title: Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use.
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).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. Audrey.Jones3@va.gov.
authors.forename: Audrey L
authors.initials: AL
authors.lastname: Jones
authors.affiliation: Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.|Department of Statistics, University of California Los Angeles, Los Angeles, CA, USA.|UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Los Angeles, CA, USA.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Cochran
authors.affiliation: UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.
authors.forename: Arleen
authors.initials: A
authors.lastname: Leibowitz
authors.affiliation: UCLA David Geffen School of Medicine, Los Angeles, CA, USA.|UCLA Center for Health Services and Society, Los Angeles, CA, USA.|Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Wells
authors.affiliation: Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.|UCLA Center for Health Policy Research, Los Angeles, CA, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Kominski
authors.affiliation: UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Los Angeles, CA, USA.|Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.|Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA.
authors.forename: Vickie M
authors.initials: VM
authors.lastname: Mays
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D008875:Middle Aged; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Affordable Care Act; mental health services; patient-centered medical home; primary care; race