精神科受診経路に関する研究

Pathways to Psychiatric Care-review of Literatures

はじめに

　1980年にGolgbergとHuxleyによって精神疾患を持つ患者が，専門機関に到達するまでにどのような経路を経るのかについての報告がなされた⁸⁾。彼らは，個人が精神的な病気があると確認されて，その結果精神医療サービスにたどり着くまでの道筋を知るために患者を5段階のレベルに分け，各レベル間に4つのフィルターを想定するモデルを提唱した(図)。彼らは，地域社会でみられる精神疾患は，精神医療サービスでみられるものより全体に重症でないこと，このような症例の大部分が精神医療サービスを受けていないことから出発し，このモデルを提唱した。

　5段階モデルは精神的な病気を持つ者が精神科的ケアに到達するまでの過程を簡略化した模式図である⁸⁾。しかし実際に患者が専門機関に到達する過程には，保健医療の組織，専門機関への紹介の仕組み，保健医療サービスの利用のしやすさ，その他の経済，文化的要因など多くの要素が影響する。そこで精神科医療サービス(レベル4，レベル5)に患者が到達するまでの経路の実態を解明すべくpathway studyが計画された。

　The pathway study is an epidemiological investigation　as to how a patient with psychological problems has found his or her way to a mental health professional. The basic method of the pathway study was established in the cross-cultural study conducted by the World Health Organization in 1988. In the pathway study, all the new patients who have visited the mental health professionals concerned are the subjects of the investigation. They are interviewed according to a special encounter form. The form contains such items as the professions of the previous carers, the length of time their patient has been under the care, the source of referral, the main problem presented, the main treatment offered, the length of time the patient needs to go and see the carer and the patient's background. Since the pathway study is a simple and inexpensive method of obtaining a lot of information. Since the publication of the results of the WHO cross-cultural study, studies of the same kind have been done in many countries around the world including developing countries. These studies have shown the characteristics of the pathways in each country, and the roles of primary care physicians, hospital doctors and native or religious healers in the pathway. They have also revealed areas in the pathway that have resulted in delays.

　In this paper, we summarize the results of the pathway studies in 27 regions. We also review some related articles from Japan.