Two-minute mental health care for elderly patients: inside primary care visits.
Two-minute mental health care for elderly patients: inside primary care visits.
复制标题
针对老年患者的两分钟心理健康护理：初级保健就诊内部。
DOI：
10.1111/j.1532-5415.2007.01467.x
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发表时间：
2007
影响因子：
6.3
通讯作者：
Cook,MaryAnn
中科院分区：
文献类型：
--
作者：
Tai-Seale,Ming;McGuire,Thomas;Colenda,Christopher;Rosen,David;Cook,MaryAnn
目的：使用老年患者办公室访问的录像带评估精神障碍的护理方式。设计：对讨论的主题的性质、讨论的内容和花费在精神健康上的时间进行混合方法观察分析。设置：三种类型的环境：学术医疗中心、管理式医疗小组和收费单独执业医生。对象：35名初级保健医生和366名老年患者。测量：分析了385次访问的录像带，涉及2472个不同的主题。对录像带进行编码，确定话题，确定谈话时间，并对谈话的动态进行编码。结果：22%的就诊者出现心理健康话题，尽管患者调查显示50%的患者患有抑郁症。典型的心理健康讨论持续了大约2分钟。定性分析表明，医生在提供心理健康护理方面的努力存在很大差异。即使是严重抑郁和自杀的患者，转诊到心理健康专家的情况也很少。结论：尽管疾病负担沉重，但老年患者在心理健康护理上花费的时间很少。基于就诊次数的护理标准可能需要补充关于就诊期间应该发生什么的指导方针。需要系统层面的干预。
OBJECTIVES:To assess how care is delivered for mental disorders using videotapes of office visits involving elderly patients.DESIGN:Mixed‐method observational analysis of the nature of the topics discussed, content of discussion, and the time spent on mental health.SETTINGS:Three types of settings: an academic medical center, a managed care group, and fee‐for‐service solo practitioners.PARTICIPANTS:Thirty‐five primary care physicians and 366 of their elderly patients.MEASUREMENTS:Videotapes of 385 visits covering 2,472 diverse topics were analyzed. Coding of the videotapes identified topics, determined talk time, and coded the dynamics of talk.RESULTS:Mental health topics occurred in 22% of visits, although patient survey indicated that 50% of the patients were depressed. A typical mental health discussion lasted approximately 2 minutes. Qualitative analysis suggested wide variations in physician effort in providing mental health care. Referrals to mental health specialists were rare even for severely depressed and suicidal patients.CONCLUSION:Little time is spent on mental health care for elderly patients despite heavy disease burdens. Standards of care based on a count of visits “during which a mental health problem is discussed” may need to be supplemented with guidelines about what should happen during the visit. System‐level interventions are needed.