精神醫療照護品質指標之比較－以四家衛生署所屬醫院急性精神住院病患之非自願性約束及隔離爲例

本研究旨在比較四所衛生署所屬醫院精神科急性病房在非自願性約束、隔離處置之比率、頻率及約束隔離導致負向結果數之差異情形。研究採立意取樣，選取台灣中部及南部二所精神科專科醫院及二所綜合醫院之精神科急性病房，於民國93年4月至6月期間於該等醫院住院之精神病患爲對象，比率指標部分共收案881人，頻率指標與負向結果數則共計收案347人次。醫院別之間的干擾變項包括：(1)比率指標：病患性別、年齡與診斷別；(2)頻率指標與負向結果數：病患性別、年齡、診斷別、整體精神狀態、過去住院次數、急性病房總住院天數、醫師是否到場評估、是否投予病患藥物以及事件發生的時段別等。研究結果顯示，在比率指標中不同醫院之間二個干擾變項有顯著差異；頻率指標中，不同醫院之間五個變項達顯著差異，在比較醫院間之照護品質指標時，「考慮干擾因素且進行統計檢定」會比「不考慮干擾因素且未進行統計檢定」所造成之差異來得小。依本研究結果建議：(1)爲求客觀比較醫院別之間醫療服務品質，應考量病患性別、年齡及醫療處置與否等干擾因素，且需進行統計檢定。(2)約束、隔離的時間與頻率，是間接測量而得的數據資料，若能以病患角度爲出發點，分析非自願約束、隔離導致之負向結果，則將能更直接反映照護品質。

關鍵字

精神醫療照護品質；約束；隔離；負向結果

並列摘要

The purpose of this study was to compare on the duration, frequency ratio and adverse outcome numbers in involuntary restraints and seclusion among four public hospitals. The samples came from the inpatients of the acute wards since April to June, 2004, who had been involuntary restrained and secluded. There were 881 patients included in terms of comparing on indicators of ratio, another 347 patients included in the aspect of comparing on the indicators of frequency. Confounding variables such as patients’ sex, age diagnosis mental status, times of previous admission, total days of admission were taken into consideration before the comparison. The results indicated that the differences of the psychiatric service quality among the hospitals became smaller after the confounding factors were controlled. Thus, we recommended: 1) the confounding factors shall be considered when comparing the psychiatric service quality among hospitals; 2) the adverse outcome of the involuntary restraint and seclusion needed to be added to reflect the quality of psychiatric care comprehensively.

並列關鍵字

psychiatric service quality ； restraint ； seclusion ； adverse outcome

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精神醫療照護品質指標之比較－以四家衛生署所屬醫院急性精神住院病患之非自願性約束及隔離爲例

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