醫院擴增不同型態精神醫療資源之影響因素探討

The Factors Associated with the Willingness of Hospitals to Expand Different Types of Mental Health Services

彭英傑(Ying-Chieh Peng) ； 陳端容(Duan-Rung Chen)

《台灣公共衛生雜誌》 24卷2期 (2005/04) Pp. 162-172

https://doi.org/10.6288/TJPH2005-24-02-08

摘要

目標：精神醫療資源長期存在資源不足、分布不均與低度發展之問題，既使在政策鼓勵與經費補助下，其成長仍相當有限。本研究旨在探討影響醫院擴增不同型態精神醫療服務之影響因素，藉以瞭解影響精神醫療資源成長之機制。方法：以郵寄問卷方式進行，對台灣地區136家提供精神醫療服務之醫院進行普查。結果：寄出問卷136份，回收82份，問卷回收率60.3%，回收個案與未回收個案在權屬別、評鑑別、型態別、地區別上無差異。教學醫院擴增急性精神病床意願較高，擴增慢性精神病床意願較低；住院個案經他院轉介比例高於20%之醫院，在擴增急性精神病床意願較高；而精神科專科醫院在擴增康復之家、社區復健中心意願會較高；中部地區的醫院擴增社區復健中心之意願較高。位居都會區周邊縣市之醫院擴增急性精神病床之意願較高，而鄉村地區醫院擴增慢性精神病床意願較高，工業地區醫院擴增社區復健中心意願較高。機構所在地縣市每萬人口急性精神病床數多者擴增急性精神病床之意願較低，擴增慢性精神病床、康復之家及社區復健中心之意願較高；機構所在地縣市每萬人口日間留院床數少者擴增擴增慢性精神病床及康復之家之意願較高。結論：醫療機構持續有擴增精神醫療資源之計畫，規模有擴大趨勢；影響醫院擴增不同型態之精神醫療服務的因素不同；醫療機構特性、機構所在地社經條件、機構所在地精神醫療資源等因素對不同型態之精神醫療服務有不同之影響，營運層面考量未有顯著影響力。

關鍵字

精神醫療資源 ； 醫院 ； 擴增意願 ； 承載能量

並列摘要

Objectives: To examine the factors associated with the investment of hospitals in five different types of mental health services and explore mechanisms of mental health resources growth in Taiwan. Method: A cross-sectional study was conducted, and mailed questionnaires were used to collected data from the managers of all (136) hospitals. Logistic regressions were employed to examine whether institutional linkages, socio-economic levels, and the mental health resources capacity surrounding hospitals, and the profit consideration were associated with the future investment of hospitals in mental health services. Results: 82 of 136 hospitals responded to the questionnaires, resulting in a response rate of 60.3%. The respondents were not different from the non-respondents across the variables examined. Institutional linkages are significantly statistically associated with future investment in different mental health services. Various variables were differently associated with the future investment of hospitals in different types of mental health service. Being a teaching hospital or a hospitals that has more than 20% of inpatients transferred from other hospitals were significant factors associated with investment in acute psychiatric inpatient service. Conclusions: Different variables are associated with different types of mental health services. The results indicate that more work should be done to look into the different mechanisms for the growth of mental health services.

並列關鍵字

mental health ； hospitals ； willingness to expand ； investment plans

參考文獻

Byrne P(1999).Stigma of mental illness: Changing mind, changing behavior.(Br J Psychiatry).

Dorwart RA,Schlesinger M,Davidson H,Epstein S,Hoover C(1991).A National Study of Psychiatric Hospital care.(Am J Psychiatry).

Eveland AP,Dever GE,Schafer E,Spinkel C,Davis S,Rumpf M(1998).Analysis of Health Service Areas: Another Piece of the Psychiatric Workforce Puzzle.(Psychiatr Serv).

Geraty RD(1995).General Hospital Psychiatry and the New Behavior Health Care Delivery System.(Gen Hosp Psychiatry).

Hosmer DW,Lemeshow S(1989).Applied Logistic Regression.