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[精神健康、脆弱性与全科医疗:对格勒诺布尔非营利性健康中心的一项研究]

[Mental health, vulnerability and general practice: a study of non-profit health centers in Grenoble].

作者信息

Dubois-Fabing Delphine, Pichon Philippe, Arnevielhe Alizée, Suscillon Marie-Paule, Caron Bruno, Saillard Fabienne, François Patrice

机构信息

Association de Gestion des Centre de Sante de Grenoble, Grenoble, France.

出版信息

Sante Publique. 2011 Nov-Dec;23 Suppl 6:S97-111.

Abstract

Very little research has been conducted on the role of general practitioners (GPs) in mental health care among socioeconomically disadvantaged populations in France. The non-profit community health care centers in Grenoble provide populations living in sensitive urban zones with high quality primary health care that includes a medico-social and prevention dimension. The aim of this study was to measure the prevalence of mental health issues diagnosed by GPs in health care centers, to identify the factors associated with these issues and to describe treatment characteristics. This cross-sectional study focused on general practice consultations in the AGECSA Grenoble health care centers over the course of one week. At the end of each consultation, the GP collected information about the patient, including personal data, psychological disorders, vulnerability, and patient health management. Among the 451 patients included in the study, GPs found that 45.2% of patients were in vulnerable situations and 43% of patients suffered from a mental disorder, including 29% of cases of anxiety and 20% of cases of depression. 44% of patients suffered from a psychological disorder (mental disorder and/or psychological suffering). For these patients, 52.8% of the consultations lasted more than 20 minutes. Their treatment generally included a mental health care follow-up (in 76% of cases), including psychological support (59%) and treatment of functional somatic disorders (46%). The study shows the high prevalence of psychological disorders diagnosed in the patients treated by GPs working in health care centers in disadvantaged urban areas. Research shows that GPs play an important and specific role in mental health care and prevention. An analysis of the organizational methods used in health care centers is highly relevant.

摘要

关于法国社会经济弱势群体中全科医生(GP)在精神卫生保健方面的作用,所开展的研究极少。格勒诺布尔的非营利性社区卫生保健中心为生活在敏感城市区域的人群提供高质量的初级卫生保健服务,其中包括医疗社会和预防层面。本研究的目的是衡量卫生保健中心的全科医生所诊断出的精神卫生问题的患病率,确定与这些问题相关的因素,并描述治疗特征。这项横断面研究聚焦于格勒诺布尔AGECSA卫生保健中心一周内的全科医疗咨询情况。在每次咨询结束时,全科医生收集有关患者的信息,包括个人数据、心理障碍、脆弱性以及患者健康管理情况。在纳入研究的451名患者中,全科医生发现45.2%的患者处于脆弱状态,43%的患者患有精神障碍,其中焦虑症病例占29%,抑郁症病例占20%。44%的患者患有心理障碍(精神障碍和/或心理痛苦)。对于这些患者,52.8%的咨询持续时间超过20分钟。他们的治疗通常包括精神卫生保健随访(76%的病例),其中包括心理支持(59%)和功能性躯体障碍治疗(46%)。该研究表明,在城市贫困地区卫生保健中心工作的全科医生所治疗的患者中,心理障碍的患病率很高。研究表明,全科医生在精神卫生保健和预防方面发挥着重要且特殊的作用。对卫生保健中心所采用的组织方法进行分析具有高度相关性。

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