Purandare Nitin, Burns Alistair, Challis David, Morris Julie
University of Manchester, School of Psychiatry and Behavioural Sciences, 2nd Floor, Education and Research Centre, Wythenshawe Hospital, Wythenshawe, Manchester, UK.
Int J Geriatr Psychiatry. 2004 Jun;19(6):549-53. doi: 10.1002/gps.1126.
To assess perceived need and adequacy of service provision by old age psychiatrists (OAPs) to older people living in care homes in the UK.
A postal survey of managers of a stratified random sample of 2638 (14% of 18,698) care homes in the UK caring for older residents. Reminders were sent to those not returning the questionnaires.
The response rate was 64% (n = 1689). Forty-one percent of care home managers felt that at least 50% of their residents needed psychiatric evaluation. Cognitive impairment, depressive symptoms and challenging behaviour was thought to be present in at least a quarter of residents by 78%, 29% and 17% respectively. Thirty-eight percent of managers reported that their homes 'never' received any visits from OAPs and only a half described the current frequency of visits as adequate. Pharmacological advice was perceived to be adequate by about three-quarters but less than a half perceived non-pharmacological advice as adequate. Eighty percent wanted more input for staff education and training. Perceived need ( p < 0.001), frequency of visits by OAPs ( p = 0.001), availability of geriatrician ( p = 0.001), amount of non-pharmacological advice ( p = 0.014) and direct referral access to OAPs for known patients ( p = 0.036) were found to be independent predictors of perceived inadequacy of service provision by OAPs.
The survey highlights the perception of unmet need and inadequacy of service provision by OAPs amongst managers of care homes in the UK. The study findings, if confirmed by direct observational studies, may have a considerable impact on already sparse resources with a need to explore efficacy of different models of care in meeting this need.
评估英国老年精神科医生（OAPs）对住在养老院的老年人所提供服务的感知需求和充足性。
对英国2638家（占18698家的14%）照料老年居民的养老院管理人员进行分层随机抽样的邮寄调查。向未回复问卷的人发送提醒函。
回复率为64%（n = 1689）。41%的养老院管理人员认为至少50%的居民需要精神科评估。分别有78%、29%和17%的管理人员认为至少四分之一的居民存在认知障碍、抑郁症状和具有挑战性的行为。38%的管理人员报告称他们的养老院“从未”有老年精神科医生来访，只有一半的管理人员认为目前的来访频率足够。约四分之三的人认为药物治疗建议足够，但不到一半的人认为非药物治疗建议足够。80%的人希望在员工教育和培训方面得到更多投入。发现感知需求（p < 0.001）、老年精神科医生的来访频率（p = 0.001）、老年病医生的可获得性（p = 0.001）、非药物治疗建议的数量（p = 0.014）以及已知患者直接转诊至老年精神科医生的途径（p = 0.036）是老年精神科医生服务提供不足感知的独立预测因素。
该调查凸显了英国养老院管理人员中对老年精神科医生未满足的需求和服务提供不足的认知。如果直接观察性研究证实了这些研究结果，可能会对本就稀缺的资源产生重大影响，因此有必要探索不同护理模式在满足这一需求方面的效果。
