精神科受診経路に関する多施設研究―パイロットスタディ

Multi-center Collaborative Study on Pathway to Psychiatric Care：A pilot study in Japan

抄録

　精神科受診経路に関する多施設共同研究である。全国13施設が参加し，精神科初診患者84例に対して，受診経路，受診の遅れ，精神科受診前の処遇内容について調査した。精神科を直接受診した症例は39.3％で，残りは総合病院一般身体科経由，一般身体科開業医経由が主たる受診経路であった。受診経路全体の90％が医療機関によって構成されていた。受診の遅れは主訴発生から3～8.5週間(中央値)であった。各経路における遅れの違いについても調査した。一般住民の精神疾患についての知識の普及が不十分で，精神科受診に対する抵抗感があることが示唆された。一般身体科医師による初療(病名告知・初期治療)は概して不十分であった。

　To improve quality of primary care in psychiatry, understanding of ‘pathway to care’ is extremely important. This study is the first multi-center collaborative study on the ‘pathways to psychiatric care’ in Japan. The study was conducted by the Japan Young Psychiatrists Organization(JYPO)and continued for one week between October, 2003 and January, 2004. Thirteen facilities participated, including 7 university hospitals, 1 general hospital and 5 psychiatric hospitals across the nation. Eighty-four new psychiatric patients were enrolled. Ninety percent of the subjects used medical resources of referral, among which were；direct referral from the community, the pathway via general hospitals(GH)and via general practitioners(GP). Median delays in each pathway were 3 to 8.5weeks from the onset of the complaints. Significantly longer delay was seen in direct referral, which can presumably be attributed to lack of knowledge of mental illness or stigma for psychiatric care. GPs are less likely to refer patients to psychiatric services, compared with physicians in GHs. A substantial number of patients were directly referred from each facility to psychiatric services without appropriate initial care. Diagnoses of psychiatric illness were rarely correctly informed either by GPs or physicians in GHs. In Japan, psychotropic drugs are less likely to be prescribed by GHs and GPs compared with other nations. Despite several limitations, this pathway study can be a successful starting point for an evidence-based mental health care system in the nation.