個案管理模式於出院精神分裂症患者連續性照護之運用

Case-management Model for the Continuous Care of Discharged Schizophrenic Patients

10.29478/TJP.200806.0003

沈淑華(Shu-Hua Shen)；張達人(Ta-Jen Chang)；白雅芳(Ya-Fang Pai)；唐心北(Hsin-Pei Tang)

個案管理 ； 電話關懷 ； 社區服務 ； 精神分裂症 ； case management ； telephone counseling ； community service ； schizophrenics

台灣精神醫學

22卷2期（2008 / 06 / 01）

96 - 106

繁體中文

目的：本研究運用個案管理模式，以探討精神分裂病患於社區中接受精神醫療照護成效。方法：由個案管理中心追蹤精神專科教學醫院於2002年11月至2004年05月出院列冊精神分裂症個案持續接受醫療情形；對連續一個月以上未再接受精神醫療者即轉介予社區醫療團隊人員，提供電話及社區關懷服務。結果以描述性與推論性統計方法進行資料分析。結果：出院個案共681人，男性、未婚、高中畢者居多，平均年齡為37.8歲(SD=11.5)。透過系統化運作於個案出院後持續提供關懷服務，尤其針對一、三個月未接受醫療者提供關懷服務；發現經電話關懷服務，病患出院後首次返診率為81.4%（554/681人）；第二次電話關懷一個月未就診者後有26%（33/127人）可再返診，返診率增加至86.2%(587/681)治療；但於三個月未就診個案透過社區居家訪視關懷服務共30人，僅有13.3%（4/30人）個案可再返本院接受醫療。結論：運用系統化個案管理及社區追蹤的方式確實有提昇個案返診率，但對於三個月未返診個案，雖已提供電話及社區關懷但返診率較出院一個月者低，可見出院個案若未持續接受醫療，宜即早介入協助就醫以降低其病情惡化與再住院。

Objectives: An investigation on the outcome of applying a case management model for the schizophrenic patients who received the community psychiatric services. Methods: The schizophrenic patients were followed by the case management center for whether receiving psychiatric services after discharge from the psychiatric teaching hospital between November 1, 2002 and May 31, 2004. The patients who did not return to the hospital within one month after discharge were referred to the community care team, providing the patients with persistent telephone counseling and other community services. Results: There were total 681 cases, and most of them were single, male and high school graduates. The average age was 37.8 (SD=11.5). We provided the systemic operation on the continuously psychiatric services after discharge from hospital, especially for the patients who did not return to the hospital within one or three month. After the telephone counseling service, the outpatient department (OPD) follow-up rate after discharge was 81.4% (554/681). After the second telephone counseling service for the patients who did not return to the hospital within one month, 26% (33/127) patients of whom returning to the hospital, which raised the follow-up rate up to 86.2% (587/681). There were only 13.3% (4/30) patients who did not return to the OPD within three months came back by continuously providing with home care community service. Conclusion: Though we provided the patients with persistent telephone counseling and community service, the OPD follow up rate for the patients who did not return to the hospital within three months was lower than those who discharged within one month. If the patients do not continue to receive follow-up cares, they should be given early intervention to decrease the risk of relapse and re-hospitalization. (Full text in Chinese)

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