Putnam Rebecca T, Hughes Phillip M, Atkins Chelsea C, Belden C Micha
From the Department of Family Medicine, Mountain Area Health Education Center, Asheville, NC (RTP); Department of Research, UNC Health Sciences at MAHEC, Asheville, NC (PMH, CCA, CMB); Division of Pharmaceutical Outcomes & Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC (PMH); Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC (PMH).
J Am Board Fam Med. 2025 Jan-Feb;38(1):180-187. doi: 10.3122/jabfm.2024.240183R2.
To provide an overview of an innovative, consultative care model for patients with Intellectual and Developmental Disabilities (IDD) within a Family Medicine department.
We conducted a retrospective chart review of all patients seen in the clinic between 2017 to 2023 to identify patient demographics (eg, age), clinical needs (eg, diagnoses and referral needs), and administrative characteristics (eg, Medicaid status). We also conducted a spatial analysis to evaluate each patient's estimated travel distance and time to the clinic.
The number of patients seen in the IDD clinic totaled 184, with 65% male patients (n = 120) and a mean age of 31.29 years (SD = 16.27). More than half of patients, 65%, were insured by Medicaid (n = 119), and almost half received services paid for by the state Medicaid waiver (43%, n = 80). Many patients lived with family (64%, n = 117) and reported family guardianship (55%, n = 101). The spatial analysis identified that the majority of patients, 86% (n = 159) were nonrural residents based on Rural-Urban Continuum Codes. The mean distance traveled was 20.41 (SD = 21.36) miles with a mean travel time of 27.08 minutes (SD = 21.78). Following the consultations, 38% received outgoing referrals. Referral locations included psychiatry (8%), neurology (3%), behavioral health counseling (3%), and other medical services (17%).
This study demonstrates the diverse characteristics of patients with IDD receiving care through a consultative-based model of care. This model appeared to provide services for patients from a wide geographic catchment area that may not have otherwise had health care access.
概述家庭医学科针对智力和发育障碍（IDD）患者的一种创新型咨询护理模式。
我们对2017年至2023年期间在该诊所就诊的所有患者进行了回顾性病历审查，以确定患者人口统计学特征（如年龄）、临床需求（如诊断和转诊需求）以及管理特征（如医疗补助状态）。我们还进行了空间分析，以评估每位患者到诊所的估计出行距离和时间。
IDD诊所的就诊患者总数为184人，其中65%为男性患者（n = 120），平均年龄为31.29岁（标准差 = 16.27）。超过一半的患者（65%，n = 119）由医疗补助承保，近一半接受由州医疗补助豁免支付费用的服务（43%，n = 80）。许多患者与家人同住（64%，n = 117），并报告有家庭监护（55%，n = 101）。空间分析确定，根据城乡连续体代码，大多数患者（86%，n = 159）为非农村居民。平均出行距离为20.41英里（标准差 = 21.36），平均出行时间为27.08分钟（标准差 = 21.78）。咨询后，38%的患者接受了外部转诊。转诊地点包括精神病学（8%）、神经学（3%）、行为健康咨询（3%）和其他医疗服务（17%）。
本研究展示了通过基于咨询的护理模式接受护理的IDD患者的多样特征。该模式似乎为来自广泛地理区域、否则可能无法获得医疗服务的患者提供了服务。
