目的:將首次住院病患比擬成正要加入一個新團體的成員,探討運用團體心理治療的「團體前準備」理論,來降低精神科急性病房的自動出院比率之可行性及成效評估。方法:為前瞻性世代研究,以2004年3月1日至2004年8月31日門診首次住院病患為對照組,共85人次,以2005年3月1日至2005年8月31日門診首次住院病患為研究介入組,共71人次。根據文獻回顧自動出院原因及「團體前準備」理論,製成入院衛教單張,由病患所在病房之護理人員執行降低自動出院的衛教。結果:門診病患首次住院的自動出院比率由14.1%下降至1.4%(p=0.004)。沒有實施「入院前衛教」的個案,其自動出院的風險是有實施「入院前衛教」個案的12.8倍。結論:運用團體心理治療的「團體前準備」理論所設計的衛教方式,可以有效降低門診初次入院病患的自動出院。
Objectives: It is assumed that patients on first admission are new members of a group. It is proposed that the use of a ”pre-group preparation” rationale will help to decrease the rate of discharge against medical advice (DAMA) from acute wards. The outcome of such an approach was assessed. Methods: The study was a prospective study. The control group was made up of 85 patients on their first admission to hospital from an outpatient department (OPD) and persons were recruited from March 1 to August 31, 2004. The intervention group consisted of 71 first admission OPD patients recruited from March 1 to August 31, 2005. An inpatient psycho-education manual was created based on a review of the causes of DAMA obtained from the literature and this formed the ”pre-group preparation” rationale. The psycho-education, which was aimed at decreasing DAMA, was conducted by the nursing staff on the wards where patients were staying. Results: The rate of DAMA among patients on first hospitalization from the OPD decreased from 14.1% to 1.4% (p=0.004) when the control and intervention groups were compared. The risk of DAMA among patients from the group who did not receive psycho-education was 12.8 times higher than among those that received psycho-education. Conclusions: The psycho-education was designed in accordance with the ”pre-group preparation” rationale and its application resulted in a significant decline in DAMA among patients on the first admission from the OPD.