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首页> 美国卫生研究院文献>The British Journal of General Practice >Are specialist mental health services being targeted on the most needy patients? The effects of setting up special services in general practice.
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Are specialist mental health services being targeted on the most needy patients? The effects of setting up special services in general practice.

机译：专业精神卫生服务是否针对最需要帮助的患者？在一般实践中设置特殊服务的效果。

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BACKGROUND: Around 25% of patients with psychoses lose contact with specialist psychiatric services, despite the government's policy to focus the efforts of community teams on this group. AIM: To identify patient and practice factors associated with continuing contact and loss of contact with specialist services. METHOD: Cross-sectional comparison was made of patients in and out of specialist contact, through detailed interviews with 102 patients among 26 south west London practices. Associations were sought between contact with specialist services and patient factors (illness severity, social functioning, quality of life, needs for care, and satisfaction with general practitioner [GP] services) and practice factors (size, location, fundholding status, training status, and the presence of mental health professionals on site). RESULTS: Thirty-one (30%) patients were currently out of specialist contact. No significant differences were found between those in and out of contact on any measures of diagnosis or psychiatric history. Those in contact had significantly more symptoms, poorer social functioning, poorer quality of life, and more needs for care. The proportion out of contact was significantly higher in two practices that had employed their own mental health professionals to provides services on site for severe mental illnesses. Two factors remained significant predictors of contact in a logistic regression model: whether or not the patient's practice offered a special service on site, and greater patient needs for care. CONCLUSIONS: Secondary mental health services are being targeted towards the more needy patients. The provision of special services in practices can shift care further away from secondary care while still meeting patients' needs.
机译：背景：尽管政府制定了将社区小组的工作重点放在这一群体上的政策，但仍有大约25％的精神病患者失去了与专业精神科服务的联系。目的：确定与持续接触和失去与专业服务联系的患者和实践因素。方法：通过与伦敦西南26个诊所的102名患者进行详细访谈，对进入和退出专科医生接触的患者进行横断面比较。在与专家服务的联系和患者因素（疾病的严重程度，社会功能，生活质量，护理需求以及对全科医生[GP]服务的满意度）与实践因素（规模，位置，资金持有状况，培训状况，以及现场的心理健康专家）。结果：31（30％）患者目前没有专科医生联系。在诊断或精神病史的任何测量方法上，接触者和非接触者之间没有发现显着差异。接触者的症状明显增加，社交功能变差，生活质量变差，并且需要更多的护理。在两种聘请了自己的精神卫生专业人员为严重精神疾病提供现场服务的做法中，接触者的比例明显更高。在Logistic回归模型中，仍然有两个因素是接触的重要预测因子：患者的实践是否在现场提供了特殊服务，以及患者对护理的需求增加。结论：二级精神卫生服务针对的是更需要帮助的患者。在实践中提供特殊服务可以使护理从二级护理进一步转移，同时仍能满足患者的需求。

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