Harrison J, Kisely S R, Jones J A, Blake I, Creed F H
Manchester Royal Infirmary.
J Public Health Med. 1997 Mar;19(1):69-75. doi: 10.1093/oxfordjournals.pubmed.a024592.
The aim of the present research was to study factors that might determine speed of access to psychiatric care, including the effect of the introduction of a community psychiatric service.
A Pathways to Care analysis was used to detail new referrals to mental health professionals (MHPs) during two one-month intervals one year apart, before and after the introduction of a community service (n = 279). Univariate analysis of possible factors that might affect access was undertaken, including socio-demographic factors, clinical factors and style of service. Significant associations were then investigated using stepwise logistic regression.
The inception rate for treatment was similar to that reported for other services (0.10 per cent). After the establishment of community teams, there was an overall 22 per cent increase in the number of patients seen, with the greatest increase being for neurotic disorders and patients seen by non-medical staff. Of patient-based factors, younger age and suicidal ideation were associated with shorter pathways. Older age, married status, somatic symptoms, anxiety and depression were associated with slower pathways. Patients with suicidal ideation were seen within three days. The introduction of a community pathways team was associated with a lengthening of time to specialist care.
Following a non-experimental change in service delivery, an increase in referrals for less severe mental illness was demonstrated. Continued comprehensive data collection of this type can be used by purchasers to monitor referral patterns and can provide a basis for determining priorities in service delivery.
本研究旨在探讨可能决定获得精神科护理速度的因素，包括社区精神科服务引入的影响。
采用护理途径分析，详细记录在引入社区服务前后一年中两个间隔一个月的时间段内新转诊至精神卫生专业人员（MHP）处的患者情况（n = 279）。对可能影响就诊机会的因素进行单因素分析，包括社会人口统计学因素、临床因素和服务方式。然后使用逐步逻辑回归研究显著关联。
治疗起始率与其他服务报告的相似（0.10%）。社区团队成立后，就诊患者数量总体增加了22%，其中神经症患者和非医务人员诊治的患者增加最多。在基于患者的因素中，年龄较小和有自杀意念与较短的就诊途径相关。年龄较大、已婚状态、躯体症状、焦虑和抑郁与较慢的就诊途径相关。有自杀意念的患者在三天内得到诊治。引入社区护理途径团队与专科护理时间延长相关。
在服务提供发生非实验性变化后，显示出较轻精神疾病转诊量增加。购买者可利用持续进行的此类全面数据收集来监测转诊模式，并可为确定服务提供的优先事项提供依据。
