安寧病房入住需求與資源分配研究

Analysis of Need and Resource Distribution for Admission to Hospice Ward

黃建勳(Chien-Hsun Huang) ； 姚建安(Chien-An Yao) ； 邱泰源(Tai-Yuan Chiu) ； 王浴(Yu Wang) ； 陳慶餘(Ching-Yu Chen)

《安寧療護雜誌》 10卷1期 (2005/02) Pp. 1-12

https://doi.org/10.6537/TJHPC.2005.10(1).1

摘要

台灣的安寧療護自1980年代發展迄今，不同的醫療機構存在供需不平衡的狀態。本研究以北部某醫學中心初次進行緩和醫療照會且簽具同意書之158位癌末患者為例，調查安寧病房供需現況，並探討影響資源分配之原因。申請照會的目的主要是控制身體的症狀(82.3%)，要求照會者以醫護人員最多(79.5%)，緩和醫療的資訊來源主要也是醫護人員(85.8%)。會談者首選床等以三人房較多(55.7%)，但登記床等以1、2、3人房皆可者最多(38.0%)，選擇床等之考量主要是為了能較快入院(48.1%)，其次是經濟因素(19.6%)等。由照會醫師評定入院急迫性，發現非常急迫者平均候床3.2±3.7天，13.9%病患候床超過一週，平均候床日為3.8±3.5天，平均每日候床人數為6.9±2.5人，候床原因包括沒有空床(79.7%)和床等不合適(39.9%)。158位候床者中最後入住124人(78.5%)，平均住院天數為9.4±7.9天，其中97人(78.2%)出院狀態為死亡（在院或回家往生），未入住之個案中，有50%於候床期間死亡。調查候床者接受轉院或居家照護的意願，結果不願意轉院者有92.4%，理由是病歷在本院(44.5%)、怕太遠或交通不便(36.3%)等；不願意先接受居家照護者有79.1%，理由是希望有醫院的環境或設備(92%)或家中人力不足(20%)等。因應之道包括：協助超長住院個案解決佔床問題、改善跨病房之共同照護、加強安寧居家療護、推廣日讓照護等，另外成立院際合作之轉介中心與增設健保床也是值得思考的作法。

關鍵字

安寧療護 ； 入住需求 ； 資源分配

並列摘要

The hospice movement in Taiwan started in the nineteen eighties. However there is imbalance of demand and supply for hospice wards between all hospice units. The purpose of the study is to investigate the influential factors and current status of demand and supply for hospice ward. We collected of a total of 158 terminal cancer patients with informed consent for hospice admission after the initial consultation in a medial center of Northern Taiwan. The result showed that symptom control (82.3%) is the principal reason for consultation. Those who asked hospice consultation are usually medical staff(79.5%), and the sources of hospice information are mainly from medical members(85.8%). The main consideration when the patients or their family choose the type of wards are whether they can be admitted as soon as possible (48.1%), followed by economic factor (19.6%). Therefore although their favorite choice is triple room (55.7%), but they are willing to accept any rooms that are available (38.0%). The average waiting time of admission is 3.2±3.7 days for patients with mostly urgent needs evaluated by consultant doctor. There are 6.9±2.5 people on daily waiting list, average waiting time is 3.8±3.5 days and 13.9% of them waited for more than a week. The reason for waiting is no vacancy (79.7%) and inappropriate type of rooms (39.9%). Total of 124 (78.5%) patients of all candidates were admitted finally and they had average admission duration of 9.4±7.9 days. Among inpatients, 97 (78.2%) of them were discharged because of death. For those not admitted, half of them were dead while waiting. However, 92.4% of the waiting patients refused to be referred to other hospice ward because of their medical records left in the initial hospital (44.5%) or transportation issues (36.3%). 79.1% of waiting patients were unlikely to receive home care program because they think hospital facilities are necessary(92.4%) or lack of sufficient man power(20%). The resolutions for resource imbalance are including of helping long-term admission patients to be discharged, improving combined care among different wards, enforcing hospice home care program, and developing hospice day care system. In addition, creating the refer center between hospice units and increasing the flexibility of wards are worth of considering for meeting patients' demands.

並列關鍵字

palliative care ； hospice admission ； need resource