정신분열병 환자의 퇴원 후 첫 외래 방문과 관련된 요인

Factors Associated with Missed First Appointments after Discharge in Patient with Schizophrenia

목 적： 정신 질환과 같은 만성질환은 치료에 따르지 않음으로써 재발과 재입원을 반복하고, 지역사회에 적응하지 못하게 된다. 정신과 환자들의 입원 치료 후 외래 재방문의 순응도에 영향을 미치는 사회인구학적 및 임상적 특성을 조사하여 순응도를 예측할 수 있는 모델을 모색해 보고자 하였다. 방 법： 정신과 입원 치료 후 퇴원을 하는 정신분열병 환자 74명을 대상으로 진료 기록부를 조사하여 퇴원 후 첫 외래 방문을 한 군과 외래 방문을 하지 않은 군으로 구분한 후 양군간의 통계적으로 유의미한 차이가 있는 사회인구학적 및 임상적 요인을 확인 하였다. 결 과： 1) 연구를 마친 74명의 환자 중 퇴원 후 첫 외래 방문을 한 군은 55명으로 총 대상자의 74%였고, 첫 외래 방문에 오지 않은 군은 19명으로 총 대상자의 26%였다. 2) 성별과 나이, 교육기간, 결혼상태, 직업유무, 보험형태, 가족형태 등의 사회인구학적 요인에서는 양군간에 유의한 차이가 없었고 3) 입원형태, 입원기간, 발병연령, 과거 입원 횟수, 입원 시 체중 변화, 입원 당시의 BPRS 점수, 퇴원 당시의 BPRS 점수, 입원 시와 퇴원시의 BPRS 점수 차이 등의 임상적 요인에서는 입원기간과, 퇴원 당시의 BPRS 점수, 그리고 입원시와 퇴원시의 BPRS 점수 차이에서 양군간에 통계학적으로 유의미한 차이가 있었는데, 입원 기간이 길수록 퇴원 후 첫 외래 방문을 하는 경우가 많았 으며, 퇴원 당시의 BPRS 점수가 낮을수록, 그리고 입원시와 퇴원시의 BPRS 점수 차가 클 수록 퇴원 후 첫 외래 방문을 하는 경우가 많았다. 결 론： 입원 치료를 시행하는 정신분열병 환자 중 순응도가 낮을 것으로 예상되는 입원기간이 짧은 환자와, 퇴원당시 BPRS 점수가 높은 정신증상이 심한 환자에서는 퇴원 후 외래 통원 치료를 잘 시행 할 수 있도록 더 많은 관심과 주의를 기울여야 할 것이다.

Objective：Chronic Illnesses such as mental disorder make recurrences and re-admissions to the hospital happen when patients do not get the treatment and can not adjust to the society. By conducting research on social demography and clinical characteristics, which affect patients’ mental compliance of revisiting a hospital, it helps to examine a model that could predict the compliance. Method：With reference to a medical chart of seventy-four patients who had been released from one of the hospitals in Korea after their completion of treatment, they were separated into two categories；A) those who made the first visit to the clinic after the release and B) those who did not visit the clinic afterwards. Statistically, it was confirmed that there was a significant difference on their tendency in terms of their demographic and clinical characteristics. Results：1) Among the seventy-four Schizophrenia patients examined, it was found that fifty-seven people re-visited the hospital after their release from the hospital, occupying around seventy-seven percent of the whole population. On the contrary, there were seventeen patients who did not make the visit to the hospital, which was about twenty three percent. 2) There was no significant difference on the result in demographic characteristics such as patients’ gender, age, educational background, marital status, type of insurance, family members. 3) The clinical characteristics include; forms and durations of hospitalization, forms of discharge, onset age, history of hospitalization, use of Benztropine, difference in weight, injection of mood stabilizer, BPRS rate during hospitalization, BPRS rate when discharged from the hospital, and the difference in BPRS rate during and after the hospitalization. Among those characteristics, statistically, there were significant differences in period of hospitalization, BPRS rate after discharged from the hospital, and the difference in rate during and after the hospitalization. However, the longer the patients were hospitalized, the higher was the percentage of their re-visiting the hospital after the discharge. Also, the BPRS rate while discharging from the hospital and the percentage of re-visiting the hospital showed a negative correlation. Conclusion：Among the Schizophrenic patients who have been treated, assumption is made to those patients with short period of hospitalization and patients with severe Psychotic symptoms who scored high on BPRS rate during discharge might be low on compliance. Therefore, these patients might need much more careful attention for their incessant treatment in the future.