Koekkoek Bauke, van Meijel Berno, Schene Aart, Hutschemaekers Giel
Altrecht Mental Health Care, Department of Outpatient Community Care, Zeist, The Netherlands.
Epidemiol Psichiatr Soc. 2009 Oct-Dec;18(4):323-30.
'difficult patients' may evoke strong feelings in health professionals. The ambivalent attitude of, especially, non-psychotic chronic patients towards psychiatric care may be frustrating and burdensome to professionals. Many of these patients are cared for in non-specialized services, where professionals are often more used to working with psychotic patients. Specific problems with 'difficult' non-psychotic patients may occur, and hamper the quality of care offered. The aim of this research is to determine precisely what problems psychiatric professionals perceive in contact with non-psychotic chronic patients in order to identify starting points for alternative or improved care in non-specialized services.
a modified five-phase Delphi study with three groups of eight participants from was used to identify and prioritize experts' judgments.
46 problems were identified of which some were relevant to one or two subgroups and some were relevant to the entire group.
a program that combines a coherent view at services level, with support and increased communication at the interprofessional level (e.g. through regular supervision, sharing of case-loads) may be highly beneficial to non-specialized services.
“难相处的患者”可能会在医护人员中引发强烈情绪。尤其是非精神病性慢性病患者对精神科护理的矛盾态度，可能会让医护人员感到沮丧和负担沉重。这些患者中的许多人在非专科服务机构接受护理，而那里的医护人员通常更习惯于治疗精神病患者。“难相处的”非精神病性患者可能会出现特定问题，进而影响所提供护理的质量。本研究的目的是准确确定精神科医护人员在接触非精神病性慢性病患者时察觉到哪些问题，以便找出在非专科服务机构中提供替代护理或改善护理的切入点。
采用经过改进的五阶段德尔菲研究法，三组，每组八名参与者，以确定专家判断并排出优先顺序。
共识别出46个问题，其中一些与一两个亚组相关，一些与整个组相关。
一个在服务层面结合连贯观点、在跨专业层面提供支持并加强沟通（例如通过定期督导、分担工作量）的项目，可能会对非专科服务机构大有裨益。
