機構內智能障礙者合併特殊疾病之健康管理制度分析

The Provision of Specific Diseases/Disorders Management for Persons with Intellectual Disabilities Living in Institutions in Taiwan

10.30072/JDR.200603.0001

嚴嘉楓(Chia-Feng Yen)；林金定(Jin-Ding Lin)；羅慶徽(Chia-Hui Loh)；卓妙如(Miao-Ju Chwo)；徐尚為(Shang-Wei Hsu)；唐紀絜(Chi-Chieh Tang)；吳佳玲(Jia-Ling Wu)

台灣 ； 疾病管理 ； 智能障礙 ； 健康管理 ； 機構 ； Health care management ； institution ； intellectual disability ； specific disease ； Taiwan

身心障礙研究季刊

4卷1期（2006 / 03 / 01）

1 - 17

繁體中文

本研究主要目的在於診斷身心障礙托育養護機構對智能障礙者的特殊疾病：癲癇、精神疾病、營養失衡及口腔疾病之健康管理制度。本研究採取普查之方式，由台灣地區智能障礙托育養護機構負責人填寫結構式問卷，共回收121份有效問卷（回收率77.1%）為本研究之研究對象。研究結果發現大多數的機構針對合併特殊疾病之智能障礙者，紀錄其用藥情形、定期追蹤他們的病情發展和設計健康管理計畫；機構照護合併癲癇的智能障礙院生，遠比照護合併精神疾病及營養失衡的院生還深具信心，進一步分析資料發現：有專任護理人員之機構，在針對癲癇及營養失調疾病管理能力上，自覺具「足夠」能力的比例明顯高於沒有專任護理人員的機構；唯有對於「精神疾病」管理上，不論有無專任護理人員，機構內對於處理精神疾病皆自覺能力略嫌不足；整體而言，從我們的調查顯示機構聘僱有專任護理人員的確對上述三種健康問題的管理有所幫助，但即使是聘有專任護理人員的機構，照顧合併有精神疾病的智能障礙者，仍感到棘手；因此，未來規劃機構式照護合併特殊疾病的智能障礙者之健康管理制度，更應朝上述缺失著手，以確保智能障礙者之健康照護品質。

The purpose of this paper was to examine the healthcare management of special diseases or disorders for persons with intellectual disabilities living in institutions. These diseases or disorders included epilepsy, psychiatric disorder, dental diseases, and nutritious disorder. A structured questionnaire involved 121 stakeholders out of 157 intellectual disability institutions in Taiwan was used to measure the healthcare management provision within the institutions. The study revealed that most of the institutions were capable to manage the special diseases or disorders for persons with intellectual disabilities in institutions. The results also stated that the respondents were more confident with the management of epilepsy than other diseases or disorders due to their practical experiences in institutions. The employment of nursing staff was related to the effective management of epilepsy and nutritious disorder. However, the sound management of psychiatric disorder still out of the staff's imagination even employed the experienced nursing staff in institutions. This study highlights that the welfare and healthcare authorities should work together to overcome the barriers of effective management of special diseases or disorders for persons with intellectual disabilities living in institutions.

1. Lin J.D.,Li C.W.,Yen C.F.,Wu J.L.,Chow M.J.,Loh C.W.,Lai C.Y.(2003).Epilepsy and healthcare utilization among people with intellectual disability: A national survey.Journal of Disability Research (Taiwan),1,65-73.
   連結：
2. Lin J.D.,Wu J.L.,Yen, CF(2004).An exploratory study into health care policy for persons with intellectual disabilities in Taiwan.Journal of Intellectual Disability Research,48,252-261.
   連結：
3. 林金定、嚴嘉楓、李志偉、吳佳玲(2003)。智能障礙者醫療需求評估與就醫障礙之分析。台灣公共衛生雜誌，22，108-117。
   連結：
4. 蔡艷清、嚴嘉楓、林金定(2003)。啟智專業工作者之實務工作經驗分析。身心障礙研究，1，43-52。
   連結：
5. 蔡艷清、嚴嘉楓、林金定(2004)。精神疾病與智能障礙：流行病學與醫療照護需求分析。身心障礙研究，2，95-108。
   連結：
6. Ackland M.J.,Wade R.W.(1995).Health status of Victorian special school children.Journal of Paediatrics & Child Health,31,423-427.
7. Beange H.(1996).Caring for a vulnerable population: who will take responsibility for those getting a raw deal from the health care system?.Medical Journal of Australia,164,159-160.
8. Beange H.,McElduff A.,Baker W.(1995)."Medical disorders of adults with mental retardation: A population study.American Journal of Mental Retardation,99,595-604.
9. Bell A.J.,Bhate M.S.(1992).Prevalence of overweight and obesity in Down`s syndrome and other mentally handicapped adults living in the community.Journal of Intellectual Disability Research,36,359-364.
10. Bowley C.,Kerr M.(2000).Epilepsy and intellectual disability.Journal of Intellectual Disability Research,44,529-543.
11. Brodie M.J.,French J.A.(2002).Management of epilepsy in adolescents and adults.Lancet,356,323-329.
12. Christianson A.L.,Zwane M.E.,Manga P.,Rosen E.,Venter A.,Downs D.,Kromberg J.G.R.(2002).Children with intellectual disability in rural South Africa: Prevalence and associated disability.Journal of Intellectual Disability Research,46,79-186.
13. Deb S.(2000).Epidemiology and treatment of epilepsy in patients who are mentally retarded.CNS Drugs,13,117-128.
14. Deb S.,Thomas M.,Bright C.(2001).Mental disorder in adults with intellectual disability. I: Prevalence of functional psychiatric illness among a community-based population aged between 16-64 years.Journal of Intellectual Disability Research,45,495-505.
15. Fernhall B.(1993).Physical fitness and exercise training of individuals with mental retardation.Medicine & Science in Sports & Exercise,25,442-450.
16. French J.(1994).The long-term therapeutic management of epilepsy.Annual of Internal Medicine,120,411-422.
17. Frey B.,Rimmer J.H.(1995).Comparison of body composition between German and American adults with mental retardation.Medicine & Science in Sports & Exercise,27,1439-1443.
18. Goulden K.L.,Shinnar S.,Koller H.,Katz M.,Richardson S.A.(1991).Epilepsy in children with mental retardation: a cohort study.Epilepsia,32,690-697.
19. Gustafsson C.(1997).The prevalence of people with intellectual disability admitted to general hospital psychiatric units: level of handicap, psychiatric diagnosis and care utilization.Journal of Intellectual Disability Research,41,519-526.
20. Holland A.J.(1999).Psychiatric and mental retardation.International Review of Psychiatry,11,76-82.
21. Hurley A.D.,Folstein M.,Lam N.(2003).Patients with and without intellectual disability seeking outpatient psychiatric services: Diagnosis and prescribing pattern.Journal of Intellectual Disability Research,47,39-50.
22. Lennox N.G.,Diggens J.N.,Ugoni A.M.(1997).The general practice care of people with intellectual disability: barriers and solutions.Journal of Intellectual Disability Research,41,380-390.
23. Lennox N.G.,Kerr M.P.(1997).Primary health care and people with an intellectual disability: The evidence base.Journal of Intellectual Disability Research,41,365-372.
24. Lin J.D.,Lee P.N.,Yen C.F.,Wu J.L.(2003).The health status profile of persons with intellectual disability in institutions in Taiwan.Journal of Medical Sciences,23,285-290.
25. Lin J.D.,Wu J.L.,Lee P.N.(2003).Health care needs of persons with intellectual disabilities in institutions in Taiwan: Outpatient utilization and implications.Journal of Intellectual Disability Research,47,169-180.
26. Lin J.D.,Yen C.F.,Li C.W.,Wu J.L.(2005).Health, healthcare utilization and psychiatric disorder in people with intellectual disability in Taiwan.Journal of Intellectual Disability Research,49,86-94.
27. Masi G.(1998).Psychiatric illness in mentally retarded adolescents: clinical features.Adolescence,33,425-434.
28. McGrother C.W.,Hauck A.,Bhaumik S.,Thorp C.,Tomb N.(1996).Community care for adults with learning disability and their carers: needs and outcomes from the Leicestershire register.Journal of Intellectual Disability Research,40,183-190.
29. Meerding W.J.,Bonneux L.,Polder J.,Koopmanschap M.A.,Maas P.(1998).Demographic and epidemiological determinants of healthcare costs in Netherlands: Cost of illness study.British Medical Journal,317,111-115.
30. Perry M.(1996).Treating obesity in people with learning disabilities.Nursing Times,92,36-38.
31. Perry M.(1992).Learning disabilities: Community nutrition.Nursing Standard,7,38-40.
32. Rimmer J.H.,Braddock D.,Fujiura G.(1993).Prevalence of obesity in adults with mental retardation: implications for health promotion and disease prevention.Mental Retardation,3,105-110.
33. Robertson J.,Emerson E.,Gregory N.,Hatto C.,Turner S.,Kessissoglou S.,Hallam A.(2000).Lifestyle related risk factors for poor health in residential settings for people with intellectual disabilities.Research in Developmental Disabilities,21,469-486.
34. Scott A.,March L.,Stokes M.L.(1998).A survey of oral health in a population of adults with developmental disabilities: Comparison with a national oral health survey of the general population.Australian Dental Journal,43,257-261.
35. Scott R.,Lhatoo S.D.,Sander J.W.(2001).The treatment of epilepsy in developing countries: where do we go from here?.Bulletin of World Health Organization,79,344-351.
36. Suzuki M.,Saitoh S.,Tasaki Y.,Shimomura Y.,Makishima R.,Hosoya N.(1991).Nutritional status and daily physical activity of handicapped students in Tokyo Metropolitan schools for deaf, blind, mentally retarded, and physically handicapped individuals.American Journal of Clinical Nutrition,54,1101-1111.
37. Welsh Office(1995).Welsh Health Survey.Cardiff:
38. Xenitidis K.,Gratsa A.,Bouras N.,Hammond R.,Ditchfied H.,Holt G.,Martin J.,Brooks D.(2004).Psychiatric inpatient care for adults with intellectual disabilities: Generic or specialist units?.Journal of Intellectual Disability Research,48,11-18.
39. 胡雅各、林千惠、徐享良(2002)。啟智教養機構內重度障礙院生問題行為及其相關因素之調查研究。台灣人文生態研究，4，119-152。
40. 莊美娥(2003)。對教養機構中住宿智障兒童精神疾患之探討。兒童福利期刊，5，145-156。

1. 洪聖雯(2016)。智能障礙學生肥胖相關因素之探討。中山醫學大學護理學系學位論文。2016。1-62。