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

目的：分析台灣地區精神分裂症患者出院後，社區復健照護及其他門診醫療利用情形。並分析使用社區復健模式對精神分裂症患者再住院風險影響，進而探討不同社區復健模式是否影響再入院風險。方法：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。結果：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。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。結論：建議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。

Purposes: The objectives of this study were to analyze the utilization rates of community rehabilitation care and outpatient services and the risk of readmission for schizophrenics in Taiwan after they were discharged from hospitals. Methods: By using data from the (PSY) of the Bureau of National Health Insurance from 2003 to 2004 as the basis for analysis, we divided the [number] patients into four groups according to type of outpatient service: community rehabilitation, halfway house, outpatient services, and no services after their inpatient stay. Survival Analysis was used as part of the longitudinal study design to determine who used community rehabilitation and outpatient services and their risk of readmission. Results: Only 7% of the schizophrenics utilized community rehabilitation, and most of these were in areas with a high concentration of resources. The risk of readmission for schizophrenics who took advantage of community rehabilitation treatment was lower. Although both community rehabilitation centers and halfway houses are community-based rehabilitation care institutions, the difference in risk of readmission was still apparent even if differences between the users were not. The fact that insufficient community rehabilitation resources increases the risk of re-hospitalization, suggests a false impression of an inadequate number of inpatient psychiatric beds. Conclusion: Community rehabilitation care should be promoted, and mobility between this kind of care and acute and chronic hospital beds be taken into consideration in order to establish a holistic psychiatric care network.