社區復健中心服務對精神分裂症病患後續醫療利用之影響

The Effects of Community Rehabilitation Services for Patients with Schizophrenia on the Utilization of Health Services

10.6288/TJPH2011-30-05-02

吳希文(His-Wen Wu)；楊銘欽(Ming-Chin Yang)

精神病患 ； 社區復健 ； 傾向分數 ； 醫療利用 ； 醫療費用 ； Psychiatric patient ； Community rehabilitation ； Propensity score ； Health Services Utilization ； Medical cost

台灣公共衛生雜誌

30卷5期（2011 / 10 / 15）

422 - 435

繁體中文

目標：本研究探討精神分裂症病患有無接受社區復健中心服務及治療時間長短，對其結束治療後1年內／2年內醫療利用的影響。方法：以2006年自精神科住院出院後一年內，連續接受30日以上社區復健中心治療的個案203人，及僅接受精神科門診追蹤之1631人為研究對象。以描述性統計、卡方檢定、t檢定、複迴歸進行資料分析，另以傾向分數分析法校正選樣誤差。結果：接受社區復健中心治療時間為10-12個月者比僅接受1-3個月者，追蹤其結束社區復健中心治療後2年內精神科急慢性住院日數、醫療費用、精神醫療治療費皆較低。相較於僅接受精神科門診治療者，接受社區復健中心治療者，其結束治療後1年內及2年內精神科急性住院日數、醫療費用、精神醫療治療費較低；但精神科慢性住院日數、醫療費用較高，結束社區復健中心治療後2年內，精神科慢性住院精神醫療治療費亦較高。結論：本研究呈現精神分裂症病患接受社區復健中心服務後之醫療利用情形，藉此反映精神分裂症患者就醫之重要資訊，並進而推論病患社區復健之成效。

The aim of this research was to investigate the effects on health service utilization among patients with schizophrenia after 1 or 2 years of treatment in community rehabilitation centers. Methods: We included 203 patients discharged from psychiatric hospitals within 1 year and continuously in treatment for more than 30 days in community rehabilitation centers. We also included 1631 patients readmitted to psychiatric hospitals within 1 year after receiving only psychiatric outpatient follow-up. Data were analyzed by descriptive methods, χ^2 tests, t-tests, and multiple regression analysis. In order to reduce selection bias, the researchers used the propensity score method to balance the covariates. Results: Patients with 10-12 months of treatment in community rehabilitation centers had a shorter length-of-stay and lower medical expenditures and psychiatric medical expenditures in acute and chronic psychiatric hospitals over a 2-year follow-up period than did those with 1-3 months of treatment. Compared with patients who received only psychiatric outpatient treatment, patients who received treatment from community rehabilitation centers had a shorter length-of-stay and lower medical expenditures and psychiatric medical expenditures in acute psychiatric facilities over 1 or 2-years of follow-up, but had a longer length-of-stay and higher medical expenditures in chronic psychiatric facilities over 1 and 2-years of follow-up, and higher psychiatric medical expenditures in chronic psychiatric facilities at 2-year follow-up. Conclusions: The results characterized the utilization of health services by patients with schizophrenia after treatment in community rehabilitation centers. They provide important information about medical utilization by these patients and show the effects of their community rehabilitation.

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