Lum Alvin Wm, Kwok Kian Woon, Chong Siow Ann
Institute of Mental Health, Singapore.
Ann Acad Med Singap. 2008 Feb;37(2):128-31.
The aim of our programme was to right site a selected group of patients to the care of the primary sector for follow-up management. Mental disorders are recognised as a major public health problem worldwide which places an enormous burden on health services. Patients on treatment in the hospitals are largely managed by specialists either in the restructured hospitals or in private practice with minimal involvement of general practitioners (GPs). Yet, there are many patients with chronic mental illnesses who are stable, require maintenance medications and are best managed in the community.
GPs were given appropriate training and support to help them manage patients with mental illnesses in their clinics. The training involved in-depth, comprehensive training on mental illness, providing the GPs with the skills necessary to manage the stable patients within the community. It also facilitated Early Detection Intervention by enhancing the GPs capabilities to detect and manage the mentally ill. Patients screened by psychiatrists who fulfill the referral criteria agreed upon by both the specialist team and the GP partners were referred to the GPs with initial support from case managers when required. The benefits to patients include: increased convenience, savings in terms of transport costs and travel time, the flexibility of being seen during after office hours, less stigma and the option of managing their other medical conditions, if any, by the same doctor.
To date, a total of 200 patients have been successfully referred to the 30 GPs in the programme. This represents an average savings of more than 1000 consultation visits to the hospital per year.
The programme allows for the right siting of care for patients and allows the hospital to channel precious resources to more appropriate uses.
我们项目的目的是将选定的一组患者安排到基层医疗部门进行后续管理。精神障碍被公认为是全球主要的公共卫生问题，给卫生服务带来了巨大负担。在医院接受治疗的患者主要由重组医院或私人诊所的专科医生管理，全科医生（GP）参与极少。然而，有许多患有慢性精神疾病的患者病情稳定，需要维持药物治疗，在社区管理最为适宜。
为全科医生提供了适当的培训和支持，以帮助他们在诊所管理精神疾病患者。培训包括对精神疾病进行深入、全面的培训，为全科医生提供在社区管理稳定患者所需的技能。这也通过提高全科医生检测和管理精神病患者的能力促进了早期发现干预。经精神科医生筛查符合专科团队和全科医生合作伙伴商定的转诊标准的患者，在需要时由个案经理提供初步支持后转诊给全科医生。对患者的好处包括：更加便利、节省交通成本和出行时间、可在办公时间外就诊的灵活性、减少耻辱感以及如有其他医疗状况可由同一位医生管理的选择。
迄今为止，该项目已成功将200名患者转诊给30名全科医生。这意味着每年平均节省超过1000次到医院的诊疗次数。
该项目实现了对患者的合理护理安排，并使医院能够将宝贵资源用于更适当的用途。
