日本会诊联络精神病学：一项全国性回顾性观察研究。

Consultation-liaison psychiatry in Japan: a nationwide retrospective observational study.

机构信息

Department of Information Technology and Management, The National Center of Child Health and Development, Tokyo, Japan.

Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138519, Japan.

出版信息

BMC Psychiatry. 2021 May 5;21(1):235. doi: 10.1186/s12888-021-03241-y.

DOI:10.1186/s12888-021-03241-y

PMID:33952238

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8097923/

Abstract

BACKGROUND

Consultation-liaison psychiatry (CLP)-professional psychiatric care provided to coordinate with surgical or medical treatment of inpatients with psychiatric disorders-was included in universal health coverage in Japan in 2012. Despite evidence of benefits of CLP, basic data and geographic distribution information regarding CLP at the national level remain unclear. This study aimed to 1) identify the geographic disparity of CLP in Japan and 2) investigate the association between number of consultations per CLP patient and region.

METHODS

We retrospectively analyzed anonymized data retrieved from the Japanese administrative inpatient database regarding inpatients who were provided CLP between April 2012 and March 2017. Demographic characteristics were summarized and geographic disparity by prefecture was visualized for fiscal years 2012 and 2016; we also summarized the data according to region. Multivariate linear regression analysis was used to investigate association between the number of consultations per CLP patient and region after adjusting for covariates.

RESULTS

Data from a total of 46,171 patients who received 138,866 CLP services were included. Results revealed more patients aged 75-84 years received CLPs than any other age group (29.7%) and the overall male/female ratio was 53:47 in 2016. In 2012 and 2016, 24.2 and 30.7% of CLP patients, respectively, were transferred to other hospitals; 9.7 and 8.8%, respectively, discharged due to the death. CLP services were provided in 14 prefectures in 2012 and 33 by 2016; 14 prefectures had no available CLP services. After adjusting for covariates, Tohoku (β = - 0.220, p < 0.034), Chugoku (β = - 0.160, p < 0.026), and Shikoku (β = - 0.555, p < 0.001) had a significant negative correlation with the number of consultations per CLP patient compared with Hokkaido region (an adjusted R square (R2) = 0.274).

CONCLUSIONS

Our study clarified the characteristics of patients in Japan who received CLPs and the geographic disparity in CLP services. Although 5 years had passed since CLP was introduced, the results imply wide availability of CLP nationally. The analysis data provided may inform future policies to improve CLP services.

摘要

背景

联络精神病学（CLP）——为与精神障碍住院患者的手术或医疗治疗相协调而提供的专业精神病学护理——于 2012 年纳入日本全民健康覆盖范围。尽管有证据表明 CLP 有益，但关于全国范围内 CLP 的基本数据和地理分布信息仍不清楚。本研究旨在：1）确定日本 CLP 的地理差异，2）调查 CLP 患者每次就诊人数与地区之间的关系。

方法

我们回顾性分析了 2012 年 4 月至 2017 年 3 月期间接受 CLP 的住院患者的匿名日本行政住院数据库中的数据。总结了人口统计学特征，并对 2012 年和 2016 年按县划分的地理差异进行了可视化；我们还按地区总结了数据。调整协变量后，采用多元线性回归分析调查 CLP 患者每次就诊人数与地区之间的关系。

结果

共纳入 46171 例接受 138866 次 CLP 服务的患者。结果显示，2016 年，75-84 岁年龄组接受 CLP 的患者比例高于其他任何年龄组（29.7%），总体男女比例为 53:47。2012 年和 2016 年，分别有 24.2%和 30.7%的 CLP 患者转往其他医院；分别有 9.7%和 8.8%的患者因死亡而出院。2012 年有 14 个县提供 CLP 服务，2016 年有 33 个县；14 个县没有提供 CLP 服务。调整协变量后，与北海道地区相比，东北地区（β=-0.220，p<0.034）、中国地区（β=-0.160，p<0.026）和四国地区（β=-0.555，p<0.001）的 CLP 患者每次就诊人数呈显著负相关（调整后的 R 平方（R2）=0.274）。