,988 patients who received at least one mental health service at an urban academic medical center during 2017 at a mental health setting, a medical setting, or both.
Most patients (59%) received all of their mental health care in medical settings and from unaffiliated providers, including a large portion (16%) with serious mental illness. Despite the availability of integrated care in the medical setting and use of unaffiliated mental health providers, rates of mental health inpatient admissions were high among all patients in this setting (including those with serious and with nonserious mental illness), considerably higher than for patients treated in a mental health clinic within the system. Rates of medical and substance abuse inpatient admissions were also much higher for patients treated in the medical setting and by unaffiliated providers, compared with those treated in the system's mental health clinics.
Findings suggest that when mental health services are available in medical and mental health settings within the same system, either patients with more severe physical illnesses are more likely to receive their mental health care in medical settings and from unaffiliated providers and thus have more hospitalizations of all types or affiliated mental health settings more effectively address clinical needs and thus reduce hospitalizations.
本研究调查了在医疗和心理健康环境中接受心理健康护理的患有严重和非严重精神疾病的个体的服务使用情况。
对纽约州医疗补助数据仓库中的数据进行了检查，共纳入 8988 名 2017 年在城市学术医疗中心的心理健康环境、医疗环境或两者均接受过至少一次心理健康服务的患者。
大多数患者（59%）在医疗环境中并由非附属提供者接受了所有的心理健康护理，其中包括很大一部分（16%）患有严重精神疾病的患者。尽管医疗环境中提供了综合护理并使用了非附属的心理健康提供者，但该环境中所有患者（包括患有严重和非严重精神疾病的患者）的心理健康住院率都很高，明显高于系统内心理健康诊所治疗的患者。与在系统内心理健康诊所治疗的患者相比，在医疗环境中接受治疗的患者和非附属提供者的医疗和药物滥用住院率也高得多。
研究结果表明，当同一系统中的医疗和心理健康环境中都提供心理健康服务时，要么是身体疾病更严重的患者更有可能在医疗环境中并由非附属提供者接受他们的心理健康护理，因此更有可能接受各种类型的住院治疗，要么是附属心理健康环境更有效地满足了临床需求，从而减少了住院治疗。
