使用精神科居家醫療整合照護病人之臨床特徵

目的：社區治療是現今精神醫學主流，其中居家治療可下降再住院率並提高生活品質。台灣缺乏本土文獻，本研究為一初步橫斷面研究，呈現一精神專科醫院使用居家治療者特質。方法：以台北巿一公立精神專科醫院之居家治療精神病患者為研究族群。分析人口學和臨床變項，並依性別比較差異。另以兩名個案以敘事方式呈現整合型居家治療模式。結果：研究樣本共51 位，86% 診斷為思覺失調症。29% 有酒藥癮共病但僅4% 合併身體疾病。居家治療後之妄想及幻覺和自殺殺人風險之比例減低，同時亦有改善病患衛生能力、獨立活動狀態、服藥順從性甚至病識感的比例。結論：結果呈現一使用居家治療之精神疾患者之特質，並顯示有改善的臨床表現。未來需要大樣本追蹤性研究來佐證本土精神居家治療的有效性。

關鍵字

居家治療；精神疾患；醫療使用；身心障礙；敘事醫學

並列摘要

Objective: Community psychiatry service has become a model in the mainstream of psychiatric care worldwide. Home healthcare service, one of the community therapy approach, has been shown to reduce rehospitalization rate and improve better quality of life among patients with severe mental disorders. In Taiwan, the empirical data for the service was lacking. The present cross-sectional study evaluated the characteristics of patients who used psychiatric home healthcare service provided by a psychiatry hospital. Methods: Patients with severe mental illness who used home healthcare program provided by a municipal psychiatric hospital in Taipei City were recruited in this study. We used both descriptive statistics and narrative approach to present the study samples. Results: There were 51 patients included in this study and 86% of them were diagnosed with schizophrenia. The proportions of comorbid substance use disorder and physical illnesses were 29% and 4%, respectively. After receiving home healthcare, the patients mitigated in severity of psychotic symptoms, suicide and homicide risk, and improved in quality of daily activities, medication compliance, and insight. Conclusions: The integrated home healthcare service improved psychiatric symptoms of the schizophrenia patients significantly. Further study with larger sample size is required to determine the effectiveness of the psychiatric home healthcare service model in Taiwan.

並列關鍵字

home healthcare service ； mental disorder ； medical utilization ； disability ； narrative medicine

國際替代計量

使用精神科居家醫療整合照護病人之臨床特徵

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