[[alternative]]Review of The Evidence for Home Care for The Community Mentally Ill Patients

[[abstract]]目的 台灣慢性精神疾患約7萬9千人生活於社區自家中，居家照護可讓病患持續接受醫療照護，穩定於社區生活。至今較缺乏居家照護措施及成效之實證整合文獻，本研究即彙整有效執行居家照護內涵之結構、過程及成效的最佳證據。方法 本居家照護實證文獻回顧運用形成問題、文獻搜尋、篩選文獻、文獻品質評析及萃取整合資料。搜尋國內、外電子資料庫包括EBSCOHOST(Academic Search Complete, CINAHL,CINAHL plus with Full Text, Medline, Medline with Full Text, ERIC)、PUBMED、PRO QUEST、COCHRANE LIBRARY、CINAHL及臺灣期刊論文索引、Airiti Library華藝線上圖書館、臺灣碩博士論文系統。運用“ Mentally ill persons” or “Mental disorders “or “Severe mental illness“及“ Community psychiatry” or “ Home care services ” or “Community mental health service”可能之同義關鍵字及上述關鍵字廣義中文名詞搜尋，應用納入標準及排除條件，逐一閱讀題目及摘要，過濾符合之文獻後，兩位作者獨自閱讀，採用JBI文獻評析工具，達一致意見選取回顧之文獻，再進行萃取並整合結果。結果 共納入17篇英文及3中文論文。文章性質以系統性回顧文章8篇最多，證據等級1為3篇。彙整證據等級最高之實證居家照護內涵，結構面之服務方式為積極型個案管理(Intensive Case Management)及整合性照護(Integrate care )；服務特徵為直接居家訪視、個案負荷量小(Small caseload)、多專業團隊(Multidisciplinary)，服務以護理師為個案管理師。過程面展現服務步驟，以彙整實證措施，融合個案管理步驟為1.建立結盟關係(Alliance)，2.評估病患需求，3、提供緊急處置，4.兼顧健康及社會照護，5.強調藥物管理，6.協調(Coordination)相關服務，7.轉介，雖然最佳證據等級為提供緊急處置及藥物管理，但可優先執行為建立結盟關係、評估病患需求、兼顧健康及社會照護。成效面為降低住院率，減少失聯，減少家屬負擔，提昇服務滿意度，降低成本，改善社會功能等，視為實證成效指標為降低住院率，減少失聯。實務應用 本實證文獻所獲得最佳居家照護服務之實證證據，結構面可供採行個案管理之依據，過程面加入探討國內醫療政策、文化、資源及人力現況，提供具可行性之居家照護實務內涵，作為護理人員培訓居家照護能力参考。最後彙整居家照護之結構、過程及成效的最佳證據，可以運用於國內發展社區精神衛生居家照護或整合性服務之實務指引。[[abstract]]Purpose In Taiwan, there are 79 thousand people who had chronic mental illness and stayed in their own communities. Home care allows the patients to continue receiving health care, and to keep stable in the community. However, we still lack the integrated literature for home care intervention and their effectiveness. As a result, this review article is to investigate and integrate the structure, process and effectiveness of home care.Method The procedure used were PUBMED search platform、PRO QUEST、COCHRANE LIBRARY、CINAHL for searching of foreign literature. Domestic literature places Index to Taiwan Periodical literature System, Airiti Library, National Digital Library of Theses and Dissertations in Taiwan as were platform, using synonym search terms. We selected the quality of papers and then used Joanna Briggs Institute (JBI) appraisal tools. Every paper was read by two authors and was discussed for the consensus.Results We selected 17 review articles in English and 3 in Chinese in total. In these cited articles, intensive case management and integrate care were most described in the care structure. The characteristics of the service were regular home visit, small caseload, and multidisciplinary team. Most case managers are from nursing profession. The process of the articles were emphasized on (1) building alliance relationship, (2) assessing patients’ needs, (3)providing crisis intervention, (4) taking responsibilities for health and social care, (5) medication management, (6) coordination of services, and (7) referral.Implications for practice The results obtained in our study can be used as guidelines for the further development of community mental health care and service