西非几内亚私营非营利性保健中心的精神卫生保健一体化：提供更以患者为中心的服务的系统切入点？
Integration of mental health care in private not-for-profit health centres in Guinea, West Africa: a systemic entry point towards the delivery of more patient-centred care?
机构信息
Fraternité Médicale Guinée, Conakry, Guinea.
Institute of Tropical Medicine, Antwerp, Belgium.
出版信息
BMC Health Serv Res. 2020 Jan 28;20(1):61. doi: 10.1186/s12913-020-4914-3.
BACKGROUND
Patient-centred care is an essential component of quality of health care. We hypothesize that integration of a mental health care package into versatile first-line health care services can strengthen patient participation, an important dimension of patient-centred care. The objective of this study is to analyse whether consultations conducted by providers in facilities that integrated mental health care score higher in terms of patient participation.
METHODS
This study was conducted in Guinea in 12 not-for-profit health centres, 4 of which had integrated a mental health care package (MH+) and 8 had not (MH-). The study involved 450 general curative consultations (175 in MH+ and 275 in MH- centres), conducted by 18 care providers (7 in MH+ and 11 in MH- centres). Patients were interviewed after the consultation on how they perceived their involvement in the consultation, using the Patient Participation Scale (PPS). The providers completed a self-administered questionnaire on their perception of patient's involvement in the consultation. We compared scores of the PPS between MH+ and MH- facilities and between patients and providers.
RESULTS
The mean PPS score was 24.21 and 22.54 in MH+ and MH- health centres, respectively. Participation scores depended on both care providers and the health centres they work in. The patients consulting an MH+ centre were scoring higher on patient participation score than the ones of an MH- centre (adjusted odds ratio of 4.06 with a 95% CI of 1.17-14.10, p = 0.03). All care providers agreed they understood the patients' concerns, and patients shared this view. All patients agreed they wanted to be involved in the decision-making concerning their treatment; providers, however, were reluctant to do so.
CONCLUSION
Integrating a mental health care package into versatile first-line health services can promote more patient-centred care.
背景
以患者为中心的护理是医疗质量的重要组成部分。我们假设，将心理健康护理套餐融入多功能的一线医疗服务中，可以增强患者的参与度，这是以患者为中心的护理的一个重要维度。本研究的目的是分析整合了心理健康护理套餐的医疗机构中的就诊，在患者参与度方面是否得分更高。
方法
本研究在几内亚的 12 家非营利性保健中心进行，其中 4 家已整合心理健康护理套餐（MH+），8 家未整合（MH-）。该研究涉及 450 次普通治疗咨询（MH+中心 175 次，MH-中心 275 次），由 18 名医护人员（MH+中心 7 名，MH-中心 11 名）进行。咨询结束后，患者会接受采访，询问他们对参与咨询的感受，使用患者参与量表（PPS）进行评估。医护人员则会完成一份关于他们对患者在咨询中参与度的自我评估问卷。我们比较了 MH+和 MH-设施以及患者和医护人员之间的 PPS 得分。
结果
MH+和 MH-保健中心的 PPS 平均得分分别为 24.21 和 22.54。参与得分取决于医护人员及其所在的医疗中心。在 MH+中心就诊的患者在患者参与评分上高于 MH-中心的患者（调整后的优势比为 4.06，95%置信区间为 1.17-14.10，p=0.03）。所有医护人员都表示他们理解患者的担忧，而患者也有同样的看法。所有患者都表示希望参与到他们的治疗决策中；然而，医护人员则不愿意这样做。
结论
将心理健康护理套餐融入多功能的一线医疗服务中，可以促进更以患者为中心的护理。
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