社区精神分裂症患者、家属和精神病防治人员对疾病认知、治疗依从性及社区服务评价的质性研究  

The qualitative study of disease cognition,treatment compliance and community services evaluation of community patients with schizophrenia,family members and disease control personnels

作　　者：高镇松[1] 陈泽华[1] 徐丽缄[1] 郭赛玲[1] 张胜佳[1] 郑闻华 吴民吉[1] Gao Zhensong;Chen Zehua;Xu Lijian;Guo Sailing;Zhang Shengjia;Zheng Wenhua;Wu Minji(Department of Psychiatry,Fourth People's Hospital of Shantou City,Shantou 515021,China)

机构地区：[1]汕头市第四人民医院精神科,515021

出　　处：《中华行为医学与脑科学杂志》2020年第3期271-276,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：广东省科技创新战略专项资金项目([汕府科]2018-157-55);汕头市医疗卫生科技计划项目([汕府科]2018-155)。

摘　　要：目的调查汕头市社区精神分裂症患者、家属、精神病防治人员对疾病的感知、治疗依从性、社区随访服务的评价,为提高管理治疗质量提供参考依据。方法采用分层抽样质性研究方法,于2019年2~8月对汕头市7个区县在册在管的社区精神分裂症患者17198人进行抽样调查,每个区县分别抽取2个镇(街道),对所抽取的镇(街道)再分别抽取10名患者、10位家属和3名精神病防治人员,对疾病的感知、治疗依从性、社区随访服务的评价进行调查分析。受访者最终纳入137例患者、138名家属和41名精神病防治人员,采用访谈调查法对受访者进行半结构式访谈,按传统方法收集数据资料,采用SPSS 12.0统计学软件包进行描述性统计分析。结果(1)34.3%患者和32.6%家属对疾病认知不全,22.6%患者和23.2%家属存在病耻感。(2)26.3%患者对治疗不依从、29.9%患者无自知力,53.3%患者和24.6%家属对药物副作用和成瘾性认识不当,35.0%患者和13.0%家属存在病好不用药的误区。(3)29.2%患者和31.2%家属厌烦长程服药,24.8%患者和21.0%家属感到被社会隔离,17.5%患者感到得不到支持和18.8%家属承认对患者关心不够。(4)31.4%患者不主动接受随访服务,37.2%患者和20.3%家属不配合随访医生,21.2%患者和10.1%家属对随访服务不满意。(5)精神病防治人员基本能掌握辖区患者的病情和定期开展随访服务(90.2%)、掌握应急处置方法(92.7%)、有开展培训(97.6%)。但精神病防治人员的精神科执业比低(58.5%)而且多为兼职(78.0%),平均工作年限为(5.7±1.4)年,对社区随访服务的满意度较高(95.1%),但认为精神病防治工作困难较大(36.6%)、对身兼多职承担多项公共卫生服务工作感到不满(31.7%)。结论汕头市严重精神障碍管理治疗项目初显成效,对社区随访服务较满意,但患者和家属对疾病认知水平仍偏低、服药依从性差、负性情绪较明显、对药物治疗�Objective To investigate the evaluation of disease perception,treatment compliance and community follow-up services of community schizophrenia patients,family members and personnel in Shantou City,and to provide a reference basis for improving the quality of management treatment.Methods With the method of stratified sampling qualitative research,a community sample of 17198 patients with schizophrenia in seven districts or county in Shantou City were sampled from February to August 2019,with 2 towns being drawn from each district or county,and 10 patients,10 family members and 3 personnel were selected in each town.The evaluation of disease perception,treatment compliance and community follow-up services were investigated and analyzed.Respondents were eventually included in 137 patients,138 family members and 41 personnel.The interviewees were conducted with semi-structured interviews,the data were collected according to traditional methods,and the descriptive statistical analysis was carried out with SPSS 12.0.Results(1)34.3%of patients and 32.6%of the family members were not fully aware of the disease.22.6%of the patients and 23.2%of the family members had a sense of ill shame.(2)26.3%of patients did not comply with treatment,29.9%of patients had not insight,53.3%of patients and 24.6%of family members on the side effects of drugs and addiction understood improperly,and,35.0%of patients and 13.0%of the family had a misunderstanding of illness and using drugs.(3)29.2%of patients and 31.2%of their families were tired of taking long-term medication,24.8%of patients and 21.0%of their families felt socially isolated,and,17.5%felt unsupported and 18.8%of their families admitted that they did not care enough about patients.(4)31.4%of patients did not actively receive follow-up services,37.2%of patients and 20.3%of family members did not cooperate with follow-up doctors,and,21.2%of patients and 10.1%of family members were not satisfied with follow-up services.(5)The personnel of psychiatric care could basically grasp the

关 键 词：精神分裂症 疾病认知 治疗依从性 社区管理 质性研究 

分 类 号：R74[医药卫生—神经病学与精神病学]