荷兰实施边缘型人格障碍临床指南的障碍。
Barriers to implementing the clinical guideline on borderline personality disorder in the Netherlands.
机构信息
Innovation of Mental Health Care Program, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands.
出版信息
Psychiatr Serv. 2011 Nov;62(11):1381-3. doi: 10.1176/ps.62.11.pss6211_1381.
OBJECTIVE
This study determined the gap between actual care and optimal care (recommended in the clinical guideline) for patients with borderline personality disorder in the Netherlands. Factors that affected guideline implementation were identified.
METHODS
Ten specialized mental health organizations participated in this cross-sectional study. The number and proportion of patients who received optimal diagnosis and treatment were calculated. Focus groups explored implementation barriers.
RESULTS
Records of 422 patients with a diagnosis of borderline personality disorder were analyzed, and 315 records from six organizations contained the necessary data. Across the six organizations, most of these patients received this as an initial diagnosis (median 85%). However, only a minority received psychotherapy as a first-step treatment (median 23%). Capacity problems and organizational barriers were the main barriers to providing psychotherapy.
CONCLUSIONS
Most patients with borderline personality disorder did not receive the recommended first-step treatment (psychotherapy). Care pathways may help improve efficiency and quality of care.
目的
本研究旨在确定荷兰边缘型人格障碍患者实际护理与最佳护理（临床指南推荐）之间的差距，并确定影响指南实施的因素。
方法
共有 10 家专业精神卫生机构参与了这项横断面研究。计算了接受最佳诊断和治疗的患者人数和比例。焦点小组探讨了实施障碍。
结果
分析了 422 例边缘型人格障碍患者的病历，其中 6 家机构的 315 份病历包含了必要的数据。在这 6 家机构中，大多数患者最初被诊断为边缘型人格障碍（中位数 85%），但只有少数患者接受了心理治疗作为一线治疗（中位数 23%）。能力问题和组织障碍是提供心理治疗的主要障碍。
结论
大多数边缘型人格障碍患者未接受推荐的一线治疗（心理治疗）。护理途径可能有助于提高护理效率和质量。
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