| 摘要: | 近年來新聞報導，精神疾病嚴重病人常因為缺乏病識感抗拒使用藥物造成疾病惡化，及伴隨行為干擾，造成襲警等影響社會重大事件。本研究目的為了解社區精神關懷照護個案護送就醫情形，探討影響護送就醫相關因子，作為社區精神病患照護資源介入之參考。
本研究以某直轄市年滿20歲之社區精神關懷照護個案為對象，擷取2018年 1月1 日至2020年12月31日間資料進行次級資料分析。研究樣本數2018-2020年分別為11,146人，12,245人，13,508人。以SPSS 18.0 for windows套裝軟體，就個案人口學特質及影響護送就醫相關因子等變項進行分析。
結果發現，2018-2020使用護送就醫人數分別為102人，126人及223人，就醫人數有逐年增加趨勢。影響護送就醫顯著變項：嚴重病人三年勝算比(OR)分別為4.15（95% CI: 2.22-7.73），3.71（95% CI: 2.18-6.32）及3.56（95% CI: 2.47-5.12）。曾有自殺行為 OR 分別為24.39（95% CI：12.95-45.93），24.8（95% CI：14.53-42.29）及15.36（95% CI: 9.70-24.31）。曾有家庭暴力OR分別為19.3（95% CI：11.78-31.62），11.65（95% CI：7.27-18.66）及9.37（95% CI：6.14-14.32）。曾酒精濫用病人，僅2019年有護送就醫個案，OR為6.05（95% CI：1.71-21.39）。
本研究顯示影響關懷照護個案護送就醫之因素有:嚴重病人、自殺、家庭暴力及酒精濫用等因子。建議主管機關透過監測護送就醫顯著變項之個案資料，建立系統性預警機制，並發展危機應變團隊及早處置，以有效提升精神病患之社區關懷照護。
Background: Patients with severe mental illness lacked insight and had poor drugs compliance that deteriorated not only their illness but also accompanied behavioral interference. It resulted in major social events such as assaults on the police was reported recently. This study aims to explore the current staus and influencial factors of escort medical treatment in community mental illness patients , and the results can serve as a reference for the future intervention..
Method: The study population is a community mental illness patients who aged 20 or above in a municipal city. The data was collected from January 1, 2018 to December 31, 2020 for a secondary data analysis. Our study samples in 2018-2020 were 11,146, 12,245, and 13,508 respectively. The patients’ demographic characteristics and the variables that affect escort medical treatment was analyzed by SPSS 18.0 software.
Results: The numbers of medical escorts in 2018-2020 were 102, 126, and 223 respectively that showed the number of medical treatments has been increasing year by year. The significant variables affected on escort treatment were as follows: The three years odds ratio (OR) for severe patients were 4.15 (95% CI: 2.22-7.73), 3.71 (95% CI: 2.18-6.32) and 3.56 (95% CI: 2.47-5.12). Suicidal behaviors OR were 24.39 (95% CI: 12.95-45.93), 24.8 (95% CI: 14.53-42.29) and 15.36 (95% CI: 9.70-24.31). Behaviors with domestic violence OR were 19.3 (95% CI: 11.78-31.62), 11.65 (95% CI: 7.27-18.66) and 9.37 (95% CI: 6.14-14.32). Escort patients with alcohol abuse only occurred in 2019, OR was 6.05 (95% CI: 1.71-21.39).
Conclusion: Serious patients, suicide, violent behavior, domestic violence, alcohol abuse were the influencial factors for the escort medical treatments. This study recommended that the authority keeps monitoring the influencial factors for the escort treatment pateints by a systematic and early warning mechanism. Also developing a crisis management team to effectively enhance the quality care of community mental illness patients. |
