惊恐障碍确诊前的疾病负担调查分析

A survey of economic burden of the patients with panic disorder before definite diagnosis

目的探讨确诊前惊恐障碍的疾病负担。方法采用一般情况问卷、经济花费调查表、惊恐障碍严重程度量表(PDSS)、汉密顿焦虑抑郁量表对86例惊恐障碍患者进行调查。结果惊恐障碍患者人均医疗费用为2.46万元,其中直接医疗费用药物为1.91万元,间接费用为0.55万元。惊恐障碍患者最多看过31个医生,人均看过6个医生;最多看过急诊26次,人均约4次。排在前三位的科室分别为急诊科,心内科和呼吸科。排在前三位住院的科室分别为心内科,呼吸科,中医科。100.00%的患者做过心电图,96.82%的患者做过胸部正位片,92.33%的患者做过血液检查,86.84%的患者做过心脏彩超,76.91%的患者做过动态心电图,58.30%的患者做过胸部CT,53.32%的患者做过脑电图,38.51%的患者做过头颅MRI,37.44%的患者做过肺功能,10.34%的患者做过冠脉造影。居住在农村的惊恐障碍患者的经济总花费和直接花费高于城镇患者,间接花费低于城镇患者(P<0.05)。惊恐障碍患者的HAMA、HAMD及PDSS评分分别与总花费、直接花费呈正相关(P<0.05)。结论惊恐障碍的经济负担重,患者确诊前多就诊于急诊科及内科,医疗资源浪费大。

Objective To investigate the economic burden of the patients with panic disorder （PD）. Methods Eighty-six patients with panic disorder were surveyed by general state questionnaire, list for investigation of economic cost, panic disorder severity scale （PDSS）, Hamilton depression rating scale （HAMD） and Hamilton anxiety rating scale （HAMA）. Results The average medical expenses per capita in the PD patients were 24600 Yuan, in which the direct medical costs was 19100 Yuan and the indirect cost is 5500 Yuan. Some patients had visited 31 doctors in the past 1 year and average number of doctors visited per capita was 6. Some pa- tients visited emergency department as many as 26 times in the past 1 year,and average-visiting times per capita was 4 times. The top three visiting departments were emergency, cardiology and respiratory medicine and the top three in-patients departments were emergen- cy, cardiology,respiratory medicine and TCM. 100% of PD patients had electrocardiogram, 96.82% had chest X-ray films,92. 33 % had blood tests, 86. 84% had heart color ultrasound,76. 91% had dynamic electrocardiogram,58.30% had chest computed tomography, 53.32% had electroeneephalography, 38. 51% had cranial magnetic resonance imaging MRI, 37.44% had lung function test and 10. 34% had coronary angiograpby, respectively. The total cost and direct cost in the PD patients who living in rural were higher than those who living in town,while the indirect cost was opposite （ P 〈 0.05 ）. the score of the HAMA, HAMD and PDSS were positively correlated with total cost and direct cost, respectively （ P 〈 0. 05 ）. Conclusion The economic burden of PD patients is very heavy. the PD patients often go to visit the emergency department and internal medicine before get definite diagnosis. The medical resources are seriously wasted.