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系統識別號 U0026-0812200913475685
論文名稱(中文) 精神分裂症患者出院後一年內再住院之因素探討
論文名稱(英文) Exploring the Readmission Factors of Discharged Schizophrenia in One Year
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 95
學期 2
出版年 96
研究生(中文) 沈淑華
研究生(英文) Shu-hua Shen
電子信箱 shuhwa@mail.cnpc.gov.tw
學號 t2693410
學位類別 碩士
語文別 中文
論文頁數 65頁
口試委員 指導教授-顏妙芬
召集委員-簡以嘉
口試委員-李引玉
中文關鍵字 藥物遵醫囑性  精神分裂症  再住院 
英文關鍵字 Drug compliance  Re-hospitalization  Schizophrenia 
學科別分類
中文摘要 目的:精神分裂症患者常經驗到疾病復發,可能導致反覆住院,而加重家屬照護負擔及增加醫療成本。本研究則是希望了解患者出院後再住院之相關影響因素,期能藉此建立精神分裂症患者照護模式,以降低再住院率。
方法:本研究採病歷回溯研究法,研究對象為台灣南部某精神專科教學醫院,個案管理中心資料庫,診斷為精神分裂症,時間於2002年11月至2006年4月之初次住院之患者,收取有效樣本資料共149位。統計分析方法以SPSS 14.0統計軟體進行資料分析。統計方法包括:百分比、平均數及標準差等描述性統計,及Chi-Square、邏輯式回歸分析等進行推論性統計。
結果:研究可見患者出院後一年內再住院比率為34.9%,以男性、未婚、高中(職)者居多、平均年齡為33.8歲;發病年齡平均為26.6歲;主要照顧者以父母親為主。另發現出院方式(2 = 7.51,p = .01)、家庭支持度(c2 = 6.98,P = .03)、家人參與治療(c2 = 21.71,P = .001)、藥物遵醫囑性(p < .01)及利用社區醫療資源(2 = 7.06,p = .008)等四項因素與是否再住院於統計上有顯著相關。透過迴歸分析與再住院風險值,研究發現家人若無參與治療者,較參與治療者增加4.64倍(p = .001);患者當時出院方式以自動出院較非自動出院,增加4.52倍(p = .04);患者家庭支持程度差,較其家庭支持程度佳者,增加5.07倍(p = .01),再住院預測力為25.7%。
臨床應用:透過研究結果發現首次住院患者之再住院比率及影響患者出院後再住院變項有出院方式、家庭支持程度、家人是否參與治療、出院後藥物治療遵醫囑性、及社區醫療資源利用。其中尤以家人若無參與治療、家庭支持程度差及自動出院者,為預測患者出院後再住院之重要因子。因此,臨床醫療人員對首次住院之患者需儘早完成家庭評估、了解家庭中重要資源、提供家人心理支持及衛生教育,鼓勵家人共同參與討論患者住院治療計畫,將是建立精神分裂症患者照護模式中之重要介入方針。
英文摘要 Objectives: Schizophrenic patients frequently experience relapses of their disorders that lead to the recurrence of re-hospitalizations and, further, the augmentation of the family’s burdens of taking care of the patients and the increase in cost of medical treatment. In the present study, it was hoped that the factors related to the re-hospitalization after the patient’s discharge would be elucidated and it was expected that by so doing the modality of taking care of schizophrenic patients would be established and the re-hospitalization rate would be decreased.
Methods: A chart review method was employed in the present study. The subjects were those patients who were diagnosed as schizophrenia from the data base of the Case Management Center of a teaching hospital specialized in psychiatry located in the Southern Taiwan. They were the inpatients of the initial hospitalization from November 2002 to April 2006, and the total number of the effectively recruited sample was 149. Statistical analyses were performed using SPSS 14.0 of the (Macintosh) statistical software. Included in the statistical analyses were percentage, average, standard deviation and other descriptive statistics as well as Chi-Square Test, logistic regression analysis and other speculative statistics.
Results: It was found in the present study that the re-hospitalization rate within a year after discharge was 34.9% and that the majority of these cases of re-hospitalization were male, single, high school graduates of whom the average age was 33.8%, the average age of onset was 26.6 years, and the caregiver were the parents. It was noticed that there was a significant co-relationship between whether or not patients would be re-hospitalized and the five factors including the modality of discharge, degree of family support, family’s participation in treatment, drug compliance, and as well as utilization of the resources of medical treatment in community. It was through the logistic regression analysis and the examination of the re-hospitalization risk that the present investigator recognized the following findings. The rate of re-hospitalization was increased as high as 4.64 times among the families who did not participate in treatment as compared with those participated; 4.52 times among the patients of A. A. discharge as compared with those of M. B. discharge; 5.07 times among those with poor family support as compared with those with favorable family support; and, thus, the power of prediction of these 3 factors was estimated as much as 25.7%.
Conclusions: It was through the aforementioned results that the present investigator figured out the re-hospitalization rate, and that the variables that influenced the re-hospitalizations after discharge were the modality of discharge, the degree of family support, whether or not the family participated in treatment, and drug compliance as well as utilization of the resources of medical treatment in Community. In particular, family’s not participating in treatment, poor family support, and A. A. discharge were the important factors that predicted the re-hospitalizations after discharge. Therefore, that the clinical medical treatment staffs need to (1) complete the family assessment for the initially admitted patients as soon as possible, (2) understand the important resources in the family, (3) provide the family with psychological support and psycho-education, and (4) encourage the family to collaboratively participate in discussing the therapeutic plans regarding the patient’s admission would be important intervention strategies in establishing the modality of taking care of schizophrenic patients.
論文目次 論文目錄
中文摘要…………………………………………………………………I
英文摘要………………………………………………………………III
致謝……………………………………………………………………V
論文目錄………………………………………………………………VII
附件目錄………………………………………………………………IX
表目錄…………………………………………………………………X
圖目錄…………………………………………………………………X

目 錄
第一章 緒論…………………………………………………………1
第一節 研究背景與重要性…………………………………………1
第二節 研究目的……………………………………………………2
第三節 研究問題……………………………………………………2
第二章 文獻查證……………………………………………………3
第一節 精神分裂症疾患特性………………………………………3
第二節 精神分裂症病患復發與再住院相關之研究………………4
第三節 人口學變項與再住院之關係………………………………5
第四節 疾病病程變項與再住院之關係……………………………7
第五節 家庭與再住院之關係………………………………………9
第六節 藥物治療遵從度與再住院之關係…………………………10
第七節 社區醫療資源利用與再住院之關係………………………11
第三章 研究方法與過程……………………………………………13
第一節 研究架構 ………………………………………………13
第二節 名詞定義……………………………………………………14
第三節 研究設計……………………………………………………15
第四節 研究對象及場所……………………………………………15
第五節 研究工具……………………………………………………15
第六節 資料收集……………………………………………………16
第七節 資料分析和解釋……………………………………………19
第八節 研究倫理考量………………………………………………22
第四章 研究結果……………………………………………………23
第一節 樣本數資料收集……………………………………………23
第二節 人口學變項…………………………………………………23
第三節 疾病歷程變項………………………………………………25
第四節 家庭層面變項………………………………………………27
第五節 藥物遵醫囑性變項…………………………………………28
第六節 社區醫療資源利用變項 ……………………………………29
第七節 人口學、疾病歷程、家庭層面、藥物遵醫囑性及社區資源利用等變項與是否再住院之關係………………………………………30
第八節 影響再住院預測因子………………………………………37
第五章 討論…………………………………………………………39
第一節 首次住院精神分裂症疾患再住院情形……………………39
第二節 人口學………………………………………………………39
第三節 疾病歷程……………………………………………………41
第四節 家庭層面……………………………………………………43
第五節 藥物治療遵從度……………………………………………45
第六節 社區醫療資源利用…………………………………………45
第七節 再住院預測因子……………………………………………47
第六章 結論…………………………………………………………49
第一節 研究限制………………………………………………49
第二節 建議……………………………………………………50
參考文獻………………………………………………………………52
中文文獻…………………………………………………………52
英文文獻…………………………………………………………55
附件
附件一 個案資料登錄單…………………………………………61
附件二 個案資料登錄指引………………………………………63

表目錄
表 3-1 描述性統計分析………………………………………20
表 3-2 推論性統計分析………………………………………21
表 4-1 研究樣本人口學變項之分佈…………………………24
表 4-2 研究樣本疾病歷程變項之分佈………………………26
表 4-3 研究樣本家庭層面變項之分佈………………………27
表 4-4 研究樣本藥物治療遵醫囑性變項之分佈……………28
表 4-5 研究樣本社區醫療資源利用變項之分佈……………29
表 4-6.1 影響是否再住院之單變項分析,按人口學變項……31
表 4-6.2 影響是否再住院之連續單變項分析,按人口學變項...31
表 4-7.1 影響是否再住院之單變項分析,按疾病歷程變項…33
表 4-7.2 影響是否再住院之連續單變項分析,按疾病歷程變項…33
表 4-8 影響是否再住院之單變項分析,按家庭層面變項…35
表 4-9 影響是否再住院之連續單變項分析,按社區醫療資源利用...36
表 4-10 預測再住院之邏輯式向前逐步回歸分析…………………38

圖目錄
圖一 精神分裂症患者與再住院關係探討之研究架構圖…………13
圖二 資料收集與建檔之流程圖……………………………………18
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