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Evaluation on a Community Health Care Program for Psychiatric Patients in Central Taiwan
|Abstract:||本研究旨在評價衛生署於 84 年至 85 年度在臺中市、臺中縣、雲林縣試辦之「 社區精神醫療保健工作計畫」。該試辦計畫目的在建立以縣市為單位之精神病患照護的局部 網絡，並加強衛生所的服務及社區緊急救護的功能，使精神病患能得到適時、適切之服務， 以降低再住院率。評價方法採不相等實驗組控制組前測後測之設計。評價指標包括「結構」 、「過程」、「結果」三方面。評價結果發現，試辦計畫已達到預期之目的，如：局部網絡 雛型已形成。 然而尚未完全達到預期之目標有：ヾ社區精神病患列管比率為 1.53 /1000； ゝ僅 30% 的緊急救護案例能符合 24 小時內完成之救護目標； ゞ病患出院一年後之再住院 率為 24%。本研究建議： 1. 由於試辦模式能促進機構間之合作、建立照護之體系，故應積極推動至其他縣市。 2. 應修正計畫目標（二）為「 36 小時內完成救護」， 及目標（三）為「病患出院後之按 時就醫率達 90% 」。 3. 應及早修訂社區復健機構設置之法規。 4. 衛生所公共衛生護士在此一計畫中的角色宜重新定位為提供資訊、 監測病情及督促定期 門診者。 5. 加強醫院之社區照護責任， 包括擔負緊急救護中心的責任、協助衛生所的居家照護.... 等。 6. 衛生所記錄電腦化，以便掌握病患需求及照護現況。|
The purpose of the study is to evaluate a pilot program on community health care for psychiatric patients in three counties/ cities of central Taiwan. This pilot program had been conducted by The Department of Health, Executive Yuan, R.O.C. from October 1994 to June 1996. A quasi-experimental design was implemented to evaluate the program effectiveness in terms of structure, process and outcome. Data were collected from official records, the results of observing the interation between organizations, and interviewing the persons in charge of psychiatric affairs, the family caregivers of patients as well as the public health nurses. The results revealed that the expected goals of pilot program have been partly attained, for example, the three counties have established their own service networks and emergency systems, and as a result enhanced their community care for patients evidently. Nevertheless, there are still some other goals have not been attained yet, for example, the readmission rate for discharged patients within a year was 24% instead of 15% as expected. Based on findings, We propose: 1. The pilot program be implemented in other counties/ cities. 2. Modify the objectives of the pilot program to a reasonable level. 3. Overcoming the legislation barriers on establishing community rehabilitation institutes for community psychiatric patients. 4. The role of public health nurse in this program needs to be redefined. 5. Encouraging hospitals to share more responsibility on providing health care for community psychiatric patients. 6. Patient's records in health centers should be computerized.
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