儿童和青少年在精神病住院治疗前的服务使用情况。

IF 1 4区 医学 Q4 HEALTH POLICY & SERVICES
Ingrid Zechmeister-Koss, Roman Winkler, Corinna Fritz, Leonhard Thun-Hohenstein, Heinz Tuechler
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引用次数: 0

摘要

背景:虽然欧洲20%的儿童和青少年患有明显的精神健康问题,但他们的疾病相关服务利用情况往往是未知的。如果有的话,现有的研究只涉及卫生保健部门,而精神卫生保健的服务要求远远超出了卫生保健系统,包括社会、教育和刑事司法系统。研究目的:本文旨在描述儿童和青少年在进入儿童和青少年精神卫生医院之前在卫生保健部门内外的服务接触模式。此外,我们还评估了主要护理人员的私人自付费用。方法:对奥地利一家儿童和青少年医院连续住院的队列进行前瞻性分析。我们使用欧洲儿童和青少年心理健康服务收据清单(EU-CAMHSRI)的改编版本,通过面对面访谈收集了主要护理人员入院前服务使用和自付费用的数据。临床数据来自有效的问卷调查(CBCL, YSR)和记忆记录。结果:在441名患者中,90%的患者在入院前与服务机构有过接触或服用过药物。大多数情况下,使用的是门诊医疗机构的服务。在保健系统之外,最经常使用的是学校的支助和咨询服务,而这些人几乎不寻求生活或就业方面的支助。每100名患者中大约有32400人是私人花费的,但这些自付费用的分布非常不均匀。服务使用和自付支出随着社会地位和性别的不同而增加。外部行为症状越严重,使用的非保健服务就越多。讨论:患有精神疾病的儿童和青少年在入院前使用跨部门的广泛服务。服务的使用与疾病的具体症状有关,但与诊断无关。对一些护理人员来说,这与相当大的财政负担有关,因为其中许多服务仅部分由公共资助或不属于卫生部门。本研究的一个局限性是自我报告的不确定性。此外,我们不知道所使用的服务是否基于需求和有效,以及未住院的儿童和青少年的利用模式是什么。对卫生政策的影响:奥地利儿童和青少年的精神卫生政策需要侧重于如何在不同部门组织一种以需求为导向和协调一致的服务组合,无论患者的社会经济背景如何,都可以平等地获得这种服务。对未来研究的启示:为了支持规划,需要对预测服务使用和服务成本效益的因素进行进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Services Use of Children and Adolescents before Admission to Psychiatric Inpatient Care.

Background: Although 20% of children and adolescents in Europe suffer from overt mental health problems, their illness-related service utilisation is often unknown. If at all, existing research has only addressed the health care sector while services requirements in mental health care go far beyond the health care system, including the social, the educational and the criminal justice system.

Aims of study: This paper aims at describing the service contact patterns of children and adolescents within and outside the health care sector before they are admitted to a child and adolescent mental health hospital. Additionally, we evaluate the private out-of-pocket payments that occur for primary carers.

Method: A cohort of consecutive admissions to a child and adolescent hospital in Austria was prospectively analysed. We collected data on service use and out-of-pocket expenses before hospital admission from primary carers through face-to-face interviews using an adapted version of the European Child and Adolescent Mental Health Service Receipt Inventory (EU-CAMHSRI). Clinical data came from validated questionnaires (CBCL, YSR) and from the anamnestic documentation.

Result: Ninety percent from a cohort of 441 patients had some contact with services or took medication before they were admitted to hospital. Most often, services in the health care outpatient setting were used. Outside of the health care system, support in school, as well as counselling services, were used most frequently, whereas the persons hardly sought support in living or employment. Roughly 32,400 per 100 patients was spent privately, yet these out-of pocket expenses were very unevenly distributed. Service use and out-of-pocket spending increased with social status and were gender-specific. The more severe external behaviour symptoms were, the more non-health care services were used.

Discussion: Mentally ill children and adolescents use a broad range of services across sectors before admission to hospital. Service use is associated with specific symptoms of the disease, yet not with the diagnosis. For some carers, this is linked to considerable financial burden because many of those services are only partly publicly funded or are not part of the health sector. A limitation of the study is the uncertainty of self-reports. Furthermore, we do not know whether the services used were needs-based and effective, and what the utilisation patterns of non-hospitalised children and adolescents are.

Implications for health policies: Mental health policy for children and adolescents in Austria needs to focus on how to organise a needs-oriented and coordinated services mix across different sectors that is equally accessible regardless of the patients' socio-economic background.

Implications for future research: To support planning, further research on the factors that predict service use and on the cost-effectiveness of services is required.

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来源期刊
CiteScore
2.20
自引率
6.20%
发文量
8
期刊介绍: The Journal of Mental Health Policy and Economics publishes high quality empirical, analytical and methodologic papers focusing on the application of health and economic research and policy analysis in mental health. It offers an international forum to enable the different participants in mental health policy and economics - psychiatrists involved in research and care and other mental health workers, health services researchers, health economists, policy makers, public and private health providers, advocacy groups, and the pharmaceutical industry - to share common information in a common language.
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