Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
BMC Health Serv Res. 2021 Sep 13;21(1):960. doi: 10.1186/s12913-021-06982-4.
Effectiveness and efficiency are part of the quality of care for mental health problems, and treatment should thus be performed at the right level of care. Norwegian guidelines specify which patients should be given priority for treatment in specialized mental health care (SMHC) centers, but there is a lack of agreement on which patients should actually receive SMHC. In this study we wanted to examine what factors (patient and GP characteristics) were related to GP patients who received treatment in SMHC centers.
In this retrospective cohort study, we looked at 12 months of data from electronic health records from six GP and SMHC centers of hospitals in the catchment area. We included all patients who had been treated at any of the GP centers during the 12-month period (N=18032). We fit a generalized linear mixed model to explore which factors were related to patients receiving treatment in SMHC centers. Further exploration was performed to study the effects of gender and contact frequency.
We found that 4.6% of all GP patients and 18.4% of the GP patients with a mental health problems were treated in SMHC centers. There were more women than men among the GP-patients (56% vs 44%) and in SMHC centers (55% vs 45%), women with mental health problems were more severely ill than men. However, after adjusting for other factors men were more likely to be treated in SMHC centers (OR: 1.44). Patients with frequent GP contact were more likely to be treated in SMHC centers. The GP characteristics age, gender and specialization did not relate to patients receiving treatment in SMHC centers.
Men were more likely to be treated in SMHC centers than women, which may imply that they have different thresholds for entering SMHC centers. GP characteristics were not related to receiving treatment in SMHC centers. More specific knowledge is needed to determine whether men and women currently receive treatment at the lowest possible level of care.
对于心理健康问题的护理质量而言，有效性和效率是其中的一部分，因此治疗应在适当的护理级别进行。挪威指南规定了哪些患者应优先在专门的心理健康护理（SMHC）中心接受治疗，但对于实际上应接受 SMHC 的患者存在缺乏共识。在这项研究中，我们想研究哪些因素（患者和全科医生的特征）与在 SMHC 中心接受治疗的全科医生患者有关。
在这项回顾性队列研究中，我们查看了来自医院六个全科医生和 SMHC 中心的电子健康记录中 12 个月的数据。我们纳入了在 12 个月期间在任何一个全科医生中心接受过治疗的所有患者（N=18032）。我们拟合了一个广义线性混合模型，以探讨哪些因素与在 SMHC 中心接受治疗的患者有关。进一步的探索是为了研究性别和接触频率的影响。
我们发现，所有全科医生患者中有 4.6%，有心理健康问题的全科医生患者中有 18.4%在 SMHC 中心接受治疗。在全科医生患者中（56%对 44%）和在 SMHC 中心中（55%对 45%），女性多于男性，患有心理健康问题的女性比男性病情更严重。然而，在调整其他因素后，男性更有可能在 SMHC 中心接受治疗（OR：1.44）。与 SMHC 中心接触频繁的患者更有可能在 SMHC 中心接受治疗。全科医生的特征（年龄、性别和专业化）与在 SMHC 中心接受治疗的患者无关。
男性比女性更有可能在 SMHC 中心接受治疗，这可能意味着他们进入 SMHC 中心的门槛不同。全科医生的特征与在 SMHC 中心接受治疗无关。需要更具体的知识来确定男性和女性目前是否在最低可能的护理水平接受治疗。
