Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27599-7411, USA.
NORC at the University of Chicago, Boston, USA.
J Gen Intern Med. 2021 Apr;36(4):970-977. doi: 10.1007/s11606-020-06429-2. Epub 2021 Jan 27.
Strategies are needed to better address the physical health needs of people with serious mental illness (SMI). Enhanced primary care for people with SMI has the potential to improve care of people with SMI, but evidence is lacking.
To examine the effect of a novel enhanced primary care model for people with SMI on service use and screening.
Using North Carolina Medicaid claims data, we performed a retrospective cohort analysis comparing healthcare use and screening receipt of people with SMI newly receiving enhanced primary care to people with SMI newly receiving usual primary care. We used inverse probability of treatment weighting to estimate average differences in outcomes between the treatment and comparison groups adjusting for observed baseline characteristics.
People with SMI newly receiving primary care in North Carolina.
Enhanced primary care that includes features tailored for individuals with SMI.
Outcome measures included outpatient visits, emergency department (ED) visits, inpatient stays and days, and recommended screenings 18 months after the initial primary care visit.
Compared to usual primary care, enhanced primary care was associated with an increase of 1.2 primary care visits (95% confidence interval [CI]: 0.31 to 2.1) in the 18 months after the initial visit and decreases of 0.33 non-psychiatric inpatient stays (CI: - 0.49 to - 0.16) and 3.0 non-psychiatric inpatient days (CI: - 5.3 to - 0.60). Enhanced primary care had no significant effect on psychiatric service and ED use. Enhanced primary care increased the probability of glucose and HIV screening, decreased the probability of lipid screening, and had no effect on hemoglobin A1c and colorectal cancer screening.
Enhanced primary care for people with SMI can increase receipt of some preventive screening and decrease use of non-psychiatric inpatient care compared to usual primary care.
需要采取策略来更好地满足严重精神疾病（SMI）患者的身体健康需求。增强对 SMI 患者的初级保健服务有可能改善对 SMI 患者的护理，但目前缺乏相关证据。
评估一种新型增强型初级保健模式对 SMI 患者服务使用和筛查的效果。
我们使用北卡罗来纳州医疗补助索赔数据，对接受新型增强型初级保健服务的 SMI 患者和接受常规初级保健服务的 SMI 患者的医疗保健使用和筛查接受情况进行回顾性队列分析。我们使用逆概率治疗加权法（inverse probability of treatment weighting），根据观察到的基线特征，对治疗组和对照组的结果进行平均差异估计。
北卡罗来纳州新接受初级保健的 SMI 患者。
增强型初级保健服务，包括针对 SMI 患者量身定制的服务。
18 个月后初始初级保健就诊后的门诊就诊、急诊就诊、住院和住院天数以及推荐筛查情况。
与常规初级保健相比，增强型初级保健在初始就诊后的 18 个月内增加了 1.2 次初级保健就诊（95%置信区间[CI]：0.31-2.1），减少了 0.33 次非精神科住院（CI：-0.49 至-0.16）和 3.0 非精神科住院天数（CI：-5.3 至-0.60）。增强型初级保健对精神科服务和急诊就诊没有显著影响。增强型初级保健增加了葡萄糖和 HIV 筛查的概率，降低了血脂筛查的概率，对血红蛋白 A1c 和结直肠癌筛查没有影响。
与常规初级保健相比，增强型初级保健服务可以增加 SMI 患者接受某些预防性筛查的机会，减少非精神科住院治疗的使用。
