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急性精神病患自動出院之影響因素
Factors Related to Discharge against Medical Advice in Acute Psychiatric Inpatients
摘要
目的：瞭解精神科急性住院病患自動出院之比率與影響因素。方法：採世代研究法，2004年4月至8月住進某一精神專科醫院急性病房者，共275人次，追蹤其是否自動出院。資料之蒐集係根據醫師病歷回顧與護理師會談，相關變項建入電腦後，再以SPSS統計軟體進行分析。結果：研究期間共有39人自動出院，其比率達14.2%。影響自動出院之因素為過去有自動出院史、家人對此次住院有意見不一致、家人預期之住院時間短、出院前症狀嚴重度高與住院期間之症狀改善程度小。住院期間時之症狀改善程度每減少一個單位，自動出院之機率即增加4.18倍。病患入院時，若家人期望於一週內出院者，其自動出院機率較由醫師做決定者高六倍。結論：精神科急性病房治療團隊應積極處理病患精神症狀並於病人入院時加強與其家屬溝通合理之住院時間，以預防自動出院之發生。
並列摘要
Objectives: This study examined the rate of discharge against medical advice (AAD) and its related factors among acute psychiatric inpatients. Methods: Acute psychiatric inpatients admitted to a psychiatric hospital between April and August, 2004 were included. The sample comprised 275 patients who were followed up to determine whether they were discharged against medical advice. Data were collected through chart review by psychiatrists and psychiatric nurses. Results: During the research period, 39 patients were discharged against medical advice. The rate of AAD was 14.2%. The factors related to AAD were past history of AAD, inconsistent opinion of family members about the need for care, short expected hospitalization time by family members, high symptom severity at discharge and limited symptom improvement. The risk of AAD was 4.18 times per decline in the unit score of symptom improvement during the hospitalization period. The risk of AAD was 6 times higher when families expected the patient to be discharge within 1 week compared to those who agreed with the hospitalization time suggested by doctors. Conclusion: To prevent the occurrence of AAD, the team in the acute psychiatric ward should manage psychiatric symptoms intensively, and discuss what may be a reasonable expectation of hospitalization time with families on admission.