Notice bibliographique
Résumé
A move towards less custodial and more community-oriented model of care for psychiatric patients is trend in many developed countries. (1) Treatment in the least restrictive and most non-discriminatory environment is fundamental to modern psychiatric service in which patients can enjoy respect, dignity, and better quality of life. Traditionally, psychiatric outpatient clinics shoulder most of the community psychiatric care workload in Hong Kong. Linkage with general outpatient clinics, general practitioners, and private psychiatrists is limited. The psychiatrist-to-population ratio in Hong Kong is far below that of other developed societies. We have only about 200 psychiatrists, or 1 for every 33,000 people, while the ratio is about 1 to 8,000 in the United States and Canada. Through necessity, our mental health service has become highly efficient. The patient-clinician ratio in our psychiatric outpatient clinics is high compared with many western countries. Both patients and clinicians expect fast service and large turnover. Usually, only the most crucial aspects of drug compliance, relapse, and risk prevention are addressed in our busy outpatient service. Clinicians trying to manage tremendous workloads inevitably sideline the finer points, such as our patients' inner selves and their quality of life. In this issue of the Journal, Hui et al (2) report that the mean consultation time in general psychiatric outpatient clinic is only 5.6 minutes. Under-recognition of patients' needs by clinicians was observed in various domains. The consultation time correlated with the number of needs identified by clinicians. It was shown that when the 2-COM checklist was used as self-report questionnaire, communication and identification of patients' needs improved. Surprisingly, there was no correlation between consultation time and service satisfaction. The authors attributed the phenomenon to the low expectations of our patients. Their major concern was gaining information about their illness and treatment. The picture might be different if we interview the carers. Our severely mentally ill patients are usually not motivated to disclose their needs or seek help. This can be due to lack of insight, fear of stigma, and mental disabilities including negative symptoms and neurocognitive impairments. This may also explain the apparently high 'baseline' service satisfaction in the study. The authors concluded that a more comprehensive management [approach] taking into account wider range of life domains is called for. Clinicians' lack of awareness of many needs as perceived by patients draws attention to the inadequate consultation time, because of service load constraints. An increase in consultation time could improve service quality. The pertinent questions are: what causes the short consultation time and how can we allow for longer consultation time? It is obvious that our current workforce is too thinly spread and the demand for our service too great. Our current service is overwhelmed by all manner of patient needs. Amongst these are the demands of the severely mentally ill as well as those suffering from highly prevalence disorders like depression and anxiety. On top of these are demands from people with age-specific problems: the old and the young. Most of our subspecialty services are underdeveloped. The psychiatric workforce needs enhancement; but even with enhancement, the mental health service alone will not be able to cope with the huge demand. We need collaboration at all levels. There is need to work out collaborative model with the primary care doctors as well as the frontline workers. At present, referral to the specialist often means one-way ticket. In the future, we need to establish model where there will be two-way flow of referral as well as frequent communication between the two parties. Instead of trying to care for all patients with mental health problems, the mental health service should focus on the treatment of patients with complex and severe problems while supporting primary care workers and doctors to provide better service for uncomplicated and currently stable patients. …
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».