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E87138
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「早期且完整之干預」對精神病患社區精神復健服務使用病患功能與照護者負荷程度之影響
The Effects of Early and Comprehensive Intervention on the Use of Psychiatric Rehabilitation Services, Patients\' Function and Caregiver Burden
1.宋麗玉
1.Li-yu Song
1.國立暨南國際大學社會政策與社會工作學系(所)
1.Department of Social Policy and Social Work, National Chi-Nan University
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1.國立暨南國際大學社會政策與社會工作學系(所)
1.Department of Social Policy and Social Work, National Chi-Nan University
002
1.行政院國家科學委員會
1.National Science Council
A.14 計畫執行期間(起):1997-08-01
A.14 計畫執行期間(訖):1999-07-31
1997-11-011998-04-301998-02-011998-07-301998-08-011999-01-30
A.16 收到日期:0000-00-00
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南投草屯療養院病患

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C.2 聯絡日期:2000-04-19
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1.國立暨南國際大學社會政策與社會工作學系(所)
1.Department of Social Policy and Social Work, National Chi-Nan University
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C.7 資料公開日期:2002-08-01
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1.社區服務
2.病患功能
3.病患照顧
4.照護者負荷
5.慢性精神病患
6.精神復健服務
1.Caregiver\'s burden
2.Chronic Mental Illness
3.Community Service
4.Patient Care
5.Patient\'s function
6.Psychiatric Rehabilitation Service
精 神疾病是一種容易慢性化的疾病,患者之社會功能往往退化因而造成其家屬之負擔。台灣的精神醫療資源欠缺,床位不足,許多病患留在社區中,因此照護精神病患 的責任大部分落在病患家屬身上。立基於此,對於精神病患之處遇,除了醫院的治療之外,社區照顧體系的建立成為重要的一環。行政院衛生署於民國七十五年加強 精神病患社區復健,並增設相關設施,儘管現有資源離理想狀況甚遠,然而另一個存在已久的問題是:社區精神復健服務的使用率偏低。至於其原因,研究結果皆指 出大部分是因為沒聽說過或認識不清。此現象顯示現行之醫院干預方式並未將訊息成功地傳達給病患。然而台灣至今尚未有關於如何促進病患使用社區復健服務之研 究,因此本研究以草屯療養院之病患為研究對象,進行一「早期且完整之干預」的兩年實驗計畫,由社會工作人員以個案管理的方式對實驗組病患(n=45)進行 實驗之干預,分為住院期間之評量、訊息傳達與教育、訂定出院計畫與轉介,與出院後對病患復健服務使用、病患功能與主要照護者負荷程度之追蹤;而控制組 (n=31)之病患則接受醫院之一般處遇方式。本研究檢驗實驗組之社區精神復健服務使用之情形是否優於控制組,再者,以t檢定分析實驗組與控制組在出院三 個月與九個月後於病患功能與照顧者負荷方面是否達顯著差異。 研究發現實驗組與控制組於出院後被轉介到其他社區復健單位接受服務的比例皆相當低,在轉介比例方面兩組人未達顯著差異,接受服務人數方面,第一次追蹤時接 受服務的四人都是實驗組病患,兩組人達顯著差異(p<.05),而於第二次追蹤時兩組人都沒有接受社區復健服務。再者,兩組人在出院後的再住院比 例、社會功能、與照顧者負荷都未達顯著不同,因此本研究的研究假設未得到支持。再者,由於第一次追蹤時接受服務的人數相當少,也無法於第二次追蹤時檢驗接 受服務病患的社會功能與其照顧者之負荷程度是否因而顯著低於未接受服務之病患。然而,本研究的假設未獲支持並不必然意涵本研究的假設不正確,亦即無法斷言 本實驗干預必然無效,其直接的原因關乎「方案執行過程」,亦即未如當初的設計般,而執行過程中的限制又與「結構性因素」有關,包括社區復健設施的缺乏與醫 院內部的角色劃分與任務分配,特別是醫院內部的專業團對分工與醫療決策權。另一方面也來自於病患與照顧者動機不足。本研究對分別由這幾方面限制加以討論, 並提出五項建議:(1)社區復健資源之增設與充實、(2)改變醫療給付制度以鼓勵社區復健服務之使用、(3)醫院內部角色分工之重劃、(4)增加社工人員 工作時間與方法之彈性、(5)對病患與家屬提供社區復健服務資訊與教育之重要性。

Mental illness is prone to be chronic; persons with mental illness usually suffer from deterioration in function and become a burden of their family. In Taiwan, resources have been limited for psychiatric treatment, and beds for psychiatric patients have been insufficient. Many patients are forced to stay in communities and cared by their family members. Thus, community care has become an important part of psychiatric treatment network. Since 1986, through government\'s act, there is an increase on psychiatric rehabilitation facilities, although the current facilities are still insufficient as compared with needs. However, another emerging problem is under-utilization of such services. According to the literature, the major reasons of under-utilization were \"never heard about\" and \"insufficient knowledge\". It revealed that current intervention mode in hospitals could not successfully and adequately give information related to psychiatric rehabilitation services to patients and caregiver. Nevertheless, to date, no study has focused on this issue. Thus, the author conducted a two-year experimental study in Tsao-Tun Psychiatric Ward using a \"Early and Comprehensive Intervention\" model. Patients in the experimental group (n=45) received intervention from social workers who act as a case manager; the intervention involves two parts: (1) During patients\' stay in the hospital, including comprehensive assessment, information giving, explanation, and education, as well as making discharge plan and referring patients\' to appropriate psychiatric rehabilitation services; (2) After discharge, including follow-up on patients\' use of psychiatric rehabilitation, patients\' function and caregiver burden. Whereas, patients in the control group (n=31) received regular intervention. The study examined if the experimental group used more of the psychiatric rehabilitation services than the control group. Also, by using T-Test procedure, the study tested if experimental and control group were significantly different in patients\' function and caregiver burden three months and nine months after the patients were discharged from the hospital. The results indicated that very few patients were referred to any community rehabilitation agency, and only four of them used such service three month after discharged from the hospital. In general, there was no significant difference in rate of referral and service use between the two groups. Neither there were significant differences on patients\' rate of re-hospitalization and social function as well as on caregiver burden between the experimental group and control group. However, such results do not necessarily imply that the research hypotheses in this study were not supported because there were problems with program implementation process and the structural issues, including insufficiency of psychiatric rehabilitation facilities and the power structure and role allocation among the different professions, deterred the psychiatric service referral and use. The final barrier but not the least important one is the lack of motivation and knowledge concerning psychiatric rehabilitation service among patients and caregivers. These problems limited social work to act the roles designed in this study. This study discussed these limitation and made the following suggestions: 1. To increase the capacity of community rehabilitation services; 2. To change the payment system in the our National Insurance system to encourage the use of psychiatric rehabilitation services; 3. To re-structure the job description and role allocations among the professions; 4. To allow flexible work time and methods for social workers; 5. To strengthen the education toward patients and caregivers about psychiatric rehabilitation service.

D.16 完成檢誤日期:2003-08-27
D.17 預定釋出日期:2003-09-23
D.18 初次釋出日期:2003-09-30
D.19_1 最新版釋出日期:2003-09-30
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10.6141/TW-SRDA-E87138-1
https://efenci.srda.sinica.edu.tw/webview/index.jsp?object=https://efenci.srda.sinica.edu.tw:80/obj/fStudy/E87138
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