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  • 學位論文

社區復健模式對精神分裂症患者再入院風險影響

The Influence of Community Psychiatric Rehabilitation on Readmission among Patients with Schizophrenia.

指導教授 : 許玫玲
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摘要


本研究目的在分析台灣地區曾住院之精神分裂症患者其使用社區復健照護及門診醫療情形。並分析不同社區復健模式對精神分裂症患者再住院之風險。利用國家衛生研究院之「精神疾病住院病患歸人檔」,將資料庫中2003年至2004年間有出院紀錄之精神分裂症患者,按照其門診利用方式劃分為社區復健中心組282人、康復之家組697人、門診組12,233人以及未使用門診3,135人。運用存活分析法,分析其使用社區復健照護及門診醫療情形,並探討在控制人口學變項、用藥情況、過去精神科住院情形以及當地精神科醫療資源等變項後,社區復健模式對精神分裂症患者再住院之風險。 研究發現僅7%左右精神分裂症患者有使用社區復健資源,且多數集中在社區復健資源較高的地區,顯示精神分裂症患者可能因就醫需求,具有向社區復健資源較高的地區聚攏情況,故推測台灣地區社區復健資源仍有不足現象。進一步分析精神分裂症患者利用社區復健治療的情形發現,未使用社區復健治療之患者再入院風險,是使用社區復健中心者的1.88倍。探究同屬社區復健治療範疇的社區復健中心與康復之家,在控制變數之後,康復之家組的再入院風險為社區復健中心組的1.31倍,再入院風險在兩組間具顯著差異。此外,本研究亦發現社區復健資源多寡可能影響精神分裂症患者再入院風險,社區復健資源較低的地區明顯有較高的再入院風險,甚至可能產生精神科病床不足之假象。建議主管機關應持續推廣社區復健醫療,並考量其與急、慢性病床病人間流動情形,建立具整體性之精神照護網絡。

並列摘要


The objectives of this study were to analyze the utilization of community rehabilitation care and outpatient services by schizophrenics in Taiwan area after they were discharged from hospitals, and to analyze the harzard of schizophrenics’ admission. By using PSY of Bureau of National Health Insurance as the basis of analysis. We divide four forms according to outpatient service types of schizophrenics from 2003 to 2004: community rehabilitation, halfway house, outpatient service and the patients only use inpatient service. Survival Analysis is used with a longitudinal study design to analyze schizophrenics in PSY database who used the community rehabilitation, outpatient service and the harzard of readmission when other influencing factors are under control. The study finds only 7% schizophrenics who used the resource of community rehabilitation, and most of them gather in high lever resource area. This situation appears the medical resources of community rehabilitation still were not sufficient. And we also find the harzard of readmission for the schizophrenics who have taken advantage of community rehabilitation treatment is lower. Although both community rehabilitation centers and halfway houses are community-based rehabilitation care institutions, the difference of readmission risk is still apparent even if the difference between the users is not obvious when other influencing factors are under control. The fact that insufficient community rehabilitation resources tend to increase the risk of schizophrenic’s re-hospitalization, even possibly leading to a false impression of inadequate psychiatric beds. It is suggested that community rehabilitation care be promoted continuously and the mobility between this kind of care and patients in acute and chronic beds be taken into consideration, thereby establishing holistic psychiatric care network.

參考文獻


胡海國 (2002)。精神分裂症之社區流行病學。當代醫學,29(9),717-727。
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張景瑞、胡海國、葉玲玲、張宏俊(1995)。出院精神分裂症患者社區生活適應的預測因子
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被引用紀錄


吳希文(2011)。臺灣社區復健模式對精神分裂症病患醫療利用的影響〔博士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2011.02937
李亞璇、謝碧晴、李中一、蘇慧芳(2013)。精神疾病社區復健使用者再入院及危險因素之探討台灣公共衛生雜誌32(6),586-598。https://doi.org/10.6288%2fTJPH201332102057

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