Essex B, Doig R, Renshaw J
Sydenham Green Health Centre, London.
BMJ. 1990 Jun 2;300(6737):1442-6. doi: 10.1136/bmj.300.6737.1442.
To develop and evaluate a record of shared care to be held by the patient designed to increase the effectiveness of long term care of patients with severe mental illness.
Questionnaires completed by medical staff, community psychiatric nurse, and patients to evaluate the shared care record.
General practices, a psychiatric outpatient clinic, and a mental health resource centre in south east London.
84 Patients held shared care records over an 18 month period. They were selected by general practitioners, a psychiatrist, or a community psychiatric nurse, the criterion being that their care was shared between the general practitioner and the psychiatrist or community psychiatric nurse. Patients who had been admitted to hospital several times with short remissions were excluded.
Patients were asked to complete a questionnaire to assess their views on the acceptability, usefulness, and problems of the shared care record. A questionnaire for health staff was designed to identify patients for whom the shared care record was most and least appropriate. It also assessed the patients' compliance and the way the record affected communication between all concerned.
Patients found the shared care records very acceptable and were enthusiastic about their use. They valued being consulted about what was recorded and found the record of their treatment and progress useful. Patients also thought that they were in a better position to challenge their doctor. Those least likely to comply were people with severe paranoia. The acceptability of the record to patients greatly exceeded that to the psychiatrists and nurse managers, none of whom were interested in using the record. Communication among health staff was greatly improved by the shared care record, and it facilitated the identification of potentially dangerous drug interactions.
Shared care records were acceptable to patients with severe mental illnesses, increased the patients' autonomy, and improved communication and the effectiveness of shared care. Obstacles to further development of this approach relate to the attitudes, perceptions, and anxieties of the doctors, nurses, and managers and can be overcome.
开发并评估一种由患者保存的共享护理记录，旨在提高对重度精神疾病患者长期护理的有效性。
由医务人员、社区精神科护士和患者填写问卷，以评估共享护理记录。
伦敦东南部的全科诊所、精神科门诊和心理健康资源中心。
84名患者在18个月期间保存了共享护理记录。他们由全科医生、精神科医生或社区精神科护士挑选，标准是其护理由全科医生与精神科医生或社区精神科护士共同负责。多次短期缓解后入院的患者被排除。
要求患者填写问卷，以评估他们对共享护理记录的可接受性、有用性和问题的看法。为医护人员设计的问卷旨在确定共享护理记录最适用和最不适用的患者。它还评估了患者的依从性以及记录对所有相关人员之间沟通的影响。
患者认为共享护理记录非常可接受，并热衷于使用它。他们重视在记录内容上得到咨询，并认为治疗和进展记录很有用。患者还认为他们更有能力挑战医生。最不可能依从的是患有严重偏执狂的人。患者对记录的可接受性大大超过了精神科医生和护士长，他们中没有人对使用该记录感兴趣。共享护理记录极大地改善了医护人员之间的沟通，并有助于识别潜在的危险药物相互作用。
共享护理记录对重度精神疾病患者是可接受的，增加了患者的自主权，改善了沟通和共享护理的有效性。这种方法进一步发展的障碍与医生、护士和管理人员的态度、看法和焦虑有关，是可以克服的。
