Commander M J, Dharan S P, Odell S M, Surtees P G
Academic Unit, Northern Birmingham Mental Health Trust.
Br J Psychiatry. 1997 Apr;170:317-20. doi: 10.1192/bjp.170.4.317.
In addition to clinical and service factors, planners need to take account of the influence of demographic variables, especially ethnicity, on access to mental health care.
Estimated prevalence rates were calculated from epidemiological surveys undertaken in three settings: psychiatric services, primary care and the general population. Associations between demographic factors and service use were examined using the 'pathways to care' model.
Considerable differences in access to mental health care were found, particularly according to ethnicity. The major impediment to Asians accessing care occurred at the interface between primary and secondary care, whereas the most striking feature for Blacks was the poor level of case recognition by GPs.
In order to improve the uptake of mental health care, new initiatives should target those who are most likely to be unwell but least likely to access services. Purchasers and providers need to address differential patterns of use when developing and reviewing services.
除临床和服务因素外，规划者还需考虑人口统计学变量，尤其是种族，对获得心理健康护理的影响。
通过在三种环境中进行的流行病学调查计算估计患病率，这三种环境分别为精神科服务、初级保健和普通人群。使用“护理途径”模型研究人口统计学因素与服务利用之间的关联。
发现获得心理健康护理方面存在相当大的差异，尤其是按种族划分。亚洲人获得护理的主要障碍出现在初级和二级护理的衔接处，而黑人最显著的特征是全科医生对病例的识别水平较低。
为了提高心理健康护理的利用率，新举措应针对那些最有可能患病但最不可能获得服务的人群。购买者和提供者在制定和审查服务时需要解决不同的使用模式问题。
