臺灣博碩士論文加值系統

摘要 本研究旨在探討精神疾患個案的急診就診原因及其問題解決情形
。採立意取樣，於87年3月12日至87年6月12日在南部某醫學中心之急診，
收集經照會精神科醫師評估處理之有精神障礙個案306人共計356人次。其
平均年齡34.7歲，未婚者居多，女性佔55.3﹪，平均受教育年限10.4年，
學歷以高中職為最多；半年內平均急診就診次數為1.6次， 精神科診斷以
精神分裂症佔最多，其次為適應障礙，再次之為情感性精神病； 共計完
成237人次個案及229人次家屬完成收案訪談。 個案及家屬對於就診原因
的認定與病歷登錄不個案排名前三位的就診原因依序為內外科問題、失眠
、自殺問題，家屬依序為幻聽及妄想、失眠、內外科問題。個案離診建議
執行情形中，藥物帶回服用者僅有43.8 %完全依醫囑指示之劑量與時間服
用；未遵循的主因是個案覺得沒有必要；而受訪家屬表示，執行上的困難
主要自於個案拒絕配合。急診就診問題解決程度得分若以10分為滿分，在
離開急診時個案及家屬感受約為5分，在離診3-7 天內受訪時個案為7分，
家屬為6.4 分，個案及家屬間並未達顯著差異。研究發現個案的年齡較高
、鰥寡、無業、急診就診前問題持續時間長及對急診治療滿意度低的個案
自覺急診就診問題解決程度較低；當有家屬與個案同住時，家屬感受個案
急診就診問題解決程度較高。在對急診治療滿意度部份個案及家屬最滿意
的是醫護人員的專業能力，最不滿意的是就診問題相關資提供，但就整體
而言有69.1 %的個案及77.7 %的家屬是滿意的。求診前問題持續時間是個
案自覺問題解決程度的重要相關因子 ,此點提醒在心理衛生工作上應提供
充分的資訊,使個案及家屬在有需要時,能儘速獲得協助 ,以便有效的進行
危機處置,解決其問題。關鍵字:問題解決程度、急診、醫療滿意度。

ABSTRACT This study aims to evaluate reasons for
emergency ofpatients with mental disorders and the outcome
related to the degree of problems being solved at the emergency
service. A purpose sampling of all cases visiting the
emergency service in a medical center for psychiatric purposes
during a three-month period from March 12 to June 12,1998were
included for the study. Altogether, there were 306subjects (356
visits; average 1.6 visits in 3 months), with mean age of 34.7
years and 10.4 years in educationallevel. Fifty-five percent of
them were females, and majority was single. Among them,
schizophrenia were themost frequent diagnosis, followed by
adjustment disordersand affective disorders. Among the 237
subjects and 229 of their family members who had been
successfully completed the inquiries, a discrepancy over their
reported and recorded reasonsfor emergency was found. Medical
or surgical problems, insomnia and suicidal behavior were the
main reasons reported by the subjects, while families accounted
for psychotic symptoms, insomnia and medical or surgical
complaints. Only 43.8% of the subjects complied with medication
after discharged. Non-compliance was mainly due to refusal of
medication because of subjects'' lack of insight. Only half of
the subjects and their familiesfelt that the problems were
solved while leaving at the emergency service. However, about
70% of the problems had been resolved during the follow-up at
3-7 days afterdischarge. Those subjects with elder ages,
widowhood,jobless, problems preceded with longer time and less-
satisfaction with emergency service had poor outcome. Factors
related to favorable outcome included living with families and
had good rapport with medical personnel.Inadequacy of medical
information over follow-up and management were the complaints
given by most families. In general, 69.1% subjects and 77.7%
family members were satisfied with the emergency service that
had been provided. The above findings could serve as a useful
information in providing better and effective crisis
intervention service for patients and their families who sought
for psychiatric emergency.