門診糖尿病病患個案管理照護之成效

Effectiveness of Case Management for Diabetes Mellitus Outpatients

郭淑娟(Shu-Chuan Kuo) ； 陳重榮(Trong-Zong Chen) ； 梁深維(Sum-Wai Leung) ； 楊素伴(Su-Pan Yang) ； 許美月(Mei-Yueh Hsu) ； 祝春紅(Chun-Hong Chu)

《北市醫學雜誌》 2卷2期 (2005/02) Pp. 157-166

https://doi.org/10.6200/TCMJ.2005.2.2.05

摘要

Purpose: To evaluate the effect of case management for outpatient diabetes on glycemic control. Method: Between July 2002 and February 2003, patients with established diabetes mellitus (DM) were referred to a chronic disease manager by the outpatient department (OPD) and were included in this study. Treatments were given according to a guideline developed by endocrinologists at the Municipal hospital, Taipei City, and subsequent patient care and follow- up were carried out by the chronic disease manager. The manager inquired into patient's education level, medication use ideas, medication discrimination ability, lifestyle, and diet behavior. The manager 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 using SPSS statistic software 11.0 version. Results: A total of 306 patients were included. The mean age was 61 year old, 108 patients were male (35.3%) and 198 patients were female (64.7%). Among the patients, 99% suffered from Type 2 DM. The number of patient taking oral hypoglycemic agents was 267 (87.2%). Of the 306 patients, 47.7% had hypertension and 42.5% had hyperlipidemia. Blood sugar monitoring rates before and after management were 81.0% and 86.0%, respectively. The percentage of patients with a total of 2-4 measures of glycosylated hemoglobin (HbA(subscript 1c)) before and after management was 70.0% and 87.4%, respectively. Analysis with a paired t test of the HbA1, total cholesterol, triglyceride, and low-density lipoprotein cholesterol data showed a significant difference between before and after management (p＜0.01). Conclusion: The intervention results from case management by the chronic case manager showed that the manager played a positive role in the improvement of glycemic control and in the measured quality indicators.

關鍵字

糖尿病 ； 門診經理 ； 個案管理

並列摘要

Purpose: To evaluate the effect of case management for outpatient diabetes on glycemic control. Method: Between July 2002 and February 2003, patients with established diabetes mellitus (DM) were referred to a chronic disease manager by the outpatient department (OPD) and were included in this study. Treatments were given according to a guideline developed by endocrinologists at the Municipal hospital, Taipei City, and subsequent patient care and follow- up were carried out by the chronic disease manager. The manager inquired into patient's education level, medication use ideas, medication discrimination ability, lifestyle, and diet behavior. The manager 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 using SPSS statistic software 11.0 version. Results: A total of 306 patients were included. The mean age was 61 year old, 108 patients were male (35.3%) and 198 patients were female (64.7%). Among the patients, 99% suffered from Type 2 DM. The number of patient taking oral hypoglycemic agents was 267 (87.2%). Of the 306 patients, 47.7% had hypertension and 42.5% had hyperlipidemia. Blood sugar monitoring rates before and after management were 81.0% and 86.0%, respectively. The percentage of patients with a total of 2-4 measures of glycosylated hemoglobin (HbA(subscript 1c)) before and after management was 70.0% and 87.4%, respectively. Analysis with a paired t test of the HbA1, total cholesterol, triglyceride, and low-density lipoprotein cholesterol data showed a significant difference between before and after management (p＜0.01). Conclusion: The intervention results from case management by the chronic case manager showed that the manager played a positive role in the improvement of glycemic control and in the measured quality indicators.

並列關鍵字

diabetes mellitus ； chronic disease manager ； case management