Utilization of Primary Care Among College Students With Mental Health Disorders

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Objective: Our goal was to assess whether integration of behavioral and medical services in college settings is associated with decreased use of primary care by patients with mental health diagnoses (MHDs). Method: The cohort consisted of 80,219 patients with at least 1 MHD in 21 universities. Two levels of service integration were defined: “standard”—universities with separate electronic health records (EHR) systems and minimal clinical collaboration between services, and “enhanced”—universities with shared EHR and collaborative patient care. Frequency, the total number of primary care visits, and complexity, the total visit length for primary care per unit time, were compared by using multilevel models. Results: Nine schools met the criteria of enhanced clinical integration; a tenth school shifted to enhanced service during the study period. Student and patient demographics and clinical diagnoses were similar between the 2 categories. When controlling for variance in age, sex, and total time in school, patients with MHDs in standard systems had 15.72% (95% confidence interval [CI]: 10.77%–20.44%) more primary care visits and 22.88% (95% CI: 21.42%–24.38%) more time than patients in enhanced systems. Conclusions: Students with MHDs have significantly lower utilization of primary care services in integrated health care systems, but only a minority of institutions nationally have adopted this model of care. Although further research is needed to specifically assess differences in health outcomes and perceived suffering, it is possible that reduced primary care visits in enhanced integrative service settings with robust mental health support indicates overall reduction in perceived suffering for patients/clients.

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