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研究生:陳其翔
研究生(外文):Chi-Hsiang, Chen
論文名稱:急性住院精神病患暴力行為之相關因素及醫療耗用探討
論文名稱(外文):The Study of Factors Associated with the Violence of Acute Psychiatric Inpatients and its Medical Consumptions
指導教授:許光宏許光宏引用關係
學位類別:碩士
校院名稱:長庚大學
系所名稱:醫務管理學研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:61
中文關鍵詞:急性住院精神病患暴力行為醫療耗用
外文關鍵詞:Acute Psychiatric InpatientsViolenceMedical Consumptions
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精神病患暴力行為是矚目焦點和住院的主因,而精神團隊之首要任務就是減少其暴力行為,可是醫護人員被病患攻擊仍時有所聞,因此若能先行辨識易有暴力行為之族群,則可提高預測精準度,減少醫療團隊或其他病患被攻擊。先前研究發現低膽固醇濃度,與非疾病死亡率、自殺行為、暴力犯罪、突發性攻擊和人格疾患的關聯性。本研究目的:一.利用診療記錄資料分析,找出與暴力行為相關之因素二.以重要影響因素,分析精神病患暴力行為發生之高危險族群特徵三.精神病患暴力行為之醫療耗用型態探討及其決定因素分析。 本研究樣本包括2005.1.1~2005.12.31期間,住入北區某精神科專科醫院四個急性病房共120床的急性精神病患,共計約一千四百多人次。研究者回顧住院護理記錄、診療記錄、特殊治療記錄等病歷資料以納入分析;另外,採用個案對照配對法(Case-control study),凡在急性病房住院期間,因攻擊或破壞具體行為,而接受特殊治療(隔離且約束)者,均認定為具暴力行為之患者。以情感性疾患(躁症為主)且有暴力行為之患者為個案組;不具暴力行為之躁症患者為對照組,但須性別相同且年齡相差小於五歲者;精神分裂症與情感性精神分裂症患者也各自成為一組配對條件亦相同,最後配對成功者每組各為41人次,因此共164人次。醫療耗用則由資訊室人員蒐集配對成功個案之各月及各項醫療費用資料成原始資料檔,進行後續分析。
結果:四組個案間人口學變項差異均不顯著僅三酸甘油脂在四組間達到顯著差異。以躁症個案進行暴力與非暴力組病例對照分析,僅衛材費用在暴力組別間具統計顯著差異。而以多變項迴歸模型,進一步探討自變項對同一個依變項所造成的影響,結果發現模型一二對依變項影響不同,住院天數與醫療耗用有關,也與暴力行為有關,因此在複迴歸分析模型中加入住院天數作為調整,更能檢視各自變項對醫療耗用的影響。本研究發現男性、高齡(年齡大於37歲)、有糖尿病、有高血壓、沒有藥酒癮、體質量指數<25、膽固醇<175 mg/dL、三酸甘油脂<97 mg/dL及高教育年數(教育年數>11.2年)為發生暴力行為及影響醫療耗用增加的高危險群。本研究亦證實暴力行為對醫療耗用確有顯著影響,根據有限的健保資料估計,有暴力行為之住院精神病患,每年所有應收費用總額約為新台幣109萬元(設申報點值一點一元)。建議:將來可能可以生理篩檢預測急性住院精神病患之暴力行為;而減少急性住院精神病患暴力行為,也能節制醫療耗用。
The violence of psychiatric patients is a main perspective of health care issue and subsequent medical consumptions occurred following admission. To alleviate the aggressive conducts of psychiatric inpatients is the top priority of psychiatric medical staff team in a medical setting. Attacked by psychiatric inpatients is not a rare event for psychiatric staff’s regular practice. Such violence attacks by psychiatric inpatients can be avoided to some extent if we can develop a method to predict the occurrence of the adverse events. Among the efforts documented previously, there are many manifestations found to be associated with low cholesterol level, such as non-disease-related mortality, suicide, violent crime, abrupt aggression, and personality disorder. Thus, the objectives of this study are many folds. Firstly, explore factors associated with the occurrence of violence by analyzing medical charts and other anthropometrical data. Secondly, identify high risk groups of violence among acute psychiatric inpatients with their distinguished factors. Thirdly, analyze the subsequent medical consumptions of violent psychiatric inpatients and its determinants.
The study population includes all inpatients who were admitted to 4 acute wards at a mental hospital in northern Taiwan from Jan. 1st, 2005 to Dec. 31st, 2005. There are more than 1,400 admissions in this study setting annually. Data from nursing records, psychiatrist records, and medical consumptions were used for further analysis of this study. A questionnaire was administered during the study period. A matched case-control design with age and sex was conducted for the purpose of estimating difference derived from violence. There are 4 groups with 41 admissions in each category.
Medical consumables were found to be the most significant items related to the occurrence of violence. While adjusted with length of stay, the characteristics of high risk to violence among psychiatric inpatients were male, aged older than 37 years old, with diabetic mellitus, with hypertension, no substance abuse history, body mass index >25, cholesterol<175 mg/dL、triglyceride<97 mg/dL, and high education level. The violence among psychiatric inpatients has cost approximately NT 1,090,000 dollars annually to our limited health insurance resources. It is possible to use some indicators for pre-screening the violence of acute psychiatric inpatients, hence reducing medical consumptions in the future.
目 錄
指導教授推薦書…………………………………………………………………
口試委員會審定書………………………………………………………………
授權書……………………………………………………………………………. iii
誌謝………………………………………………………………………………. iv
中文摘要…………………………………………………………………………… v
英文摘要…………………………………………………………………………. vii
目錄………………………………………………………………………………. ix
圖表目錄…………………………………………………………………………. ix
第一章 緒論…………………………………………………………………….. 1
第一節 研究緣起………………………………………………………… 1
第二節 研究目的………………………………………………………… 3
第二章 文獻探討………………………………………………….. 4
第一節 暴力行為………………………………………………………… 4
第二節 急性精神病患與暴力行為……………………………………… 5
第三節 暴力行為的預測及危險因子…………………………………… 5
第四節 膽固醇、三酸甘油脂濃度與暴力行為之相關性……………… 6
第五節 精神病患之醫療耗用與其影響因子…………………………… 8
第三章 研究方法與樣本……………………………………………………. 9
第一節 研究期間及範圍………………………………………………… 9
第二節 取樣方法………………………………………………………… 9
第三節 研究方法與資料處理…………………………………………… 10
第四章 結果………………………………………………………. 12
第一節 樣本特性描述…………………………………………………… 12
第二節 暴力行為別醫療資源耗用分析………………………………… 14
第三節 醫療耗用相關因素探討………………………………………… 15
第四節 個案暴力月份之醫療資源耗用分析…………………………… 26
第五章 討論………………………………………………………………… 44
第六章 研究限制及未來展望……………………………………………. 55
第一節 研究限制………………………………………………………… 55
第二節 未來展望………………………………………………………… 55
參考文獻………………………………………………………………….…… 56
附錄(論文研究問卷)…………………………………………………….…… 61
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李鶯喬,范世華,蔡果荃,〈住院精神病患攻擊行為之探討---回溯性研究〉,《中華醫誌》,頁323-32,第三十九卷,民國七十六年。
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