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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

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段艳平, 耿文奇, 魏镜, 洪霞, 史丽丽, 曹锦亚, 李涛, 姜忆南, 赵晓晖. 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[J]. 协和医学杂志. doi: 10.12290/xhyxzz.2022-0590
引用本文: 段艳平, 耿文奇, 魏镜, 洪霞, 史丽丽, 曹锦亚, 李涛, 姜忆南, 赵晓晖. 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[J]. 协和医学杂志. doi: 10.12290/xhyxzz.2022-0590
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DUAN Yanping, GENG Wenqi, WEI Jing, HONG Xia, SHI Lili, CAO Jinya, LI Tao, JIANG Yinan, ZHAO Xiaohui. Study of Feasibility to Hospitalized Treatment of Inpatients’ Mental Disorders in a General Hospital[J]. Medical Journal of Peking Union Medical College Hospital. doi: 10.12290/xhyxzz.2022-0590
Citation: DUAN Yanping, GENG Wenqi, WEI Jing, HONG Xia, SHI Lili, CAO Jinya, LI Tao, JIANG Yinan, ZHAO Xiaohui. Study of Feasibility to Hospitalized Treatment of Inpatients’ Mental Disorders in a General Hospital[J]. Medical Journal of Peking Union Medical College Hospital. doi: 10.12290/xhyxzz.2022-0590
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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

doi: 10.12290/xhyxzz.2022-0590

  • 中国医学科学院北京协和医院心理医学科, 北京 100730

基金项目: 

北京协和医院院内基金（ ZC201902261）； 建立基于医患心理行为评估和分级预警干预体系对促进综合医院医疗质量和患者安全的效果研究（ 2022-2-4012）； 科技创新 2030-“脑科学与类脑研究”重大项目“焦虑障碍的发病机制及干预技术研究”项目（ 2021ZD0202001）

详细信息
    通讯作者:

    魏镜,E-mail:weijing@pumch.cn

  • 中图分类号: R749

Study of Feasibility to Hospitalized Treatment of Inpatients’ Mental Disorders in a General Hospital

  • Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

Funds: 

Hospital Fund of Peking Union Medical College Hospital (ZC201902261)

    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 回顾性纳入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，对照组纳入2019年1月1日至2019年12月31日全院所有接受心理医学科会诊的患者。该治疗模式在会诊-联络精神医学（consultation-liaison psychiatry，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。根据会诊记录提取会诊量、随诊量、诊断结果和干预方式，并计算会诊率、随诊率。 结果 共纳入接受心理医学科联络会诊住院式治疗患者1196例（会诊1647例次），会诊科室涉及全院所有躯体疾病科室。全院总会诊率为1.21%（1196/98 496），总随诊率为23.08%（276/1196），联络科室的随诊率为23.98%（158/659），非联络科室的随诊率为21.97%（118/537）。2019年全院总住院患者数114 917例，总会诊率为1.10%（1269/114 917），总随诊率为17.65%（224/1269），联络科室的随诊率为19.0%（177/933），非联络科室的随诊率为14.0%（47/336）。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。对于精神障碍疾病患者的干预方式，单纯采用心理咨询/治疗者占比30.66%（505/1647），几乎所有患者均进行了非药物治疗干预。 结论 综合医院应用CLP理念实现精神障碍住院式治疗具有可行性，可提高精神医疗服务的可及性。
    Abstract: Objective To analyze the feasibility to realizing hospitalized treatment of inpatients’ mental disorders in a general hospital by innovatively 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 of the department of Psychological medicine from July 1, 2020 to June 30, 2021. Based on the concept of consultation-liaison psychiatry (CLP), this treatment mode integrated the three-level ward round and follow-up system to promote the diagnosis and treatment of inpatients with mental disorders. According to the consultation records, the consultation volume, follow-up volume, diagnosis results and intervention methods were extracted, and the consultation rate and follow-up rate were calculated. Results A total of 1647 consultation services were provided for 1196 patients. The consultation departments involved all the physical disease departments of the hospital. The total consultation rate was 1.21% (1196/98 496) and total follow-up rate was 23.08% (276/1196). The follow-up rate of liaison departments was 23.98% (158/659), and the follow-up rate of liaison departments was 21.97% (118/537). In 2019, the general consultation rate was 1.10% (1269/114 917), the total follow-up rate was 17.65% (224/1269), the follow-up rate of liaison departments was 19.0% (177/933), and the follow-up rate of non-liaison departments was 14.0 (47/336). 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 need psychological counseling or treatment, and almost all patients had non-drug treatment intervention. Conclusions It is feasible to apply the concept of CLP to realize the hospitalized treatment of mental disorders in general hospitals, which can improve the accessibility of mental medical services.
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