Managed care, access to mental health specialists, and outcomes among primary care patients with depressive symptoms.
J Gen Intern Med
; 17(4): 258-69, 2002 Apr.
Article
em En
| MEDLINE
| ID: mdl-11972722
ABSTRACT
OBJECTIVE:
To determine whether managed care is associated with reduced access to mental health specialists and worse outcomes among primary care patients with depressive symptoms.DESIGN:
Prospective cohort study.SETTING:
Offices of 261 primary physicians in private practice in Seattle. PATIENTS Patients (N = 17,187) were screened in waiting rooms, enrolling 1,336 adults with depressive symptoms. Patients (n = 942) completed follow-up surveys at 1, 3, and 6 months. MEASUREMENTS ANDRESULTS:
For each patient, the intensity of managed care was measured by the managedness of the patient's health plan, plan benefit indexes, presence or absence of a mental health carve-out, intensity of managed care in the patient's primary care office, physician financial incentives, and whether the physician read or used depression guidelines. Access measures were referral and actually seeing a mental health specialist. Outcomes were the Symptom Checklist for Depression, restricted activity days, and patient rating of care from primary physician. Approximately 23% of patients were referred to mental health specialists, and 38% saw a mental health specialist with or without referral. Managed care generally was not associated with a reduced likelihood of referral or seeing a mental health specialist. Patients in more-managed plans were less likely to be referred to a psychiatrist. Among low-income patients, a physician financial withhold for referral was associated with fewer mental health referrals. A physician productivity bonus was associated with greater access to mental health specialists. Depressive symptom and restricted activity day outcomes in more-managed health plans and offices were similar to or better than less-managed settings. Patients in more-managed offices had lower ratings of care from their primary physicians.CONCLUSIONS:
The intensity of managed care was generally not associated with access to mental health specialists. The small number of managed care strategies associated with reduced access were offset by other strategies associated with increased access. Consequently, no adverse health outcomes were detected, but lower patient ratings of care provided by their primary physicians were found.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Atenção Primária à Saúde
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Encaminhamento e Consulta
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Programas de Assistência Gerenciada
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Avaliação de Resultados em Cuidados de Saúde
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Transtorno Depressivo
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Acessibilidade aos Serviços de Saúde
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Serviços de Saúde Mental
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Evaluation_studies
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Guideline
/
Incidence_studies
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Observational_studies
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Qualitative_research
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Risk_factors_studies
Limite:
Adolescent
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Adult
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Aged
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Female
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Humans
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Male
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Middle aged
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2002
Tipo de documento:
Article