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全科医生在为患有精神病的患者提供护理时有着怎样的体验?

How do General Practitioners experience providing care for their psychotic patients?

作者信息

Oud Marian J T, Schuling Jan, Slooff Cees J, Meyboom-de Jong Betty

机构信息

Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands.

出版信息

BMC Fam Pract. 2007 Jun 28;8:37. doi: 10.1186/1471-2296-8-37.


DOI:10.1186/1471-2296-8-37
PMID:17598879
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1933537/
Abstract

BACKGROUND: In primary care, GPs usually provide care for patients with chronic diseases according to professional guidelines. However, such guidelines are not available in the Netherlands for patients with recurring psychoses. It seems that the specific difficulties that GPs experience in providing care for these patients hinder the development and implementation of such guidelines. This study aims to explore the chances and problems GPs meet when providing care for patients susceptible for recurring psychoses, including schizophrenia and related disorders, bipolar disorder, and psychotic depression. METHODS: A qualitative study of focus group discussions with practising GPs in both town and rural areas. Transcripts from three focus groups with 19 GPs were analysed with the computer program 'Kwalitan'. Theoretical saturation was achieved after these three groups. RESULTS: Analysis showed that eight categories of factors influenced the GPs' care for psychotic patients: patient presentation (acute vs. chronic phase), emotional impact, expertise, professional attitude, patient related factors, patient's family, practice organization, and collaboration with psychiatric specialists. CONCLUSION: Current primary care for psychotic patients depends very much on personal characteristics of the GP and the quality of local collaboration with the Mental Health Service. A quantitative study among GPs using a questionnaire based on the eight categories mentioned above would determine the extent of the problems and limitations experienced with this type of care. From the results of this quantitative study, new realistic guidelines could be developed to improve the quality of care for psychotic patients.

摘要

背景:在初级医疗保健中,全科医生通常根据专业指南为慢性病患者提供护理。然而,荷兰没有针对复发性精神病患者的此类指南。全科医生在为这些患者提供护理时遇到的具体困难似乎阻碍了此类指南的制定和实施。本研究旨在探讨全科医生在为易患复发性精神病的患者(包括精神分裂症及相关障碍、双相情感障碍和精神病性抑郁症)提供护理时遇到的机会和问题。 方法:对城乡执业全科医生进行焦点小组讨论的定性研究。使用计算机程序“Kwalitan”对三个焦点小组中19名全科医生的记录进行分析。在这三个小组之后达到了理论饱和。 结果:分析表明,八类因素影响全科医生对精神病患者的护理:患者表现(急性期与慢性期)、情感影响、专业知识、职业态度、患者相关因素、患者家庭、医疗机构以及与精神科专家的合作。 结论:目前对精神病患者的初级医疗保健很大程度上取决于全科医生的个人特征以及与心理健康服务机构的当地合作质量。使用基于上述八类问题的问卷对全科医生进行定量研究,将确定此类护理所经历问题和局限性的程度。根据这项定量研究的结果,可以制定新的切实可行的指南,以提高对精神病患者的护理质量。

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本文引用的文献

[1]
Physical health care of patients with schizophrenia in primary care: a comparative study.

Fam Pract. 2007-2

[2]
Patients with a psychiatric disorder in general practice: determinants of general practitioners' psychological diagnosis.

Gen Hosp Psychiatry. 2006

[3]
Schizophrenia and increased risks of cardiovascular disease.

Am Heart J. 2005-12

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J Psychopharmacol. 2005-11

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How do general practitioners manage subjects with early schizophrenia and collaborate with mental health professionals? A postal survey in South-Western France.

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General practitioners and schizophrenia: results from a Swiss survey.

Br J Psychiatry. 2005-9

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[9]
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BMJ. 2004-6-19

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Attitudes and roles of general practitioners in the treatment of schizophrenia compared with community mental health staff and patients.

Soc Psychiatry Psychiatr Epidemiol. 2004-1

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