D'Arcy C
Can Psychiatr Assoc J. 1977 Feb;22(1):31-6. doi: 10.1177/070674377702200109.
A previous paper dealt with an overview of service sectors and patient volumes (2), whereas this one concentrates on types of contacts and some patient career characteristics. Analysis of a comprehensive psychiatric care utilization data file for Saskatchewan for the 1971-1972 period shows that 'public' sector patients were hospitalized for a greater average length of time than were 'private' sector patients. This may reflect differences in the styles of practice, exigencies of the demand for hospital beds in the 'private' as opposed to the 'public' sector and/or intrinsic differences in the nature of the problem treated in each sector. Some interesting facts regarding patterns of contact were uncovered. The bimodal nature of the 'psychiatric population' was further evident from the data which show that the majority of patients used relatively few services whereas a few used a large number of services. This suggests that the majority of the people seen for psychiatric reasons by medical practitioners were suffering from relatively minor psychiatric disorders. Heavy users of services were much more likely to have had some'public' or University Hospital-based contact. Conversely, light users were predominantly private sector patients. In the 'public' sector, those who had had some in patient treatment were consistently higher users of all services. It is evident that psychiatrists held a dominant position in this community-oriented public sector, having seen a large number of patients, but having had a low average rate of services per patient. In contrast, community nurses saw relatively few patients but saw them very often. This no doubt reflects their role in providing 'maintenance' services to chronic patients in approved homes in the community. In the 'private' sector, 69 percent of the services were delivered by GPs and 23 percent by psychiatrists were more likely to have had 'public' sector activity than were those seen only by GPs; also once in the 'public' sector, they were likelier to have had in patient as well as outpatient treatment. This suggests a 'sifting' of the more "difficult" patients through the private specialist sector into the public sector.
之前的一篇论文探讨了服务部门和患者数量的概况(2)，而本文则专注于接触类型和一些患者就医特征。对1971 - 1972年萨斯喀彻温省综合精神科护理利用数据文件的分析表明，“公共”部门患者的平均住院时间比“私人”部门患者更长。这可能反映了医疗方式的差异、“私人”部门与“公共”部门对医院床位需求的紧迫性差异，以及/或者每个部门所治疗问题性质的内在差异。发现了一些关于接触模式的有趣事实。“精神科患者群体”的双峰性质从数据中进一步显现出来，数据表明大多数患者使用的服务相对较少，而少数患者使用大量服务。这表明，医生诊治的大多数有精神问题的人患有相对较轻的精神障碍。大量使用服务的患者更有可能有过一些“公共”部门或大学医院的接触。相反，少量使用服务的患者主要是私立部门的患者。在“公共”部门，那些接受过一些住院治疗的患者一直是所有服务的更高使用者。显然，精神科医生在这个以社区为导向的公共部门中占据主导地位，看过大量患者，但每位患者的平均服务率较低。相比之下，社区护士看诊的患者相对较少，但看诊频率很高。这无疑反映了他们在社区认可的家庭中为慢性病患者提供“维持性”服务的角色。在“私人”部门，69%的服务由全科医生提供，23%由精神科医生提供。看过精神科医生的患者比只看过全科医生的患者更有可能有过“公共”部门的就医经历；而且一旦进入“公共”部门，他们更有可能接受过住院和门诊治疗。这表明，更多“棘手”的患者通过私立专科部门被筛选到了公共部门。
