Page 98 - 中国全科医学2022-16期

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of 397 mental health workers（one sample of 183 cases from district-level psychiatric hospitals，and the other sample of 214
cases from community-level hospitals），using a questionnaire named Status of the Rule of Mental Health Laws in Beijing for
understanding these workers' general information and their perceptions of the SMIRS. Results The SMIRS was assessed as "very
important" by 56.3%（103/183）of the mental health workers from district-level hospitals and 54.7%（117/214）of those from
community-level hospitals，and as "relatively important" by 66.7%（156/234）of those from municipal-level hospitals.The major
role of the SMIRS was assessed as "risk warnings for mental illnesses" by 76.9%（180/234）of the mental health workers from
municipal-level hospitals and 82.7%（177/214）of those from community-level hospitals，and as facilitating community-based
management of mental illnesses by 80.9%（148/183）of those from district-level hospitals. The implementation effectiveness of
the SMIRS was evaluated as "relatively good" by 44.4%（104/234） of mental health workers from municipal-level hospitals，
50.3%（92/183）of those from district-level hospitals，and 50.9%（109/214）of those from community-level hospitals. And the
number of workers choosing "relatively good" accounted for the highest percentage of the total workers from each kind of hospitals.
The major problem during the implementation of the SMIRS was assessed as "involving patient privacy" by 77.8%（182/234）of
the mental health workers from municipal-level hospitals，78.1%（143/183）of those from district-level hospitals，and 83.2%
（178/214）of those from community-level hospitals. And the number of workers choosing "involving patient privacy" accounted
for the highest percentage of the total workers from each kind of hospitals. "Standardizing the system of information entry，
registration，correction，and summary" was chosen as a measure for improving the implementation of the SMIRS by 73.5%（172/234）
of the mental health workers from municipal-level hospitals，and 76.6%（164/214） of those from community-level hospitals，
while "standardizing the system of information sharing and protection of patients' privacy" was chosen by 68.9%（126/183） of
those from district-level hospitals. Conclusion The role and implementation effectiveness of the SMIRS have won the approval
of mental health workers from municipal-，district- and community-level hospitals. To further improve the implementation of
SMIRS with a dual emphasis on risk containment and privacy protection and consideration for patient management services，we
put forward the following recommendations：detailing relevant legal provisions；insisting on ensuring patients access to relevant
services（including management），improving the mental health service system，and implementing the essential and major
public health service programs；increasing policy publicity to improve the recognition of the system by patients and their families.
【Key words】 Mental disorders，severe；Medical staff；Severe Mental Illness Reporting System；Beijing

全国卫生与健康大会时提出的“公共卫生与健康治 1 对象与方法
理理论”中，特别强调了需要加大精神与心理健康基础 1.1 研究对象 法律规定具有精神障碍诊疗资质的医
性研究，规范相关健康服务，构建公共卫生与预防控制 疗机构为严重精神障碍发病报告的责任报告单位，而精
体系 ［1］ 。相关研究显示，我国目前约有 2.3 亿名患者 神科执业医师作为责任报告人，其对于报告制度应较为
正在遭受各种精神障碍疾病的困扰 ［2］ ，其中严重精神 了解。故本研究将精神卫生医务人员作为调研对象，共
障碍患者是病情最严重的一类群体。这类患者在发病时 调研了三类精神卫生医务人员。调研开展时间为 2019
会丧失对自身患病的认知及对于自身行为能力的控制， 年 3—6 月，本研究保证所有受访者对研究背景、研究
可能会对公共安全和他人人身安全造成伤害。目前北 内容、研究目的等信息知情并同意。（1）北京市现有
京市严重精神障碍患者约有近 20 万人，有过肇事肇祸 3 家市级精神专科医院，即北京回龙观医院、首都医科
行为的严重精神障碍患者占严重精神障碍患者总数的 大学附属北京安定医院和北京大学第六医院，本研究方
10%~15% ［3］ 。严重精神障碍发病报告制度的建立旨在 便抽取此三家市级精神专科医院精神科医务人员作为调
通过医疗机构将严重精神障碍患者的信息上报至卫生行 查对象。（2）区级精神专科医院精神卫生医务人员采
政部门，便于精防医务人员在重大活动期间对信息系统 取分层抽样的方法纳入：首先将北京市 16 个区划分为
中的患者开展全面排查访视工作，以有效预防患者危害 4 个功能区域，然后在每个功能区域中随机抽取 1 个辖
公共安全的情况发生。北京市人民政府制定的《“健康 区作为代表，在 2 个首都功能核心区中抽取西城区作为
北京 2030”规划纲要》中强调，要完善严重精神障碍 代表，在 4 个城市功能拓展区中抽取朝阳区作为代表，
患者管理机制，加强严重精神障碍患者报告登记、康复 在 4 个城市发展新区中抽取大兴区作为代表，在 6 个生
服务和救治救助管理 ［4］ 。本文在对北京市市级精神专 态涵养发展区中抽取房山区作为代表。最终抽取的 4 家
科医院、区级精神专科医院和社区从事精神病防治管理 区级精神专科医院分别为西城区平安医院、朝阳区精神
医务人员开展调研的基础上，分析此三类精神卫生医务 病医院、大兴区精神病医院和房山区精神卫生保健院，
人员对发病报告制度的认知情况，以期为北京市完善发 这 4 家区级精神专科医院的所有精神科医务人员均被纳
病报告制度、加强患者管理与服务提供参考意见。 为研究对象。（3）对于社区精神卫生防治医务人员的