中国西部地区农村重性精神病患者健康管理现状调查:问题及对策分析

An Investigation of Present Situation in Health Management of Patients with Severe Psychotic Disorders in Rural Areas of the Western Region of China:Problems and Countermeasures Analysis

目的：调查农村重性精神病患者健康管理现状，发现存在的问题并进行对策分析。方法2014年3-4月对四川省郫县农村地区6家基层医疗卫生机构管理的790例重性精神病患者健康管理状况进行调查，同时访谈30例基层公共卫生人员和6例公共卫生服务评审检查专家。收集农村重性精神病患者健康管理情况，通过讨论、分析目前存在的问题。结果790例重性精神病患者中，男433例（54.8%），女357例（45.2%）；年龄5-96岁，平均47.4岁。在不同年龄组中35-64岁年龄段所占比例最大（454/790，57.5%）；在不同疾病类型中精神分裂症所占比例最大（511/790，64.7%），其次是精神发育迟滞伴发精神障碍（242/790，30.6%）。基层机构开展了排查工作，坚持“应管尽管”，为所有确诊患者建立了健康档案。706例（89.4%）患者接受过每年至少4次随访；患者危险性评级为：0级290例（36.7%），1级451例（57.1%），2级37例（4.7%），3级1例（0.1%），未评等级11例（1.4%）。以《国家基本公共卫生服务规范（2011年版）》（以下简称《国家规范》）为分析依据，目前健康管理存在四方面问题：健康档案记录不规范；健康管理服务的分类干预不规范；基层卫生机构精神卫生服务能力严重不足，专业人才缺乏；部分患者及其家属配合程度低。结论农村基层医疗卫生机构开展了重性精神病健康管理工作，但管理能力不足，档案管理不规范，患者配合度不高，管理实效欠佳。建议创新农村重性精神病患者综合防治管理机制以提升管理实效，加强《国家规范》培训以进一步提升基层机构服务能力，加强指导、质控和督导检查工作以确保做实重性精神病患者服务工作，加大精神卫生健康教育宣传和患者帮扶减免力度以提升患者及其家属配合度。

Objective To investigate present situation in health management of patients with severe psychotic disorders in rural areas,and to find problems and make countermeasures analysis. Methods 790 patients with severe psychotic disorders from 6 primary health care institutions were investigated from March to April,2014. 30 primary public health staff and 6 public health service accreditation inspection experts were interviewed. The status of health management of patients with severe psychotic disorders in rural areas was collected,then the existing problems were discussed and analyzed. ResUlts Among the 790 pa-tients,433 cases were male（54. 8%）,357 were female（45. 2%）;aged 5-96,average 47. 4. 35-64 age group accounted for the largest in different age groups（454/790,57. 5%）;schizophrenia accounted for the largest in different disease types （511/790,64. 7%）,followed by mental retardation comorbid mental disorders（242/790,30. 6%）. The primary health care institutions carried out investigation and screening work,according to the rule that management should be managed as much as possible,and established health records for all patients diagnosed. 706 cases（89. 4%）had received follow-up at least 4 times a year;patients with risk ratings are：level 0（290 cases,36. 7%）,level 1（451 cases,57. 1%）,level 2（37 cases, 4. 7%）,level 3（1 case,0. 1%）,not rating（11 cases,1. 4%）. According to the National Basic Public Health Services Specifications,the current health management problems exist in four areas：health archival records are not standardized;the classification of intervention in health management service is not standardized;the ability of mental health service in the primary health care institutions is serious insufficient,and a shortage of professional personnel;part of patients and their family members＆amp;nbsp;are in low degree of cooperation. ConclUsion Primary health care institutions in rural areas have carried out the health manage-ment of severe mental health,but there exists problems：the lack of management ability,nonstandard health files management,low cooperation from patients,and poor management effectiveness. The suggestions are as follows：innovate the management mechanism for the prevention and control of patients with severe psychotic disorders to improve management effectiveness;strengthen the Na-tional Standard training to further enhance the service capability of primary health care institutions;strengthen the guidance,the su-pervision of the quality control and inspection work to ensure the service for patients with severe psychotic disorders;strengthen mental health education and increase patient aid relief to improve the cooperation of patients and their family.