入院前衛教以降低自動出院

Reducing the Rate of Discharge against Medical Advice by Pre-hospitalization Psycho-education

10.29478/TJP.200803.0003

郭建成(Chien-Cheng Kuo)；丘小丹(Hsiao-Tan Chiou)；張達人(Ta-Jen Chang)；邱照華(Jaw-Haw Chiou)；張雅芬(Yan-Fen Chang)；沈淑華(Su-Hwa Shen)；歐陽文貞(Wen-Chen Ouyang)

自動出院 ； 團體心理治療 ； 衛生教育 ； 團體前準備 ； discharge against medical advice ； group psychotherapy ； psycho-education ； pre-group preparation

台灣精神醫學

22卷1期（2008 / 03 / 01）

16 - 25

繁體中文

目的：將首次住院病患比擬成正要加入一個新團體的成員，探討運用團體心理治療的「團體前準備」理論，來降低精神科急性病房的自動出院比率之可行性及成效評估。方法：為前瞻性世代研究，以2004年3月1日至2004年8月31日門診首次住院病患為對照組，共85人次，以2005年3月1日至2005年8月31日門診首次住院病患為研究介入組，共71人次。根據文獻回顧自動出院原因及「團體前準備」理論，製成入院衛教單張，由病患所在病房之護理人員執行降低自動出院的衛教。結果：門診病患首次住院的自動出院比率由14.1%下降至1.4%(p=0.004)。沒有實施「入院前衛教」的個案，其自動出院的風險是有實施「入院前衛教」個案的12.8倍。結論：運用團體心理治療的「團體前準備」理論所設計的衛教方式，可以有效降低門診初次入院病患的自動出院。

Objectives: It is assumed that patients on first admission are new members of a group. It is proposed that the use of a ”pre-group preparation” rationale will help to decrease the rate of discharge against medical advice (DAMA) from acute wards. The outcome of such an approach was assessed. Methods: The study was a prospective study. The control group was made up of 85 patients on their first admission to hospital from an outpatient department (OPD) and persons were recruited from March 1 to August 31, 2004. The intervention group consisted of 71 first admission OPD patients recruited from March 1 to August 31, 2005. An inpatient psycho-education manual was created based on a review of the causes of DAMA obtained from the literature and this formed the ”pre-group preparation” rationale. The psycho-education, which was aimed at decreasing DAMA, was conducted by the nursing staff on the wards where patients were staying. Results: The rate of DAMA among patients on first hospitalization from the OPD decreased from 14.1% to 1.4% (p=0.004) when the control and intervention groups were compared. The risk of DAMA among patients from the group who did not receive psycho-education was 12.8 times higher than among those that received psycho-education. Conclusions: The psycho-education was designed in accordance with the ”pre-group preparation” rationale and its application resulted in a significant decline in DAMA among patients on the first admission from the OPD.

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