Glied S
Division of Health Policy and Management, Columbia School of Public Health, New York, NY 10032, USA.
Health Serv Res. 1998 Oct;33(4 Pt 1):891-910.
To assess the effect of practice characteristics on the diagnosis and treatment of mental health problems in primary care.
National Ambulatory Medical Care Survey (NAMCS) 1991-1994.
We examine the effect of visit characteristics and practice characteristics on rates of diagnosis of mental health problems, rates of referral, and rates of use of psychotropic medications. We characterize each primary care physician's practice using information about the ways in which that physician treated patients who did not have mental health problems.
We find that median visit duration has a small, statistically insignificant effect on the rate of diagnosis and treatment of mental health problems. Physicians with large HMO caseloads are slightly more likely to diagnose mental health problems, but less likely to prescribe psychotropic medications, than are physicians who see few HMO patients. Practice style and specialty are important determinants of diagnosis and, to a lesser extent, of treatment.
Physicians specialty and practice style are more strongly related to mental health diagnosis and treatment than are system characteristics such as visit duration and insurance composition.
评估执业特征对初级保健中精神健康问题诊断和治疗的影响。
1991 - 1994年国家门诊医疗护理调查（NAMCS）。
我们考察就诊特征和执业特征对精神健康问题诊断率、转诊率以及精神类药物使用率的影响。我们利用每位初级保健医生治疗非精神健康问题患者方式的信息来描述其执业特点。
我们发现就诊持续时间中位数对精神健康问题的诊断和治疗率有微小且无统计学意义的影响。与接诊很少健康维护组织（HMO）患者的医生相比，HMO病例量大的医生诊断精神健康问题的可能性略高，但开具精神类药物的可能性较低。执业风格和专业是诊断的重要决定因素，在较小程度上也是治疗的重要决定因素。
与诸如就诊持续时间和保险构成等系统特征相比，医生的专业和执业风格与精神健康诊断及治疗的关联更为紧密。
