精神科慢性病房病人因身體疾患轉診治療的因子分析

Transfers due to Physical Illnesses among Patients in the Chronic Psychiatric Ward

目的：精神疾患的病人比一般群眾更容易有身體疾患的共病，死亡率也更高。精神醫療 機構在有限的醫療資源下，個案的身體狀況處理是一大挑戰，尤其是在精神科慢性病房。本 研究目的在收集精神科慢性病房中，因身體疾患而轉診的病人資料，並檢視相關危險因子。 方法：本研究為一回溯性病歷回顧研究。研究族群為 2011 年 1 月 1 日至 2013 年 6 月 30 日 之間，住在本院慢性病房且曾因身體疾患而轉診的病人，本研究萃取轉診、臨床醫學以及 人口統計學相關資料。結果：在此期間住在本院慢性病房的個案，34.8% 曾因身體疾患而轉 診，22.7% 曾至急診就診，7.8% 曾至綜合醫院住院。轉診及綜合醫院住院最常見的診斷為肺 炎，年齡較大（風險比數 = 1.04, 95% 信賴區間 = 1.02 - 1.06, p < 0.001）及思覺失調症之診斷 （風險比數 = 3.63, 95% 信賴區間 = 1.51 - 8.68, p < 0.01）和急診就診有顯著正相關，年紀較 大（風險比數 = 1.03, 95% 信賴區間 = 1.01 - 1.06, p < 0.0）及抽煙史（風險比數 = 2.71, 95% 信賴區間 = 1.23 - 5.97, p < 0.01）和肺炎診斷有顯著正相關。結論：因身體疾患而轉診之盛 行率在精神科慢性病房的病人中相當的高，未來需要更多關於精神科慢性病房中身體疾患之 研究，以進一步了解影響因子及機制，並發展早期預防及發現身體疾患的方案。

Objectives: Patients with psychiatric diseases are more likely to have medical co-morbidities and increased mortality than those in the general population. Staff at psychiatric institutions face challenges in the aspect of medical care toward physical illnesses with limited medical resources, especially in the psychiatric chronic ward. In this study, we intended to examine the characteristics and related risk factors of transfers due to physical illnesses among individuals in the chronic psychiatric ward. Methods: This is a retrospective chart review study. We extracted records of transfers due to physical illness among the patients in the chronic psychiatric ward of Taoyuan Psychiatric Center from January 1, 2011 to June 30, 2013. Demographic data were also collected. Results: During the study period, 34.8% of the patients in the chronic psychiatric ward were ever transferred due to physical illnesses. Of 455 episodes of transfers, 22.7% of them visited emergency department at least once and 7.8% of them suffered from at least one general medical hospital admission. The most common diagnosis of transfers and further general medical hospital admission was pneumonia. Elder age (adjusted odds ratio = 1.04, 95% confidence interval = 1.02 - 1.06, p < 0.001) and schizophrenia diagnosis (AOR = 3.63, 95% CI = 1.51 - 8.68, p < 0.01) were significantly associated with higher emergency department transfers. Further, elder age (AOR = 1.03, 95% CI= 1.01 - 1.06, p < 0.05) and smoking history (AOR = 2.71, 95% CI = 1.23 - 5.97, p < 0.01) were also significantly associated with higher risk of pneumonia. Conclusion: High prevalence of medical transferals due to physical illness was found among the chronic psychiatric ward. Studies further focusing on the physical health among the chronic ward was mandated. Programs for enhancing psychical health, early prevention and detection of physical diseases among individuals in the chronic psychiatric ward are needed.