RESUMEN
Only 28% of individuals suffering from psychiatric disorders seek care from mental health specialists. In this paper, the authors describe how the de facto PCP mental health care system gained ground when it seemed the financing and organizational structure of managed care would have predicted the opposite result. They argue that the new realities of mental health practice require new approaches to improving behavioral health treatment. These approaches, they believe, will maximize the benefit of care delivered in and accessed through the primary care office.
Asunto(s)
Manejo de la Enfermedad , Servicios de Salud Mental/normas , Innovación Organizacional , Atención Primaria de Salud/normas , Garantía de la Calidad de Atención de Salud , Servicios Contratados , Asignación de Recursos para la Atención de Salud , Humanos , Programas Controlados de Atención en Salud , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/terapia , Servicios de Salud Mental/economía , Servicios de Salud Mental/tendencias , Atención Primaria de Salud/economía , Psicoterapia/economía , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Estados UnidosRESUMEN
Patients with inflammatory bowel disease are susceptible to thromboembolism and recently small vessel thrombosis has been implicated as an aetiological factor in Crohn's disease. This study therefore investigated platelet function in 104 patients with inflammatory bowel disease of whom eight had previous thromboembolism. Thirty five patients had reproducible spontaneous platelet aggregation of more than 30% (0 in controls) (p < 0.0001). A further 20 patients showed hypersensitivity of platelets to low concentrations of aggregating agents (p < 0.001). Plasma thromboxane B2 and beta thromboglobulin levels were significantly higher than controls (p < 0.001 and p < 0.001), but platelet lifespan studies were normal. There was no correlation with disease activity. Patients with inflammatory bowel disease have abnormal platelet activity, which may contribute to the inflammatory process.