思覺失調症患者非計畫性十四天再入院之相關因素探討

Factors Related to Unplanned Readmission within Fourteen Days after Discharge from Psychiatric Teaching Center in Southern Taiwan

目的：精神病患出院後再入院與較高的醫療支出和較差的預後有關，本研究目的在探討精神科急性病房出院後十四天再入院的相關因素。方法：本研究設計為個案對照研究法，以78名精神科急性病房出院十四天再入急性病房住院之思覺失調症為個案組，以入院日期相配對三倍比例的思覺失調症急性病房住院病患234名為對照組，採用卡方檢定及邏輯迴歸分析出院十四天再入院之相關因子。結果：卡方檢定發現個案組在男性、獨居狀態的比例有明顯高於對照組(p<0.05)。邏輯迴歸分析發現男性(OR=2.57，p=0.002)與前一次入院日期在週五或週六(OR=2.02, p<0.05)呈現顯著差異。結論：假期前收治的男性思覺失調症急性住院個案容易出院後十四天再入院；建議目前的健保給付或長照給付制度應加強精神科假期前後住院患者的出院準備服務計畫。

Objectives. Psychiatric re-admission is associated with higher medical expenses and poorer prognosis. We aimed to explore the relative factors of 14-day re-admission after discharge from acute psychiatric ward of one psychiatric teaching center in southern Taiwan.
Methods. This study using a case-control study. Seventy-eight schizophrenic inpatients from acute ward who met the criteria of 14-day re-admission were defined as the study group. We randomly selected 234 control subjects (the ratio of control group to study group is three to one) for each case subject, which were matched by admission date of study group. Chi-square test and logistic regression were used to identify the risk factors of 14-day re-admission.
Results. The results of chi-square test showed that the proportion of male and live along of study group was significantly higher than the control group (p<0.05). Further, logistic regression demonstrated that male gender (OR=2.57, p=0.002) and last admission date on Friday or Saturday (OR=2.02, p<0.05) were the predictors 14-day re-admission.
Conclusion. Male patients with schizophrenia who admitted prior to the weekend tend to re-admit within 14 days after discharge. Discharge planning from our national health insurance or long-term care services should focus on schizophrenic patients who receive acute care prior to holidays.