综合医院精神科设置状况及其作用的对照研究

The investigation of settings of psychiatric service and comparison of related factors in general hospitals in Shanghai

目的 调查上海综合医院精神卫生服务资源及临床医师培训等现状,为制定综合医院精神卫生服务政策提供相关依据。方法 (1)对上海市15家三级综合医院和14家二级综合医院的精神卫生服务现状进行问卷调查。包括医院规模及医疗服务资源,精神卫生服务机构设置及人员配置状况,会诊联络精神医学开展情况等。(2)选择两家已开设和未开设精神卫生服务科室的三级综合医院,对临床医师参加精神卫生培训情况、对精神卫生知识、对开展精神卫生服务工作意向的认识等进行对比分析。结果 (1)开设精神卫生服务科室的医院为17家,占58.6％,提供精神卫生服务的专科医师人数为65人,平均3.2名/千张床位。(2)已开设精神卫生科室的医院中精神科会诊率平均为0.63％,未开设精神卫生科室的医院中精神科会诊率平均为0.10％,二者具有显著性差异。(3)所有调查医院均未成立由精神科医师和临床医师共同参加的会诊联络小组;缺乏专职的会诊联络医师常规地参与临床和宣教工作;(4)已开设精神卫生科室医院的临床医师在接受精神卫生培训、掌握精神卫生知识程度以及对开展精神卫生服务的工作意向等方面均显著优于未开设精神卫生科室的医院。结论 设立精神卫生机构,提高各级综合医院的精神卫生服务的能力势在必行。

Objective; By investigating the current situation of the service of mental health in general hospitals in Shanghai as well as the consultation liaison psychiatry, the study aimed to provide corresponding basis for constituting policy on mental health service in general hospital. Methods: (1) 29 general hospitals including 15 3-level and 14 2-level hospitals in Shanghai were investigated in the study, in which such information as the scale and the medical resources, the establishment of mental health department and manpower resources and consultation liaison psychiatry were assessed. (2) In two general hospitals, one with the department of psychiatry or mental health whereas another without department of psychiatry, the clinical physicians were investigated about mental health training situation, acquaintance with mental health and mental health service situation. Results: ( 1 ) 17 hospitals set up special departments of mental health, which accounted for 58.6%. There were 65 psychiatrists and 3.2 per thousand beds among the 29 general hospitals. (2) The consultation rates of 0.63% among hospitals with mental health departments was significantly higher than that of 0.10% among the hospitals without mental health departments. (3 ) There were no consultation-liaison group consisted of psychiatrist and clinician in all investigated general hospitals, and no special consultation-liaison doctor participating in clinical and educational practice routinely. (4) There were significant differences between the two hospitals, the one with the department of mental health showing higher consultations on mental problems of patients, than the other hospital, the training for clinical physicians, the level of education of mental health, as well as the intentions for developing mental health service. Conclusion: The establishment of department of psychiatry is essential in order to improve the ability of mental health service in general hospital.