居家治療影響再住院次數之相關因素

Factors Affecting the Readmission Rate after Psychiatric Home Treatment

目的：本研究主要探討影響台灣居家治療改善住院次數之相關因素，以為將來介入處遇之參考依據。方法：由三總北投分院正接受居家治療的病人中抽樣70人，並由嘉義基督教醫院正接受居家治療的病人中抽樣27人。收集歷年居家治療病歷記錄及個管師會談結果做描述統計、廣義線性模型進行比較分析。結果：研究結果顯示先前住院次數與居家治療對住院次數之改善效果有顯著正相關(p<0.001)。病情嚴重度（以CGI-S分數表示）(p<0.001)及先前犯罪史（p<0.01或p<0.05〔兩種分析的結果〕）與居家治療對住院次數之改善效果有顯著負相關。結論：建議精神醫療從業人員可多鼓勵先前住院次數多的精神病患接受居家治療以改兩善住院次數，而對於病情較嚴重或是先前有犯罪史的病人則可能需要更多關注與介入，才較有可能見著居家治療來達到改善效果。

Objective:The objective of this study was to explore the factors associated with differences in hospital admission rates before and after psychiatric home treatment in Taiwan. Specifically, this study was to focus on social, demographic, clinical, and service-related factors. Methods:We recruited 97 convenient samples of patients who received psychiatric home treatment from either the Beitou Branch, Tri-Service General Hospital (Beitou Branch, TSGH) in Taipei, Taiwan, or Chiayi Christian Hospital (CCH) in Chiayi, Taiwan. The data were collected from the participants’ home treatment medical records and from data of interviews with their case managers to assess the effects of several factors on the numbers of hospital admissions before and after home treatment. Results:A generalized, multivariate linear model revealed that more frequent hospital admissions were significantly associated with more difference in admission after home treatment (p< 0.001). In addition, higher Clinical Global Impressions-Severity (CGI-S) scores (p < 0.001) and a criminal history (p< 0.01 in univariate analysis, and p< 0.05 in multivarate anlysis) were significantly associated with less improved hospital admission. The most important predictors of improvements in hospital admission rates after home treatment in Taiwan were the previous admission rate, CGI-S score and criminal history. Previous admission positively predicts the improvement in hospital admission whereas CGI-S and criminal history predict negatively. Conclusion:Our findings of this study suggest that home treatment should be encouraged among patients with higher rates of previous hospital admissions. In addition to home treatment, other adjuvant interventions should be used for patients with high CGI-S scores or criminal records to reduce the likelihood of future hospitalization.