比較呼吸照護病房與居家照護對長期呼吸器依賴病患之成效

Comparing the Effects of Respiratory Care Ward and Home Care for Long-term Ventilator-dependent Patients

本研究為一描述比較性研究。以立意取樣方式，針對中部地區符合中央健保局呼吸器依賴病患整合性照護計劃病情穩定之病患，進行橫斷式之結構性問卷調查與每隔2～3個月之定期訪視或電話訪談，以了解與比較呼吸照護病房與居家照護病患之照護成本、照護成果與滿意度之差異。本研究對象包括30位呼吸照護病房病患及30位居家照護病患。結果在人口學特質方面，顯示呼吸照護病房組的病患年齡比居家照護病患較高、子女數較多及大多已婚，但教育程度略低及呼吸器使用月數較短，以上變項均達統計上之顯著差異(p<.05)。在成本方面，呼吸照護病房組（154,696元／月）之總成本花費較居家照護組（64,742元／月）為高，其中以呼吸照護病房組之醫療成本比率為最高，約佔總成本之87%。照護成果方面，呼吸照護病房組之呼吸道感染次數（3.7次／人）高於居家照護組（1.32次／人），迴轉次數（0.13次／人）低於居家照護組(0.76次／人），此兩項均達統計上之顯著差異(P<.002)。在主要照顧家屬之滿意度方面，雖呼吸照護病房組總平均分數3.43約略高於居家照護組3.03，但未達統計上之顯著差異；僅以病患緊急狀況處理、呼吸治療師與醫師專業照護、整體醫療照護及經濟負擔五項達統計上之顯著差異(p<.05)。因長期呼吸器依賴病患之居家照護較合乎成本效益，故應能做為日後政策規劃與實施之參考。同時，亦應鼓勵及積極輔導長期呼吸器依賴病患接受居家照護以降低未來醫療成本及提昇照護品質。

The design was descriptive comparative analysis. The purpose of this study was to compare the effects between ventilator-dependent patients cared at respiratory care ward (RCW) and at home (HC). A purposive sampling was used to collect data from stable long-term ventilator-dependent patients who met the criteria for national insurance coverage integrated care plan and lived in central areas of Taiwan. A structured questionnaire and regular 2-3 months home or telephone interviews were used to understand the differences in care costs, care outcomes, and caregivers' satisfaction. Thirty patients from RCW and 30 from HC were recruited in this study. The results indicated as follows. 1. A statistical significant difference was found between RCW and HC in which patients in RCW were older, higher education, more married, and more number of children, but less months of ventilator used than HC patients. 2. The total cost of RCW (NT154,696) was higher than those cared at home (NT64,742). The health care costs were the major costs of RCW and possessed 87 % of total costs. 3. A statistical significant difference was found in both infection rate and returned rate between these two groups (p<0.02). The infection rate was reported 3.7 times per person for patients at RCW and 1.32 times per person at HC. For the returned rate, the RCW (M=0.13) was lower than those of patients cared at home (M=0.76). 4. For the main caregiver's satisfaction, although the score of satisfaction was slightly higher at RCW, it was not reach the significant level. Only emergency care, respiratory therapists, professional physicians, overall care, and economic burden of the family were shown significant differences between these two groups (p<0.05). Because the HC for long-term ventilator-dependent patients was more cost-effective, the results may provide valuable information for policy decision-making in planning long-term ventilator-dependent care. Moreover, encouraging home care is needed to improve the quality of long-term ventilator-dependent care and to reduce the health care expenditure in the future.