Kessler R C, Zhao S, Katz S J, Kouzis A C, Frank R G, Edlund M, Leaf P
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Am J Psychiatry. 1999 Jan;156(1):115-23. doi: 10.1176/ajp.156.1.115.
The authors present nationally representative descriptive data on 12-month use of outpatient services for psychiatric problems. They focused on the relationship between DSM-III-R disorders and service use in four broadly defined service sectors as well as the distribution of service use in multiple service sectors.
Data from the National Comorbidity Survey were examined.
Summary measures of the seriousness and complexity of illness were significantly related to probability of use, number of sectors used, mean number of visits, and specialty treatment. One-fourth of the people in outpatient treatment were seen in multiple service sectors, but no evidence was found of multisector offset in number of visits.
Use of outpatient services for psychiatric problems appears to have increased over the decade between the early 1980s and early 1990s, especially in the self-help sector. Aggregate allocation of treatment resources was related to need, highlighting the importance of making provisions for specialty care in the triage systems currently evolving as part of managed care.
作者提供了关于精神问题门诊服务12个月使用情况的全国代表性描述性数据。他们重点关注了《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中的疾病与四个大致定义的服务部门中服务使用之间的关系，以及多个服务部门中服务使用的分布情况。
对来自全国共病调查的数据进行了检查。
疾病严重程度和复杂性的汇总指标与使用概率、使用的部门数量、平均就诊次数以及专科治疗显著相关。接受门诊治疗的人群中有四分之一在多个服务部门就诊，但未发现就诊次数存在多部门抵消的证据。
在20世纪80年代初至90年代初的十年间，精神问题门诊服务的使用似乎有所增加，尤其是在自助部门。治疗资源的总体分配与需求相关，这凸显了在当前作为管理式医疗一部分而不断发展的分诊系统中提供专科护理的重要性。
