Asunto(s)
Pautas de la Práctica en Medicina/tendencias , Práctica Privada/estadística & datos numéricos , Psiquiatría/estadística & datos numéricos , Recolección de Datos , Grupos Diagnósticos Relacionados/estadística & datos numéricos , Utilización de Medicamentos/tendencias , Humanos , Práctica Privada/tendencias , Psiquiatría/tendencias , Psicoterapia/tendencias , Estados UnidosRESUMEN
The Study of Outpatient Referral Patterns was conducted in 1998 to examine the nature of the communication relationship between psychiatrists and primary care physicians regarding outpatient referrals. Nationally representative psychiatrists were surveyed (N = 542) regarding their aggregate experience with outpatient referrals from non-psychiatric physicians in the previous 60 days. Data regarding frequency and type of information and mode of communication were gathered. Results indicate that primary care physicians represent a significant source of referrals to psychiatrists and that psychiatrists are generally satisfied with the communication interface with the referring physicians. Psychiatrists' level of satisfaction was related to the quantity and quality of information provided by referring physicians.
Asunto(s)
Comunicación , Relaciones Interprofesionales , Atención Primaria de Salud , Psiquiatría , Derivación y Consulta , Atención Ambulatoria , Femenino , Humanos , Masculino , Medicina , Persona de Mediana Edad , EspecializaciónRESUMEN
Using data from the 1996 National Survey of Psychiatric Practice from the American Psychiatric Association (APA), the authors updated information on psychiatrists who are high geriatric providers (HGPs). In 1996, HGPs comprised 18% of the sample. Only 23% reported no geriatric patients in their practice, a 51% reduction from 1988-89; the proportion of HGPs is increasing. HGPs were more often male, minority, international medical school graduates, certified in geriatric psychiatry, and not medical school-affiliated. HGPs worked longer hours/week in direct patient care, had more patient visits/week, and saw more new patients/month, spending more time in hospitals and nursing homes and less time in office-based practice, and seeing more patients with mood disorders, psychotic disorders, and other disorders. Medicare was a proportionally higher payment source. Older psychiatrists were likely to have more patients over age 65. Tracking practice activities of HGPs may help inform policy discussion regarding staffing needs for geriatric patients with late-life mental disorders.
Asunto(s)
Psiquiatría Geriátrica/tendencias , Servicios de Salud para Ancianos/tendencias , Pautas de la Práctica en Medicina/estadística & datos numéricos , Psiquiatría/tendencias , Anciano , Femenino , Psiquiatría Geriátrica/economía , Psiquiatría Geriátrica/estadística & datos numéricos , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/economía , Práctica Profesional/economía , Práctica Profesional/tendencias , Psiquiatría/estadística & datos numéricos , Sociedades Médicas/tendencias , Estados Unidos , Recursos HumanosRESUMEN
Nationally representative data regarding the organizational, financial, and procedural features of health plans in which psychiatric patients receive treatment indicate that fewer privately insured, Medicaid, and Medicare managed care enrollees receive care from a psychiatrist than is true for "nonmanaged" enrollees. Financial considerations were reported to adversely affect treatment for one-third of all patients. Although utilization management techniques and financial/resource constraints commonly applied to patients in both managed and nonmanaged plans, performance-based incentives were rare in nonmanaged plans. The traditional health plan categories provide limited information to identify salient plan characteristics and guide policy decisions regarding the provision of care.
Asunto(s)
Accesibilidad a los Servicios de Salud/economía , Cobertura del Seguro/economía , Programas Controlados de Atención en Salud/economía , Trastornos Mentales/economía , Adolescente , Adulto , Anciano , Control de Costos , Femenino , Humanos , Masculino , Trastornos Mentales/terapia , Persona de Mediana Edad , Grupo de Atención al Paciente/economía , Psiquiatría/economía , Estados UnidosRESUMEN
Despite extensive studies on the epidemiology of mental disorders and advances in the treatment of these conditions, there is a paucity of detailed information concerning the characteristics of psychiatric patients and how treatments are administered in routine psychiatric practice. This 1997 observational study collected detailed information from 417 psychiatrists on the demographic, diagnostic, clinical, and treatment characteristics of a systematic sample of 1228 patients. Six hundred thirty-seven patients (51.9%) were women and the mean patient age was 41.9 years. The most common diagnostic category (53.7%) was mood disorders, followed by schizophrenia/psychotic disorders (14.6%), anxiety disorders (9.3%), and disorders of childhood (7.7%). Six hundred seventy-one patients (54.6%) had at least one comorbid Axis I condition and almost half (49.8%) had a history of psychiatric hospitalization. Patients received a mean of 2.0 psychotherapeutic medications, most commonly antidepressants (62.3%). Findings demonstrate that psychiatrists in routine practice treat a patient population with severe, complex conditions.
Asunto(s)
Trastornos Mentales/terapia , Práctica Profesional/estadística & datos numéricos , Psiquiatría/estadística & datos numéricos , Adolescente , Adulto , Anciano , Atención Ambulatoria , Niño , Preescolar , Femenino , Investigación sobre Servicios de Salud/estadística & datos numéricos , Hospitalización , Humanos , Masculino , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Pautas de la Práctica en Medicina/estadística & datos numéricos , Distribución Aleatoria , Reproducibilidad de los Resultados , Muestreo , Encuestas y Cuestionarios , Estados Unidos/epidemiologíaAsunto(s)
Trastorno por Déficit de Atención con Hiperactividad/terapia , Servicios de Salud Mental/estadística & datos numéricos , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Estimulantes del Sistema Nervioso Central/uso terapéutico , Niño , Preescolar , Encuestas de Atención de la Salud , Humanos , Medicina , Servicios de Salud Mental/provisión & distribución , Visita a Consultorio Médico/estadística & datos numéricos , Especialización , Estados UnidosRESUMEN
CONTEXT: Psychotropic medications are widely prescribed, but how new classes of psychotropic medications have affected prescribing patterns has not been well documented. OBJECTIVE: To examine changes between 1985 and 1994 (data from 1993 and 1994 were combined) in the prescribing patterns of psychotropic medications by office-based primary care physicians, psychiatrists, and other medical specialists. DESIGN: National estimates for the number of visits during which a physician prescribed a psychotropic medication based on the National Ambulatory Medical Care Surveys conducted in 1985, 1993, and 1994. SETTING: Office-based physician practices in the United States. PARTICIPANTS: A systematically sampled group of office-based physicians. MAIN OUTCOME MEASURES: National estimates of visits that included a psychotropic medication. RESULTS: The number of visits during which a psychotropic medication was prescribed increased from 32.73 million to 45.64 million; the proportion of such visits, as a proportion of all visits, increased from 5.1% to 6.5% (P< or =.01). Antianxiety or hypnotic drug visits, previously the largest category, decreased as a proportion of psychotropic drug visits (P< or =.01) and are now surpassed by antidepressant visits. Visits for depression increased from 10.99 million in 1988 to 20.43 million in 1993 and 1994 (P< or =.01). Stimulant drug visits increased from 0.57 million to 2.86 million (P< or =.01). Although visits for depression doubled for both primary care physicians and psychiatrists, the proportion of visits for depression during which an antidepressant was prescribed increased for psychiatrists but not for primary care physicians. CONCLUSIONS: The patterns of psychotropic medication use in outpatient medical practice changed dramatically during the study period, especially in psychiatric practice.