出院準備服務病患入住機構式長期照護之相關因素探討

Exploring the Factors Affecting Discharge Planning Patients' Residing Institutional Long-Term Care Facilities

梁亞文(Yia-Wun Liang) ； 王素美(Su-Mei Wang) ； 李卓倫(Jwo-Leun Lee) ； 林育秀(Yu-Hsiu Lin) ； 鄭瑛琳(Ying-Lin Cheng)

《醫護科技學刊》 10卷1期 (2008/01) Pp. 1-14

https://doi.org/10.6563/TJHS.2008.10(1).1

摘要

目標：探討影響出院準備服務病患使用機構式長期照護之因素。
方法：本研究以台中市某區域教學醫院之出院準備服務病患爲研究對象，透過結構式問卷進行調查，經訪視完成有效問卷259份，完成率爲86%。統計方法包含描述性統計、卡方檢定及對數復迴歸分析。
結果：入住機構式長期照護的重要預測因子包含病人教育程度、居住型態、主要經濟來源、自評健康狀態、慢性病、日常功能狀態、訪視次數。相較於不識字者，國中畢業及高中以上畢業者入住機構式長期照護的勝算比分別爲5.98(95% CI=1.456-25.517, P=0.016)及5.869(95% CI=1.033-3.353, P=0.046)；相較於獨居者，與他人同住者的勝算比爲0.122(95% CI=0.019-0.766, P=0.025)；相較於子女爲主要經濟來源者，主要經濟來源來自政府補助者的勝算比爲13.027(95% CI=1.309-129.616, P=0.029)；相較於健康狀態普通者，自評健康狀態不好及非常不好者的勝算比分別爲4.975(95% CI=1.043-23.742, P=0.044)及9.815(950% CI=1.550-62.134, P=0.015)；有慢性病者的勝算比爲4.919(95% CI-1.117-21.669, P=0.035)；相較於日常生活完全依賴他人照顧者，日常功能狀態至少能步行及維持大部份自我照顧者的勝算比爲15.215(95% CI=1.235-187.513, P=0.034)；相較於訪視次數僅有一次者，訪視次數爲2-3次者的勝算比爲0.203(95% CI=0.071-0.576, p=0.003)。
結論：在地老化是台灣長期照護政策的目標，在地老化或能延後入住的時問，但避免不了入住。因此，一個聯結病患、醫院及機構式長期照護的出院準備服務計劃仍有其存在的必要性。建議衛生主管機關應持續推動出院準備服務計畫，且積極整合醫師、社工人員等專業人員於其中，並加強其深度與廣度，提高病人及其家屬對機構式長期照護的接受度。

關鍵字

長期照護 ； 出院準備服務 ； 長期照護機構 ； 機構式長期照護

並列摘要

Object: This study explores factors affecting patient discharge from institutional long-term care facilities.
Methods: Data was collected from a central Taiwan regional hospital. The sample included 259 subjects receiving discharge planning services. Descriptive analysis, bivariate analysis and multiple logistic regression were used to examine possible factors associated with use of institutional long-term care facilities.
Results: After adjusting for various variables, the data indicated that education level, living arrangement, income source, self-rated health status, chronic disease, daily life activity, and discharge planning intensity were significantly related to entering the institutional long-term care facilities. Junior high school (OR=5.989, 95% CI=1.456-25.517) and senior high school (OR=5.869, 95% CI=1.033-3.353) graduates were more likely to enter institutional long-term care facilities. People living with others (OR=0.122, 95% CI=0.019-0.766) were less likely to enter institutional long-term care facilities. People receiving government benefits (OR=13.027, 95% CI=1.309-129.616) were more likely to enter institutional long-term care facilities. Subjects who self-rated their health as poor (OR=4.975, 95% CI=1.043-23.742) or very poor (OR=9.815, 95% CI=1.550-62.134) were more likely to enter institutional long-term care facilities. Additionally, the corresponding risk of entering institutional long-term care facilities in subjects with chronic diseases was 4.919 times higher than those without chronic disease (95% CI=1.117-21.669). Similarly, better functional status of daily life was also associated with higher risk (OR=15.215, 95% CI=1.235-187.513). Subjects who received more discharge planning visits (OR=0.203, 95% CI=0.071-0.576) were less likely to enter institutional long-term care facilities.
Conclusion: ”Aging in Place” is currently the guiding principle for devising elderly care policy in Taiwan. To some extent, aging in place may delay the time of entry into institutional long-term care facilities but cannot replace it completely. Consequently, a more comprehensive transfer system for patients, hospitals and institutional long-term care facilities is needed. Policy makers should develop policies that improve discharge planning and integrate the expertise of more health professionals to promote the acceptance of institutional long-term care facilities.

並列關鍵字

Long-term care ； discharge planning ； institutional long-term care facility

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