Pathways to psychiatric care in Bangladesh
Pathways to psychiatric care in Bangladesh
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DOI：
10.1007/s00127-010-0315-y
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发表时间：
2012-01-01
影响因子：
4.4
通讯作者：
Waheed, Shafquat
中科院分区：
文献类型：
--
作者：
Giasuddin, Noor Ahmed;Chowdhury, Nafia Farzana;Waheed, Shafquat
精神病患者的就医模式对服务和政策问题都很重要。我们于2008年在孟加拉国进行了一项研究，以了解转诊模式，到达精神卫生专业人员（MHP）的延迟，在到达精神科护理等之前接受的诊断和治疗。我们使用WHO路径遭遇表的翻译版本在三级医院的精神科门诊部连续采访了50名新患者。我们采访的患者在到达MHP之前咨询了其他护理人员（到达MHP需要2.5-3.1个步骤），延迟范围为8-78周（间接途径）。16%的患者直接进入MHP，从精神疾病发作开始平均延迟10.5周（直接途径）。在采取间接途径的患者中，44%的人首先拜访了私人执业医生（PP），22%的人首先拜访了当地或宗教治疗师（NRH），12%的人首先拜访了农村医生（RMP）。达到NRH或RMP的患者延迟最少（2-2.5周），达到MHP的路径最短（4.5-7周）。大多数延迟发生在从PP到MHP/综合医院（22-31周）。约三分之一的患者被告知诊断与MHP的诊断一致性较差。70%和40%的精神疾病患者谁出席综合医院和PP分别被转介到MHP。在这项研究中，我们发现了四个主要途径，在孟加拉国的精神卫生保健。他们是直接途径和转介从PP，综合医院和NRH。在实现MHP方面，PP没有发挥关键作用。家庭成员在决定寻求卫生服务方面发挥了重要作用。
The pattern of care seeking of psychiatric patients is important for service and policy issues. We conducted a study in 2008 in Bangladesh to find out the referral patterns, delays to reach mental health professional (MHP), diagnoses and treatment received before reaching psychiatric care etc.We interviewed 50 consecutive new patients at the Psychiatry outpatient department of a tertiary hospital using the translated version of WHO pathway encounter form.84% of the patients we interviewed consulted other carers before they arrived at a MHP (2.5-3.1 steps were needed to reach MHP) and the range of delay was 8-78 weeks (indirect pathway). 16% of the patients came directly to a MHP with mean delay of 10.5 weeks from onset of mental illness (direct pathway). Among the patients who took the indirect pathway 44% first visited the Individual Private practitioners (PP), 22% first visited native or religious healers (NRH) and 12% rural medical practitioners (RMP). Patients reaching NRH or RMP made the least delay (2-2.5 weeks) and the shortest pathway to MHP (4.5-7 weeks). Most delay occurred from PP to MHP/General Hospital (22-31 weeks). About a third of patients were informed of diagnosis with poor concordance with the diagnosis made by MHP. 70 and 40% of patients with mental illness who attended General Hospital and PP were referred to MHP, respectively.In the study we found four major pathways to mental health care in Bangladesh. They are direct pathway and referrals from PP, general hospitals and NRH. PP did not play a pivotal role in reaching MHP. Family members had a significant role on the decision to seek help from health service.