某地區教學醫院糖尿病門診病患個案管理照護之成效探討
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篇名：某地區教學醫院糖尿病門診病患個案管理照護之成效探討
並列篇名：An Evaluation of Effectiveness of Case Management for Diabetes Mellitus Outpatients in a Regional Teaching Hospital
作者：郝立智(Lyh-Jyh Hao);馬瀰嘉(Mi-Chia Ma);趙海倫(Hailun Chao);簡崇仁(Chung-Ren Jan);楊純宜(Chwen-Yi Yang);林興中(Hing-Chung Lam);李鎮堃(Jenn-Kuen Lee);奚明德(Ming-Der Shi);葛光中(Kuang-Chung Ko);柴國樑(Kuo-Liang Chai);鄭錦翔(Jin-Shiung
關鍵字：糖尿病;糖尿病衛教師;糖尿病醫療給付改善方案;個案管理;diabetes mellitus;diabetes mellitus educator;diabetes mellitus medical benefit improvement project;case management
期刊/會議論文集名稱 ：中華民國內分泌暨糖尿病學會會刊
卷期：20卷4期
出版年：2007
中文摘要：背景：糖尿病是國人最重要的慢性病之一，糖尿病的長期控制需仰賴醫療團隊提供周全的衛教，定期篩檢可能併發症，以達到良好代謝的控制標準，期能減緩各式併發症的發生。中央健保局有鑑於糖尿病衛教的重要，為提升衛教水準，提出糖尿病醫療給付改善方案，以增加衛教給付為誘因，在全台醫療院所進行試辦。
目的：本研究目的在了解『糖尿病醫療給付改善方案』門診個案管理介入措施，對完成年度回診的糖尿病患者，管理前後的血糖控制、糖化血色素及相關代謝指標之影響。
方法：自民國九十三年一月到十二月經由新陳代謝科專科醫師診斷為糖尿病（診斷碼ICD-9為250.0至250.93）確立者，列為收案及管理對象，給予必要之處置及治療。個案轉介給糖尿病衛教師後安排既定之介入措施，包括了解病患之教育水平、服藥習慣、藥物辨識力、生活模式、飲食習性、提供個別的衛教諮詢及引導，並給予適度之心理支持與鼓勵。此外，設計病患就醫提示單，提醒醫師病患此次就診應開立之檢驗及最近一次檢驗數據。同時收集個案基本資料、疾病特性、血液生化檢查，以SPSS10.5中文版統計軟體進行資料分析，以描述性統計方法，描述研究對象的基本資料，如性別、年齡、教育程度、身體質量指數；疾病特性，如糖尿病型態、治療方式、糖尿病史、是否合併其他疾病。以成對樣本t檢定(paired t test)和線性迴歸方法，分析研究對象管理前後各種變項之差異程度。
結果：本研究期間共收集162位個案，平均年齡為67.14歲，男、女性分別佔101位(62.35%)及61位(37.65%)。全部是屬於第二型糖尿病患者，以口服降血糖藥控制血糖者佔153位(95%)。162位之中合併有高血壓者佔67.28%，合併高血脂者佔51.86%。統計結果顯示，經成對樣本t檢定分析發現，舒張壓、體重、空腹血糖、糖化血色素等值，在管理前後，呈現顯著性的改善(P<0.05)。
結論：『糖尿病醫療給付改善方案』門診個案管理介入措施，對於改善血糖、糖化血色素及相關代謝指標，扮演一個正面的角色，特別是那些最初糖化血色素較高的病人(A1C≧9%)。
英文摘要：Background: Diabetes mellitus has become one of the major chronic diseases in Taiwan. Long-term control of diabetes mellitus largely depends on comprehensive education program and regular screening of diabetes related complications in order to achieve optimal control goals. To enhance delivery of education program to diabetic subjects in various medical settings, Bureau of National Health Insurance has proposed a Diabetes Education Improvement Program by providing additional reimbursement as an incentive.
Purposes: To evaluate the effect of diabetes mellitus medical benefit improvement project case management for those outpatient diabetes who completed the annual education program on glycemic control and associated metabolic index.
Methods: Between January 2004 and December 2004, patients with established diabetes mellitus (ICD-9 number 250.0 to 250.93) were referred to a diabetes mellitus educator and were included in this study. Treatments were given and subsequent patient care and follow up were carried out by the diabetes mellitus educator. The educator inquired into patients' education level, medication use ideas, medication discrimination ability, lifestyle, and diet behavior. The educator then provided necessary healthcare education and instruction as well as offering appropriate psychosocial support. In addition, a table with the latest tests and laboratory data, together with any suggested necessary examinations, was created for the doctor to consult at each OPD consultation. Data including the patients′ baseline characteristics, disease type and biochemical laboratory data were also collected. Differences in the before and after management data were compared by using SPSS 10.5 version statistic software (paired t test and linear regression method).
Results: A total of 162 patients were included. The mean age was 67.14 years old, 101 patients were male (62.35%) and 61 patients were female (37.65%). They are all of type 2 diabetes mellitus. The number of patient taking oral hypoglycemic agents was 153 (95%). Of the 162 patients, 67.28% had hypertension and 51.86% had hyperlipidemia. Analysis with a paired t test of the diastolic blood pressure, body weight, fasting plasma glucose, A1C data showed a significant difference between before and after management (P<0.05).
Conclusion: The intervention results suggested that the diabetes mellitus medical benefit improvement project outpatient case management played a positive role in the improvement of glycemic control and associated metabolic index, especially for those patients who have the higher initial A1C level(≧9%).
起始頁-結束頁：11-33
資料語文：繁體中文
主題分類：醫學與生命科學＞醫學
出版單位：中華民國內分泌暨糖尿病學會
篇名：某地區教學醫院糖尿病門診病患個案管理照護之成效探討
並列篇名：An Evaluation of Effectiveness of Case Management for Diabetes Mellitus Outpatients in a Regional Teaching Hospital
作者：郝立智(Lyh-Jyh Hao);馬瀰嘉(Mi-Chia Ma);趙海倫(Hailun Chao);簡崇仁(Chung-Ren Jan);楊純宜(Chwen-Yi Yang);林興中(Hing-Chung Lam);李鎮堃(Jenn-Kuen Lee);奚明德(Ming-Der Shi);葛光中(Kuang-Chung Ko);柴國樑(Kuo-Liang Chai);鄭錦翔(Jin-Shiung
關鍵字：糖尿病;糖尿病衛教師;糖尿病醫療給付改善方案;個案管理;diabetes mellitus;diabetes mellitus educator;diabetes mellitus medical benefit improvement project;case management
期刊/會議論文集名稱 ：中華民國內分泌暨糖尿病學會會刊
卷期：20卷4期
出版年：2007
中文摘要：背景：糖尿病是國人最重要的慢性病之一，糖尿病的長期控制需仰賴醫療團隊提供周全的衛教，定期篩檢可能併發症，以達到良好代謝的控制標準，期能減緩各式併發症的發生。中央健保局有鑑於糖尿病衛教的重要，為提升衛教水準，提出糖尿病醫療給付改善方案，以增加衛教給付為誘因，在全台醫療院所進行試辦。
目的：本研究目的在了解『糖尿病醫療給付改善方案』門診個案管理介入措施，對完成年度回診的糖尿病患者，管理前後的血糖控制、糖化血色素及相關代謝指標之影響。
方法：自民國九十三年一月到十二月經由新陳代謝科專科醫師診斷為糖尿病（診斷碼ICD-9為250.0至250.93）確立者，列為收案及管理對象，給予必要之處置及治療。個案轉介給糖尿病衛教師後安排既定之介入措施，包括了解病患之教育水平、服藥習慣、藥物辨識力、生活模式、飲食習性、提供個別的衛教諮詢及引導，並給予適度之心理支持與鼓勵。此外，設計病患就醫提示單，提醒醫師病患此次就診應開立之檢驗及最近一次檢驗數據。同時收集個案基本資料、疾病特性、血液生化檢查，以SPSS10.5中文版統計軟體進行資料分析，以描述性統計方法，描述研究對象的基本資料，如性別、年齡、教育程度、身體質量指數；疾病特性，如糖尿病型態、治療方式、糖尿病史、是否合併其他疾病。以成對樣本t檢定(paired t test)和線性迴歸方法，分析研究對象管理前後各種變項之差異程度。
結果：本研究期間共收集162位個案，平均年齡為67.14歲，男、女性分別佔101位(62.35%)及61位(37.65%)。全部是屬於第二型糖尿病患者，以口服降血糖藥控制血糖者佔153位(95%)。162位之中合併有高血壓者佔67.28%，合併高血脂者佔51.86%。統計結果顯示，經成對樣本t檢定分析發現，舒張壓、體重、空腹血糖、糖化血色素等值，在管理前後，呈現顯著性的改善(P<0.05)。
結論：『糖尿病醫療給付改善方案』門診個案管理介入措施，對於改善血糖、糖化血色素及相關代謝指標，扮演一個正面的角色，特別是那些最初糖化血色素較高的病人(A1C≧9%)。
英文摘要：Background: Diabetes mellitus has become one of the major chronic diseases in Taiwan. Long-term control of diabetes mellitus largely depends on comprehensive education program and regular screening of diabetes related complications in order to achieve optimal control goals. To enhance delivery of education program to diabetic subjects in various medical settings, Bureau of National Health Insurance has proposed a Diabetes Education Improvement Program by providing additional reimbursement as an incentive.
Purposes: To evaluate the effect of diabetes mellitus medical benefit improvement project case management for those outpatient diabetes who completed the annual education program on glycemic control and associated metabolic index.
Methods: Between January 2004 and December 2004, patients with established diabetes mellitus (ICD-9 number 250.0 to 250.93) were referred to a diabetes mellitus educator and were included in this study. Treatments were given and subsequent patient care and follow up were carried out by the diabetes mellitus educator. The educator inquired into patients' education level, medication use ideas, medication discrimination ability, lifestyle, and diet behavior. The educator then provided necessary healthcare education and instruction as well as offering appropriate psychosocial support. In addition, a table with the latest tests and laboratory data, together with any suggested necessary examinations, was created for the doctor to consult at each OPD consultation. Data including the patients′ baseline characteristics, disease type and biochemical laboratory data were also collected. Differences in the before and after management data were compared by using SPSS 10.5 version statistic software (paired t test and linear regression method).
Results: A total of 162 patients were included. The mean age was 67.14 years old, 101 patients were male (62.35%) and 61 patients were female (37.65%). They are all of type 2 diabetes mellitus. The number of patient taking oral hypoglycemic agents was 153 (95%). Of the 162 patients, 67.28% had hypertension and 51.86% had hyperlipidemia. Analysis with a paired t test of the diastolic blood pressure, body weight, fasting plasma glucose, A1C data showed a significant difference between before and after management (P<0.05).
Conclusion: The intervention results suggested that the diabetes mellitus medical benefit improvement project outpatient case management played a positive role in the improvement of glycemic control and associated metabolic index, especially for those patients who have the higher initial A1C level(≧9%).
起始頁-結束頁：11-33
資料語文：繁體中文
主題分類：醫學與生命科學＞醫學
出版單位：中華民國內分泌暨糖尿病學會
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