- 學位論文
探討精神科病人就醫特性、疾病與處方關聯性之研究
Applying medical database to explore the relationships of characteristics of hospital visits , disease and medical prescriptions among psychiatric patients
摘要
精神疾病容易造成病人失能，以致於帶給家庭與社會沉重的心理與醫療資源使用負擔。在台灣精神科的醫療服務中，門診新病人“new patient”和初診病人“first-visiting patient”就醫狀況、醫療利用行為以及成長數量是醫療機構確保醫療的服務品質，和服務品質是否優質與完善的重要指標。本研究的目的為應用資料庫資料分析探討精神科門診病人就醫特性及疾病和處方關聯性之分析。 透過大型醫院的龐大就醫資料、以回溯性研究將病人三年內回診及住院的資料，探究處方與病人就診的關聯。以資料庫分析的方法，針對此族群門診醫療利用情形及住院情形進行描述性與推論性統計分析。 研究結果發現精神科門診病人持續性就醫及服藥遵從性欠佳，女性就醫比例比男性高，精神科病人有年輕化的趨勢。再次回診天數以57天居多。這三年的新病人、初診病人、複診病人都是以精神官能性憂鬱症病人為最多。美沙東的病人三年住院病人以在骨科病房住院最多。在精神科開立藥物筆數分析中發現以1-3筆佔多數、而複診病人則以4-6筆佔多數。使用抗精神病藥物以第一代佔多數，使用抗憂鬱藥物以單胺再吸收抑制劑 SSRI佔多數，使用抗焦慮藥物及鎮靜安眠藥物以BZD類抗焦慮藥物佔多數。 此研究結果提供給臨床護理人員精神科常見的疾病及使用的藥物，並提供醫院擬定照護政策以及居家服務之參考，讓醫院相關醫療人員能針對不同行為的精神科病人制定較為合適的衛教單元或追蹤模式，以確保精神科病人的良好就醫狀態和服藥順從性。
並列摘要
Mental illness, which is generally associated with distress or disability, has significant impacts on their family, society, and medical resource utilization. The behavior of medical care seeking, utilization of medical resources and the increase of the number of new and first-visiting patients are important indicators of quality of care service of any health care organization. The objective of this study was: to examine by analysis of the medical database, the relationships of characteristics of hospital visits, disease and medical prescriptions among psychiatric patients. This study utilized a retrospective study method to analyze the hospital database from a large hospital in southern Taiwan. Frequency of coming back for follow up at the hospital, and relationship between characteristics of medication descriptions and number of doctor appointments were evaluated. Descriptive and inferential statistics were used. This study found that medication compliance among patients with mental illness was rather poor. Female patients had more number of physician visits than male patients. This study also found the trend of patients suffering from chronic mental illness started at a younger age. The majority of new patients, the newly diagnosed patient, and patients who came back for follow-up consultation had a diagnosis of neurotic depression. In every visit, the majority of patients had 1-3 kinds of medications whereas those patients who came back for follow-up consultation had 4-6 kinds of medications. Most of patients were prescribed the first generation antipsychotics. Serotonin-specific reuptake inhibitors (SSRIs) were mostly used as antidepressants, and benzodiazepines as the anxiolytics. Overall, this study provides information regarding the most frequently diagnosed types of mental illness and the common medications prescribed for psychiatric patients. This information will be helpful for hospital policy making, and references of home care. It will also help health professionals to develop the appropriate patient education program or follow up procedures to improve the regular outpatient visits and medication compliance for patients with different help seeking behaviors.