影響病人違背醫囑自動出院之因素探討

The Study of Against Medical Advice Discharge Factors-A Regional Hospital Experience

高淑琴(Shu-Chin Kao) ； 黃崇謙(Chung-Chien Huang)

《醫務管理期刊》 7卷3期 (2006/09) Pp. 287-305

https://doi.org/10.6174/JHM2006.7(3).287

摘要

本研究旨在探討影響違背醫囑自動出院病人在個人及醫療因素上的特色，病人與臨床醫師對於醫療服務的期待與感受之間的差異。以北部某區域醫院350位違背醫囑自動出院及醫師許可出院病人為研究對象，利用回溯性資料進行分析，另模擬PZB模式設計結構式問卷測量違背醫囑自動出院病人及臨床醫師對於醫療服務期待與感受之落差缺口。
研究結果顯示違背醫囑自動出院病人與醫師許可出院病人相較，在統計上有顯著差異是男性多於女性、台北縣市大於當地居民、急診住院多於門診住院、出院後14天再入院率高。有關違背醫囑出院病人及臨床醫師對於醫療服務的期待與感受，利用問春資料統計後發現，在PZB模式之服務五大構面上無論是有形性、可靠性、反應性、關懷性、保證性皆達顯著差異，其中以關懷性的落差最大。
依據研究結果建議，臨床醫療人員當病人住院進行評估時，若有易違背醫囑出院之特質，則應儘早與病人討論並擬定醫療計畫，以降低違背醫囑出院機率，縱使其出院後亦能有完善的醫療照護體系接手。此外，考量病人出院是在尚未完成治療之階段，基於尊重病人自主權及避免後續爭議，完整的文件記錄是必要的。舉辦醫療人文教育對臨床服務工作者而言有助於醫病關係及醫療品質之提升，可以促進醫療服務之可近性。

關鍵字

違背醫囑自動出院 ； 醫療服務之期待與認知 ； PZB模式 ； 缺口理論

並列摘要

Objectives: This study investigates the against medical advice (AMA) discharges concludes that the majority of the AMA patients leave hospitals for personal and medical reasons. There are medical perception and experience gaps between patients and physicians.
Methods: A retrospective chart review and a matching survey based on PZB model was performed. A total of 350 AMA patients discharged from a regional teaching hospital were compared retrospectively with another 350 general physician-approved discharged patients during the same period. The questionnaire compares the medical perception and experience from patients discharged AMA and their attending physicians.
Results: Patients who leave hospital against medical advice differ from the general patient population. They include a higher proportion of male gender, living in other city, admission through the emergency department and readmission with l4days after discharge. Regarding medical perception and experience appear to be significant on reliability, assurance, responsiveness, and empathy aspects. The largest gaps in five constructed differentials is empathy.
Conclusions: The study establishes a profile of AMA patients leave hospital. Early identification of targeted patients may facilitate this process. Such as, early discharges planning for appropriate outpatient treatment are recommended, thereby decreasing readmission and improving health outcomes. One challenge that patients who leave hospital AMA authority may not best interest and the doctrine of informed consent, so comprehensive documentation should be planned and reinforced. It has been suggested in postgraduate medical education. Healthcare quality professionals should also receive formal training on patient relations as part of the management program, programs to improve continuity of care and to provide easier access to the health care system.

並列關鍵字

Against Medical Advice AMA Discharges ； Medical Perceptions and Experience ； PZB Model ； Gaps Theory

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