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http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/48032完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 楊銘欽 | |
| dc.contributor.author | Hsi-Wen Wu | en |
| dc.contributor.author | 吳希文 | zh_TW |
| dc.date.accessioned | 2021-06-15T06:44:47Z | - |
| dc.date.available | 2012-01-01 | |
| dc.date.copyright | 2011-10-03 | |
| dc.date.issued | 2011 | |
| dc.date.submitted | 2011-06-29 | |
| dc.identifier.citation | 英文部分
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/48032 | - |
| dc.description.abstract | 社區精神醫療模式已成為各國慢性精神病患治療的主流，過去研究顯示，我國精神社區復健服務使用率相較於其他國家顯著偏低。為了暸解接受社區復健模式治療後的精神分裂症病患，是否會降低其後續醫療利用，藉此評估社區復健是否尚有加強擴充或鼓勵病患轉介的需要，因此，本研究之目的在探討精神分裂症病患在出院後是否接受社區復健模式(包括社區復健中心、康復之家、或日間留院) 治療、治療時間的長短，以及是否跨區接受治療，對其結束前述治療後1年內以及2年內醫療利用的影響。
本研究由全民健保資料庫擷取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病患203人、康復之家治療的病患196人、日間留院治療的病患203人，接受前述三種照護模式的病人為治療組，另以接受精神科門診追蹤之1631人為對照組，以描述性統計、卡方檢定、t檢定、複迴歸、差異中之差異法進行資料分析，另以傾向分數分析法校正選樣誤差。 研究結果發現，有接受日間留院治療者，可降低其結束治療後1年內之非精神科住院醫療利用；有接受社區復健中心治療者，可降低其結束治療後1年內以及2年內的精神科急性住院醫療利用；有接受康復之家治療者，可降低其結束治療後1年內的精神科急性住院醫療利用。至於接受日間留院治療時間為4-6個月者，相較僅接受1-3個月之治療者，其結束治療後2年內之精神科急性住院醫療利用較低；接受社區復健中心治療時間為10-12個月者，相較僅接受1-3個月之治療者，其結束治療後2年內之精神科急性、慢性住院醫療利用較低；接受康復之家時間為10-12個月者，相較僅接受1-3個月之治療者，其結束治療後1年內之精神科慢性住院醫療利用較低、結束治療後2年內之精神科急性、慢性住院醫療利用較低。在跨區就醫對精神分裂症後續醫療利用影響的結果發現，有跨區接受日間留院治療，相對於無跨區者，其結束治療後1年內的精神科慢性住院精神醫療治療費、結束治療後1年內及2年內精神科慢性住院次數較高；有跨區接受社區復健中心治療者，相對於無跨區者，其結束治療後1年內非精神科住院次數及精神科慢性住院次數較高；至於是否跨區接受康復之家治療，與其結束治療後1年內以及2年內的醫療利用無顯著相關。 結論：本研究結果呈現精神分裂症患者在出院後接受社區復健中心、康復之家或日間留院治療至少30日以上，相對於接受門診追蹤治療者，其後續醫療利用均有顯著減少。 | zh_TW |
| dc.description.abstract | Community mental health care model has become the mainstream of the treatment in patients with chronic mental health illness among the world. According to the literature reviews, the proportion of the utilization of psychiatric community rehabilitation services in Taiwan was relative lower than that of the other countries. Reseacher would like to investigate whether the treatment of community rehabilitation services for patients with schizophrenia could decline the health services utilization after admission, and to evaluate that the community rehabilitation models is still needed to be expanded, strengthen or encouraged to referral. The aim of this research was to investigate the effects of health services utilization among patients with schizophrenia after 1 and 2 years treatment in the community rehabilitation (including models of community rehabilitation center, half-way house, and day care center). This research also investigated the effects of health services utilization after 1 and 2 years treatment in the community rehabilitation among patients with schizophrenia when the different length of treatment or cross-section to receive the treatment.
We included 203 patients discharged from psychiatric hospitalization within 1 year continuously treatment for more than 30 days in community rehabilitation centers, 196 patients treatment for more than 30 days in half-way houses, and 203 patients treatment for more than 30 days in day care centers. We also included 1631 patients discharged from psychiatric hospitalization within 1 year and only receive psychiatric outpatient follow-up. Data were analyzed by using descriptive method, χ2 test, t-test, multiple regression, and difference in difference method. In order to reduce selection bias, the researchers used propensity score method to balance the covariates. The results revealed that, compared with patients who received only psychiatric outpatient treatment, patients who received treatment from day care centers had lower non-psychiatric inpatient health services utilization after 1-year follow-up. Patients who received treatment from community rehabilitation centers had lower acute psychiatric inpatient health services utilization after 1 and 2-year follow-up. Patients who received treatment from half-way houses had lower acute psychiatric inpatient health services utilization after 1-year follow-up. Compared with patients who received 1-3 months treatment from day care centers, patients who received 4-6 months treatment from day care centers had lower acute psychiatric inpatient health services utilization after 2-year follow-up. Compared with patients who received 1-3 months treatment from community rehabilitation centers, patients who received 10-12 months treatment had lower acute and chronic psychiatric inpatient health services utilization after 2-year follow-up. Compared with patients who received 1-3 months treatment from half-way houses, patients who received 10-12 months treatment had lower chronic psychiatric inpatient health services utilization after 1-year follow-up and had lower acute and chronic psychiatric inpatient health services utilization after 2-year follow-up. Patients received the treatment from day care centers cross-sectionally had higher chronic inpatient psychiatric medical expenditure after 1-year follow-up, and had higher numbers of chronic psychiatric hospitalization. Patients received the treatment from community rehabilitation centers cross-sectionally had higher non-psychiatric and chronic psychiatric hospitalization after 1-year follow-up, and had higher numbers of chronic psychiatric hospitalization. However, whether patients received the treatment from half-way houses cross-sectionally or not, that would not effects the health services utilization after 1 and 2-year follow-up. Conclusion: The results indicated that compared with patients who received psychiatric outpatient follow-up, patients who received treatment over 30 days in community rehabilitation centers, half-way houses, or day care centers had lower health services utilization after 1 and 2-year follow-up. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-15T06:44:47Z (GMT). No. of bitstreams: 1 ntu-100-D94843005-1.pdf: 610023 bytes, checksum: 9a448d6d0dac6be60e30231ce3d8ca98 (MD5) Previous issue date: 2011 | en |
| dc.description.tableofcontents | 誌謝....................................................i
中文摘要................................................iii 英文摘要................................................v 目錄....................................................viii 第一章 緒論.............................................1 第一節 研究背景與動機...................................1 第二節 研究目的.........................................2 第三節 研究重要性及預期貢獻.............................2 第四節 重要名詞解釋.....................................3 第二章 文獻探討.........................................5 第一節 精神分裂症之流行病學.............................5 第二節 精神病患之照護模式...............................7 第三節 精神病患之醫療利用及相關影響因素.................13 第四節 影響精神病患利用社區照護模式之因素...............34 第五節 精神病患社區復健模式之成效.......................38 第六節 文獻小結.........................................40 第三章 材料與方法.......................................42 第一節 研究架構.........................................42 第二節 研究假說.........................................44 第三節 資料來源與研究對象...............................44 第四節 研究變項定義.....................................47 第五節 資料分析方法.....................................53 第四章 結果.............................................55 第一節 描述性及二變項統計分析結果.......................55 第二節 社區復健模式的治療時間長短及其相關因素對病患醫療利用之影響..................................................62 第三節 接受社區復健模式治療與否及其相關因素對病患醫療利用之影響....................................................80 第五章 討論.............................................109 第一節 臺灣精神分裂症病患精神治療之情形.................109 第二節 日間留院治療對精神分裂症病患醫療利用的影響.......110 第三節 社區復健中心治療對精神分裂症病患醫療利用的影響...111 第四節 康復之家治療對精神分裂症病患醫療利用的影響.......113 第五節 研究限制.........................................115 第六章 結論與建議.......................................117 第一節 結論.............................................117 第二節 建議.............................................118 參考文獻................................................120 附錄一 簡述本研究所使用之傾向分數分析法 (Propensity Score Method).................................................130 附錄二 差異中之差異法檢定結果............................................................................132 | |
| dc.language.iso | zh-TW | |
| dc.subject | 社區復健 | zh_TW |
| dc.subject | 傾向分數 | zh_TW |
| dc.subject | 醫療利用 | zh_TW |
| dc.subject | 醫療費用 | zh_TW |
| dc.subject | 精神分裂症病患 | zh_TW |
| dc.subject | Community rehabilitation | en |
| dc.subject | Medical cost | en |
| dc.subject | Health Services Utilization | en |
| dc.subject | Patients with schizophrenia | en |
| dc.subject | Propensity score | en |
| dc.title | 臺灣社區復健模式對精神分裂症病患醫療利用的影響 | zh_TW |
| dc.title | The Effects of Community Rehabilitation Models on Health Services Utilization among Patients with Schizophrenia in Taiwan | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 99-2 | |
| dc.description.degree | 博士 | |
| dc.contributor.oralexamcommittee | 胡海國,林恆慶,潘璦琬,葉玲玲 | |
| dc.subject.keyword | 精神分裂症病患,社區復健,傾向分數,醫療利用,醫療費用, | zh_TW |
| dc.subject.keyword | Patients with schizophrenia,Community rehabilitation,Propensity score,Health Services Utilization,Medical cost, | en |
| dc.relation.page | 137 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2011-06-29 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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