综合医院联络会诊住院治疗模式对住院患者精神障碍治疗的可行性研究

段艳平; 耿文奇; 魏镜; 洪霞; 史丽丽; 曹锦亚; 李涛; 姜忆南; 赵晓晖

doi:10.12290/xhyxzz.2022-0590

综合医院联络会诊住院治疗模式对住院患者精神障碍治疗的可行性研究

Feasibility of Hospitalized Treatment of Inpatients' Mental Disorders in General Hospitals

摘要

摘要:
目的分析通过联络会诊住院治疗模式在综合医院实现住院患者精神障碍住院式治疗的可行性。
方法本研究为回顾性分析。以2020年7月1日至2021年6月30日北京协和医院躯体疾病科室所有接受心理医学科联络会诊住院式治疗的患者为研究组, 以2019年1月1日至2019年12月31日所有接受心理医学科会诊-联络精神医学(consultation-liaison psychiatry, CLP)会诊的患者为对照组。对照组基于CLP理念, 开展联络会诊与应邀会诊; 研究组在CLP理念的基础上, 整合了三级查房和随访制度, 通过会诊、随诊的方式促进住院患者精神障碍的诊断与治疗。根据会诊记录提取诊断结果和干预方式, 并计算会诊率、随诊率。
结果共纳入研究组患者1196例(会诊1647例次), 对照组患者1269例(会诊1558例次), 两种会诊模式涉及的会诊科室均包括全院所有躯体疾病科室。相较于对照组, 研究组全院总会诊率1.21%(1196/98 496)比1.10%(1269/114 917)、总随诊率23.08%(276/1196)比17.65%(224/1269)均有不同程度提高。联络会诊住院式治疗对患者的诊断结果涉及几乎所有精神障碍, 其中以焦虑障碍(18.76%, 309/1647)、抑郁障碍(17.12%, 282/1647)、脑器质性精神障碍(16.45%, 271/1647)的占比较高; 对于干预方式, 单纯采用心理咨询/治疗者占比30.66%(505/1647), 且几乎所有患者均进行了非药物治疗干预。
结论综合医院基于CLP理念, 结合三级查房和随访制度, 实现住院患者精神障碍住院式治疗具有可行性。

Abstract:
Objective To analyze the feasibility of hospitalized treatment of inpatients' mental disorders in a general hospital by an innovative consultation-liaison psychiatric hospitalized treatment mode.
Methods Retrospective study involved the patients in the department of physical diseases of Peking Union Medical College Hospital who received hospitalized treatment in the Department of Psychological Medicine from July 1, 2020 to June 30, 2021(study group). All patients who received consultation-liaison psychiatry (CLP) services by Department of Psychological Medicine from January 1 to December 31 in 2019 were taken as the control group. The control group conducted liaison consultation and invited consultation based on the CLP concept, whereas the study group integrated a three-level check-in and follow-up system based on the CLP concept to facilitate the diagnosis and treatment of inpatient mental disorders through consultation and follow-up. According to the consultation records, the diagnosis results and intervention methods were extracted, and the consultation rate and follow-up rate were calculated.
Results A total of 1196 patients (1647 times of consultation) were included in the study group and 1269 patients (1558 times of consultation) in control group. The consultation departments involved all the physical disease departments of the hospital. Compared with the control group, in the study group the general consultation rate1.21%(1196/98 496) vs. 1.10%(1269/114 917), the general follow-up rate23.08%(276/1196) vs. 17.65%(224/1269) were improved to varying degrees. The diagnosis results of consultation-liaison hospitalized treatment involved almost all mental disorders, among which anxiety disorder (18.76%, 309/1647), depressive disorder (17.1%, 282/1647) and brain organic mental disorder (16.45%, 271/1647) accounted for a high proportion. As for the intervention mode of patients, 30.66% (505/1647) only needed psychological counseling or treatment, and almost all patients had non-drug treatment intervention.
Conclusion It is feasible for general hospitals to realize hospitalized treatment of mental disorders based on CLP concept, combined with three-level ward round and follow-up system, which can improve the accessibility of mental medical services.

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