中国严重精神障碍管理运行机制现状及其效果分析

Evaluation on effectiveness and operation mechanism of management system for severe mental disorders:a literature study

目的了解中国严重精神障碍防制体系管理运行机制的现状,并探究其完善程度对严重精神障碍管理效果的影响,为后续政策制定提供科学参考。方法收集2018年12月31日之前中国内地31个省(自治区、直辖市)公开发布的所有涉及严重精神障碍管理的政策文件,依据适宜公共健康体系评价标准,从管理监控、计划评价、筹资补偿、协调激励4个角度分析管理运行机制的完善程度;并应用固定效应模型结合严重精神障碍信息系统报告的31个省(自治区、直辖市)2014年1月1日—2018年12月31日管理数据分析其与严重精神障碍管理结果指标间的关系。结果2018年中国内地31个省(自治区、直辖市)严重精神障碍管理运行机制平均适宜程度为43.87%,较2014年提升了22.08%,但与适宜标准的85%仍相差48.39%;其中,筹资与补偿机制在4个要素中完善程度相对最高(64.96%),协调与激励机制适宜程度最低(23.69%);从具体定位看,内容形式完备程度和中长期规划覆盖程度均较高,分别达89.29%和96.24%,而职责分工明确程度仅为24.91%,管理机制可行程度仅为6.48%。固定效应模型分析结果显示,在控制了GDP的影响后,地区严重精神障碍管理运行机制完善程度提高了1%,31个省(自治区、直辖市)平均规范管理率提升了1.54%,规律服药率提升了0.28%(均P<0.05)。结论中国严重精神障碍管理运行机制在2014—2018年稳步提升,其中管理规范、中长期规划覆盖已较为全面,有效改善了患者管理质量,但仍需进一步加强协调与激励机制建设并明确各方职责分工。

Objective To analyze operational effectiveness and mechanism of management system for severe mental disorder(SMD)prevention and control in China for providing references to subsequent policy formulation.Methods Through searching official websites,we retrieved policy documents relevant to management on SMDs issued by governmental departments and professional institutions as of December 31,2018 in 31 provincial-level administrative divisions(PLADs)across China's Mainland and analyzed the completeness and operation mechanism of the management scheme from four perspectives:management and monitoring,planning and evaluation,financing and compensation,and coordination and motivation based on evaluation standards for effectiveness of a public health system.The indicator data on management of SMD from 2014 through 2018 were also collected from National Severe Mental Disorder Information System and research literatures.The relationships between management implementation and effectiveness were analyzed using fixed effects model.Results For 31 PLADs in 2018,the average appropriate degree of SMD management scheme was 43.87%,with an increment of 22.08%to that in 2014 and a gap of 48.39%to the appropriate standard(85%).The dimensional appropriate degree of the SMD management scheme was the highest(64.96%)for financing and compensation mechanism but the lowest(23.69%)for coordination and motivation mechanism.For the dimension of management and monitoring in 2018 at national level,the completeness degree of content and form was relatively high(89.29%)but the degree of clarity for responsibility assignment was relatively low(24.91%),and the degree of management procedure feasibility was only 6.48%;for the dimension of planning and evaluation,the coverage of long-term planning was as high as 96.24%.The results of fixed effect model analysis showed that after adjusting for gross domestic product,significant increase of 1.00%for completeness of regional SMD scheme,1.54%for average standardized management rate,and 0.28%for average regular medication of SMD patients were observed(all P<0.05).Conclusion The management mechanism of severe mental disorders has been steadily improved in China from 2014 to 2018;for the management scheme,the coverage of management standards and medium and long-term planning were relatively high,but the coordination and motivation mechanism and t responsibility assignment need to be improved.