Treatment of Borderline Personality Disorder: Is Supply Adequate to Meet Public Health Needs?
Treatment of Borderline Personality Disorder: Is Supply Adequate to Meet Public Health Needs?
复制标题
DOI：
10.1176/appi.ps.201900073
复制
发表时间：
2019-09-01
影响因子：
3.8
通讯作者：
Choi-Kain, Lois W.
中科院分区：
文献类型：
--
作者：
Iliakis, Evan A.;Sonley, Anne K., I;Choi-Kain, Lois W.
目的：本研究旨在评估边缘性人格障碍(BPD)治疗的供需情况，以便在全球可用资源的背景下了解当前的护理和培训标准。方法：通过使用公开来源和培训计划的数据，估计22个国家获得BPD专科循证治疗认证的精神卫生专业人员和精神卫生专业人员的总供应量。BPD的患病率和求诊率来自大规模的国家流行病学研究。计算寻求治疗的患者与现有提供者的比率，以评估当前的系统是否能够满足需求。总结了培训和认证要求，计算了寻求治疗的患者与现有提供者的比率，以评估现有系统是否能够满足需求。总结了培训和认证要求。结果：在澳大利亚、荷兰和挪威，寻求治疗的BPD患者与精神卫生专业人员(不管专业人员对治疗BPD的兴趣或培训)的比例从大约4：1到新加坡的192：1不等。在挪威，寻求治疗的患者与获得循证护理认证的临床医生的比例从49：1到墨西哥的148,215：1不等。认证要求因治疗方法和国家不同而不同。结论：在所研究的22个国家中，大多数国家都缺乏可用于治疗BPD的提供者和获得BPD专科治疗认证的提供者。在资源充足的国家，除了专科治疗外，培训临床医生为BPD提供全科或简化治疗，可能有助于弥补目前的实施差距。必须在工作人员不足的国家考虑更节约资源的替代方案，即使是通用型治疗也是如此。对护理的现实分配的考虑可能会形成未来BPD治疗的指导方针和标准，而不仅仅是强化的循证心理治疗。
Objectives: This study aimed to assess the supply of and demand for treatment of borderline personality disorder (BPD) to inform current standards of care and training in the context of available resources worldwide.Methods: The total supply of mental health professionals and mental health professionals certified in specialist evidence-based treatments for BPD was estimated for 22 countries by using data from publicly available sources and training programs. BPD prevalence and treatment-seeking rates were drawn from large-scale national epidemiological studies. Ratios of treatment-seeking patients to available providers were computed to assess whether current systems are able to meet demand. Training and certification requirements were summarized.Ratios of treatment-seeking patients to available providers were computed to assess whether current systems are able to meet demand. Training and certification requirements were summarized. Results: The ratio of treatment-seeking patients with BPD to mental health professionals (irrespective of professionals' interest or training in treating BPD) ranged from approximately 4:1 in Australia, the Netherlands, and Norway to 192:1 in Singapore. The ratio of treatment-seeking patients to clinicians certified in providing evidence-based care ranged from 49:1 in Norway to 148,215:1 in Mexico. Certification requirements differed by treatment and by country.Conclusions: Shortages of both providers available to treat BPD and providers certified in specialist treatments of BPD exist in most of the 22 countries studied. In well-resourced countries, training clinicians to provide generalist or abbreviated treatments for BPD, in addition to specialist treatments, could help address the current implementation gap. More resource-efficient alternatives must be considered in countries with insufficient staff to implement even generalist treatments. Consideration of realistic allocation of care may shape future guidelines and standards of BPD treatments, beyond intensive evidence-based psychotherapies.