個案管理介入門診第2型糖尿病人之照護成效探討--某區域醫院為例

The Effectiveness of Applying Case Management for Type 2 Diabetes Mellitus Patients at Outpatient Department--a Case of Regional Hospital

李綉彩(Shiow-Tsae Lee)

指導教授 ： 盧美秀

臺北醫學大學/護理學院/護理學研究所/碩士(2004年)

摘要

本研究目的旨在比較個案管理介入與否，對門診第2型糖尿病患在過程指標(預約就診率、服務滿意度、自我照顧能力)及結果指標(血糖值、糖化血色素及住院率)的差異。 本研究採類實驗性研究（Quasi-experimental design）設計，以立意取樣方式，依門診先後分配至實驗組與對照組，研究期間自2003年4月至同年11月，研究樣本為某區域醫院第2型糖尿病門診病患，且符合本研究條件者。實驗組採個案管理介入，對照組接受一般常規照護。於實施前收集兩組基本資料與前測資料--包括過程指標的預約就診率、滿意度及自我照顧能力，結果指標的血糖值、糖化血色素及住院率等，實施照護方案三個月後，再依前測方式收集後測資料，比較不同照護方式成效差異。資料以EPI-INFO（6.0）鍵入及SAS for Windows 8.0套裝軟體處理，以Chi-Square及t-test分析兩組基本屬性，並以GEEs（Generalized Estimateing Equations）之迴歸模式、McNemar’s test及Fisher’s exact test，比較兩組照護成效之前後測差異性。 本研究實驗組29人，對照組28人。研究結果顯示：實施個案管理後，過程指標：病患預約就診率，統計上未具顯著差異（p＝.125），病患服務滿意度，迴歸係數為負值，而統計上未具顯著差異（p＞.05）。病患的自我照顧能力成效構面中的運動自我照顧、飲食自我照顧、藥物與血糖監測自我照顧、足部自我照顧、高低血糖的預防及處理自我照顧，統計上均未具顯著差異（p＞.05）。結果指標：血糖值及糖化血色素值，迴歸係數為負值，均具有統計上顯著差異（p＜.001），住院率統計上未具顯著差異（p＝.49）。但以上研究在個案管理介入後均有進步，建議臨床上可以此個案管理模式嘗試推廣。

關鍵字

個案管理 ； 門診第2型糖尿病 ； 照護成效

並列摘要

The purpose of this study is to find out the differences of process index (return rate of reserved registration, service satisfaction rate and self-care ability) and result index (blood sugar level, HbA1c level and admission rate) of type 2 DM (diabetic mellitus) patients in OPD (out patient department) while they received the regular nursing care and the case management care was introduced in to the nursing care process. The methodologies used in this study are Quasi-experimental design and purposeful sampling method. The study samples (DM patients) were collected from the OPD at a regional hospital. During the period from April to Novem- ber 2003, the OPD patients who fulfill the criteria of this study were divided into experimental group and control group according to their visiting sequen- ce. The experimental group received case management nursing care while the control group received regular nursing care. The data of process index (return rate of reserved registration, service satisfaction rate an self-care ability) and result index (blood sugar level, HbA1c level and admission rate) of the two groups were collected prior to the case management care was introduced and specified as pre-testing data. The same kinds of data were collected again 3 months later and specified as post-testing data. The two set of data were compared to find out if there is any difference between the two different nursing care process. The data were treated with software of EPI-INFO (6.0) and SAS for Windows 8.0. The attributes of these two groups were analyzed with Chi- Square and Student T-Test. The nursing care effect were compared by using regression model of GEES (Generalized Estimating Equations), McNemar’s test and Fisher’s exact test. There were 29 patients being classified as experimental group and 28 patients being classified as control group separately. The results of this study indicated that there was no significant statistical difference in process index: return rate of reserved registration (p= .125); service satisfaction rate (p>.05) and regression-coefficient of service satisfaction rate is negative; self-care ability (p>.05) which including exercise, diet, drugs, blood sugar monitoring, foot care, and prevention of hyper- or hypoglycemia. However, the result index showed that the regression-coefficient of blood sugar and HbA1c level (p<.001) were negative and had significant difference in statistics. But the admission rate (p=.49) was no significant difference. In the study period, the patients who received the case management nursing care had good improvement so we would recommend the case management nursing care model being promoted in clinical practice.

並列關鍵字

case management ； type 2 DM outpatient ； effectiveness

參考文獻

莊嬌榮、林宏達、鄭 綺(1999)?影響第2型糖尿病患血糖控制因素的探討?中華民國內分泌暨糖尿病學會會訊，12(3)，39-50。

施木青(1999)?糖化血色素的臨床應用?中華民國內分泌暨糖尿病學會會訊，12(5)，71-75。

戴東原(1993)?老年人糖尿病的治療?臺灣醫界，36(6)，25-27。

盧美秀、魏玲玲、廖美南、徐美玲(1999)?應用個案管理於控制消化性潰瘍合併出血病患照護品質及成本效益之成效探討?新台北護理期刊，1(1)，81-89。

陳嫣芬、李玟玲(2001)?規律性的有氧運動對老年第二型糖尿病患者之影響?大專體育，53，153-159。