探討以電話追蹤門診憂鬱症初診病患之成效

1. 探討以電話追蹤門診憂鬱症初診病患之成效 • 中文摘要 • 目的：本研究旨在瞭解提供電話追蹤對門診憂鬱症初診病患之憂鬱程度、生活品質、門診規則就醫及服務滿意度之影響。 • 方法：採隨機控制試驗（Randomized controlled trial; RCT），以北市某精神科專科醫院門診為研究場所，研究對象為門診憂鬱症初診病患，自民國96年1月10日起至民國96年9月15日，經隨機分配為實驗組32人及控制組31人，實驗組流失6人，控制組流失6人。最後，實驗組共26人及控制組共25人完成研究。控制組接受門診例行性照護，實驗組除了接受門診例行性照護外，還接受每週一次，為期八週之電話追蹤，內容包括憂鬱症狀監測、疾病和藥物衛教指導、壓力處置、自殺預防以及規律返診重要性的衛教。測量工具為貝氏憂鬱量表、簡明版世界衛生組織生活品質問卷、精簡門診使用者滿意量表、並經由病歷查詢門診規則返診情形，研究結束後，以半結構式訪談瞭解實驗組及控制組對治療照護療效的看法。 • 結果：研究顯示實驗組及控制組各組病患的憂鬱程度在8週後，皆有顯著改善，比較實驗組與控制組的憂鬱進步值則無顯著差異（p =.774）。實驗組與對照組生活品質之生理範疇（p=.108）、心理範疇（p=.328）、環境範疇（p=.070）未達顯差異，但社會範疇（p=.032）達顯著差異。以精簡門診使用者滿意量表測量電話追蹤介入前後之差異，發現實驗組門診滿意度前後值顯著差異（p=.010），控制組研究前後測無顯著差異（p=.156），比較控制組與實驗組進步值亦無顯著差異（p=.478）。實驗組病患於研究後，規則返診率比控制組顯著高（p=.049），顯示電話追蹤能改善憂鬱症病患之門診規則率。 • 結論：電話追蹤方式能促進規則返診率的效果，和提升門診憂鬱症患者社會範疇之生活品質，可作為提升門診憂鬱症初診患者護理照護品質的模式。

2. A Study of Efficacy of Telephone Follow-Up for Patients With Depressive Disorders After First Psychiatrist’s Outpatient Appointment • 英文摘要 • The aim of this study is to examine the efficacy of a telephone follow-up program in reducing the depressive symptoms, increasing quality of life, enhancing adherence to outpatient appointment and service satisfaction among the outpatients who had their first outpatient visit for depressive disorders. A randomized control trial (RCT) was applied to the study. The subjects were recruited from outpatient department of the psychiatric hospital in Taipei and they were randomly assigned into experiment from January 10, 2007 to September 15, 2007. The 26 patients in the experimental group and the 25 patients in the control group completed the study. Patients in the experimental group received the usual care and the 8 weekly telephone follow-up program; while the control group only received usual care. This telephone follow-up program consisted of monitoring depressive symptoms, psychoeducation, and suicide prevention. The result of pair t-test showed that there was a significant reduction of the scores of the Beck Depression Inventory (BDI) both in experiment (p<.001) and control groups (p<.001). However, the result of independent t-test indicated that there was no significant difference in reducing depression (p=.774) between experimental group and control group. With regard to the quality of life, the results revealed that while there was no significant difference in changes of the scores on social domain of the scores of World Health Organization quality of life questionnaires (WHOQOL-BREF) in control group ((p=.322) at pre-post test, there was significant difference in improving social domain of quality of life in experimental group(p=.001). This significant difference between two groups was confirmed by independent t-test (p=.032). Moreover, the results found that the rate of adherence to scheduled outpatient appointments was higher in experimental group than in control group （p=.049）. The scores on the concise OPD User Satisfaction Scale was higher in experimental group （p=.010）while no significant change was found in control group（p=.478）. Conclusion: This study revealed that the 8-week telephone follow-up program could improve social domain of quality of life and could enhance the adherence to scheduled outpatient appointments among outpatients with depressive disorders. These results demonstrated that nurse’s follow-up could improve quality of care for patients with depressive disorders after their first psychiatrist’s outpatient appointment.