山东省重性精神疾病患者门诊诊疗和家庭经济负担情况调查

目的了解重性精神病患者门诊诊疗情况及直接或间接家庭经济负担情况。方法在2010年山东省重性精神疾病患者的排查登记的基础上，选择9个县（市、区）进行调查，调查内容包括患者和家庭的基本情况，门诊诊疗情况，直接医疗费用、间接费用等。结果共调查重性精神病患者2351例，资料完整的共有2142例。患者和家庭月平均收入分别为1295．57元、309．92元，家庭有借债或银行贷款的491例，占22．92％，平均为21056．18元。1401例患者采取居家服药的方式，占65．41％；中断治疗的患者有289例，占13．49％；有87例从未接受任何治疗，占4．06％，后两者主要原因为经济条件限制。初发病3个月就诊的占64．13％，在1年内提高至80．04％。1446例患者1年内到门诊诊疗，平均为6．29次，其中挂号、诊断和治疗平均花费3390．19元；有37．91％患者缺勤，平均170．13人天，有35．9％患者亲属误工，平均48．83人天；仅有35．18％患者通过医保报销门诊费用，平均报销3211．62元。结论大部分重性精神疾病患者通过门诊诊疗稳定病情，患者家庭直接或间接经济负担较重，部分患者因为经济负担耽误或中断治疗，门诊医疗费用报销覆盖面需要进一步改善。

Survey on the OPD Visits and the Family Burdens Among the Patients with Severe Psychosis,Shandong Province

Objective To understand the OPD visits and the direct and indirect family burden among the patients with se- vere psychosis in Shandong province. Methods On the basis of dragnet survey on severe psychosis in 2010,9 counties （cities, districts） were selected for research and the questionnaire contents included visiting clinics,medical costs and the e- conomic status of family. Results A total of 2 351 patients were surveyed and 2 142 samples with complete data were analyzed. The average monthly income of family and patient were 1 295.57 RMB Yuan and 309.92 RMB Yuan respective- ly. 491 patients had debts or loans,accounting for 22.92% ,with the average level of 21 056.18 RMB Yuan. 1 401 patients took medicine at home for therapy, accounting for 65.41%, whereas 289 patients interrupted treatment, accounting for 13.49% ,and 87 cases had never received any treatment,accounting for 4.06%. Most of the patients were not treated be- cause of family economic burdens. There were 64.13~//00 patients to visit clinics at onset, and the number would reach 80. 04~ after one year. In the past year, 1 446 patients had visiting treatment of about 6.29 times, and the average costs for diagnosis and treatments were 3 390.19 RMB Yuan;37.910%o of patients had absenteeism with average 170.12 person- days,and 35.90% of their relatives had 48.83 person-days;only 35.18 ~ of OPD patients reimbursement through Medi- care,with the average level of 3 211.62 RMB Yuan. Conclusion Most patients with severe psychosis maintain the con- ditions by visiting clinics. Families of patients have heavy economic burdens directly and indirectly. Because of economic conditions, some patients delay and interrupt treatment, so reimbursement coverage needs to improve.