PDF(Pubmed)
Abstract：
US government quality measures prioritize pharmaceuticalization and care coordination to promote patient treatment adherence. How these measures affect outpatient mental health service delivery and patient-provider communication where psychiatrists and nonphysicians collaborate is understudied. Analyzing 500 hours of participant-observation, 117 appointments, and 98 interviews with 45 new patients and providers, I show that psychiatrists and social workers coordinated care by encouraging medications and seeing two mental health providers as the default treatment, irrespective of patient preferences. Ethnographic perspectives crucially account for models of service delivery and provider behaviors in researching treatment adherence.
摘要：
美国政府的质量措施优先考虑药物化和护理协调，以提高患者的治疗依从性。这些措施如何影响精神科医生和非医师合作的门诊精神卫生服务提供和患者与提供者的沟通，目前尚未得到充分研究。分析500小时的参与者观察，117个任命，对45名新患者和提供者进行了98次访谈，我展示了精神科医生和社会工作者通过鼓励药物治疗和将两名心理健康提供者视为默认治疗来协调护理，不管病人的喜好。人种学观点在研究治疗依从性时至关重要地解释了服务提供和提供者行为的模型。
