地域医療と健康教育

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Beyond Primary Care: Integrating Psychiatry into a Certified Home Health Agency to Identify and Treat Homebound Older Adults with Mental Disorders

Ceïde ME, Nguyen SA, Korenblatt J, Kennedy GJ

Introduction: The purpose of this study was to determine if the Montefiore Home Care (MHC) Geriatric Psychiatry Program (MHC-GPP) increases access to mental health care and appropriate management as evidenced by timeliness of psychiatric evaluation, patient acceptance of the intervention, communication of diagnoses and recommendations to primary care physicians (PCPs) and rate of medical hospitalization. Methods: 178 MHC patients’ charts were reviewed. The time from social work referral to initial psychiatric evaluation was calculated as well as how many patients were agreeable to pharmacological intervention at the time of assessment. The rate of 30-days and 60-days hospitalization from the date of the in-home geriatric psychiatric evaluation to inpatient medical hospitalization was calculated. A group of 95 patients with Montefiore Medical Center (MMC) PCPs were sampled from the original 178. The percentage of new mental disorders diagnosed by the psychiatrist was collected and the percentage of primary care physicians who continued to prescribe the recommended pharmacologic intervention at 6 months follow-up. Results: In terms of timeliness of psychiatric evaluation, 13% were seen the same day, 46% of patients were evaluated within one week of referral. 92% of patients were agreeable to pharmacological intervention at the time of evaluation. In regards to the risk of hospitalization, 16% of patients were admitted to a within 30 days of psychiatric evaluation. An additional 9% were admitted within 60 days of evaluation. 78% of the new diagnoses were a neurocognitive disorder. At 6 months follow-up 59% of PCPs were prescribing and titrating the recommended medication. Conclusion: The MHC-GPP has successfully increased access to mental health evaluation and treatment for this unrecognized and undertreated population for the past 12 years.