遠距照護即時溝通過程中溝通特質與照護成效關係

The Relationship between the Synchronous Telehealth Communication Process Characteristics and Care Effectiveness

徐則彬(Tse-Pin Hsu)

指導教授 ： 戴玉慈

國立臺灣大學/醫學院/護理學研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.02874

摘要

本研究目的在探討即時遠距照護過程中影響照護成效的因子。本研究採次級資料回溯分析方法，針對台北市某醫學中心之遠距照護中心自2009年11月16日至2010年6月30日止進行之即時遠距照護，共70位高血壓個案，先運用質性分析，以內容種類歸類分析其接受遠距照護過程中電話諮詢的問題種類，及個案管理師的溝通行為，再依照不同人口學、疾病特質、量測血壓次數、量測血壓日數、電話諮詢次數、電話諮詢時間、電話諮詢問題種類、個管師溝通行為分類與血壓變化等量性資料進行t test、Peaarson’s 相關檢定、逐步迴歸分析及邏輯式迴歸分析。
結果發現：（1）超過72歲以上病人使用電話諮詢總時間較多。（2）血壓量測總次數的影響因子為年齡超過72歲（t=.399, p=<.01）、電話諮詢總次數（r=.34, p<.01）、電話諮詢總時間（r=.27, p<.05）、個管師溝通行為分類次數之資料收集（r＝.255, p<.05）、病人教育與諮詢（r＝.407, p<.001）、提供關懷與建立關係（r＝.262, p<.05）、強化自我效能與自主（r＝.370, p<.01）、電話諮詢內容類別次數之生命徵象（r＝.241, p<.05）、儀器設備（r＝.266, p<.05）、醫院行政（r＝.352, p<.01）。（3）血壓測量總日數的影響因子為年齡超過72歲（t＝2.499, p<.05）、個管師溝通行為分類次項之心理社會諮詢次數（r＝-.402, p<.01）。（4）與收縮壓降低幅度相關因素有收案初期之收縮壓值（r=-.531, p<.001）、肺臟疾病（t=-1.009, p<.01）、痛風（t=2.770, p<.01）三項，共可解釋41.9%變異量。（5）初期收縮壓較高者（OR=1.063, 95% CI=1.021-1.107, p<0.01）、教育程度國中以下者（OR=2.876, 95% CI=1.048-7.893, p<0.05）收案末期其收縮壓下降超過2 mmHg的機率較高。（6）無痛風診斷（OR=3.556, 95%CI=1.248-10.127, p<0.05）、電話諮詢內容屬門急住流程次數較多者（OR=1.821, 95% CI=1.050-3.156, p<0.05），血壓可控制在治療建議範圍內的機率較高。
本研究顯示即時遠距照護確實能協助個案達到有效的血壓控制，個案管理師的即時的線上溝通行為能增進個案血壓量測的自我照顧行為。

關鍵字

即時遠距照護 ； 電話諮詢 ； 溝通過程

並列摘要

The present study sought to explore factors associated with telehealth care during the Synchronous Telehealth (ST) process. This investigation was based on secondary analysis of existing data from a medical center in Taipei city from November 2009 to June 2010 and 70 hypertension patients with the ST care during the study period constituted our sample. Content analysis was first employed to categorize home care problems and communication behaviors of case managers. Then, descriptive tabulations characterized the distributions of socio-demographic characteristics, co-morbidity, blood pressure, and telehealth care utilizations of the sample population by t-test and Pearson’s correlation. The final multivariate logistic regressions with stepwise procedures were conducted to estimate all models.
Bivariate analyses show that (1) participants aged 72 and older were more likely to use tele-consultations than their counterparts; (2) significant factors associated with frequency of blood pressure measurement included age (t=.399, p<.01), frequency of tele-consultation (r=.34, p<.01), total length of tele-consultation (r=.27, p<.05), and case manager‘s behaviors such as data gathering (r=.255, p<.05), information giving and counseling (r=.407, p<.01), caring and building relationship (r=.262, p <.05), empowerment and activate partnering (r=.370, p<.01), problems about vital signs (.241, p<.05), devices (r=.266, p<.05), hospital administration (r=.352, p<.01); (3) factors associated with days of blood pressure measurement were age (r=2.499, p<.05) and such case manager’s behaviors as psychosocial counseling (r=-.402, p<.01); and (4) patients who were less likely to decrease level of systolic blood pressure were those with initial high systolic blood pressure (r=.531, p<.001), lung disease (t=-1.009, p<.01), and gout (t=2.770, p<.01). And, these three factors contributed to 41.9% of total variance in telehealth utilizations. In addition, findings from logistic regression models further indicated that (5) higher initial systolic blood pressure (OR=1.063; 95% CI=1.021-1.107) and education level lower than junior high school (OR=2.876; 95% CI=1.048-7.893) were significantly associated with reduced systolic blood pressure; and (6) patients with no gout history (OR=3.556, 95%CI=1.248-10.127, p<0.05) and more telehealth utilizations (e.g. consultations for OPD, ED, and administration procedure) performed better self- control over systolic blood pressure.
Results suggest that ST care significantly improves the blood pressure control. Immediate tele-consultation from case managers assists patient self-care behaviors.

並列關鍵字

Synchronous Telehealth ； tele-consultation ； communication process

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