Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use.

Jones AL, Cochran SD, Leibowitz A, Wells KB, Kominski G, Mays VM. Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use. Journal of general internal medicine. 2015 Dec 1; 30(12):1828-36.

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Abstract:

BACKGROUND: The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. OBJECTIVE: To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS). DESIGN: Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics. PARTICIPANTS: A total of 2,358 adults, aged 18-64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics. MAIN MEASURES: We defined "usual provider" as a primary care provider/practice, and "PCMH provider" as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year. RESULTS: Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME]? = 8.5, 95 % CI? = 3.2-13.8) and to have received psychiatric medication (ME? = 15.5, 95 % CI? = 9.4-21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME? = 7.6, 95 % CI? = 0.7-14.4) and receive mental health counseling (ME? = 8.5, 95 % CI? = 1.5-15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME? = 10.0, 95 % CI? = 1.0-19.0). CONCLUSIONS: Access to a usual provider is associated with increased receipt of needed MHS. Patients who have a usual provider with PCMH qualities are more likely to receive mental health counseling.