Koet Lukas B M, Verhoog Sanne, Erdem Özcan, Gerger Heike, Bindels Patrick J E, de Schepper Evelien I T, Jansen Wilma
Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 50, Rotterdam, 3000 CA, the Netherlands.
Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Eur Child Adolesc Psychiatry. 2024 Dec 12. doi: 10.1007/s00787-024-02619-z.
Integration of child mental health services in general practice may improve early detection and treatment and reduce strain on specialized services. In this study we investigated whether outpatient mental health care utilization and associated costs in children and adolescents were affected by the introduction of youth mental health practice nurses (YMHPNs) in general practice. We linked healthcare data of the Rijnmond Primary Care Database to municipal registry data on child outpatient mental health care expenditures between 2019 and 2022. Using mixed models, we assessed if the presence of a YMHPN in practices was associated with outpatient mental health care utilization. Our cohort consisted of 33,971 children aged 0-17 years registered in 38 general practices in Rotterdam, the Netherlands. 5.5% of these children attended outpatient mental health services between 2019 and 2022. The proportion of children utilizing outpatient mental health care and associated costs increased over time. After correction for practice demographics and trends over time, the presence of a YMHPN in a practice was associated with small non-significant reductions in the number of children receiving outpatient care (Rate Ratio = 0.99, 95%CI 0.92 to 1.06) and associated costs (-395.80 euros 95%CI -1431.27 to 639.67) compared with practices without YMHPN. Considering the study limitations, we cautiously concluded that the introduction of YMHPNs in general practice was not associated with significant changes in outpatient mental health care utilization one to four years after implementation. Future studies should elucidate the long-term impact and underlying changes in pathways to care due to the introduction of the YMHPN.
将儿童心理健康服务纳入全科医疗可能会改善早期发现和治疗，并减轻专科服务的压力。在本研究中，我们调查了在全科医疗中引入青少年心理健康执业护士（YMHPNs）是否会影响儿童和青少年的门诊心理健康护理利用率及相关成本。我们将莱茵蒙德初级保健数据库的医疗数据与2019年至2022年期间儿童门诊心理健康护理支出的市政登记数据相链接。使用混合模型，我们评估了执业机构中YMHPN的存在是否与门诊心理健康护理利用率相关。我们的队列由荷兰鹿特丹38家全科医疗诊所登记的33971名0至17岁儿童组成。其中5.5%的儿童在2019年至2022年期间接受了门诊心理健康服务。随着时间的推移，使用门诊心理健康护理的儿童比例和相关成本都有所增加。在对执业机构人口统计学和时间趋势进行校正后，与没有YMHPN的执业机构相比，执业机构中有YMHPN的情况下，接受门诊护理的儿童数量（率比 = 0.99，95%置信区间0.92至1.06）和相关成本（-395.80欧元，95%置信区间 -1431.27至639.67）有小幅但不显著的降低。考虑到研究局限性，我们谨慎地得出结论，在全科医疗中引入YMHPNs在实施一至四年后与门诊心理健康护理利用率的显著变化无关。未来的研究应阐明由于引入YMHPNs而导致的长期影响以及护理途径的潜在变化。
