思覺失調症病人的居家照護效益分析

Effectiveness Analysis of Home Care Services for Patients with Schizophrenia

許曉芬(Hsiao-Fen Hsu) ； 高家常(Chia-Chan Kao) ； 應純哲(Jeremy C. Ying) ； 潘麗馡(Li-Fei Pan)

《榮總護理》 37卷1期 (2020/03) Pp. 43-54

https://doi.org/10.6142/VGHN.202003_37(1).0005

摘要

落實去機構化運動與發展有效的社區精神復健模式已是現今精神醫療照護的重要方向，思覺失調症病人的再住院率高，所產生的住院費用造成醫療負擔，本研究係以南部某醫學中心接受精神科居家照護的病人為調查對象，探討精神科居家照護的效益，以做為推展以醫院為基礎的精神科居家照護服務。本研究為回溯性研究，利用醫院「居家資料庫」2006年1月至2016年12月共計10年的資料，篩選主診斷為思覺失調症病人為研究樣本，研究結果顯示：病人平均發病年齡為36.68歲（SD=11.06），精神科居家照護期間使用之藥物以長效針劑占最多83.33%；接受精神科居家照護後的第一年在住院次數及住院天數上明顯減少達顯著（p＜.001），住院第一年是介入精神科居家照護最好的契機，目前政府正積極推動長期照護，應鼓勵精神科院所提供精神科居家照護服務，建構思覺失調症病人長期照護網絡。

關鍵字

思覺失調症 ； 精神居家照護 ； 住院天數 ； 再住院次數

並列摘要

In the modern mental health care system, the development of an effective community-based service model is essential for implementing institutionalization policies. However, the cost of home care and attention required from the caregivers and officials of medical care systems are high. We evaluated the efficacy of the hospital-based psychiatric home care systems in a medical center in Taiwan for improving the current care model among patients with schizophrenia. We applied a retrospective study design for the period from January 1, 2006 to December 31, 2016. Patients who had received home care services for more than a year were enrolled in the study program. The primary outcomes in the study were the number of acute admissions and duration of admission. The primary outcomes were compared before and after the enrollment date over a 1-year period. The mean age of the participants was 36.68 years(SD =11.06). The most common treatment strategy for the participants receiving home care services was the administration of a long-acting injection of antipsychotics (83.33% of all participants). After adjustment of possible confounding factors such as medication use, a significant decrease was observed in both the number of acute admissions and duration of admission in the patients with schizophrenia who received home care services for a 1-year period(p＜ .001). The study revealed that even short-term home care can reduce the re-hospitalization rate and the duration of admission among patients with schizophrenia. However, the shortcomings of the pre-post study necessitate further randomized and controlled trials.

並列關鍵字

schizophrenia ； psychiatric home care service ； duration of admission ； re-hospitalization

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