河南省严重精神障碍患者管理治疗现状分析

背景　严重精神障碍管理治疗作为重大的公共卫生问题和突出的社会问题，更强调多部门综合管理及医院-社区一体化的全程治疗。通过研究分析在册严重精神障碍患者的管理治疗现状，可健全服务体系，为恢复患者社会功能、减少疾病负担提供依据。目的　对2014—2018年河南省严重精神障碍患者管理治疗状况进行分析，以期为各级政府健全、完善精神卫生服务体系，制定救治救助政策及推进社区康复服务提供决策支持。方法　2019年1—4月选取2014年1月—2018年12月信息系统中河南省所有在册的严重精神障碍患者。2018年河南省各省辖市、省直管县（市）常住人口数来源于中国疾病预防控制中心公布数据。记录2018年信息系统使用情况（包括信息系统覆盖率、信息系统注册用户数）、在册患者一般资料、患者登记管理及治疗情况〔包括各省辖市、省直管县（市）常住人口数、在册患者数、规范管理患者数、规律服药患者数、病情稳定患者数、居家患者数、报告患病率、规范管理率、规律服药率、稳定率〕，比较2014年与2018年报告患病率、规范管理率、规律服药率、稳定率，记录2014—2018年在册患者未治期、病程，在册患者政策利用情况。结果　截至2018年底，河南省174个县/区全部开通信息系统用户账号，均开展患者信息录入随访工作，信息系统覆盖率为100.00%，系统注册总用户数为3 429例。2018年河南省在册患者共413 240例，对比2014年248 128例，环比增长66.54%。2018年河南省报告患病率平均为4.34‰，各省辖市中报告患病率前3位依次为商丘市（5.23‰）、周口市（5.23‰）、驻马店市（5.23‰）；省直管县（市）中报告患病率前3位依次为新蔡县（5.68‰）、兰考县（5.17‰）、滑县（5.12‰）。2018年河南省规范管理率平均为72.99%，各省辖市中漯河市规范管理率最高（87.96%）；省直管县（市）中兰考县规范管理率最高（96.08%）。2018年河南省规律服药率平均为30.31%，各省辖市中洛阳市规律服药率最高（51.15%）；省直管县（市）中邓州市规律服药率最高（74.95%）。2018年河南省稳定率平均为81.43%，各省辖市中济源市稳定率最高（97.76%）；各省直管县（市）中兰考县稳定率最高（98.46%）。与2014年相比，2018年河南省报告患病率、规范管理率、规律服药率、稳定率同比增长率分别为66.92%、115.31%、80.10%、62.44%。2018年河南省报告患病率、规范管理率、规律服药率、稳定率均高于2014年（P<0.05）。河南省精神分裂症在册患者的未治期2014—2018年逐年缩短；双相情感障碍、精神发育迟滞（伴发精神障碍）在册患者的未治期2015年较2014年有所延长，之后3年逐年缩短；偏执性精神病在册患者的未治期2014—2016年逐年缩短，之后2年先延长后缩短；分裂情感性精神障碍在册患者的未治期2014—2017年逐年缩短，2018年与2017年保持一致；癫痫所致精神障碍在册患者的未治期2014—2017年逐年缩短，2018年较2017年略有延长。以精神分裂症在册患者为标准，2014—2018年河南省在册患者病程分别为13.45、12.12、10.66、10.50、10.10年，逐年缩短。参加严重精神障碍门诊救助的2 500例患者中，享有低保救助者1 629例（65.16%），享有残联救助者631例（25.24%），享有民政救助者304例（12.16%），享有门诊慢性病报销者966例（38.64%），享有3种及以上救助政策者346例（13.84%）。结论　2014—2018年河南省严重精神障碍患者建档登记人数不断增多，患者管理和治疗状况有所提高，在册患者未治期有所缩短。但部分地市工作差距较大，规律服药率有待进一步提高。

Management and Treatment of Severe Mental Disorders in Henan Province

Background As a major public health problem and a prominent social problem,the management and treatment of severe mental disorders emphasizes the comprehensive management of multiple departments and the integrated wholeprocess treatment of hospital and community.Studying the management and treatment status of registered patients with severe mental disorders may facilitate the improvement of healthcare delivery system,and may provide a basis for the recovery of patients'social function and reduction of disease burden.Objective To analyze the management and treatment status of patients with severe mental disorders in Henan Province from 2014 to 2018,to provide supports for government departments to improve mental healthcare delivery system,develop treatment-and aid-related policies,and for the promotion of community rehabilitation services.Methods The number of permanent residents in provincial cities,and counties(cities)directly administered by Henan provincial government stemmed from the data published by Chinese Center for Disease Control and Prevention.All patients with severe mental disorders in Henan Province registered in the information system between January 2014 and December 2018 were selected during January to April 2019.The usage of information system(coverage rate and the number of users),general information of registered patients,the registration,management and treatment of patients in 2018(the number of permanent residents,registered patients,patients with standardized management,patients taking medicine regularly,stable patients,home-based management patients,reported prevalence,rates of standard management,regular medication and stability)were recorded.Prevalence rates of severe mental disorders,standard management,regular medication and stability in 2014 and 2018 were compared.The mean untreated period,mean course of disease and policy utilization of registered patients from 2014 to 2018 were analyzed.Results By the end of 2018,174 counties/districts in Henan Province had opened user accounts of national information system,and input the information of the patients and provided follow-up services for them.The coverage rate of the system was 100.00%and the registered users numbered 3429 in total.There were 413240 registered patients in 2018,which increased by 66.54%compared with that(248128)of 2014.In 2018,the reported prevalence rate of severe mental disorders was 4.34‰for the whole province.The top three provincial cities with highest prevalence rate were Shangqiu(5.23‰),Zhoukou(5.23‰)and Zhumadian(5.23‰),and the top three counties(cities)directly administered by the provincial government with highest prevalence rate were Xincai(5.68‰),Lankao(5.17‰)and Huaxian(5.12‰).In 2018,the rate of standard management of severe mental disorders was 72.99%for the whole province.The top one provincial city with highest rate of standard management was Luohe(87.96%),and the top one city(county)directly administered by the provincial government with highest rate of standard management was Lankao(96.08%).The province owned a rate of regular medication of 30.31%in severe mental disorders patients in 2018.The top one provincial city and top one city(county)directly administered by the provincial government owning highest rate of regular medication were Luoyang(51.15%)and Dengzhou(74.95%),respectively.The province had a rate of stability of severe mental disorders of 81.43%.Jiyuan(97.76%)was the top one provincial city and Lankao(98.46%)was the top one city(county)directly administered by the provincial government owning highest rate of stability.Compared with 2014,in 2018,the province had higher reported prevalence rate of severe mental disorders,and higher rates of standard management,regular medication and stability,with growth rates of 66.92%,115.31%,80.10%and 62.44%,respectively(P<0.05).The mean untreated period of patients with schizophrenia in the province showed a gradually shortened trend year by year from 2014 to 2018.In those with bipolar disorder and mental retardation(accompanied with mental disorders),the mean untreated period in 2015 was longer than that of 2014,then decreased annually during 2016—2018.For those with paranoid mental disorder associated with epilepsy,the mean untreated period decreased from 2014 to 2016,and then it was prolonged first and then shortened in the next two years.The mean untreated period of patients with schizoaffective disorder showed a gradually shortened trend year by year from 2014 to 2017,but the mean length of period in 2018 was consistent with that of 2017.For those with mental disorders associated with epilepsy,the mean untreated period decreased from 2014 to 2017,but the mean length of period in 2018 was slightly longer than that of 2017.The mean course for severe mental disorders(calculated based on the data of schizophrenia,which was selected as a representative disease)in the province from 2014 to 2018 was 13.45,12.12,10.66,10.50 and 10.10 years,respectively,with a trend of gradual decrease.Among the 2500 cases receiving outpatient medical aids,1629(65.16%)had subsistence allowance,631(25.24%)had benefits gained from the local federation of disabled persons,304(12.16%)had assistance from the local civil affairs departments,966(38.64%)had reimbursement for outpatient treatment of chronic diseases,and 346(13.84%)had at least 3 kinds of assistance derived from related policies.Conclusion In Henan from 2014 to 2018,the number of registered patients with severe mental disorders increased gradually,the management and treatment status improved,and the untreated period shortened,with significant interareadifferences.The rate of regular medication needs to be improved further.