[The patient record form in psychiatry: nomenclature of the types of management].Encephale. 1996 Jan-Feb; 22(1):23-33.E
The patient form (PF) is a data carrier in mental health, established by the French General Department of Health to improve the annual report of each psychiatric sector, the assessment of the care given and the patients involved. We suppose that despite of national efforts to standardize the use of the PF, in practice are noticed: 1) different operative senses given to the codes of care; 2) a hierarchical system of treatments and a counting far from being unequivocal. This study undertaken in Centre Hospitalier Spécialisé de Maison Blanche investigates and compares: 1) the different operative senses given to the codes of care; 2) the use of these codes to transcribe and to count psychiatric treatments. These goals were fulfilled by a strictly anonymous questionnaire survey that ensures an analysis of the replies individually, in relation to occupational groups and to psychiatric sectors. In particular, all the psychiatrists, the nurse supervisors and the medical secretaries who worked in the hospital for at least 9 months, including 6 months at least in their current sector at the time of the survey, in the previous calendar year were concerned. Altogether that comes to 207 subjects. The administrative staff and the employees of the Medical Information Department were not involved. Upon 207 questionnaires, 58 replies were sent back i.e. a general reply rate of 28.02 +/- 6.12%. The secretaries took a more active part in the survey: 43.06 +/- 11.44% (31/72) significantly higher than the general rate (p = 0.03). The results show that regardless of the occupational groups neither the coding of treatments nor their counting are carried out the same way in different sectors respectively 70.69 +/- 11.71% and 77.59 +/- 10.73%. The operative senses of some codes like CO, AT, AP, AJ vary a lot. Sometimes the multiplicity of treatments coming under a code lead to these changes. At other times local initiatives explain the divergences. When senses are unequivocal, the hierarchical system of treatments is rather a problem. So, in case of several treatments the same day, the study makes obvious: 1) a giving up of the hierarchical system and as a result, the one of the incompatibility between some codes; 2) the coding and the count of as many as possible services the same day. The outpatient care is the 3rd of the three kinds of treatment according to the hierarchical system. It is the one for which codings and counts vary the most. It is essentially without hotel element. On the other hand accommodation twenty-four hours a day characterizes the full-time (inpatient) care. The part-time care, between both previous is a patchwork where predominates sometimes a mode of accommodation and sometimes a place for care. It is less accurate than the full-time care. The PF serves many purposes among which some are irreconcilable. It certainly allows a more accurate count of the patients who refer to a sector during a year period; but the various care and treatments are less assessed. The main subdivisions of the nomenclature of patient care maintain the dichotomy inpatient care/outpatient care. The links between the PF and the Information System Medicalization Program (ISMP) can no longer be concealed. Unfortunately, even the analysis of the data collected by the PF, for a financial assessment of the sectors, leads to very biased outcomes because of the qualitative and quantitative underestimation of care, treatments and all the necessary activities. The patient form looks like a multipurpose tool serving the minimum requirements for either descriptive, analytic or evaluative epidemiology; hospital management; planning; etc. Even though this multipurpose vocation could be a weakness, advantage could be also be taken of it to make a more efficient instrument, hence the need for some suggestions.