Citation

Matsubara J, Masuda Y, Obata S, Aoki T, Kumakura Y, Yamana H, Ichihashi K, Kondo S, Kasai K. Suicide Prev. Crisis Interv. 2021; 41(1): 32-38.

Vernacular Title

東京大学医学部附属病院において救急搬送後に精神科医が診察を行った患者の特徴--精神科急性期医師配置加算新設に伴って明らかになった救急診察の実態報告--

Copyright

(Copyright © 2021, Japanese Association of Suicide Prevention)

DOI

10.51098/spcijasp.41.1_32

PMID

unavailable

Abstract

A reimbursement for assigning psychiatrists to emergency care started in 2016 to promote smooth collaboration between emergency and psychiatric departments. Although this was a significant incentive for the psychiatric department, there is a scarce literature that assesses the scheme. We used medical records to conduct a retrospective analysis of patients who were treated under this scheme at the University of Tokyo Hospital between April 2016 and March 2019. Patients who underwent medical examination by psychiatrists within 12 hours of arrival at the hospital were included. Of the 325 cases, suicidal attempt or self-injury was observed in 164 cases. Twenty-one out of 30 cases with no psychiatric history had suicidal attempts. Multiple approaches were applied in 14% of suicidal attempt cases. Fewer proportion of patients were hospitalized into psychiatric department compared with previous reports. This study suggests that, following the implementation of the reimbursement, patients with no psychiatric examination history and patients with minor symptoms were being referred to psychiatric department promptly during off hours.

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救急医療と精神医療の連携を図るため平成28年度診療報酬改定で精神科急性期医師配置加算が新設された。有床総合病院精神科にとって大きなインセンティブとなったが、同加算の評価に関する報告は乏しい。本研究では平成28年4月から平成31年3月の間に東京大学医学部附属病院へ救急搬送後、同加算の枠組みのもとで12時間以内に精神科医が診察を行った患者を対象に診療録を用いた後方視的分析を行った。対象325例中164例に自殺企図または自傷行為が認められた。精神科受診歴がない患者30例のうち21例に自殺企図が見られ、自殺企図の症例では複数の手段を用いた事例が13.6%で見られた。精神科入院に至った患者は既報に比べ少なかった。本研究から、同加算の導入以降、未受療者や軽傷者を時間外でも速やかに精神科診察につなげられていることが示唆された。

Language: ja

Keywords

multiple methods; psychiatric examination history; reimbursement for assigning psychiatrists to emergency care; self-injury; suicidal attempt; 精神科受診歴; 精神科急性期医師配置加算; 自傷行為; 自殺未遂; 複数手段