中国全科医学 ›› 2018, Vol. 21 ›› Issue (35): 4322-4327.DOI: 10.12114/j.issn.1007-9572.2018.00.202

所属专题: 精神卫生最新文章合集

• 专题研究 • 上一篇    下一篇

严重精神障碍患者社区规范管理模式及实施效果研究

李喆1,杨亚黎2,吴胜利3,叶庆4,黄芸5,玉素甫江?依明6,方静2,高阳2,李志雄7*   

  1. 1.610041四川省成都市,四川大学华西医院心理卫生中心 2.834000新疆维吾尔自治区克拉玛依市人民医院临床心理二科 3.834000新疆维吾尔自治区克拉玛依市人民医院 4.834000新疆维吾尔自治区克拉玛依市卫生和计划生育委员会疾病预防控制科 5.834000新疆维吾尔自治区克拉玛依市疾病预防控制中心 6.834000新疆维吾尔自治区克拉玛依市人民医院临床心理一科 7.834000新疆维吾尔自治区克拉玛依市人民医院临床心理三科
    *通信作者:李志雄,副主任医师;E-mail:865818683@qq.com
  • 出版日期:2018-12-15 发布日期:2018-12-15
  • 基金资助:
    基金项目:四川省科学技术厅课题(2017SZ0049);四川省卫生和计划生育委员会科研课题(17PJ080);克拉玛依市科技计划项目(JK2012-7);中央高校基本科研基金(2017SCU11072)

Effect of Community-based Standardized Mental Disorders Management on Patients with Severe Mental Disorders  

LI Zhe1,YANG Yali2,WU Shengli3,YE Qing4,HUANG Yun5,YUSUFUJIANG? Yiming6,FANG Jing2,GAO Yang2,LI Zhixiong7*   

  1. 1.Mental Health Center,West China Hospital,Sichuan University,Chengdu 610041,China
    2.No.2 Department of Clinical Psychology,Karamay Municipal People's Hospital,Karamay 834000,China
    3.Karamay Municipal People's Hospital,Karamay 834000,China
    4.Divison of Disease Control and Prevention,Health and Family Planning Commission of Karamay,Karamay 834000,China
    5.Karamay Center for Disease Control and Prevention,Karamay 834000,China
    6.No.1 Department of Clinical Psychology,Karamay Municipal People's Hospital,Karamay 834000,China
    7.No.3 Department of Clinical Psychology,Karamay Municipal People's Hospital,Karamay 834000,China
    *Corresponding author:LI Zhixiong,Associate chief physician;E-mail:865818683@qq.com
  • Published:2018-12-15 Online:2018-12-15

摘要: 目的 探索新疆维吾尔自治区克拉玛依市严重精神障碍患者的社区规范管理模式,并评估实施效果。方法 选取2012年7月—2015年12月常住(连续居住半年及以上)克拉玛依地区5个社区的6类严重精神障碍患者。采用整群随机抽样法抽取昆仑、金龙两个社区为开展规范管理试点区,共计85例;胜利、银河、天山3个社区为仅开展常规住院治疗和门诊随访的非试点区,共计211例。建立地区三级防控网络管理体系以及基础、个案、应急处置的规范管理模式。以住院率、管理率、病情稳定率、社会活动参与率、治疗率、治疗脱落率、应急处置率、轻度滋事率、肇事肇祸率评估实施效果。结果 试点区2013年、2014年、2015年住院率均低于非试点区(P<0.05)。试点区2012年住院率分别高于试点区2013年、2014年、2015年住院率(χ2=12.66,P<0.01;χ2=4.67,P=0.03;χ2=13.07,P<0.01)。试点区与非试点区社会活动参与率比较,差异无统计学意义(P>0.05);试点区管理率、病情稳定率、治疗率均高于非试点区,治疗脱落率低于非试点区(P<0.05)。试点区2014年患者应急处置率与2013年比较,差异无统计学意义(χ2=0.03,P=0.84);2015年患者应急处置率低于2013年(χ2=5.49,P=0.02)。试点区2015年轻度滋事率、肇事肇祸率均低于2012年(χ2=7.37,P=0.02;χ2=8.27,P=0.02)。结论 严重精神障碍患者的社区规范管理模式的建立,取得了一定的社会和经济效益,为地区的稳定发展起到了促进作用,可考虑在其他社区推广开展。

关键词: 精神障碍, 社区精神卫生服务, 规范管理

Abstract:
Objective To explore the effect of community-based standardized mental disorders management on patients with severe mental disorders in Xinjiang's Karamay.Methods We conducted this study from July 2012 to December 2015.We selected 296 patients with 6 types of severe mental disorders from the permanent residents(living at their current residence for 6 months or longer) of 5 communities〔Kunlun and Jinlong(pilot communities),Shengli,Yinhe and Tianshan(non-pilot communities)〕 sampled from Karamay by using cluster random sampling,including 85 from Kunlun and Jinshan communities(experimental group),and 211 from Shengli,Yinhe and Tianshan communities(control group).The experimental group received community-based standardized mental disorders management(including basic,case and emergency management by the institutions in an internet-based three-level mental disorders control and prevention system),while the control group received the conventional hospitalized treatment and outpatient follow-ups.The management effects were evaluated by hospitalization rate,management rate,rate of mental disorders remaining stable over the intervention period,rate of participating in social activities,treatment rate,drop-out rate,rate of receiving emergency management,rate of causing minor affrays,and rate of causing accidents.Results The hospitalization rates in the experimental group in 2013,2014,2015 were all much lower than those of the control group(P<0.05).The experimental group demonstrated obviously higher hospitalization rate in 2012 compared with 2013,2014,2015(χ2=12.66,P<0.01;χ2=4.67,P=0.03;χ2=13.07,P<0.01).The rate of participating in social activities was similar in both groups(P>0.05).The experimental group showed much higher management rate,rate of mental disorders remaining stable over the intervention period,treatment rate,and notably lower drop-out rate compared with the control group(P<0.05).The rate of receiving emergency management in the experimental group in 2013 was similar to that of 2014(χ2=0.03,P=0.84),but was significantly higher than that of 2015(χ2=5.49,P=0.02).The experimental group exhibited a much decreased rate of causing minor affrays(χ2=7.37,P=0.02),as well as a severely declined rate of causing accidents(χ2=8.27,P=0.02).Conclusion The community-based standardized mental disorders management demonstrated good effect on patients with severe mental disorders and achieved good socio-economical benefits,which contributes to the stable development of Karamay,so it can be used more extensively.

Key words: Mental disorders, Community mental health services, Standard management