公共衛生人員與病患家屬對社區追踪工作接納度之探討

STUDY ON THE ACCEPTANCE OF FOOLLOW-UP SERVICE BY THE PUBLIC HEALTH WORKERS AND THE PATIENTS' FAMILY

臺北市社區心理衛生保健工作模式發展的第一個階段是統合16區衛生所社會工作員、公共衛生護士的人力，並聘請四所臺北市內主要精神科醫療中心的資深精神科醫師，督導各所推展心理衛生工作。民國七十年開始有系統的追踪臺北市各大醫院出院精神病患，建立了臺北市社區精神醫學服務輸送網的開端，而社區追踪服務網，是運用衛生所工作人員，深入社區追踪訪視精神病患，衛生所工作人員及接受追踪的病患家屬是推展這工作模式重要的一環，因此他們的接納、支持與否，將影響整個社區追踪工作的運作。本研究是為了解公共衛生人員及被追踪的精神病患家屬對社區追踪工作的感受，以作為日後推展社區精神醫學工作的參考。接受調查的對象為臺北市衛生所社會工作員14名，公共衛生護士157名，行政人員207名，及社區追踪的病患家屬93名。評估結果約90%的公共衛生人員認為定期追踪出院精神病患，在公共衛生體系的工作上是需要的，並認同從事心理衛生工作的意義及重要性，又對推展社區心理衛生工作表示支持。社區追踪的病患家屬約75%對工作人員的來訪，覺得在照顧精神疾病的家人方面獲得幫忙，在照顧精神病患如遇有問題或困難時，約77%的家屬會主動與衛生所工作人員連絡。綜合而言，公共衛生人員及精神病患家屬對社區追踪工作的反應均很好，我們認為這項探討對日後在推展臺北模式社區精神醫學的工作，是非常重要的。

The follow-up care of the discharged patients is a major integral part of the whole community mental health services developed by the Taipei City Psychiatric Center since 1972. It is the very first step of the service models in community psychiatry, and was started in 1980 aiming at the reduction of the readmission rate and furthmore to enhance social readjustment of the discharged patients in community. The main characteristics of operation is to integrate this service into the daily pubic health services of all public health nurses and social workers involving all (16) health stations and 4 major teaching hospitals in Taipei City. This study reports the attitudes Of public health workers and the patients' families toward this model of service. Altogether 14 social workers, 157 public health nurses, 207 administration personnels and 93 family members of the discharged patients were studied by means of the specifically designed guestionnaires. Around 90% of the public health workers considered that the follow-up care of the discharged patients was an important part of the public health service and can be meaningfully integrated into their daily services. About 75% of the patients' families considered that the service was helpful to their daily care of the patients. If they had difficulties, 77% of them reported they would call for help from the public health workers. Some differences in attitudes between the public health nurses and social workers was revealed and discussed. In general, the public health workers and the patients' family faver the service provided by this model, and we consider this is important in further development of the Taipei model of community psychiatry.