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首页> 外文期刊>The journal of clinical psychiatry >Limiting access to psychiatric services can increase total health care costs.
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Limiting access to psychiatric services can increase total health care costs.

机译：限制获得精神科服务的机会会增加医疗总费用。

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摘要

Restricted access to health care services and medication is associated with overall higher utilization and higher health care costs. Although randomized controlled trials (RCTs) are regarded as the best method of determining whether a treatment strategy does more good than harm, clinical practice improvement (CPI) methods may be a more effective way of achieving superior medical outcomes for the least cost over the course of a patient's care. The Managed Care Outcomes Project, a large-scale CPI study, tracked detailed factors regarding medical care, patients, and outcomes from different managed care settings. Results showed that cost-containment strategies employed by various health maintenance organizations were associated with poor treatment outcomes for patients and in fact increased total health care costs. Psychiatric illnesses were underdiagnosed, and care ranged from patients receiving psychiatric medications without a psychiatric diagnosis to patients with a psychiatric diagnosis receiving no psychiatric treatment at all. Cost-containment strategies appeared to limit psychiatric referrals, frequency of psychiatric visits, and use of certain antidepressants (i.e., selective serotonin reuptake inhibitors). Further, the severity of the primary physical illness in the study population was associated with greater psychiatric illness. The fact that treatment was inconsistent and frequently inappropriate shows the need for better diagnostic and management protocols.
机译：限制获得卫生保健服务和药物的使用会带来总体利用率的提高和卫生保健成本的增加。尽管随机对照试验（RCT）被认为是确定治疗策略是否胜于弊的最佳方法，但临床实践改进（CPI）方法可能是一种在整个过程中以最低的成本获得优异医疗成果的更有效方法病人的护理。 “管理式照护结果项目”是一项大规模的CPI研究，跟踪了有关医疗护理，患者以及不同管理式照护环境下的结局的详细因素。结果表明，各种健康维护组织采用的成本控制策略与患者治疗效果差有关，实际上增加了总体医疗保健成本。对精神疾病的诊断不足，其治疗范围从接受无精神病诊断的精神科用药的患者到根本没有接受精神科治疗的精神病患者。成本控制策略似乎限制了精神科的转诊，精神科就诊的频率以及某些抗抑郁药（即选择性5-羟色胺再摄取抑制剂）的使用。此外，研究人群中原发性身体疾病的严重程度与更大的精神疾病有关。治疗前后不一致且经常不合适的事实表明需要更好的诊断和管理方案。

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