Wheeler Amanda, Harrison Jeff, Homes Zara
Clinical Research & Resource Centre, Waitemata District Health Board, Auckland, New Zealand.
J Prim Health Care. 2009 Mar;1(1):11-9.
People with mental illness have higher rates of morbidity and mortality, largely due to increased rates of cardiovascular disease (CVD). Metabolic syndrome is well recognised but rarely expressed as a need to assess and manage cardiovascular risk factors; furthermore there is confusion about whose role this is. This study explores health practitioners' knowledge, attitudes, barriers/solutions towards cardiovascular risk assessment and management in mental health patients.
A survey of mental health practitioners (MHPs n = 421) and general practitioners (GPs n = 232)
Three-quarters of respondents agreed mental illness predisposes to CVD. Fifty-five percent of MH doctors agreed they could effectively assess CVD risk compared to 67% of GPs. Only 21% of MH doctors agreed they could effectively manage CVD risk compared to 57% of GPs. Seventy-nine percent of MHPs believed that assessing CVD risk was a joint responsibility between GP and MHP, compared to 33% of GPs; 62% of GPs believed it was their sole responsibility. Forty-six percent of MHPs believed managing CVD risk was a joint responsibility compared with 29% of GPs; 58% of GPs saw this as their role. Only 13% of MHPs and fewer than 4% of GPs agreed that MH services were effectively assessing and managing CVD risk. MHPs identified lack of knowledge and skills (58%) and poor communication between primary-secondary care (53%) as the main barriers. GPs identified barriers of poor communication (64%) and patient compliance with health care management (71%). The top two solutions proposed by MHPs were provision of GP subsidies (47%) and training (43%). GPs also identified provision of a subsidy (66%) and collaborative management between GPs and MH (44%) as solutions.
There is widespread recognition of increased risk of CVD in MH patients. MHPs do not believe they have the knowledge and skills to manage this risk. GPs believe this is their responsibility. Both groups recognise communication with, and access to, primary care for MH patients as key barriers.
患有精神疾病的人群发病率和死亡率更高，这主要归因于心血管疾病（CVD）发病率的上升。代谢综合征已广为人知，但很少被视为需要评估和管理心血管危险因素；此外，对于这是谁的职责还存在困惑。本研究探讨了医疗从业者对心理健康患者心血管风险评估和管理的知识、态度、障碍及解决方案。
对心理健康从业者（n = 421）和全科医生（n = 232）进行调查。
四分之三的受访者认为精神疾病易引发心血管疾病。55%的精神科医生认为他们能够有效评估心血管疾病风险，而全科医生的这一比例为67%。只有21%的精神科医生认为他们能够有效管理心血管疾病风险，而全科医生的这一比例为57%。79%的心理健康从业者认为评估心血管疾病风险是全科医生和心理健康从业者的共同责任，而全科医生中持此观点的比例为33%；62%的全科医生认为这是他们的 sole责任。46%的心理健康从业者认为管理心血管疾病风险是共同责任，而全科医生中持此观点的比例为29%；58%的全科医生认为这是他们的职责。只有13%的心理健康从业者和不到4%的全科医生认为心理健康服务正在有效评估和管理心血管疾病风险。心理健康从业者认为知识和技能缺乏（58%）以及初级 - 二级护理之间沟通不畅（53%）是主要障碍。全科医生认为沟通不畅（64%）和患者对医疗保健管理的依从性（71%）是障碍。心理健康从业者提出的前两个解决方案是提供全科医生补贴（47%）和培训（43%）。全科医生也认为提供补贴（66%）以及全科医生和心理健康从业者之间的协作管理（44%）是解决方案。
人们普遍认识到心理健康患者患心血管疾病的风险增加。心理健康从业者认为他们没有管理这种风险的知识和技能。全科医生认为这是他们的责任。两组都认识到与心理健康患者的初级护理沟通和获得初级护理是关键障碍。
