影響腦中風患者使用居家復健服務相關因素之探討

Investigation of the Correlated Factors Influencing the Home-based Rehabilitation for Stroke Patients

吳淑娟(Shu-chuan Wu)

指導教授 ： 葉德豐

中臺科技大學/管理學院/健康產業管理研究所/碩士(2011年)

https://doi.org/10.6822/CTUST.2011.00060

摘要

本研究引用Andersen健康行為模式，探討在政府「長期照顧十年計畫」政策推動下，影響腦中風個案使用居家復健服務的相關因素。本研究資料來源為2008年7月至2010年6月期間，初次向「台中縣長期照護中心」申請服務之腦中風個案。本研究採用橫斷研究法，擷取個案「長期照顧管理服務個案評估量表」中的資料，依據Andersen第一階段健康行為模式理論架構，探討「人口學及社會結構特徵」的前傾因素構面、「社會醫療資源」的使能因素構面及「身心功能狀況」的需求因素構面與腦中風個案使用居家復健服務的影響。
本研究共收集759位腦中風個案，其中有119位個案(15.7%)使用居家復健服務。研究結果顯示影響個案使用居家復健服務的關鍵預測因素為使能因素之社會福利身份之低收入戶和中低收入戶；需求因素之罹患其他疾病數、距離最近一次罹病時間少於6個月、個案有安全維護和復健關節活動協助需求、及個案申請居家護理服務者；然而，個案使用「居家服務」的社會福利資源和申請「居家服務」項目者，預測使用居家復健服務的機率則較低，推論與這些付費服務之資源排擠效應有關。
本研究顯示除了個案的需求外，經濟因素明顯影響腦中風個案使用居家復健服務的意願。政府「長期照顧十年計畫」政策之「居家復健服務」提供腦中風個案更切身的居家復健指導與無障礙環境改善，期望能增進個案日常生活功能的獨立；但為了確保長期照顧服務資源分配之效率與效益，並做為未來「長期照顧保險」規畫的參考，相關單位應進一步規畫公平及精確的經濟補助方式。

關鍵字

Andersen健康行為模式 ； 腦中風 ； 居家復健 ； 長期照顧十年計畫

並列摘要

This study applys the Andersen Health Behavior model to explore the correlating factors which may influence the utilization of home-based rehabilitation services for stroke victims, whose care are provided under guidance of the state policy of "10-year Long-term Care Plan". The research data were collected from the stroke victims who initially applied for services to "the long-term care centers of the Bureau of Public Health at Taichung County". The data were collected from July 2008 to June 2010. The data were retrieved from the "Evaluation Form of the Long-term Care Management Services". Under the Andersen health behavior model, we investigate how the factors, such as demographic and social structure of predisposing level, social welfare and medical resources of enabling level and physical and mental health of need level, influence the utilization of home-based rehabilitation services for stroke victims.
Total of 759 stroke cases are collected, of which 119 cases (15.7%) employed the home-based rehabilitation services. The results of the study suggests the key predicting factors on the utilization of home-based rehabilitation services are low-income and medium-low-income households (social welfare status) of the enable factors; the comobidity of number of other diseases, less than 6 months from the last episode of stroke, necessity of safety maintenance and rehabilitation for joint range of motion and application of "home care" service of the need factors. otherwise, cases current employ of "home services" of the social welfare resources and applicate of "home services" of the need factors,were predicted using the home-based rehabilitation services less likely, we inferred this may be due to the crowding out effect of resources related to these paid services.
This study showed that in addition to various demand of each individual, economic factors significantly affect the willingness of stroke victims to employ the home-based rehabilitation services. Under the state policy of "10-year Long-term Care Plan", the agencies provide stroke victims with reliable sources of home-based rehabilitation services and an upgrade on home safety for disability. The agencie’s goal is to promote the level of independent activities of daily living for all stroke victims. To ensure the efficiency of delivery and adequate allocation of long-term care services, and to serve as a reference for future policy for the "long-term care insurance" plan, the agencies shall have in plan the financial subsidy for the ecomomically disavantaged families.

並列關鍵字

Andersen health behavior model ； stroke ； 10-year Long-term Care Plan ； Home-bsaed rehabilitation

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