徐卫平 仇玉兰 韦莉君 刘荣 王晓英

摘 要 目的：探索社区家庭医生团队对严重精神障碍患者进行健康管理的效果。方法：以社区严重精神障碍患者为研究对象，随机抽样120例，其中男性69例，占57.5%；女性51例，占42.5%，年龄14～90岁。年龄中位数为56.3岁；平均病程（33±16.8）年。比较家庭医生团队对严重精神障碍患者进行健康管理前后的自测健康评定量表（SRHMS）得分以及接受服务的满意度。结果：研究对象接受家庭医生健康管理服务6个月后，SRHMS得分有明显改善（P<0.01）；同时，研究对象对服务的满意度由管理前的90.0%提升到管理后的97.5%。结论：社区家庭医生团队对严重精神障碍患者进行健康管理是有益的，应支持推广家庭医生健康管理服务。

关键词 严重精神障碍患者；家庭医生；健康管理；自测健康评定量表

中图分类号：R749.01 文献标志码：A 文章編号：1006-1533（2020）16-0057-03

Evaluation of the effect of family doctors on the health management of patients with severe mental disorders in the community

XU Weiping1， QIU Yulan2， WEI Lijun3， LIU Rong1， WANG Xiaoying4（1. Science and Education Section of Qibao Community Health Service Center of Minhang District， Shanghai 201101， China； 2. Department of Epidemiology and Biostatistics of Public Health School of Jiao Tong University， Shanghai 200025， China； 3. Office of Qibao Community Health Service Center of Minhang District， Shanghai 201101， China； 4. Public Health Center of Qibao Community Health Service Center of Minhang District， Shanghai 201101， China）

ABSTRACT Objective： To explore the effect of the community family doctor team on the health management of patients with severe mental disorders. Methods： The patients with severe mental disorders in the community were taken as the research objects， 120 cases were randomly selected， 69 of them were male， accounting for 57.5%； 51 of them were female， accounting for 42.5%， and the age was 14～90 years old. The median age was 56.3 years； and the average course of disease was （33±16.8） years. The scores of the self-rated health assessment scale（SRHMS） of the family doctor team before and after the health management of patients with severe mental disorders and the satisfaction of receiving the service were compared. Results： Six months after receiving the health management service from family doctors， the scores of SRHMS were significantly improved（P<0.01）； at the same time， the research objects satisfaction with the service increased from 90.0% before management to 97.5% after management. Conclusion： The community family doctor team is beneficial to the health management of patients with severe mental disorders， and the promotion of family doctor health management service should be supported.

KEY WORDS patient with severe mental disorders； general practitioner； health management； self-rated health assessment scale

严重精神障碍主要包括各型精神分裂症、精神发育迟滞伴发精神障碍、癫痫所致精神障碍、双相情感障碍、分裂情感性障碍和偏执性精神病等6种精神疾病[1]。很多居住在社区的患者会发生因为疾病而导致伤害自己或伤害他人的情况，成为社区管理的重点人群。随着我国医改的全面推进，作为国家基本公共卫生服务的一部分[1]，严重精神障碍患者的健康管理得到了政府和社会的重视。本研究旨在探讨家庭医生对社区严重精神障碍患者健康管理的效果，为社区健康管理提供经验和建议。

1 对象与方法

1.1 对象

在上海七宝社区签约并接受健康管理服务的1 133例居家严重精神障碍患者中，系统随机抽取120例作为研究对象。其中男性69例，占57.5%，女性51例，占42.5%，年龄14～90岁，年龄中位数为56.3岁；平均病程（33±16.8）年。在6种严重精神障碍中，患者以各型精……