精神分裂症患者的初级保健模式：患者、全科医生及中心因素的作用。
Patterns of primary care among persons with schizophrenia: the role of patients, general practitioners and centre factors.
作者信息
Castillejos Anguiano Mª Carmen, Martín Pérez Carlos, Bordallo Aragón Antonio, Sepúlveda Muñoz Jesus, Moreno Küstner Berta
机构信息
Departament of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Andalusian Group of Psychosocial Research (GAP), Biomedical Research Institute of Malaga (IBIMA), University of Malaga, Campus Teatinos, 29071, Malaga, Spain.
Clinical Management Unit At Marquesado, Andalusian Health Service, Carretera Los Pozos, North East Granada Sanitary District, 18518, AlquifeGranada, Spain.
出版信息
Int J Ment Health Syst. 2020 Nov 10;14(1):82. doi: 10.1186/s13033-020-00409-z.
BACKGROUND
Patients with schizophrenia and related disorders have more physical problems than the general population. Primary care professionals play an important role in the care of these patients as they are the main entry point into the healthcare system. We aimed to identify patient, general practitioner, and primary care centre factors associated with the number of visits of patients with schizophrenia and related disorders to general practitioners.
METHODS
A descriptive, cross-sectional study was conducted in 13 primary care centres belonging to the Clinical Management Unit of Mental Health of the Regional Hospital of Málaga, Spain. The eligible population was composed of patients with schizophrenia and related disorders attending the primary care centres in the study area, and the general practitioners who attend these patients. Our dependent variable was the total number of general practitioner visits made by patients with schizophrenia and related disorders during the 3.5-year observation period. The independent variables were grouped into three: (a) patient variables (sociodemographic and clinical), (b) general practitioner variables, and (c) primary care centre characteristics. Descriptive, bivariate, and multivariate analyses using the random forest method were performed.
RESULTS
A total of 259 patients with schizophrenia and related disorders, 96 general practitioners, and 13 primary care centres were included. The annual mean was 3.9 visits per patient. The results showed that younger general practitioners, patients who were women, patients who were married, some primary care centres to which the patient belonged, taking antipsychotic medication, presenting any cardiovascular risk factor, and more frequency of mental health training sessions at the primary care centre were associated with an increased number of visits to general practitioners.
CONCLUSIONS
The only general practitioner variable that was associated with the number of visits was age, the older the less contact. There were also patient variables involved in the number of visits. Finally, mental health training for general practitioners was important for these professionals to manage patients with schizophrenia and related disorders.
背景
精神分裂症及相关障碍患者比普通人群有更多的身体问题。初级保健专业人员在这些患者的护理中发挥着重要作用，因为他们是医疗保健系统的主要入口。我们旨在确定与精神分裂症及相关障碍患者就诊于全科医生的次数相关的患者、全科医生和初级保健中心因素。
方法
在西班牙马拉加地区医院心理健康临床管理单元所属的13个初级保健中心进行了一项描述性横断面研究。符合条件的人群包括研究区域内初级保健中心的精神分裂症及相关障碍患者以及诊治这些患者的全科医生。我们的因变量是精神分裂症及相关障碍患者在3.5年观察期内就诊于全科医生的总次数。自变量分为三类：（a）患者变量（社会人口统计学和临床变量），（b）全科医生变量，以及（c）初级保健中心特征。使用随机森林方法进行了描述性、双变量和多变量分析。
结果
共纳入259例精神分裂症及相关障碍患者、96名全科医生和13个初级保健中心。患者年均就诊3.9次。结果显示，年轻的全科医生、女性患者、已婚患者、患者所属的一些初级保健中心、服用抗精神病药物、存在任何心血管危险因素以及初级保健中心心理健康培训课程频率较高与就诊于全科医生的次数增加相关。
结论
与就诊次数相关的唯一全科医生变量是年龄，年龄越大接触越少。就诊次数还涉及患者变量。最后，对全科医生进行心理健康培训对于这些专业人员管理精神分裂症及相关障碍患者很重要。
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