Objective

The objective of this study was to examine whether linkage with mental health (MH) treatment differed across 3 different integrated care arrangements (ICAs), following incident attention deficit hyperactive disorder (ADHD) and major depressive disorder (MDD) diagnoses given by primary care providers (PCPs) in the pediatric setting.

Methods

Using claims linking with multiple public data sources, we examined the treatment initiation among children receiving an incident diagnosis of ADHD or MDD from PCPs working in practices with various ICAs. ICAs were categorized as PCP practiced alone (non–co-located), PCP practiced with specialist outside the practice but co-located at the practice site (co-located), and employed specialists who were co-located (co-located and co-affiliated).

Results

A total of 4203 incident ADHD and 298 incident MDD cases diagnosed by PCPs were identified, of which 3123 (74%) with ADHD and 200 (67%) with MDD received treatment within 90 days since the diagnosis. Children diagnosed with ADHD by co-located and co-affiliated PCPs were twice as likely to receive treatment as those diagnosed by non–co-located PCPs (odds ratio [OR] = 1.93; 95% confidence interval [CI], 1.24–2.78). Of those treated, children diagnosed by co-located and co-affiliated PCPs were 2 times more likely to receive guideline recommended psychotherapy (OR = 2.15; 95% CI, 1.35–3.44). These patients were also more likely to be treated at the diagnosing site versus elsewhere. Similar beneficial effects were not observed in those first diagnosed by co-located but non-affiliated PCPs.

Conclusions

Service co-location between co-affiliated PCPs and MH specialists was associated with significant higher ADHD treatment rate and the receipt of guideline-recommended psychotherapy.

中文翻译：

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儿科精神障碍治疗初级和行为健康综合护理协会

客观的

本研究的目的是在初级保健提供者对注意力缺陷多动障碍 (ADHD) 和重度抑郁症 (MDD) 做出事件诊断后，探讨 3 种不同的综合护理安排 (ICA) 与心理健康 (MH) 治疗的联系是否存在差异（PCP）在儿科环境中。

方法

使用与多个公共数据源相关的声明，我们检查了在不同 ICA 实践中工作的 PCP 接受 ADHD 或 MDD 事件诊断的儿童的治疗开始情况。ICA 被分类为单独执业的 PCP（非同地办公）、与执业之外的专家一起执业但在执业地点同地办公（同地办公）以及雇用同地办公的专家（同地办公和共同办公）。 -附属）。

结果

共确定了由 PCP 诊断的 4203 例 ADHD 病例和 298 例 MDD 病例，其中 3123 例 (74%) 患有 ADHD 和 200 例 (67%) 患有 MDD 在诊断后 90 天内接受了治疗。由同一地点和共同附属的 PCP 诊断为 ADHD 的儿童接受治疗的可能性是非同一地点 PCP 诊断的儿童的两倍（比值比 [OR] = 1.93；95% 置信区间 [CI]，1.24–2.78 ）。在接受治疗的儿童中，由同一地点和共同附属的 PCP 诊断的儿童接受指南推荐的心理治疗的可能性高出 2 倍（OR = 2.15；95% CI，1.35-3.44）。与其他地方相比，这些患者也更有可能在诊断地点接受治疗。在由同一地点但非附属的 PCP 首次诊断的患者中，没有观察到类似的有益效果。

结论

共同附属的 PCP 和 MH 专家之间的服务在同一地点与显着较高的 ADHD 治疗率和接受指南推荐的心理治疗有关。