Kendrick T, Burns T, Freeling P, Sibbald B
Division of General Practice and Primary Care, St George's Hospital Medical School, London.
Br J Gen Pract. 1994 Jul;44(384):301-5.
Increasing numbers of long-term mentally ill people now live in the community, many of whom lose contact with psychiatric services and come to depend on general practitioners for medical care. However, it has been suggested that general practitioners may be unaware of some of these patients and their needs.
This study set out to investigate the care received by this group of patients.
Case registers of adults disabled by long-term mental illness were set up in 16 of 110 group general practices asked to participate. A search of each practice's record systems was combined with a survey of local psychiatric and social service teams, to seek practice patients who might not be identified from the general practice data.
Of the 440 patients found, 90% were identified from information within the practices, mainly computerized repeat prescription and diagnostic data. The other 10% were identified only by psychiatric services. Over one third of the patients had no current contact with psychiatric services. Patients in contact with psychiatric services had been ill for a shorter time than those not in contact. More patients suffering from psychotic illnesses were in current contact than those with non-psychotic diagnoses. Over 90% of the patients had been seen by their general practitioners within 12 months, on average eight times. Most consultations were for minor physical disorders, repeat prescriptions and sickness certificates. Elements of the formal mental state examination were recorded in one third of cases and adjustments of psychotropic medication in one fifth.
These findings suggest that patients in long-term contact with specialist services cannot be taken as representative of the whole population with long-term mental illness. General practitioners could use their frequent contacts with long-term mentally ill people to play a greater role in monitoring the mental state and drug treatment of this group.
现在越来越多的长期精神病患者生活在社区中，其中许多人与精神科服务失去联系，转而依赖全科医生提供医疗护理。然而，有人认为全科医生可能并未意识到其中一些患者及其需求。
本研究旨在调查这组患者所接受的护理情况。
在受邀参与的110家团体全科诊所中的16家，建立了因长期精神疾病而致残的成年人病例登记册。对每家诊所的记录系统进行检索，并结合对当地精神科和社会服务团队的调查，以寻找可能无法从全科诊所数据中识别出来的诊所患者。
在找到的440名患者中，90%是从诊所内部信息中识别出来的，主要是计算机化的重复处方和诊断数据。另外10%仅由精神科服务识别出来。超过三分之一的患者目前未与精神科服务机构接触。与精神科服务机构有接触的患者患病时间比未接触的患者短。目前有接触的患有精神病性疾病的患者比非精神病性诊断的患者更多。超过90%的患者在12个月内曾被全科医生诊治过，平均就诊八次。大多数会诊是针对轻微身体疾病、重复处方和病假证明。三分之一的病例记录了正式精神状态检查的内容，五分之一的病例记录了精神药物的调整情况。
这些发现表明，与专科服务长期接触的患者不能被视为整个长期精神病患者群体的代表。全科医生可以利用他们与长期精神病患者的频繁接触，在监测该群体的精神状态和药物治疗方面发挥更大作用。
