精神分裂症病患三種社區精神復健模式之醫療利用分析

The Analysis of Health Services Utilization of Three Types of Community Psychiatric Rehabilitation Services for Patients with Schizophrenia

吳希文(Hsi-Wen Wu) ； 楊銘欽(Ming-Chin Yang)

《臺灣職能治療研究與實務雜誌》 8卷1期 (2012/06) Pp. 1-14

https://doi.org/10.6534/jtotrp.2012.8(1).01

摘要

目的：本研究之目的在探討精神分裂症病患接受社區復健中心、康復之家治療後之住院醫療利用及其影響因素。方法：以「2002-2007精神疾病住院病患歸人檔」中擷取2006年精神分裂病患，自精神科住院出院後一年期間，連續接受30日以上社區復健中心治療者203人、接受康復之家治療者196人，及接受精神科門診追蹤者1631人為研究對象。以卡方檢定、檢定、one-way ANOVA、差異中之差異法、複迴歸等方法進行分析，另以傾向分數分析法校正選樣誤差。結果：以差異中之差異法分析，相較僅接受門診追蹤者，曾接受社區復健中心治療者，結束治療後一年期間精神科住院精神醫療治療費每人淨減少4.64千元，結束治療後二年期間精神科住院精神醫療治療費每人淨減少6.86千元。而影響病患社區精神復健成效的因素有年齡、性別、前一年精神科住院日數、非精神科住院日數、非精神科住院之總醫療費用、社區精神復健機構之權屬別、是否跨區接受社區精神復健治療，以及接受社區精神復健的時間長短等。結論：精神分裂症病患出院後曾接受社區復健中心治療者，其結束治療後一年及二年期間精神科住院之精神醫療治療費較接受門診追蹤者低；然接受康復之家治療者僅於其結束治療後一年期間精神科住院之精神醫療治療費較接受門診追蹤者低。

關鍵字

精神病患 ； 社區復健成效 ； 康復之家 ； 差異中之差異法 ； 傾向分數

並列摘要

Objective: The aim of this research was to examine the effects of community rehabilitation centers or half-way houses on medical care utilization for patients with schizophrenia and related factors. Methods: We used the 2002-2007 Psychiatric Inpatients Medical Claims Data from the National Health Research Institute to extract 203 schizophrenic patients who discharged from psychiatric hospitalization in 2006 and continuously received treatment for more than 30 days in community rehabilitation centers within 1 year and 196 schizophrenic patients in half-way houses. We also included 1631 schizophrenic patients who discharged from psychiatric hospitalization within 1 year and only received psychiatric outpatient follow-ups. Data were analyzed by using, -test, one-way ANOVA, difference in difference, and multiple regressions. We also used propensity score matching to adjust for selection bias. Results: Compared with patients who received only psychiatric outpatient follow-ups, the net psychiatric medical expenditure decreased NT$4641.18 during the first year follow-up and decreased NT$6856.95 during the second year follow-up in patients who received treatment from community rehabilitation centers.The influences factors of the effects of community rehabilitation service were age, gender, psychiatric length-of-stay, non-psychiatric length-of-stay, non-psychiatric medical expenditure 1 year before receiving treatment, ownership of community psychiatric rehabilitation institutions, received community psychiatric rehabilitation services from institutions outside the region of residency, and the duration of treatment received. Conclusion: Compared with patients who received only psychiatric outpatient treatment, patients who received treatment from community rehabilitation centers had lower psychiatric medical expenditure in one and two-year follow-ups. Patients who received treatment from half-way houses had lower psychiatric medical expenditure in one-year follow-up.

並列關鍵字

Psychiatric patient ； Effects of community rehabilitation ； Half-way house ； Difference in difference method ； Propensity score