S. Z. Medical College Hospital, Bogra, Bangladesh.
Soc Psychiatry Psychiatr Epidemiol. 2012 Jan;47(1):129-36. doi: 10.1007/s00127-010-0315-y. Epub 2010 Nov 13.
The pattern of care seeking of psychiatric patients is important for service and policy issues. We conducted a study in 2008 in Bangladesh to find out the referral patterns, delays to reach mental health professional (MHP), diagnoses and treatment received before reaching psychiatric care etc.
We interviewed 50 consecutive new patients at the Psychiatry outpatient department of a tertiary hospital using the translated version of WHO pathway encounter form.
84% of the patients we interviewed consulted other carers before they arrived at a MHP (2.5-3.1 steps were needed to reach MHP) and the range of delay was 8-78 weeks (indirect pathway). 16% of the patients came directly to a MHP with mean delay of 10.5 weeks from onset of mental illness (direct pathway). Among the patients who took the indirect pathway 44% first visited the Individual Private practitioners (PP), 22% first visited native or religious healers (NRH) and 12% rural medical practitioners (RMP). Patients reaching NRH or RMP made the least delay (2-2.5 weeks) and the shortest pathway to MHP (4.5-7 weeks). Most delay occurred from PP to MHP/General Hospital (22-31 weeks). About a third of patients were informed of diagnosis with poor concordance with the diagnosis made by MHP. 70 and 40% of patients with mental illness who attended General Hospital and PP were referred to MHP, respectively.
In the study we found four major pathways to mental health care in Bangladesh. They are direct pathway and referrals from PP, general hospitals and NRH. PP did not play a pivotal role in reaching MHP. Family members had a significant role on the decision to seek help from health service.
精神科患者的求诊模式对于服务和政策问题很重要。我们于 2008 年在孟加拉国进行了一项研究，以了解转诊模式、寻求心理健康专业人员（MHP）的延迟、到达精神科护理之前的诊断和治疗等情况。
我们使用世界卫生组织路径接触表的翻译版本，对一家三级医院的精神科门诊的 50 名连续新患者进行了访谈。
我们访谈的患者中有 84%在到达 MHP 之前咨询了其他照顾者（需要 2.5-3.1 个步骤才能到达 MHP），延迟时间范围为 8-78 周（间接途径）。16%的患者直接到 MHP 就诊，从精神疾病发作到就诊的平均延迟为 10.5 周（直接途径）。在采用间接途径的患者中，44%的人首先就诊于个体私人医生（PP），22%的人首先就诊于本土或宗教治疗师（NRH），12%的人首先就诊于农村医疗从业者（RMP）。NRH 或 RMP 就诊的患者延迟时间最短（2-2.5 周），到达 MHP 的路径最短（4.5-7 周）。从 PP 到 MHP/综合医院的延迟时间最长（22-31 周）。大约三分之一的患者被告知诊断结果，但与 MHP 做出的诊断一致性较差。分别有 70%和 40%的精神疾病患者在综合医院和 PP 就诊后被转诊到 MHP。
在这项研究中，我们发现了孟加拉国四条主要的精神卫生保健途径：直接途径和从 PP、综合医院和 NRH 的转诊。PP 在到达 MHP 方面并没有发挥关键作用。家庭成员在寻求卫生服务帮助的决策中发挥了重要作用。
