- 期刊
社區慢性精神病人長照服務量表之效度及其服務效果之評價
Validity of the Long-Term Care Service Evaluation Scale for Community Chronic Mental Patients and Evaluation of Service Effects
摘要
目的：了解Kihon Checklist（KCL）在社區慢性精神病人長照服務之適用情形及精神病人長期照顧之服務成效。方法：本研究採回溯前瞻世代之研究設計，回溯評量為自2021年9月起接受南投縣精神長照服務之個案，使用KCL做為前測、前瞻評量針對2022年持續接受南投縣精神長照服務之慢性精神障礙者，平均每3個月進行1次KCL評量做為後測；回溯與前瞻最多追蹤4次，總評量254人次（樣本數共73人）。結果：分析4次回溯與前瞻之KCL評量，25項需求中之5項有部分樣本（37.3%～10.6%）表達生活中無此需求，其餘20項全部樣本均有表達意見。精神病人長期照顧示範計畫對社區慢性精神病人的服務效果，良好有7項、尚可1項、稍差13項、不佳4項；若依KCL的7個面向分析，服務效果良好與尚可主要在獨立生活與口腔面向，其餘運動、營養、社交、認知與憂鬱等5個面向的服務效果多為稍差與不佳，究其原因為計畫執行內容與研究指標之不對稱。結論：精神病人長照計畫對社區慢性精神病人之獨立生活與口腔面向為正向結果，惟介入內容之口腔方面比率偏低，故口腔面向（咬硬物、嗆到）之良好結果與介入無關，此效果屬研究樣本之成熟效應、且由於計畫介入內容與研究指標不對稱，故不宜僅以KCL作為精神病人長照示範計畫之評估與評價工具。建議應強化獨立生活功能的訓練，以提升個案社區生活之適應與獨立性、並增加多元化的評量工具，以持續了解精神長照個案需求，提供符合社區慢性精神病人需求之服務。
並列摘要
Purpose. To understand the application of Kihon Checklist (KCL) in long-term care services for chronic mental patients in the community and the service effectiveness of the long-term care for mental patients. Methods. This study adopts a prospective-retrospective cohort study design; the retrospective collection was for cases that have received Nantou County’s long-term care services since September 2021. KCL was used as the pre-test and the prospective evaluation was for those who continue to receive Nantou County’s long-term care services in 2022. For patients with chronic mental disorders in long-term care services, the KCL assessment was conducted on average once every 3 months as a post-test; retrospective and prospective follow-up was carried out up to 4 times, with a total of 254 assessments (a total of 73 patients in the sample). Results. Analyzing 4 prospective-retrospective KCL evaluations, some samples (37.3%~10.6%) expressed that there is no such need in life for 5 of the 25 needs, and all samples for the remaining 20 items expressed their opinions. The service effects of the Long-term Care for Mental Patients on chronic mental patients in the community are good in 7 items, fair in 1 item, slightly worse in 13 items, and poor in 4 items. According to the analysis of the 7 aspects of KCL, the service effects are mainly good and acceptable in independent living and dental aspects, while the service effects in the remaining 5 aspects such as exercise, nutrition, social interaction, cognition and depression are mostly poor and poor. The reason is the asymmetry between the plan execution content and the outcome indicators. Conclusion. The long-term care program for mentally ill patients has positive results on the independent living and oral aspects of chronic mental illness in the community. However, the proportion of oral aspects of the intervention content is low, so the good results and intervention on the oral aspects (biting hard objects, choking) are irrelevant. This effect is a mature effect of the research sample, and due to the asymmetry between the program intervention content and the outcome indicators, it is not appropriate to use KCL as an evaluation tool for the long-term care program of mental patients. It is recommended that training on independent living functions should be strengthened to improve the adaptability and independence of patients in community life, and diversified assessment tools should be added to continuously understand the needs of long-term mental care cases and provide services that meet the needs of chronic mental patients in the community.