Khemani Manisha Chetan, Premarajan Kariyarath Cheriyath, Menon Vikas, Olickal Jeby Jose, Vijayageetha Mathavaswami, Chinnakali Palanivel
School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Indian J Psychiatry. 2020 Nov-Dec;62(6):664-669. doi: 10.4103/psychiatry.IndianJPsychiatry_512_19. Epub 2020 Dec 12.
Pathways to care can be defined as the pathway adopted by the patient to reach the appropriate health facility. In India, health workforce related to mental health care is inadequate. Persons with mental disorders approach different types of care providers. This study describes the number, sequence of care providers visited, and time gap between providers among individuals newly diagnosed with severe mental disorders.
We conducted a facility-based descriptive study in the psychiatric outpatient department of a tertiary care center in South India between April and September 2017. All patients with any of the following diagnosis; acute psychosis, depression, bipolar disorder, or schizophrenia were included in the study. Information on number and sequence of care providers visited and the reasons for preference of providers were assessed using a validated World Health Organization questionnaire. Patients seeking care was summarized as numbers.
Of the total 150 participants, 86 (57%) were females and the mean (standard deviation) age was 35 (11.5) years. The first point of contact were traditional healers in 52 (34.7%) participants, general hospitals in 23 (15.3%), and psychiatric services in the remaining 75 (50%). The patients with schizophrenia and bipolar disorder had greater delays in accessing psychiatric care when compared to other disorders. Median (interquartile range) number of care providers visited till the diagnosis made was 2 (1-3). The availability and recommendation by close relatives were the major reasons for the preference of traditional healers.
One-third of patients visited traditional healers as the first point of contact and about half visited the psychiatric facilities directly.
就医途径可定义为患者前往合适医疗机构所采用的路径。在印度，与精神卫生保健相关的卫生人力不足。精神障碍患者会求助于不同类型的护理提供者。本研究描述了新诊断为严重精神障碍的个体所拜访的护理提供者的数量、顺序以及提供者之间的时间间隔。
2017年4月至9月，我们在印度南部一家三级护理中心的精神科门诊部进行了一项基于机构的描述性研究。所有患有以下任何一种诊断的患者：急性精神病、抑郁症、双相情感障碍或精神分裂症均纳入研究。使用经过验证的世界卫生组织问卷评估所拜访的护理提供者的数量和顺序以及对提供者偏好的原因。寻求护理的患者情况以数字形式汇总。
在总共150名参与者中，86名（57%）为女性，平均（标准差）年龄为35（1l.5）岁。52名（34.7%）参与者的首个接触点是传统治疗师，23名（15.3%）是综合医院，其余75名（50%）是精神科服务机构。与其他疾病相比，精神分裂症和双相情感障碍患者在获得精神科护理方面的延迟更大。直到确诊所拜访的护理提供者的中位数（四分位间距）为2（1 - 3）。近亲的可及性和推荐是偏好传统治疗师的主要原因。
三分之一的患者将传统治疗师作为首个接触点，约一半患者直接前往精神科机构。
