湖北省严重精神障碍患者网络管理现状研究

Analysis of the current status of network management for psychotic patients in Hubei province

目的分析湖北省严重精神障碍网络管理患者的基本情况，为研究制定湖北省严重精神障碍患者救助救治政策提供基础信息。方法选取截止到2013年12月31日湖北省15岁以上常住人口中明确诊断为严重精神障碍的173494例在管患者为研究对象，由湖北省各级精神卫生中心或疾病预防控制中心、严重精神障碍管理治疗工作领导小组和省级专家指导组提供医疗技术指导、培训、会诊等服务，以村委会或居委会为基本单位，由基层卫生医疗机构负责采集患者基础信息及随访情况，录入国家数据收集分析系统，按人口学特征和疾病特征进行统计分析。结果18～44岁严重精神障碍患者占53．43％；严重精神障碍患者小学文化及以下占54．23％；98．03％的严重精神障碍患者为汉族；严重精神障碍患者未婚者占39．12％；离婚及丧偶者占6．72％；有严重精神障碍家族史者占4．35％；农村严重精神障碍患者占65．51％，城市下岗职工或无业人员占14．25％；经济状况处于当地贫困线以下的严重精神障碍患者占64．47％；精神分裂症患者占81．88％；不服药和间断服药患者占54．99％，随访病情不稳定占4．45％，近3年平均肇事肇祸率为1．19％。在纳入网络管理的173494例患有严重精神障碍患者中，同意接受随访患者133929例，接受治疗患者71131例，随访管理率为77．19％，规范治疗率为53．11％。结论应加强政府领导，完善协调机制，依法对贫困、肇事肇祸严重精神障碍患者免费开展救治救助工作，确保患者得到全程连续性管理治疗服务，促进公共安全和社会稳定。

Objective To analyze the basic condition of network management for psychotic patients in Hubei province and to provide the basis data for supporting policy on psychotic patients. Methods Up to 31, December of 2013, 173 494 cases with severe psychosis in Hubei province served as the subjects. All levels of mental health facilities, CDCs, management group of psychotic patients and experts took charge of providing the professional guidance, training and diagnosis. The basic medical care facilities were responsible for collecting the basis and following up information of patients. The collected data were entered into the national data collection and analytic system to perform the statistical analysis according to demographic and pathology characteristics. Results The proportion of psychotic patients （18-44 years old） was 53.43%, the proportion of psychotic patients below elementary school level was 54.23%, 98.03% of psychotic patients were Han population, the proportion of unmarried psychotic patients was 39.12%, the proportion of divorced and widowers or widows psychotic patients was 6.72%, the proportion of psychotic patients with family psychosis history was 4.35%, the proportion of rural psychotic patients was 65.51%, the proportion of urban unemployed psychotic patients was 14.25%, the proportion of psychotic patients with income below local poverty line was 64.47%, the proportion of psychotic patients with schizophrenia was 81.88%, the proportion of psychotic patients with inadequately taking medications was 54.99%, the proportion of psychotic patients with unstable disease condition was 4.45%, the rate of troubles or accidents last three years was 1.19% which was higher than national norm. Among 173 494 cases, 133 929 cases （77.19%） agreed with following up visit, 71 131 cases （53.11%） agreed with standard treatment. ConcLusion Government should lead and improve the management of psychotic patients, according to regulation, fulfil the coordinative work, promote the free care and support on psychotic patients, and guarantee the medical service of psychotic patients and promote the public security or stable society.