Goldman W, McCulloch J, Cuffel B, Zarin D A, Suarez A, Burns B J
United Behavioral Health, San Francisco, CA 94105-2426, USA.
Psychiatr Serv. 1998 Apr;49(4):477-82. doi: 10.1176/ps.49.4.477.
This exploratory study examined utilization and costs among depressed patients in two treatment models-integrated treatment, in which psychotherapy and pharmacotherapy were provided by a psychiatrist, and split treatment, in which pharmacotherapy was provided by a psychiatrist and psychotherapy by a nonphysician psychotherapist.
A quasi-experimental retrospective design was used to compare claims data from a national managed mental health care organization for 191 patients in integrated treatment and 1,326 in split treatment.
During the 18-month study, patients receiving integrated treatment used significantly fewer outpatient sessions and had significantly lower treatment costs, on average, than those in split treatment. Integrated treatment appeared to be associated with a pattern of utilization characterized by frequent treatment episodes in contrast to that of split treatment, which was characterized by more sessions with fewer breaks of 90 days or more.
The results do not support the prevailing assumption that integrated treatment is more costly than split treatment in a managed care network. Despite limitations in the study methods, the strength of these preliminary findings poses a powerful challenge and invites further study.
本探索性研究考察了两种治疗模式下抑郁症患者的治疗利用情况及成本——综合治疗模式，即由精神科医生同时提供心理治疗和药物治疗；以及分开治疗模式，即由精神科医生提供药物治疗，由非医生心理治疗师提供心理治疗。
采用准实验性回顾性设计，比较一家全国性管理式心理健康服务机构中191例接受综合治疗患者和1326例接受分开治疗患者的理赔数据。
在为期18个月的研究中，接受综合治疗的患者平均门诊治疗次数显著少于接受分开治疗的患者，治疗成本也显著更低。综合治疗似乎与一种治疗利用模式相关，其特点是治疗周期频繁，而分开治疗的特点是治疗次数较多，但90天及以上的间隔较少。
研究结果不支持在管理式医疗网络中综合治疗比分开治疗成本更高这一普遍假设。尽管研究方法存在局限性，但这些初步研究结果的力度构成了有力挑战，并引发了进一步研究的需求。
