严重精神障碍患者连续化“专全结合”管理模式效果评价  

Effect evaluation of continuous“combination of general practice with specialties”management mode for patients with severe mental disorder

作　　者：张佩佩[1] 张宝霞[1] ZHANG Peipei;ZHANG Baoxia(Tianjin Anding Hospital(Tianjin Mental Health Center),Tianjin 300222,China)

机构地区：[1]天津市安定医院,天津市精神卫生中心社区预防科,天津300222

出　　处：《中国神经精神疾病杂志》2022年第6期360-364,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：天津医科大学2021年度医院管理创新研究项目(编号:2021YG18);天津市医学重点学科(专科)建设项目资助(编号:TJYXZDXK-033A)。

摘　　要：目的评估天津市严重精神障碍患者连续化“专全结合”管理模式的实施效果。方法回顾性收集2018-2020年由天津市精神卫生中心明确诊断并接受社区随访管理的6种严重精神障碍患者,包括精神分裂症、偏执性精神病、分裂情感性障碍、双相(情感)障碍、癫痫所致精神障碍、精神发育迟滞伴发精神障碍,将患者分为由天津市精神卫生中心负责指导的连续化“专全结合”管理模式组(试点组),共计1435例,以及由其他精神卫生医疗机构负责指导的非连续化“专全结合”管理模式组(非试点组),共计3514例。以规范管理、规律服药、病情稳定、发生危险行为情况来评估患者管理效果。结果单因素分析显示,试点组规范管理(99.02%vs.97.89%)、病情稳定(91.85%vs.85.83%)患者比例高于非试点组(P<0.01),规律服药(89.97%vs.90.10%)、发生危险行为(0.35%vs.0.46%)情况组间无统计学差异(P>0.05)。控制一般资料,多因素logistic回归分析显示,试点组患者规范管理率高于非试点组患者(OR=2.08,95%CI:1.11~3.92),规律服药率高于非试点组(OR=1.56,95%CI:1.23~1.99)。结论连续化“专全结合”管理模式能提高社区严重精神障碍患者的规范管理率及服药依从性。Objective To evaluate the effect of continuous"combination of general practice with specialties"management mode for patients with severe mental disorders in Tianjin.Methods A retrospective survey was used to select 4949 patients with 6 types of severe mental disorders including schizophrenia,schizoaffective disorder,paranoid psychosis,bipolar disorder,mental disorders caused by epilepsy,and intellectual disability with mental disorders who were clearly diagnosed by Tianjin Mental Health Center and received community follow-up management during 2018-2020.The patients were divided into a continuous"combination of general practice with specialties"management mode group(pilot group)guided by Tianjin Mental Health Center with a total of 1435 patients and a discontinuous"combination of general practice with specialties"management mode group(non-pilot group)supervised by other mental health facilities with a total of 3514 patients.The implementation effects were evaluated by the situation of standardized management,regular medication,stable condition and risky behavior.Results The proportion of standardized management(99.02%vs.97.89%)and stable condition(91.85%vs.85.83%)were higher in the pilot group than in the non-pilot group(P<0.01).The proportion of regular medication(89.97%vs.90.10%)and risky behaviors(0.35%vs.0.46%)were not significantly different between the two groups(P>0.05).Adjusted for general data such as age and gender,multivariate logistic regression analysis showed that the standardized management rate(OR=2.08,95%CI:1.11~3.92)and regular medication rate(OR=1.56,95%CI:1.23~1.99)of patients in the pilot group was higher than that of patients in the non-pilot group.Conclusion The continuous"combination of general practice with specialties"management mode can improve the standardized management rate and medication compliance of patients with severe mental disorders.

关 键 词：精神障碍 社区精神卫生服务 专全结合管理 社区管理 服药依从性 规范管理 服务模式 

分 类 号：R749[医药卫生—神经病学与精神病学]