家庭医の専門医養成におけるメンタルヘルスのcompetencyに関するscoping review

メンタルヘルスをプライマリ・ケアへ統合することは，適切なケア，アウトカム改善，資源の適正利用などへ貢献し，世界的な潮流である．諸外国においては，プライマリ・ケアでのメンタルヘルス教育の開発がされてきたが，日本において家庭医への体系的な教育は十分でない．本稿では，家庭医養成で求められるメンタルヘルスのcompetencyを明らかとすることを目的にscoping reviewを行い，諸外国の教育カリキュラムなどをthematic analysisを用いて分析した．抽出されたcompetencyは，「プライマリ・ケアの一般的能力」「プライマリ・ケアにおけるメンタルヘルスの一般的能力」「プライマリ・ケ...

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Published in日本プライマリ・ケア連合学会誌 Vol. 44; no. 3; pp. 116 - 127
Main Authors 鵜飼, 万実子, 岡田, 唯男, 高橋, 亮太, 河田, 祥吾
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本プライマリ・ケア連合学会 20.09.2021
Subjects
コンピテンシー
プライマリ・ケア
メンタルヘルス
家庭医療
専門医養成
Online AccessGet full text
ISSN2185-2928
2187-2791
DOI10.14442/generalist.44.116

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Abstract メンタルヘルスをプライマリ・ケアへ統合することは，適切なケア，アウトカム改善，資源の適正利用などへ貢献し，世界的な潮流である．諸外国においては，プライマリ・ケアでのメンタルヘルス教育の開発がされてきたが，日本において家庭医への体系的な教育は十分でない．本稿では，家庭医養成で求められるメンタルヘルスのcompetencyを明らかとすることを目的にscoping reviewを行い，諸外国の教育カリキュラムなどをthematic analysisを用いて分析した．抽出されたcompetencyは，「プライマリ・ケアの一般的能力」「プライマリ・ケアにおけるメンタルヘルスの一般的能力」「プライマリ・ケアにおけるメンタルヘルスの特異的能力」に大別される包括的なものであった．本稿のデータを基に，日本の現状を踏まえたcompetency list作成やモデルカリキュラムの策定などが求められる．
AbstractList メンタルヘルスをプライマリ・ケアへ統合することは，適切なケア，アウトカム改善，資源の適正利用などへ貢献し，世界的な潮流である．諸外国においては，プライマリ・ケアでのメンタルヘルス教育の開発がされてきたが，日本において家庭医への体系的な教育は十分でない．本稿では，家庭医養成で求められるメンタルヘルスのcompetencyを明らかとすることを目的にscoping reviewを行い，諸外国の教育カリキュラムなどをthematic analysisを用いて分析した．抽出されたcompetencyは，「プライマリ・ケアの一般的能力」「プライマリ・ケアにおけるメンタルヘルスの一般的能力」「プライマリ・ケアにおけるメンタルヘルスの特異的能力」に大別される包括的なものであった．本稿のデータを基に，日本の現状を踏まえたcompetency list作成やモデルカリキュラムの策定などが求められる．
Author 高橋, 亮太
岡田, 唯男
河田, 祥吾
鵜飼, 万実子
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18) 日本プライマリ・ケア連合学会. 新・家庭医療専門医制度研修の目標. 東京: 日本プライマリ・ケア連合学会; [not revised; cited 9 January 2021]. Available from: https://www.shin-kateiiryo.primary-care.or.jp/aims?lang=ja
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27) 堤明純, 石川善樹, 乾明夫, 他. 医学部卒業時に求められる行動科学に関するコンピテンシー: デルファイ法による調査結果. 行動医学研究. 2014; 20 (2): 63-68. doi: https://doi.org/10.11331/jjbm.20.63.
References_xml – reference: 9) Fogarty CT, Sharma S, Chetty VK, et al. Mental health conditions are associated with increased health care utilization among urban family medicine patients. J Am Board Fam Med. 2008; 21 (5): 398-407. doi: 10.3122/jabfm.2008.05.070082.
– reference: 28) Stensrud TL, Gulbrandsen P, Mjaaland TA, et al. Improving communication in general practice when mental health issues appear: piloting a set of six evidence-based skills. Patient Educ Couns. 2014; 95 (1): 69-75. doi: 10.1016/j.pec.2013.12.005.
– reference: 25) Chin HP, Guillermo G, Prakken S, et al. Psychiatric training in primary care medicine residency programs. A national survey. Psychosomatics. 2000; 41 (5): 412-417. doi: 10.1176/appi.psy.41.5.412.
– reference: 30) Jones LR, Knopke HJ, Parlour RR, et al. Shaping the mental health role of family physicians. J Fam Pract. 1981; 12 (4): 697-702.
– reference: 33) Royal College of General Practitioners. The RCGP curriculum: clinical modules: 3.10 care of people with mental health problems. London: RCGP; 19 January 2016. [not revised; cited 9 January 2021]. Available from: https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/~/media/B9B066784CED42518D2E5F80E141D504.ashx
– reference: 12) World Health Organization, World Organization of Family Doctors. Integrating mental health into primary care: a global perspective. Geneava, Switzerland: World Health Organization; 2008. [not revised; cited 8 January 2021]. Available from: https://www.who.int/mental_health/policy/services/integratingmhintoprimarycare/en/
– reference: 36) General Practice Mental Health Standards Collaboration. Mental health training standards 2020-22: a guide for training providers. East Melbourne, Vic: RACGP; October 2019. [not revised; cited 21 January 2021]. Available from: https://gpmhsc.org.au/Info/Detail/68017c4a-37af-429d-a971-abd6fa01a54c
– reference: 42) Richard L Brandt-Kreutz RL, Ferguson KE, Sawyer D. Behavioral science priorities in residency education: The perspective of practicing family physicians. Fam Syst Health. 2015; 33 (4): 339-348. doi: 10.1037/fsh0000144.
– reference: 21) Manning G, Andrades M, Sindh J. Final report WONCA accreditation visit: Japan Primary Care Association (JPCA). Brussels: WONCA; 27 April 2020. [not revised; cited 9 January 2021]. Available from: https://43e22853-aff1-4b8b-a794-d204fec68511.filesusr.com/ugd/30fddf_480beae7545741929832a26cff874654.pdf
– reference: 10) Yamanashi H, Nobusue K, Nonaka F, et al. The role of mental disease on the association between multimorbidity and medical expenditure. Fam Pract. 2020; 37 (4): 453-458. doi: 10.1093/fampra/cmaa015.
– reference: 14) American Academy of Family Physicians. Mental Health Care Services by Family Physicians (Position Paper) Kansas: American Academy of Family Physicians; 2018. [not revised; cited 8 January 2021]. Available from: https://www.aafp.org/about/policies/all/mental-health-services.html
– reference: 1) World Health Organization. The world health report 2001: mental health: new understanding, new hope. Geneva, Switzerland. World Health Organization. 2001. 5.
– reference: 38) Edgar L, Roberts S, Yaghmour NA, et al. Competency crosswalk: a multispecialty review of the Accreditation Council for Graduate Medical Education Milestones across four competency domains. Acad Med. 2018; 93 (7): 1035-1041. doi: 10.1097/ACM.0000000000002059.
– reference: 8) Leigh H, Stewart D, Mallios R. Mental health and psychiatry training in primary care residency programs. Part I. Who teaches, where, when and how satisfied? Gen Hosp Psychiatry. 2006; 28 (3): 189-194. doi: 10.1016/j.genhosppsych.2005.10.003.
– reference: 18) 日本プライマリ・ケア連合学会. 新・家庭医療専門医制度研修の目標. 東京: 日本プライマリ・ケア連合学会; [not revised; cited 9 January 2021]. Available from: https://www.shin-kateiiryo.primary-care.or.jp/aims?lang=ja
– reference: 37) Virginia B, Victoria C. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3 (2): 77-101.
– reference: 27) 堤明純, 石川善樹, 乾明夫, 他. 医学部卒業時に求められる行動科学に関するコンピテンシー: デルファイ法による調査結果. 行動医学研究. 2014; 20 (2): 63-68. doi: https://doi.org/10.11331/jjbm.20.63.
– reference: 3) 厚生労働省. 平成29年 (2017) 患者調査の概況. 東京: 厚生労働省; 1 March 2019. [not revised; cited 8 January 2021]. Available from: https://www.mhlw.go.jp/toukei/saikin/hw/kanja/17/index.html
– reference: 13) Xierali IM, Tong ST, Petterson SM, et al. Family Physicians Are Essential for Mental Health Care Delivery. J Am Board Fam Med. 2013; 26 (2): 114-115. doi: 10.3122/jabfm.2013.02.120219.
– reference: 7) 三木治. プライマリ・ケアにおけるうつ病の実態と治療. 心身医学. 2002; 42 (9): 585-591. doi: https://doi.org/10.15064/jjpm.42.9_585.
– reference: 29) H W Dove HW. Postgraduate education and training in addiction disorders. Defining core competencies. Psychiatr Clin North Am. 1999; 22 (2): 481-488. doi: 10.1016/s0193-953x (05) 70088-5.
– reference: 40) Irish college of general practitioners. ICGP curriculum for gp training in Ireland version 5.0. Dublin: ICGP; September 2020. [not revised; cited 28 March 2021]. Available from: https://www.icgp.ie/speck/properties/asset/asset.cfm?type=LibraryAsset&id=C44C5005%2D45C0%2D4C3B%2D9DEC696012199406&property=asset&revision=tip&disposition=inline&app=icgp&filename=2020%5FV5%5F0%2Epdf
– reference: 4) 厚生労働省. 平成30年 (2018年) 医師・歯科医師・薬剤師統計の概況. 東京: 厚生労働省; 19 December 2019. [not revised; cited 8 January 2021]. Available from: https://www.mhlw.go.jp/toukei/saikin/hw/ishi/18/index.html
– reference: 41) Kinman CR, Gilchrist EC, Payne-Murphy JC, et al. Provider- and practice-level competencies for integrated behavioral health in primary care: a literature review. Rockville, MD: Agency for Healthcare Research and Quality. March 2015. [not revised; cited 11 January 2021]. Available from: http://integrationacademy.ahrqdemo.org/sites/default/files/AHRQ_AcadLitReview.pdf
– reference: 11) World Health Organization, Wonca Working Party on Mental Health. What is primary care mental health? Ment Health Fam Med. 2008; 5 (1): 9-13.
– reference: 17) 日本専門医機構. 総合診療専門研修専攻医2019年度版研修手帳. 東京: 日本専門医機構; 18 December 2019. [revised 1 January 2020; cited 9 January 2021]. Available from: https://jmsb.or.jp/sogo/#an03
– reference: 26) 河本慶子. 卒後研修における行動科学教育の必要性. 医学教育. 2015; 46 (4): 335-342. doi: https://doi.org/10.11307/mededjapan.46.4_335.
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SubjectTerms コンピテンシー
プライマリ・ケア
メンタルヘルス
家庭医療
専門医養成
Title 家庭医の専門医養成におけるメンタルヘルスのcompetencyに関するscoping review
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