急性精神科住院之青少年病患醫療利用及護理照護之相關性探討

Abstract

背景:生命週期發展的階段中，青少年期是精神疾病罹患率最高的時期之一。青少年心理健康問題若未給予適當介入，其負面影響將持續至成年期或終其一身，可能損害身心健康與限制發展。青少年精神疾病患者於住院期間所接受的治療及照護，影響疾病的預後，然而國內對急性住院之青少年精神疾病患者之醫療利用和護理照護的研究相對欠缺，值得運用長期資料進一步了解。 目的:本研究旨在探討近年青少年精神病患之住院概況、住院前醫療利用情形，以及住院期間護理評估之健康問題與護理照護措施等情形，並利用十三年長期資料來探討住院照護與疾病預後之相關性。 方法: 本研究採取回溯性世代研究之設計，運用臺大醫療體系醫療整合資料（Integrated Medical Database, National Taiwan University Hospital）分析2007年1月1日至2019年12月31日共計13年期間，於精神科急性病房住院的青少年精神疾病患者，了解該族群之人口學特徵、住院概況，包含疾病診斷及共病情形、健康問題與護理照護評估，並透過多元邏輯斯迴歸，探討患者出院後一年內再入院和一年內急診求診之相關因子。 結果:本研究納入共1024人（男性436人與女性588人），平均住院天數26.46天；出院後一年內再入院率為22.07%，再入院之相關因子為出院後醫療利用（門診和急診）頻率高、住院時護理照護發現病人有家庭因應能力失調的健康問題；青少年精神疾病患者出院後一年內有急診就醫率為25.78%，相關因子為出院後門診次數多、有自傷或暴力之健康問題、有思考過程紊亂之健康問題、出院後為獨居者、有服藥問題需持續追蹤者。 結論:由過去13年之回溯性世代研究發現青少年精神疾病急性住院患者之基本人口學特性、診斷類型、住院期間之健康問題、出院後動向與家庭支持資源，都與出院後一年內再入院或至急診就醫有關，此研究結果可提供急性精神科住院青少年病患治療照護計畫之參考，醫護針對每位青少年精神病人急性住院期間，透過完整評估個人及家庭狀況，可針對較為相關的風險因素設計個別化精準照護計畫，以降低疾病惡化而於出院後一年內再入院或赴急診就醫之機率。建議未來研究可再將藥物與特殊處置等納入分析，亦可持續長期追蹤探討護理照護措施與出院規劃及社區銜接之成效。

Background: In the stage of life cycle development, adolescence is one of the period with the highest incidence of mental illness. If adolescents' mental health problems are not properly intervened, the negative effects will last until adulthood or impact the whole life, which may damage the physical and mental health and restrict a healthy development. The treatment and care received by adolescents with mental illness during hospitalization will affect the prognosis of the mental illness. However, the research on the medical utilization and nursing care for adolescent patients with acute psychiatric hospitalization is insufficient and need further investigation on longitudinal data. Objective: The purpose of this study was to use a 13-year longitudinal data to investigate the adolescent patients with acute psychiatric hospitalization, including pre-hospital medical utilization, health problems, nursing interventions, and nursing evaluation during hospitalization. Methods: The Integrated Medical Database, National Taiwan University Hospital was used to expolore the adolescent psychiatric patients hospitalized in the acute ward of the psychiatric department from January 1, 2007 to December 31, 2019. The demographic characteristics and hospitalization profile of adolescent patients, including disease diagnosis and comorbid conditions, health problems and nursing care assessment, were analyzed. Using multivariate logistic regression to discover the associated factors for readmission and emergency department visits within one year after the discharge. Results: The study sample consisted of 1024 patients (436 males and 588 females). The averaged length of inpatient stay were 26.46 days. The readmission rate within one year after discharge was 22.07%, and the visits to emergency department was 25.78%. The factors associated with readmission within one year after discharge included frequent outpatient department and emergency department visits, as well as the health problems of family inefficient coping. The factors associated with emergency department visits within one year after discharge included more outpatient department visits after discharge, having health problems of Risk for Self Harm or Violence, having health problems with Disturbed Thought Processes, living alone, and with the issue of medication adherence needing for follow-ups. Conclusions: The retrospective cohort study over the past 13 years found that the basic demographic characteristics, diagnosis, health problems during hospitalization, placements after discharge, and family support resources of acutely hospitalized adolescents with mental illness were significantly related to readmission and to emergency department within one year after discharge. The results of this study can be used as the reference for the treatment and care plan of acute psychiatric inpatients, and provide the care reference for medical personnel in their care. It is suggested that future research can include drugs and other special treatment frequency into analysis, and continue to explore the application of health care and nursing interventions, as well as the continuity of patient care from acute admission to discharge preparations and placements.