PATTERNS OF RURAL MENTAL-HEALTH-CARE - AN EXPLORATORY-STUDY

In rural areas, it is important to clarify our understanding of how pr imary care and specialty mental health professionals organize care for those with mental disorders, and the role that linkages between speci alty mental health and primary health care providers can play in the e ffectiveness of such care. Although these are issues that must be gene rally addressed, in rural areas fewer institutional and individual pro viders per capita accentuate problems of health care organization and delivery. This paper reports findings from an exploratory study of ser vice use in two primary care sites in a rural, group-model HMO (Site A enrollment = 2,625; Site B = 6,019). We found that patients in the pr imary care site who had weaker mental health consultative linkages, hi gher rurality, and less availability of mental health specialty care u sed more mental health services by primary care providers (XX = 5.19 ( 3.78,6.61)), received more ambulatory care from joint mental health/pr imary care providers (XX = 1.68 (1.02,2.78)), and had more mental heal th hospital utilization (adjusted OR = 1.84 (0.54,6.23)). These findin gs point to the need for further study of primary care providers and t heir linkage relationships in rural areas, in this large and currently often underserved population.