社区医生督导下的重性精神障碍患者社区管理效果分析

Analysis of community management effectiveness about patients with severe mental disorders under the supervision of community doctors

目的 探讨社区医生督导下重性精神障碍患者社区管理模式的实施效果。方法 2011年1月1日至2012年12月31日连续2年一直居住在同一社区并由鄞州区第三医院社区科建档管理的精冲分裂症、分裂情感性障碍、偏执性精神障碍、双相障碍、癫痫所致的精神障碍、精神发育迟滞伴发精神障碍患者146例，男85例，女61例。对患者进行六级危险性评估，再结合临床表现做出四级管理分类。根据患者管理分级，制定相应的个性化督导方案，通过定期入户随访，督导家属监护患者服药、及时发现异常行为及疾病复发迹象，督导患者参加社区集体康复活动。管理2年，对管理前后服药依从率、症状稳定和好转率、社区康复活动参与率和肇事肇祸率进行比较。结果 管理后患者监护率达98．7％，服药依从率从管理前的58．8％提高到管理后的69．9％；社区康复活动参与率从27．7％提高到69．9％，肇事肇祸率从44．6％下降到11．6％。结论 社区医生督导下的重性精神障碍患者社区管理模式有利于提高患者对药物的依从性，参与社区康复活动的积极性，有效降低了病情复发和肇事肇祸率。

Objective To explore the effect of community management mode for patients with severe mental disorders under the supervision of the community physicians. Method From January 1, 2011 to Deeember 31, 2012 for two consecutive years 146 cases with psychiatric disorders who have been living in the same community and the Yinzhou District third hospital community science archiving management of schizophrenia, schizoaflective disorder, paranoid disorder, bipolar disorder, epilepsy induced mental disorders, mental retardation associated with mental disorders were enrolled. Of the 146 cases, 85 were male and 61 were female. Six-level risk assessment was applied for the patients, with four levels of management classification and clinical manifestations. According to the management of patients with grade, an individualized corresponding supervision scheme was made, through regular home follow-up, supervision and monitoring of patients with medication were applieJ, family memlaers time}y found signs of abnormal behavior and disease recurrence, patients were encouraged to participate in the community supervision and collective rehabilitation activities. Through 2 years of management, the compliance rate, symptoms and improvement rate, community rehabilitation activities and the accident rate were compared. Result After management, patient monitoring rate reached 98.7%; compliance rate increased from 58.8% to 69.9%; to participate in community rehabilitation rate increased from 27.7% to 69.9%, accident rate fell from 44.6% to 11.6%. Conclusion Community management mode for patients with severe mental disorders under the supervision of the community physician is helpful to improve the compliance of patients with drugs, active participation in community rehabilitation activities, effectively reduce the recurrence of disease and the accident rate.