Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA.
Health Serv Res. 2024 Dec;59 Suppl 2(Suppl 2):e14354. doi: 10.1111/1475-6773.14354. Epub 2024 Aug 21.
To examine the relationship between the penetration (or reach) of a national program aiming to integrate mental health clinicians into all primary care clinics (PC-MHI) and rates of guideline-concordant follow-up and treatment among clinic patients newly identified with depression in the Veterans Health Administration (VA).
DATA SOURCES/STUDY SETTING: 15,155 screen-positive patients 607,730 patients with 2-item Patient Health Questionnaire scores in 82 primary care clinics, 2015-2019.
In this retrospective cohort study, we used established depression care quality measures to assess primary care patients who (a) newly screened positive (score ≥3) and (b) were identified with depression by clinicians via diagnosis and/or medication (n = 15,155; 15,650 patient-years). Timely follow-up included ≥3 mental health, ≥3 psychotherapy, or ≥3 primary care visits for depression. Minimally appropriate treatment included ≥4 mental health visits, ≥3 psychotherapy, or ≥60 days of medication. In multivariate regressions, we examined whether higher rates of PC-MHI penetration in clinic (proportion of total primary care patients in a clinic who saw any PC-MHI clinician) were associated with greater depression care quality among cohort patients, adjusting for year, healthcare system, and patient and clinic characteristics.
DATA COLLECTION/EXTRACTION METHODS: Electronic health record data from 82 VA clinics across three states.
A median of 9% of all primary care patients were seen by any PC-MHI clinician annually. In fully adjusted models, greater PC-MHI penetration was associated with timely depression follow-up within 84 days (∆P = 0.5; SE = 0.1; p < 0.001) and 180 days (∆P = 0.3; SE = 0.1; p = 0.01) of a positive depression screen. Completion of at least minimal treatment within 12 months was high (77%), on average, and not associated with PC-MHI penetration.
Greater PC-MHI program penetration was associated with early depression treatment engagement at 84-/180-days among clinic patients newly identified with depression, with no effect on already high rates of completion of minimally sufficient treatment within the year.
探讨旨在将精神卫生临床医生整合到所有初级保健诊所（PC-MHI）的国家计划的渗透（或覆盖）程度与退伍军人事务部（VA）新诊断为抑郁症的诊所患者遵循指南的随访和治疗率之间的关系。
数据来源/研究设置：2015-2019 年，在 82 个初级保健诊所中，对 15155 名筛查阳性患者和 607730 名 2 项患者健康问卷得分患者进行了研究。
在这项回顾性队列研究中，我们使用已建立的抑郁症护理质量指标评估了新筛查阳性（得分≥3）的初级保健患者和（b）通过诊断和/或药物治疗被临床医生诊断为抑郁症的患者（n=15155；15650 患者年）。及时随访包括≥3 次心理健康、≥3 次心理治疗或≥3 次抑郁症初级保健就诊。最低适当治疗包括≥4 次心理健康就诊、≥3 次心理治疗或≥60 天的药物治疗。在多变量回归中，我们研究了诊所中 PC-MHI 渗透率（诊所中接受任何 PC-MHI 临床医生治疗的总初级保健患者比例）的高低与队列患者的抑郁症护理质量之间的关系，调整了年份、医疗系统以及患者和诊所特征。
数据收集/提取方法：来自三个州的 82 个 VA 诊所的电子健康记录数据。
每年约有 9%的所有初级保健患者由任何 PC-MHI 临床医生接诊。在完全调整的模型中，更高的 PC-MHI 渗透率与 84 天内（∆P=0.5；SE=0.1；p<0.001）和 180 天内（∆P=0.3；SE=0.1；p=0.01）及时进行抑郁症随访有关。在 12 个月内完成至少最低限度治疗的比例较高（平均为 77%），与 PC-MHI 渗透率无关。
在新诊断为抑郁症的诊所患者中，更高的 PC-MHI 计划渗透率与 84/180 天内的早期抑郁症治疗参与度相关，而对年内完成最低限度充分治疗的高比例（77%）没有影响。
