虚拟护理和一体化护理同日获得对退伍军人健康管理局精神健康专科治疗参与度的影响
Effects of Virtual Care and Same-Day Access to Integrated Care on Specialty Mental Health Engagement in the Veterans Health Administration.
机构信息
U.S. Department of Veterans Affairs, North Hills, CA, USA.
VHA HSR&D Center for the Study of Health care Innovation, Implementation, and Policy (CSHIIP), Greater Los Angeles VA Medical Center, Los Angeles, CA, USA.
出版信息
J Prim Care Community Health. 2023 Jan-Dec;14:21501319231159311. doi: 10.1177/21501319231159311.
BACKGROUND
In the Veterans Health Administration (VA), Primary Care-Mental Health Integration (PC-MHI) clinics offer mental health services embedded in primary care, a strategy shown to reduce overall specialty mental health clinic burden while facilitating prompt referrals when indicated. Among newly initiated patients, same-day access to PC-MHI from primary care increases subsequent specialty mental health engagement. However, the impact of virtual care on the association between same-day access to PC-MHI and subsequent mental health engagement remains unclear.
OBJECTIVE
To examine the effects of same-day access to PC-MHI and virtual care use on specialty mental health engagement.
METHODS
We used administrative data from 3066 veterans who initiated mental health care at a large, California VA PC-MHI clinic during 3/1/2018 to 2/28/2022 and had no previous mental health visits for at least 2 years prior to the index appointment. We conducted Poisson regression analyses to examine the effects of same-day access to PC-MHI, virtual access to PC-MHI and their combined effect on subsequent specialty mental health engagement.
RESULTS
Same-day access to PC-MHI from primary care was positively associated with specialty mental health engagement (IRR = 1.19; 95% CI 1.14-1.24). Virtual access to PC-MHI was negatively associated with specialty mental health engagement (IRR = 0.83; 95% CI 0.79-0.87). The positive effect of same-day access on specialty mental health engagement was smaller among patients who initiated PC-MHI in a virtual visit (IRR = 1.07) compared to in-person visits (IRR = 1.29; 95% CI 1.22-1.36).
CONCLUSIONS
Although same-day access to PC-MHI increased overall specialty mental health engagement, the magnitude of this effect varied between in-person and virtual modalities. More research is needed to understand mechanisms of the association between virtual care use, same-day access to PC-MHI, and specialty mental health engagement.
背景
在退伍军人健康管理局（VA）中，初级保健-心理健康整合（PC-MHI）诊所提供嵌入初级保健的心理健康服务，这一策略已被证明可以减轻整体专业心理健康诊所的负担，同时在需要时促进及时转诊。在新开始接受治疗的患者中，从初级保健获得 PC-MHI 的当日就诊机会增加了随后的专业心理健康治疗参与度。然而，虚拟护理对当日获得 PC-MHI 与随后的心理健康治疗参与度之间的关联的影响尚不清楚。
目的
研究当日获得 PC-MHI 和虚拟护理使用对专业心理健康治疗参与度的影响。
方法
我们使用了来自 2018 年 3 月 1 日至 2022 年 2 月 28 日期间在加利福尼亚州 VA 的一个大型 PC-MHI 诊所开始接受心理健康治疗的 3066 名退伍军人的行政数据，他们在指数预约前至少 2 年没有进行过任何心理健康治疗。我们进行了泊松回归分析，以研究当日获得 PC-MHI、虚拟获得 PC-MHI 及其对随后的专业心理健康治疗参与度的综合影响。
结果
从初级保健获得 PC-MHI 的当日就诊机会与专业心理健康治疗参与度呈正相关（IRR=1.19；95%CI 1.14-1.24）。虚拟获得 PC-MHI 与专业心理健康治疗参与度呈负相关（IRR=0.83；95%CI 0.79-0.87）。在虚拟就诊中开始接受 PC-MHI 的患者中，当日就诊对专业心理健康治疗参与度的积极影响较小（IRR=1.07），而在门诊就诊中（IRR=1.29；95%CI 1.22-1.36）。
结论
虽然当日获得 PC-MHI 增加了整体专业心理健康治疗参与度，但这种效果的大小在门诊和虚拟模式之间有所不同。需要进一步研究以了解虚拟护理使用、当日获得 PC-MHI 与专业心理健康治疗参与度之间关联的机制。
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