探討精神分裂症病患出院後遵囑服藥與再住院關係之前瞻性研究

The Relationship between Medication Adherence and Rehospitalization: A Prospective Study of Schizophrenia Patients Discharged From Psychiatric Acute Wards

背景：目前藥物治療為精神分裂症主要的治療方式，然而，其不遵囑治療的比例高達50-80%，實為不可忽視的照護挑戰，並且不遵囑治療與再發病之間具有顯著相關性。目的：探究精神分裂症病患出院後的遵囑服藥表現與再住院次數之間的相關性與預測性關係。方法：採前瞻性研究設計，以即將從精神科急性病房出院、且預計居住於社區之精神分裂症病患為研究對象，進行為期六個月的居家追蹤與評量，評量工具包括：遵囑服藥行為、遵囑服藥態度、服藥處方認知；並以病歷回顧同期間的再住院情形，進一步分析其間關係。結果：完成本研究病患共有77位，以男性、青壯年、未婚、整體功能偏中下、高中職畢業、出院後六個月內未再住院者居多。經迴歸模式分析發現：當出院後六個月內整體遵囑服藥表現、遵囑服藥態度以及服藥處方認知之分數提高時，會顯著降低再住院的相對風險（0.194-0.79倍）。結論／實務應用：精神分裂症病患出院後六個月期間遵囑服藥表現可預測其再住院之發生，未來宜針對此族群發展本土化出院規劃及社區追蹤處置。

Background: Antipsychotics have been regarded as the most effective therapy for schizophrenia; however, Taiwan's non-adherence rate for prescribed antipsychotics of 50-80% is an important issue that relates directly and significantly to schizophrenia patient relapse rates.Purposes: This study examines the correlational and predictive relationships between medication adherence and rehospitalization in schizophrenia patients discharged from an acute ward.Methods: This study used a prospective research design. Schizophrenia patients discharged from a psychiatric acute ward who stated their plan to live in the community were recruited as participants. Participant medication adherence was assessed via home visits during the 6-month follow-up period using scales including the Medication Adherence Questionnaire (MAQ), drug attitudes, and regimen knowledge. Rehospitalization data were retrieved from electronic medical records. Relationships between medication adherence and rehospitalization were analyzed using t-tests and regression analysis.Results: Seventy-seven patients with schizophrenia discharged from the acute ward were recruited in accordance with sampling criteria. The majority were male, young, unmarried, had poorer global function, had 12 years of education, and were not rehospitalized during the past 6-month period. Using binomial regression analysis, we found the relative risk for number of rehospitalizations during the 6-month period to be significantly less and the average scores for the total scale, attitude subscale, and knowledge subscale of medication adherence to have increased (0.194-0.79 times).Conclusions / Implications for Practice: Our findings support that better medication adherence in people with schizophrenia decreases rehospitalization risk. We urge clinicians to develop sensitive interventions to promote antipsychotics adherence in this population.