影響急性住院精神分裂症患者治療結果之相關因素

Factors Related to Treatment Outcome for Acute Schizophrenics

張淑莉(Shu-Li Chang)

指導教授 ： 劉俊昌

亞洲大學/健康學院/健康管理研究所/碩士(2006年)

摘要

精神分裂症，因疾病容易慢性化，反覆發作且整體功能易退化，往往造成患者重複住院或長期滯院，會增加醫療負擔，耗用社會成本。本研究目的在於找尋可以作為判別急性精神分裂症住院患者轉復健病房繼續留院之因素。本研究採病歷回顧方式，資料來源為台灣中部某精神專科醫院自93年1月1日至93年12月31日間，依據ICD-10被診斷為295.××疾病的401位住院患者的病歷。由病歷記載中讀取患者之社會人口學變項（包括性別、入院時年齡、婚姻狀態、教育程度）、住院次數、發病年齡、罹病時間、住院原因、主要照顧者之社會人口學變項及其與患者關係、醫院因素:主治醫師別等。將急性期治療後的患者分為：遵醫囑出院及轉復健病房繼續住院二類，作為依變項。以性別（女性為參照）、婚姻狀態、入院時年齡（歲）、住院次數、發病年齡、罹病時間、患者工作狀態、自我照顧能力、患者是否有攻擊性、破壞性、主要照顧者之特性及醫師別等作為自變項，進行對數回歸分析，並進一步就此主題對臨床醫療工作人員進行訪談。研究結果發現未婚或婚姻困難者、入院時年齡越高者、自我照顧能力較差者、罹病時間越長、發病年齡越低者與近一年無工作者，轉復健病房繼續留院治療之可能性越高，當主要照顧者為其他親友或兄弟姊妹時患者轉復健病房之可能性較主要照顧者為父母高，另發現醫師別亦是影響急性住院精神分裂症患者治療結果之相關因素。患者之性別、教育程度、住院次數、經濟狀況、患者對藥物接受度、患者是否有精神疾病家族史、因攻擊破壞性與自殺自傷傾向等原因而入院者及主要照顧者之特性與患者是否轉復健病房無顯著相關。此結果可當成醫療單位設計臨床改善指引方針，以及未來病房設置及人員培訓方向參考。建議在人員培訓上加強高齡及自我照顧能力缺失患者之照護訓練，而精神病復健病房在硬體設置標準也應針對高齡化族群患者之需求，考慮增設精神科老年病房並於各病房增加更多病人安全保護措施，醫療單位更應針對不同患者按其工作能力之程度差異安排工作場所及足夠之訓練人員配置，以幫助患者能早日培養獨立生活能力並避免因長期罹病造成之整體功能退化。

關鍵字

精神分裂患者者、出院患者、轉復健病房、復健患者

並列摘要

Becoming chronic or relapsing, or degradation of organ’s function would make the schizophrenic patient to visit the hospital repeatedly or even to get long stay. This issue costs a lot to not only medication but also public resource. The purpose of this study was to discover the factors that would influence the leaving or staying hospital of schizophrenic patients. The source of this study was based on the data of 401 patients of a psychiatric hospital in central Taiwan who were diagnosed as “disease 295.xx” in the time span of 2004-Jan-1 through 2004-Dec-31. A nominal regression was performed by using the assigned conditions for the peracute patients (leaving hospital per doctor’s advice, and move to chronic ward) as the dependent, and gender, marital, age, frequency of hospitalization, tendency of violence, self-care function as covariates. The result shows that the patients with older age, single, earlier onset of the disease, ability of self-care, and when key person were siblings were more likely to be assigned to stay at hospital for further therapy. There is no significant evidence to show that patient’s gender, patient’s economic situation, the patient accepts degree the medicine, family's history, frequency of hospitalization or tendency of violence are related to stay at hospital for further therapy. The study shows that some factors, including marital status, age of being hospitalized, time of onset of disease, ability of self-care, and the job condition of recent one year of patient, are related to if patient should continue the treatment at chronic ward, and leads to the recommendation of enhancing the security of hardware of chronic ward. It also advises that hospital should enhance the training to concerned staffs in taking care of the patients that is old age or lacking of self-care ability. At last, but not least, the study recommends the hospital should arrange proper working environment and sufficient trainers specifically for patients with diverse working ability.

並列關鍵字

Factors Related

參考文獻

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