精神障碍患者家庭签约服务管理模式的实效性研究

目的 通过家庭签约服务对社区严重精神障碍患者的管理效果进行探讨，以期为社区精神卫生服务实践提供合理依据。 方法 应用整群随机抽样方法，选取潍坊安丘市1个乡镇卫生院和1个社区卫生服务中心辖区各100例患者为调查对象，用问卷调查法、回顾性分析法及量表评定方法，评估签约服务前后阳性和阴性症状量表(PANSS)评分、Morning Side康复状态量表(MRSS)评分、危险性分级及家属精神卫生知识知晓率4方面的差异性，应用SPSS 19.0统计学软件进行数据分析。 结果 家庭签约服务2年末、1年末与签约服务前PANSS量表总分明显下降。家庭签约服务2年末、1年末与签约服务前MRSS总分、症状、行为表现因子分及依赖性因子分明显下降。家庭签约服务后1年末、2年末与签约服务前比较，危险性分级差异具有统计学意义(H＝240.33，P＜0.005)。签约服务后1年末、2年末与签约服务前比较，家属精神卫生知识知晓情况差异具有统计学意义(H=201.021，P＜0.005)。 结论 家庭签约服务管理模式有利于稳定患者病情和社会康复，减少患者危险性行为，提高家属精神卫生知识知晓率，是适合我国国情的社区精神卫生服务模式，值得不断完善与全面推广应用。 

Effectiveness study of family contract service in the management of patients with mental disorders

Objective To investigate the family contract service in the management of patients with severe mental disorders and provide reasonable basis for community mental health service. Methods The cluster random sampling was used to identify 100 individuals from one township hospital and one community health service center in Anqiu county of Weifang.The methods of questionnaire survey,retrospective analysis and rating scale were used to study the scores of Positive and Negative Syndrome Scale(PANSS),Morningside Rehabilitation States Scale(MRSS),risk assessment and family mental health knowledge awareness in the respect of if the family contract was signed with patients. Results The scores of PANSS were significant declined in 2year after signed contract,1 year after signed contract and signed before. MRSS total scores,symptom,behavioral expression scores and dependent factor scores were also declined in 2 year after signed contract,1 year after signed contract and signed before. It has significant difference in the risk classification among 1 year after signed contract,2 years after signed contract and signed before (H=240.33,P<0.005). Significant difference also appeared in the family mental health knowledge awareness among 1 year after signed contract,2 years after signed contract and signed before (H=201.021,P<0.01). Conclusion The family contract service is benefit to the stability of the patients and social rehabilitation,it can reduce patient risk behavior and improve the family mental health knowledge awareness.It is suitable for our country's community mental health service and deserve to continuous improvement and comprehensive application.