CAJ | 학술논문

目的：探讨个案管理培训对乡村精神卫生服务能力的影响。方法于2011年4月-2012年4月，采用简单随机抽样法选取新乡县合河乡、大召营乡经过省级全科医师培训并取得全科医师资格的41名乡村医生，选取由乡卫生院随访管理的精神分裂症患者82例及其相应的患者家属116名。采用随机数字表法将乡村医生、精神分裂症患者分为研究组和对照组，其中乡村医生研究组21名，对照组20名；精神分裂症患者研究组42例，对照组40例。患者家属根据患者分组情况相应的分为研究组56名和对照组60名。两组乡村医生均进行基本培训，研究组在此基础上进行个案管理培训；两组患者均进行精神疾病健康教育，研究组在此基础上进行综合干预；两组患者家属均进行家属护理教育，研究组在此基础上参与针对患者制定的个案管理计划。采取病例测验问卷评定两组医生对精神疾病的识别能力；于干预前后对两组患者进行社会功能缺陷筛选量表（SDSS）评分；采用精神卫生与心理保健知识问卷对两组患者家属进行精神卫生与心理保健知识知晓率调查。结果研究组精神分裂症复发率为2.4%（1/42），低于对照组的7.5%（3/40）（χ2=4.046，P é0.05）。研究组医生诊断阳性症状为主的精神分裂症、躁狂症及阴性症状为主的精神分裂症正确率高于对照组（P é0.05）；对阳性症状为主的精神分裂症、躁狂症及阴性症状为主的精神分裂症的症状识别率高于对照组（P é0.05）；提出的阳性症状为主的精神分裂症、躁狂症及阴性症状为主的精神分裂症治疗建议正确率高于对照组（P é0.05）。干预后，研究组患者职业工作、家庭内活动、自理能力、兴趣和关心评分均低于对照组（P é0.05）。不同文化程度和不同年龄患者 SDSS 评分比较，差异有统计学意义（P é0.05）。研究组患者家属精神卫生基本知识和精神卫生纪念日回答正确率分别为76.8%（43/56）、17.8%（10/56），分别高于对照组的38.3%（23/60）、8.3%（5/60）（χ2=4.328、4.124，P é0.05）。结论个案管理培训对乡村精神卫生综合服务能力的提高、精神分裂症患者社会功能的恢复具有促进作用。目的：探討箇案管理培訓對鄉村精神衛生服務能力的影響。方法于2011年4月-2012年4月，採用簡單隨機抽樣法選取新鄉縣閤河鄉、大召營鄉經過省級全科醫師培訓併取得全科醫師資格的41名鄉村醫生，選取由鄉衛生院隨訪管理的精神分裂癥患者82例及其相應的患者傢屬116名。採用隨機數字錶法將鄉村醫生、精神分裂癥患者分為研究組和對照組，其中鄉村醫生研究組21名，對照組20名；精神分裂癥患者研究組42例，對照組40例。患者傢屬根據患者分組情況相應的分為研究組56名和對照組60名。兩組鄉村醫生均進行基本培訓，研究組在此基礎上進行箇案管理培訓；兩組患者均進行精神疾病健康教育，研究組在此基礎上進行綜閤榦預；兩組患者傢屬均進行傢屬護理教育，研究組在此基礎上參與針對患者製定的箇案管理計劃。採取病例測驗問捲評定兩組醫生對精神疾病的識彆能力；于榦預前後對兩組患者進行社會功能缺陷篩選量錶（SDSS）評分；採用精神衛生與心理保健知識問捲對兩組患者傢屬進行精神衛生與心理保健知識知曉率調查。結果研究組精神分裂癥複髮率為2.4%（1/42），低于對照組的7.5%（3/40）（χ2=4.046，P é0.05）。研究組醫生診斷暘性癥狀為主的精神分裂癥、躁狂癥及陰性癥狀為主的精神分裂癥正確率高于對照組（P é0.05）；對暘性癥狀為主的精神分裂癥、躁狂癥及陰性癥狀為主的精神分裂癥的癥狀識彆率高于對照組（P é0.05）；提齣的暘性癥狀為主的精神分裂癥、躁狂癥及陰性癥狀為主的精神分裂癥治療建議正確率高于對照組（P é0.05）。榦預後，研究組患者職業工作、傢庭內活動、自理能力、興趣和關心評分均低于對照組（P é0.05）。不同文化程度和不同年齡患者 SDSS 評分比較，差異有統計學意義（P é0.05）。研究組患者傢屬精神衛生基本知識和精神衛生紀唸日迴答正確率分彆為76.8%（43/56）、17.8%（10/56），分彆高于對照組的38.3%（23/60）、8.3%（5/60）（χ2=4.328、4.124，P é0.05）。結論箇案管理培訓對鄉村精神衛生綜閤服務能力的提高、精神分裂癥患者社會功能的恢複具有促進作用。
목적：탐토개안관리배훈대향촌정신위생복무능력적영향。방법우2011년4월-2012년4월，채용간단수궤추양법선취신향현합하향、대소영향경과성급전과의사배훈병취득전과의사자격적41명향촌의생，선취유향위생원수방관리적정신분렬증환자82례급기상응적환자가속116명。채용수궤수자표법장향촌의생、정신분렬증환자분위연구조화대조조，기중향촌의생연구조21명，대조조20명；정신분렬증환자연구조42례，대조조40례。환자가속근거환자분조정황상응적분위연구조56명화대조조60명。량조향촌의생균진행기본배훈，연구조재차기출상진행개안관리배훈；량조환자균진행정신질병건강교육，연구조재차기출상진행종합간예；량조환자가속균진행가속호리교육，연구조재차기출상삼여침대환자제정적개안관리계화。채취병례측험문권평정량조의생대정신질병적식별능력；우간예전후대량조환자진행사회공능결함사선량표（SDSS）평분；채용정신위생여심리보건지식문권대량조환자가속진행정신위생여심리보건지식지효솔조사。결과연구조정신분렬증복발솔위2.4%（1/42），저우대조조적7.5%（3/40）（χ2=4.046，P é0.05）。연구조의생진단양성증상위주적정신분렬증、조광증급음성증상위주적정신분렬증정학솔고우대조조（P é0.05）；대양성증상위주적정신분렬증、조광증급음성증상위주적정신분렬증적증상식별솔고우대조조（P é0.05）；제출적양성증상위주적정신분렬증、조광증급음성증상위주적정신분렬증치료건의정학솔고우대조조（P é0.05）。간예후，연구조환자직업공작、가정내활동、자리능력、흥취화관심평분균저우대조조（P é0.05）。불동문화정도화불동년령환자 SDSS 평분비교，차이유통계학의의（P é0.05）。연구조환자가속정신위생기본지식화정신위생기념일회답정학솔분별위76.8%（43/56）、17.8%（10/56），분별고우대조조적38.3%（23/60）、8.3%（5/60）（χ2=4.328、4.124，P é0.05）。결론개안관리배훈대향촌정신위생종합복무능력적제고、정신분렬증환자사회공능적회복구유촉진작용。
Objective To investigate the effect of case management training model on mental health service ability of rural areas. Methods By means of simple random sampling,41 village doctors from Hehe township and Dazhaoying township of XinXiang County in April 2011 to April 2012 who became general practitioners after provincial training were selected and divided into 21 in research group and 20 in control group. Similarly,82 schizophrenic patients under the follow - up management of town-ship hospitals were selected and divided into 42 in research group and 40 in control group;116 family members were divided into 56 in research group and 60 in control group accordingly. The village doctors in the two groups all received basic training and the doctors in research group also received eXtra case management training. All the patients received mental health education and the patients in research group also received comprehensive intervention. All family members received nursing education and the family members in research group also took part in the case management plan designed for their own relatives only. Case test questionnaire was used to evaluate mental obstacle recognition ability of the village doctors in the two groups;social disability screening sched-ule(SDSS)was used to evaluate patientsˊ social ability;mental health and psychological health knowledge questionnaire was used to investigate the family membersˊ awareness rate. Results The recurrence rate of the patients in research group 2. 4% (1 /42)was lower than that in control group 7. 5% (3 / 40)and the difference was significant(χ2 = 4. 046,P é 0. 05). For schiz-ophrenia and mania disorder mainly with positive symptoms and schizophrenia with negative symptoms,the diagnostic accurate rate of the village doctors,the recognition rate and the correct rate of treatment suggestion in the research group were all higher than those in the control group(P é 0. 05). After intervention,the scores of profession work,family activities,self - care abil-ity,interest and care of the patients in research group were all lower than those in control group(P é 0. 05). The difference of SDSS between patients with different educational background and ages was significant(P é 0. 05). The rates of right answers to mental health basic knowledge and mental health day of the family members in research group were 76. 8% (43 / 56),17. 8%(10 / 56)respectively,which were all higher than those in control group 38. 3% (23 / 60),8. 3% (5 / 60) ( χ2 = 4. 328, 4. 124,P é 0. 05). Conclusion Case management training has a promoting effect on the improvement of rural mental health service ability and the recovery of patientsˊ social function.