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  • 學位論文

臺灣社區復健模式對精神分裂症病患醫療利用的影響

The Effects of Community Rehabilitation Models on Health Services Utilization among Patients with Schizophrenia in Taiwan

指導教授 : 楊銘欽

摘要


社區精神醫療模式已成為各國慢性精神病患治療的主流,過去研究顯示,我國精神社區復健服務使用率相較於其他國家顯著偏低。為了暸解接受社區復健模式治療後的精神分裂症病患,是否會降低其後續醫療利用,藉此評估社區復健是否尚有加強擴充或鼓勵病患轉介的需要,因此,本研究之目的在探討精神分裂症病患在出院後是否接受社區復健模式(包括社區復健中心、康復之家、或日間留院) 治療、治療時間的長短,以及是否跨區接受治療,對其結束前述治療後1年內以及2年內醫療利用的影響。 本研究由全民健保資料庫擷取2006年自精神科住院出院後一年內,連續接受30日以上社區復健中心治療的病患203人、康復之家治療的病患196人、日間留院治療的病患203人,接受前述三種照護模式的病人為治療組,另以接受精神科門診追蹤之1631人為對照組,以描述性統計、卡方檢定、t檢定、複迴歸、差異中之差異法進行資料分析,另以傾向分數分析法校正選樣誤差。 研究結果發現,有接受日間留院治療者,可降低其結束治療後1年內之非精神科住院醫療利用;有接受社區復健中心治療者,可降低其結束治療後1年內以及2年內的精神科急性住院醫療利用;有接受康復之家治療者,可降低其結束治療後1年內的精神科急性住院醫療利用。至於接受日間留院治療時間為4-6個月者,相較僅接受1-3個月之治療者,其結束治療後2年內之精神科急性住院醫療利用較低;接受社區復健中心治療時間為10-12個月者,相較僅接受1-3個月之治療者,其結束治療後2年內之精神科急性、慢性住院醫療利用較低;接受康復之家時間為10-12個月者,相較僅接受1-3個月之治療者,其結束治療後1年內之精神科慢性住院醫療利用較低、結束治療後2年內之精神科急性、慢性住院醫療利用較低。在跨區就醫對精神分裂症後續醫療利用影響的結果發現,有跨區接受日間留院治療,相對於無跨區者,其結束治療後1年內的精神科慢性住院精神醫療治療費、結束治療後1年內及2年內精神科慢性住院次數較高;有跨區接受社區復健中心治療者,相對於無跨區者,其結束治療後1年內非精神科住院次數及精神科慢性住院次數較高;至於是否跨區接受康復之家治療,與其結束治療後1年內以及2年內的醫療利用無顯著相關。 結論:本研究結果呈現精神分裂症患者在出院後接受社區復健中心、康復之家或日間留院治療至少30日以上,相對於接受門診追蹤治療者,其後續醫療利用均有顯著減少。

並列摘要


Community mental health care model has become the mainstream of the treatment in patients with chronic mental health illness among the world. According to the literature reviews, the proportion of the utilization of psychiatric community rehabilitation services in Taiwan was relative lower than that of the other countries. Reseacher would like to investigate whether the treatment of community rehabilitation services for patients with schizophrenia could decline the health services utilization after admission, and to evaluate that the community rehabilitation models is still needed to be expanded, strengthen or encouraged to referral. The aim of this research was to investigate the effects of health services utilization among patients with schizophrenia after 1 and 2 years treatment in the community rehabilitation (including models of community rehabilitation center, half-way house, and day care center). This research also investigated the effects of health services utilization after 1 and 2 years treatment in the community rehabilitation among patients with schizophrenia when the different length of treatment or cross-section to receive the treatment. We included 203 patients discharged from psychiatric hospitalization within 1 year continuously treatment for more than 30 days in community rehabilitation centers, 196 patients treatment for more than 30 days in half-way houses, and 203 patients treatment for more than 30 days in day care centers. We also included 1631 patients discharged from psychiatric hospitalization within 1 year and only receive psychiatric outpatient follow-up. Data were analyzed by using descriptive method, χ2 test, t-test, multiple regression, and difference in difference method. In order to reduce selection bias, the researchers used propensity score method to balance the covariates. The results revealed that, compared with patients who received only psychiatric outpatient treatment, patients who received treatment from day care centers had lower non-psychiatric inpatient health services utilization after 1-year follow-up. Patients who received treatment from community rehabilitation centers had lower acute psychiatric inpatient health services utilization after 1 and 2-year follow-up. Patients who received treatment from half-way houses had lower acute psychiatric inpatient health services utilization after 1-year follow-up. Compared with patients who received 1-3 months treatment from day care centers, patients who received 4-6 months treatment from day care centers had lower acute psychiatric inpatient health services utilization after 2-year follow-up. Compared with patients who received 1-3 months treatment from community rehabilitation centers, patients who received 10-12 months treatment had lower acute and chronic psychiatric inpatient health services utilization after 2-year follow-up. Compared with patients who received 1-3 months treatment from half-way houses, patients who received 10-12 months treatment had lower chronic psychiatric inpatient health services utilization after 1-year follow-up and had lower acute and chronic psychiatric inpatient health services utilization after 2-year follow-up. Patients received the treatment from day care centers cross-sectionally had higher chronic inpatient psychiatric medical expenditure after 1-year follow-up, and had higher numbers of chronic psychiatric hospitalization. Patients received the treatment from community rehabilitation centers cross-sectionally had higher non-psychiatric and chronic psychiatric hospitalization after 1-year follow-up, and had higher numbers of chronic psychiatric hospitalization. However, whether patients received the treatment from half-way houses cross-sectionally or not, that would not effects the health services utilization after 1 and 2-year follow-up. Conclusion: The results indicated that compared with patients who received psychiatric outpatient follow-up, patients who received treatment over 30 days in community rehabilitation centers, half-way houses, or day care centers had lower health services utilization after 1 and 2-year follow-up.

參考文獻


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被引用紀錄


湯茹雲(2018)。充權團體工作應用於精神科日間病房之成效評估〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU201800704

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