Do mental health professionals use diagnostic classifications the way we think they do? A global survey
Do mental health professionals use diagnostic classifications the way we think they do? A global survey
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DOI：
10.1002/wps.20525
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发表时间：
2018-06-01
期刊：
影响因子：
73.3
通讯作者：
Reed, Geoffrey M.
中科院分区：
文献类型：
--
作者：
First, Michael B.;Rebello, Tahilia J.;Reed, Geoffrey M.
我们报告了一项对诊断精神卫生专业人员（主要是精神病医生）的全球调查，该调查是ICD-11精神和行为障碍分类发展的一部分。该调查评估了这些专业人员对ICD-10和DSM各组成部分的使用情况，他们对这些系统的效用的态度，以及对残差（即，其他或未指定的）类别。在以前的调查中，大多数心理健康专业人员报告说，他们经常在日常临床工作中使用正式的分类系统，但很少有人知道他们是如何使用这些系统的。例如，有人建议大多数临床医生只使用ICD-10的诊断标签或代码，以满足行政要求。本调查是与全球临床实践网络（GCPN）成员的临床医生进行的，该网络由世界卫生组织建立，作为全球参与ICD-11实地研究的工具。共有来自92个国家的1，764名GCPN成员完成了调查，其中1，335人回答了关于ICD-10的问题，429人回答了DSM（DSM-IV，DSM-IV-TR或DSM-5）。报告中最常使用的分类系统是用于行政或计费目的，68.1%的人经常或经常将其用于此目的。超过一半（57.4%）的受访者报告经常或定期系统地通过诊断指南或标准来确定它们是否适用于个体患者。虽然ICD-10的使用者比DSM-5的使用者更有可能将该分类用于行政目的，但其他差异要么轻微，要么不显著。这两种分类被认为是最有用的分配诊断，与其他卫生保健专业人员和教学沟通，和治疗选择和确定预后最有用。ICD-10被认为比DSM-5在行政管理方面更有用。大多数临床医生报告至少有时使用剩余类别，约12%的ICD-10用户和19%的DSM用户经常或常规使用它们，最常见的是不符合特定诊断类别的临床表现或当没有足够的信息进行更具体的诊断时。这些结果提供了关于在普通临床实践中使用精神障碍诊断分类的最全面的可用信息。
We report on a global survey of diagnosing mental health professionals, primarily psychiatrists, conducted as a part of the development of the ICD-11 mental and behavioural disorders classification. The survey assessed these professionals' use of various components of the ICD-10 and the DSM, their attitudes concerning the utility of these systems, and usage of residual (i.e., other or unspecified) categories. In previous surveys, most mental health professionals reported they often use a formal classification system in everyday clinical work, but very little is known about precisely how they are using those systems. For example, it has been suggested that most clinicians employ only the diagnostic labels or codes from the ICD-10 in order to meet administrative requirements. The present survey was conducted with clinicians who were members of the Global Clinical Practice Network (GCPN), established by the World Health Organization as a tool for global participation in ICD-11 field studies. A total of 1,764 GCPN members from 92 countries completed the survey, with 1,335 answering the questions with reference to the ICD-10 and 429 to the DSM (DSM-IV, DSM-IV-TR or DSM-5). The most frequent reported use of the classification systems was for administrative or billing purposes, with 68.1% reporting often or routinely using them for that purpose. A bit more than half (57.4%) of respondents reported often or routinely going through diagnostic guidelines or criteria systematically to determine whether they apply to individual patients. Although ICD-10 users were more likely than DSM-5 users to utilize the classification for administrative purposes, other differences were either slight or not significant. Both classifications were rated to be most useful for assigning a diagnosis, communicating with other health care professionals and teaching, and least useful for treatment selection and determining prognosis. ICD-10 was rated more useful than DSM-5 for administrative purposes. A majority of clinicians reported using residual categories at least sometimes, with around 12% of ICD-10 users and 19% of DSM users employing them often or routinely, most commonly for clinical presentations that do not conform to a specific diagnostic category or when there is insufficient information to make a more specific diagnosis. These results provide the most comprehensive available information about the use of diagnostic classifications of mental disorders in ordinary clinical practice.