Yanagisawa Yuta, Kimura Hiroshi, Komatsu Hideki, Watanabe Hiroyuki, Iyo Masaomi
Department of Psychiatry Chiba University Graduate School of Medicine Chiba Japan.
Department of Psychiatry Gakuji-kai Kimura Hospital Chiba Japan.
PCN Rep. 2024 Apr 14;3(2):e192. doi: 10.1002/pcn5.192. eCollection 2024 Jun.
The large number of new long-stay (NLS) patients and high readmission rates in psychiatric hospitals are longstanding concerns in Japan despite reforms to encourage multidisciplinary support of such patients. Staffing shortages of specialists, especially mental health social workers (MHSWs), may be one of the reasons for these problems to remain unsolved.
The authors examined the effectiveness of the MHSW-centered multidisciplinary care model in preventing NLSs and rehospitalization in terms of both patient dynamics and cost by retrospective comparison of before and after program implementation.
After our program was introduced, NLS was almost completely prevented. In addition, a significant decrease in readmissions of involuntarily admitted patients was also observed. On the other hand, the resulting decrease in treatment costs and hospital revenues was mismatched by an increase in personnel costs.
While MHSW-centered multidisciplinary care is effective for the community integration of patients, there are cost challenges. State policy changes are needed to resolve staffing problems, along with the introduction of appropriate indicators of community integration.
尽管日本进行了改革以鼓励对长期住院患者提供多学科支持，但精神病医院中大量的新长期住院（NLS）患者和高再入院率一直是长期存在的问题。专家人员短缺，尤其是心理健康社会工作者（MHSW）短缺，可能是这些问题仍未得到解决的原因之一。
作者通过回顾性比较项目实施前后的情况，从患者动态和成本两方面研究了以MHSW为中心的多学科护理模式在预防NLS和再住院方面的有效性。
在引入我们的项目后，几乎完全预防了NLS。此外，还观察到非自愿入院患者的再入院率显著下降。另一方面，治疗成本和医院收入的下降与人员成本的增加不匹配。
虽然以MHSW为中心的多学科护理对患者融入社区有效，但存在成本挑战。需要国家政策变革来解决人员配备问题，并引入适当的社区融入指标。
