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首页> 外文期刊>Journal of general internal medicine >Utilization of primary care by veterans with psychiatric illness in the National Department of Veterans Affairs Health Care System.
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Utilization of primary care by veterans with psychiatric illness in the National Department of Veterans Affairs Health Care System.

机译：国家退伍军人事务卫生保健系统部门中患有精神病的退伍军人对初级保健的利用。

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BACKGROUND: Psychiatric illness is associated with increased medical morbidity and mortality. Studies of primary care utilization by patients with psychiatric disorders have been limited by nonrepresentative samples and confounding by medical co-morbidity. OBJECTIVE: To determine whether patients with psychiatric disorders use primary care services differently than patients without these disorders, after controlling for medical co-morbidity. DESIGN: Data from the 1999 Large Health Survey of Veterans (LHS) (n = 559,985) were linked to VA administrative data in order to identify veterans who received primary care. After adjusting for sociodemographic and clinical characteristics, medical co-morbidity, and facility characteristics, multivariate logistic regression was used to evaluate whether seven psychiatric diagnoses were associated with an increased or decreased likelihood of any primary care visit over 12 months. RESULTS: Veterans with either schizophrenia, bipolar disorder or a drug use disorder were less likely to have had any primary care visit during the study period: [OR 0.61, 95% CI 0.59 to 0.63], [OR 0.63, 95% CI 0.60 to 0.67] and [OR 0.88, 95% CI 0.83 to 0.92], respectively, than veterans without these diagnoses, even after controlling for medical co-morbidity. Among patients with any primary care utilization, those with six of the seven psychiatric diagnoses had fewer visits in the study period. CONCLUSIONS: Patients with schizophrenia, bipolar disorder or drug use disorders use less primary care than patients without these disorders. Interventions are needed to increase engagement in primary care by these vulnerable groups.
机译：背景：精神病与医疗发病率和死亡率增加相关。精神障碍患者对初级保健的利用研究受到非代表性样本的限制，并因医学合并症而混淆。目的：确定精神疾病患者在控制医疗合并症后，与没有这些疾病的患者在使用初级保健服务方面是否有所不同。设计：将1999年大型退伍军人健康调查（LHS）（n = 559,985）中的数据与VA行政数据相关联，以识别接受初级保健的退伍军人。在对社会人口统计学和临床​​特征，医学合并症和设施特征进行调整之后，使用多元逻辑回归分析来评估七项精神病诊断与12个月内任何初级保健就诊的可能性增加还是减少有关。结果：患有精神分裂症，躁郁症或药物滥用疾病的退伍军人在研究期间不太可能接受任何初级保健就诊：[OR 0.61，95％CI 0.59至0.63]，[OR 0.63，95％CI 0.60至甚至在控制了合并症之后，比没有这些诊断的退伍军人分别高出[0.67]和[OR 0.88，95％CI 0.83至0.92]。在所有使用初级保健的患者中，在七项精神病学诊断中有六项的患者在研究期间的访视次数较少。结论：精神分裂症，双相情感障碍或药物滥用疾病的患者比没有精神分裂症的患者使用的初级保健少。需要进行干预，以增加这些弱势群体对初级保健的参与。

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