隔離室入室期間に投入される人的資源に関する研究―コストおよび行動制限最小化の視点から

A Quantitative Analysis of Human Resources for Patients in Seclusion in Acute Psychiatric Care: From the perspective of economic balance and the minimization of seclusion

抄録

　精神科急性期医療のあるべきケア体制を明らかにするため，精神科病棟における急性期多職種チームへの直接ケア時間に関するヒアリング調査を実施した。対象は以前に予備的研究を実施した3病院を含む合計11病院である。その結果，病院の立地条件により直接ケア投入量が異なった。非都市部の病院では，より多くの投入量がみられ，隔離室入室1日目の直接ケア時間と隔離日数に有意な負の相関を認めた。新たに調査した8病院中5病院は理想的なケア時間が達成できれば隔離日数を短縮化できると回答したが，全8病院で理想的なケア時間の投入は収支を悪化させた。最適なケア提供のためには合理的な診療報酬の設定が必要である。

　We interviewed multi-disciplinary acute psychiatric care teams of physicians, nurses, and PSWs to evaluate the current system of acute psychiatric care. Eleven psychiatric hospitals including three in which a preliminary survey has been performed, were sampled. The survey presented hypothetical cases to participants and asked how much time they would spend on acute psychiatric inpatient care for each case. The results suggest that the location of the hospital is highly correlated with time investment in seclusion periods；professionals in rural hospitals tend to spend more hours on inpatient care than those working in urban hospitals. A significant negative correlation was found between hours spent on inpatient care on the first day of admission and the length of seclusion for rural hospitals but not urban hospitals. Interviewees from five of the eight hospitals that did not perticipate in the preliminary survey indicated that they would idealy spend more time on inpatient care, which would lead to shorter seclusion periods. However, based on the current reimbursement scheme, the hospitals surveyed would not be able to afford the extra costs if they spend the ideal amount of time on inpatient care. Hence, the reimbursement scheme should be restructured to provide the optimal care for the patients.