| Abstract: | 本研究目的是探討精神障礙者使用健康服務的情形。研究方法為分層叢集取樣，對桃園、台中、台南、高雄四個都市共19間精神復健機構進行取樣，對象是病況穩定、可理解及有意願填寫問卷者。資料蒐集方式為自編式問卷。調查期間自2018年4月至6月，共發放361份，有效回收333份問卷，廢卷28份。統計工具為SPSS for windows 20.0zh-TW版，進行描述性與推論性統計分析。研究架構參考Andersen第四階段的健康服務使用模式，並納入時間因素，將資料蒐集區間設定為精障者未就醫時期（S1）、就醫時期（S2）與進入精復機構後（S3）三個時期。研究結果發現性別、年齡、教育程度、婚姻、就業狀態、診斷別與障礙程度等差異之精障者在使用健康服務有不同的樣貌。其次，性別、年齡、S2精神醫療導向服務、S2精神科回診頻率、收入影響因素、未就醫期間、睡眠影響因素、S1-S2尋助型態、S123總尋助數量這九個變項對於精障者的服務使用程度及健康成果具有預測力。 本篇研究重要性是指出精神復健機構內的精障者對自己在不同時期使用健康服務的看法，了解服務使用上有哪些影響因素，藉此獲得精障者的整體服務使用樣貌。最後針對精神衛生政策、精神復健機構、研究三個部份提出建議：1.精神衛生政策方面：持續宣導心理衛生教育及關注特別對象群，強化各服務系統的整合機制。2.精神復健機構方面：應建構良好的夜眠環境，重視服務使用的影響因素，連結長照與社區資源以提昇對中高齡者的後續服務準備，並充實精神復健服務相關元素。3.研究方面，拓展對精障者尋助研究的範疇，並可納入重要他人作為資料蒐集的對象。
This study aims to investigate the use of health services by people with mental disorders. The research was based on stratified cluster sampling from a total of 19 mental rehabilitation institutions in Taoyuan, Taichung, Tainan and Kaohsiung. The subjects were stabled, understandable and willing to fill out the questionnaires. The method of collecting data was from a self-made questionnaire. During the investigation period from April to June 2018, a total of 361 copies were distributed, and of the number of copies 333 questionnaires were effectively recovered, while 28 copies were abandoned. The SPSS for windows 20.0 tool (Chinese version) was used for descriptive and inferential statistical analysis. The research structure refers to Andersen's fourth-stage health service model, which incorporates the factor of time, and collects data at three intervals: the period of not having received medical care(S1), the period of medical treatment(S2) and the period of having entered the mental institute(S3).The study discovered that mentally disabled people who differed in gender, age, education, marriage, employment status, and degree had different approaches with using the health care services. Moreover, the nine variables of sex, age, psychiatric oriented services in S2, frequency of psychiatric treatment in S2, income influence factor, period of no medical treatment, sleep influence factor, the type of help in S1-S2, and number of those who seek help were predictive of the health outcomes of individuals, which positively correlated with the number of frequent psychiatric returns.The significance of this study shows that people with mental illness at the rehabilitation institutes have their own views on when to use the health care services. With the understanding of the overall factors that may influence the use of the services, we recognize the overall manner of which the service is used. All and all, proposals were made on the mental health policy, rehabilitation institute and on research as follows:1.With the mental health policy, continue to promote the education on mental health and provide attention to special needs group, as well as strengthen the integration of various service systems. 2.In terms of mental rehabilitation institutions: a better nighttime atmospheric quality should be developed, and emphasis should be placed on factors affecting the use of service. Long-term care and community resources should be connected to improve follow-up services of middle-aged and elderly, as well as broaden the elements of mental rehabilitation. 3.In terms of research, the scopes of research with supporting mentally disabled are being expanded to the extent where it can be included data from key person. |
