GENERAL PHYSICIAN'S ROLE IN TREATMENT OF THE SMI

全科医生在 SMI 治疗中的作用

• 批准号: 3475984
• 负责人: AILEEN B ROTHBARD
• 金额: $ 11.22万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 1993
• 资助国家: 美国
• 起止时间: 1993-09-01 至 1998-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3475984
• 关键词: community mental health services; health care cost /financing; health care service evaluation; human data; longitudinal human study; mental disorders; posthospitalization care; primary care physician; psychiatric patient care

This proposal to examine the general physician's role in the mental health treatment of the seriously mentally ill (SMI) client population. The policy issue to be addressed in this study is to what degree do the SMI receive treatment for their psychiatric conditions following hospital discharge from primary care physicians and what system and client factors impede or support follow-up community care. Questions to be examined are the following: (l) Are SMI patients in capitated health care plans (HIO/HMOs) more likely than those in fee for service plans to have ambulatory mental health care provided by their primary care physician? (2) Has the implementation of Intensive Case Management programs for the SMI significantly decreased the proportion of clients using a general physician for mental health care and, if so, what are the cost effectiveness implications with respect to continuity and rehospitalization rates? (3) What is the impact of comorbidity on the probability and level of use of physicians for the treatment of mental disorders? How does the initial treatment setting; i.e. primary care versus specialty, effect subsequent patterns of care such as cross over between sectors? (4) How does involuntary commitment and forensic status effect the choice of provider and the level of service? Are their significant provider barriers to care for this population or are these clients simply treatment resistant, using only costly emergency and inpatient services during periods of crisis? These areas of investigation have significant policy implications given the large percent of public funds that are allocated to the mental health treatment of the SMI. Given the pressure on public systems to become more efficient and recognizing the possible economies of scope that are present in using a physician to provide both health and mental health care, it is important to investigate the effect that system and social case mix changes are having on the patterns of psychiatric care in the general health care sector. This will hopefully provide a richer knowledge base for the planning and delivery of public health and psychiatric services.

该提案旨在审查全科医生在心理健康方面的作用 严重精神疾病 (SMI) 客户群的治疗。这 本研究要解决的政策问题是 SMI 在多大程度上 出院后接受精神疾病治疗 初级保健医生出院以及哪些系统和客户因素 阻碍或支持后续社区护理。要检查的问题是 下列： (l) SMI 患者参加按人头医疗保健计划 (HIO/HMO) 的可能性是否更大 比那些接受门诊精神卫生保健服务计划付费的人 由他们的初级保健医生提供？ (2) 已实施强化案件管理计划 SMI显着降低使用通用的客户比例 精神保健医生，如果有的话，费用是多少 对连续性和有效性的影响 再住院率？ (3) 合并症对使用概率和水平有何影响 治疗精神障碍的医生有哪些？初始如何 治疗环境；即初级保健与专业保健，影响随后 护理模式，例如部门之间的交叉？ (4) 非自愿承诺和法医身份如何影响选择 提供商和服务水平？是他们的重要提供者 照顾这一人群的障碍或者这些客户只是接受治疗 抵抗力强，在治疗期间仅使用昂贵的急诊和住院服务 危机时期？ 这些调查领域具有重大的政策影响 分配给心理健康的公共资金的很大一部分 SMI 的治疗。鉴于公共系统面临的压力，需要变得更加 高效并认识到现有的可能的范围经济 在使用医生提供健康和心理保健方面， 研究制度与社会案例结合的效果很重要 一般情况下，精神科护理模式正在发生变化 医疗保健部门。这有望提供更丰富的知识库 用于规划和提供公共卫生和精神病学服务。