精神科日間照護病房住院病人的出席率與預測因子之回溯性研究

Clinical Correlates of Attendee Patients in Psychiatric Day Care: A Multiple Correspondence Analysis

目的：探討精神科日間照護病房住院病人出席率與相關的預測因子。方法：利用病歷回 顧方式收集自 2015 年 1 月至 2016 年 12 月於基隆長庚醫院精神科日間照護病房住院病人病 歷，收集分析資料包括人口學變項（性別、年紀、教育程度）、轉介方式、日間照護病房組 別、住院時間、診斷、過去住院次數、環境因素（至日間照護病房所需的時間、轉乘公共交 通工具的班數）、認知功能與行為功能的評估結果，並以多元對應分析法進行統計分析以了 解可能影響出席率的變項。結果：截切點為 5% 的前提下，可整理出七種組合的維度，第三 和第四維度可解釋大部分的變異數（各為 47.6% 和 63.1%）。在第三維度中，不佳的出席率 與鬱症 （p < 0.001）、女性 （p < 0.001）、認知功能障礙 （p < 0.001）、較短通勤時間 （p < 0.001）、 少於兩班的轉乘次數 （p < 0.05）、及在 2015 年住院 （p < 0.05） 有顯著的相關。在第四維度中， 出席率佳 與 2015 年後住院 （p < 0.001）、干擾行為少 （p < 0.01）、物質使用障礙症 （p < 0.01）、 轉介自門診 （p < 0.05）、及中年 （p < 0.05） 有顯著的相關。結論：不佳的日間病房出席率與鬱 症、女性、認知功能障礙、居住處離日間病房較近、長期住院、年齡較小以及有明顯的干擾 行為相關。

Objectives: The objective of this study was to examine the attendance rate and its correlates among the patients in a psychiatric day care unit. Methods: We recruited 86 patients who entered the psychiatric day care unit at Chang Gung Memorial Hospital-Keelung between January 2015 and December 2016. Most of the observed patients' variables were categorized with multiple correspondence analysis, we examined the association of attendance rate with their individual clinical, and environmental factors. Results: Using the cutoff of 5% of the explained variation, seven dimensions were extracted. Among those , the categories of day care attendance contributed to a majority of the variance of the dimensions 3 and 4 (47.6% and 63.1%, respectively). In dimension 3, poor day care attendance was signifi cantly clustered with major depressive disorder (p < 0.001), female gender (p < 0.001), absence of cognitive impairment (p < 0.001), a short time of commute (p < 0.001), requiring fewer than two transfers (p < 0.05), and admission before 2015 (p < 0.05). In dimension 4, good day care attendance was clustered signifi - cantly with admission since 2015 (p < 0.001), low behavioral disturbance (p < 0.01), substance use disorder (p < 0.01), outpatient referral (p < 0.05), and middle age (p < 0.05). Conclusion: We found that un-attendance was clustered with major depressive disorder, female gender, absence of cognitive impairment, living close to the hospital, long-term admission, younger age and signifi cant behavioral disturbance. Since we have identifi ed these contributing factors, mental health professionals should thoroughly re-assess the patient before referral, offer assistance or reminders for attendance, and review the process of preparation, in order to improve the attendance.