社區復健模式對精神分裂症患者再入院風險影響
本研究目的在分析台灣地區曾住院之精神分裂症患者其使用社區復健照護及門
診醫療情形。並分析不同社區復健模式對精神分裂症患者再住院之風險。利用
國家衛生研究院之「精神疾病住院病患歸人檔」，將資料庫中 2003 年至 2004
年間有出院紀錄之精神分裂症患者，按照其門診利用方式劃分為社區復健中心
組 282 人、康復之家組 697 人、門診組 12,233 人以及未使用門診 3,135 人。運
用存活分析法，分析其使用社區復健照護及門診醫療情形，並探討在控制人口
學變項、用藥情況、過去精神科住院情形以及當地精神科醫療資源等變項後，
社區復健模式對精神分裂症患者再住院之風險。
研究發現僅 7% 左右精神分裂症患者有使用社區復健資源，且多數集中在社區
復健資源較高的地區，顯示精神分裂症患者可能因就醫需求，具有向社區復健
資源較高的地區聚攏情況，故推測台灣地區社區復健資源仍有不足現象。進一
步分析精神分裂症患者利用社區復健治療的情形發現，未使用社區復健治療之
患者再入院風險，是使用社區復健中心者的 1.88 倍。探究同屬社區復健治療範
疇的社區復健中心與康復之家，在控制變數之後，康復之家組的再入院風險為
社區復健中心組的 1.31 倍，再入院風險在兩組間具顯著差異。此外，本研究亦
發現社區復健資源多寡可能影響精神分裂症患者再入院風險，社區復健資源較
低的地區明顯有較高的再入院風險，甚至可能產生精神科病床不足之假象。建
議主管機關應持續推廣社區復健醫療，並考量其與急、慢性病床病人間流動情
形，建立具整體性之精神照護網絡。
The Influence of Community Psychiatric
Rehabilitation on Readmission among Patients
with Schizophrenia.
The objectives of this study were to analyze the utilization of community rehabilitation care an d outpatient services by schizophrenics in Taiwan area after they were discharged from hospit als, and to analyze the harzard of schizophrenics’ admission. By using PSY of Bureau of Natio nal Health Insurance as the basis of analysis. We divide four forms according to outpatient ser vice types of schizophrenics from 2003 to 2004: community rehabilitation, halfway house, out patient service and the patients only use inpatient service. Survival Analysis is used with a lon gitudinal study design to analyze schizophrenics in PSY database who used the community re habilitation, outpatient service and the harzard of readmission when other influencing factors a re under control.
The study finds only 7% schizophrenics who used the resource of community rehabilitation, a
nd most of them gather in high lever resource area. This situation appears the medical resource
s of community rehabilitation still were not sufficient. And we also find the harzard of readmis
sion for the schizophrenics who have taken advantage of community rehabilitation treatment i
s lower. Although both community rehabilitation centers and halfway houses are community-b
ased rehabilitation care institutions, the difference of readmission risk is still apparent even if t
he difference between the users is not obvious when other influencing factors are under contro
l. The fact that insufficient community rehabilitation resources tend to increase the risk of schi
zophrenic’s re-hospitalization, even possibly leading to a false impression of inadequate psych
iatric beds. It is suggested that community rehabilitation care be promoted continuously and th
e mobility between this kind of care and patients in acute and chronic beds be taken into consi
deration, thereby establishing holistic psychiatric care network.
