探討公共衛生護理師家庭訪視與社區精神病人緊急護送就醫之關係

Abstract

背景：在過去幾十年中，精神疾病的比例持續增加，精神病人除了規則藥物治療，也需要持續的心理社會復健，隨著精神疾病去機構化照護模式的展開，社區照護模式慢慢變成主流，而疾病發作的風險也悄悄落到了社區。目的：本研究旨在探討新北市某區社區精神病人使用緊急護送就醫之現況，以及影響社區精神病人使用緊急護送就醫的因素，並進一步了解其是否具有預測力。方法：採回溯性研究設計，以新北市某區公共衛生護理師管理關懷的社區精神病人為對象，使用衛生福利部「精神照護資訊管理系統」擷取2018~2019年新北市某區社區精神病人的資料，以SPSS 22.0 for Windows統計軟體進行資料整理與分析，使用卡方檢定與邏輯斯迴歸，分析社區精神病人使用緊急護送就醫相關的因素。結果： 新北市某區公共衛生護理師管理關懷的研究樣本425人，女性占56%，平均年齡：47.6歲，教育程度高中職為多，未領有身心障礙手冊及領有中度障礙手冊者為主，約各佔32%，診斷以思覺失調症者為主。男性、35~49歲、教育程度高中職、未領有身心障礙手冊者、診斷思覺失調症者、曾通報嚴重病人者使用緊急護送就醫的比例較高。結論：本研究發現接受公共衛生護理師管理關懷級數減少、曾通報為嚴重病人，對社區精神病人緊急護送就醫的發生具有預測力。建議：本研究結果可提供衛政、警政、社政單位第一線工作人員，包括：公共衛生護理師、警察、消防單位、及社區關懷訪視員等及中央與地方政府決策者參考。進行公共衛生護理師的充能教育與社區護理人才培育的前瞻規劃是有必要的，不僅能強化社區民眾對健康服務的連結，更鞏固了生活中最基層的社會安全網絡。Background: In the past few decades, the proportion of mental illness has continued to increase. In addition to regular drug treatment, people with mental illness also need continuous psychosocial rehabilitation. When the psychiatric treatment are shift from a hospital-based to a community-based health care system, the risk management are essential aspects of the provision of effective mental health care.

Objective: The purpose of this study was to explore the prevalence of emergency escort formedical treatment by people with mental illness in the community in a district of New Taipei City and associated factors among people with mental illness.Methods: A retrospective research design was adopted, using the "mental care information management system" of the Ministry of Health and Welfare to collect the data of people with mental illness in a district of New Taipei City from 2018 to 2019. SPSS 22.0 for Windows statistical software was used for data summarization and analysis, and chi-square test and logistic regression analysis were used.

Results: 425 people with mental illness who cared by public health nurse in a district of New Taipei City were enrolled, more female (56%)than male(44%), the average age of the sample was 47.6 years old, the education level was mostly vocational high school, and the majority of those who did not have the disability identification card, the diagnosis was mainly schizophrenia. The proportion of males, 35-49 years old, high school education level, without disability identification card, those who were diagnosed with schizophrenia, and those who had reported severe patients had a higher proportion of experiencing emergency escort for medical treatment.Conclusions: This study found that patients who received reduced grades of care managed by public health nurses, and who were reported as critically ill were predictive of emergency escort visits.