某精神科專科醫院病人高頻率住院相關因素探討

Factors Associated with High-frequency Users of Psychiatric Services in a Public Psychiatric Hospital in Taiwan

目的：本研究主要探討北台灣某精神科專科醫院多次重複住院病人之特徵及影響住院之 相關因素，以為將來介入處遇之參考依據。方法：以2007 年1 月至2010 年12 月間，北台 灣某精神科專科醫院住院病人依10% 比例隨機抽樣109 人為研究對象。根據modified Weiden’s criteria，將高頻率住院病人共38 人列為研究組，其餘71 人為對照組。兩組皆為作者以 歷年病歷記錄及轉院摘要收集相關資料。所收集資料以描述統計、邏輯式多變項迴歸及卜瓦 松迴歸之統計方法進行組間比較分析。結果：研究結果顯示未接受社區復健治療、平均住院 天數較短、診斷為一般性醫學狀況造成的精神病性疾患、有自殺行為及教育程度低於高中與 多次重複住院有顯著相關。結論：建議精神醫療從業人員在面對未接受社區復健治療、平均 住院天數較短、診斷為一般性醫學狀況造成的精神病性疾患、有自殺行為及教育程度低於高 中之病人，應提前介入處遇，以降低再住院率。

Objective: The purpose of this study was to explore factors associated with high-frequency users (HFUs) of psychiatric inpatient services in Taiwan compared with low-frequency users (LFUs), focusing on their social, demographic, clinical and service-related profi les. Methods: A random sample of 10% (n = 109) of all subjects admitted to Beitou Armed Forces Hospital, in Taipei, Taiwan, from January 2008 to December 2010 were divided into HFUs (n = 38) and LFUs (n = 71) in accordance with modifi ed Weiden’s criteria. We collected data from medical records of HFUs and LFUs to assess the impact of the profi les on the patterns of hospitalization. Results: According to these criteria, 34.9% of the study population were HFUs. Logistic regression analyses indicated that community-based outpatient services were signifi cantly associated with decreasingly more frequent readmissions (p < 0.05). A Poisson regression model showed shorter mean length of each admission (p < 0.001), a diagnosis of psychotic disorder due to general medical condition (p < 0.001), suicidal behavior (p < 0.05) and educational level lower than senior high school (p < 0.01) to be the signifi cant predictors of HFUs. Conclusions: The most important factors related to frequency of hospitalization were community-based outpatient services, shorter mean length of each admission, a diagnosis of psychotic disorder due to general medical condition, suicidal behavior, and educational level lower than senior high school. The mental health system should therefore provide better resources to these patients to reduce hospitalization rates.