多團隊照護在慢性腎臟病病人之醫療成效：系統性文獻回顧

慢性腎臟病(Chronic Kidney Disease, CKD)是一種普遍存在的慢性疾病，已成為當今世界各國防治的重要疾病。由於此疾病複雜度高，為增進疾病的照護，透過多團隊照護(Multidisciplinary care, MDC)進一步延緩慢性腎臟病的病程進展。慢性腎臟病患者的照護，透過不同專科領域的專家共同合作，以多團隊照護概念為基礎，制定全面性的照護策略，使患者得到更完整、連續且非片斷性的照護方式，並改善臨床結果。本研究搜尋華藝線上圖書館、台灣碩博士論文知識加值系統網、PubMed、Cochrane Library及CINAHL等五個中英文資料庫1990至2017年的慢性腎臟病患接受多團隊照護之相關研究。以系統性文獻回顧方式探討多團隊照護在慢性腎臟病患者之醫療成效。總共收錄八篇文獻共有14,813位慢性腎臟病患者，平均年齡約68.65歲。由腎臟專科醫師、其他專科醫師、護理人員、營養師、藥師、心理治療師或社工師組成團隊，提供全面性的醫療照護。研究結果顯示多團隊照護能延緩慢性腎臟病患者腎絲球過濾率的下降、有較高的腎臟替代療法率、降低緊急透析率的發生及年度醫療費用的支出。在生理指標成效顯示多團隊照護能讓慢性腎臟病患者的鈣、磷離子及副甲狀腺素控制得更好，能降低骨病變及心臟血管疾病的風險，且改善副甲狀腺亢進。但在全因死亡率、血壓控制及藥物的使用率的成效結果不一，尚無較一致性的定論。

關鍵字

慢性腎臟病；多團隊照護；醫療成效；系統性回顧

並列摘要

Chronic Kidney Disease (CKD) is one of the common existence of chronic disease that has become prevention and cure of an important disease of the world today. Owing to the high complexity of the disease, Multidisciplinary care (MDC) is used to delay the progression of CKD in order to improve the care quality of the disease. The care of patients with chronic kidney disease, through the cooperation of experts in different specialties area, based on the concept of multidisciplinary care, to formulate a comprehensive care strategy that patients receive the care of more complete, continuous and non-fragmentary, and improve the clinical outcome . We search five database of Chinese and English, which included Airiti Library, National digital library of Theses and Dissertations in Taiwan, PubMed, Cochrane Library, and CINAHL. Searching articles published between 1990 and 2017. Screening the relevant research of patients with chronic kidney disease, who accepted multidisciplinary care. This study examines the medical effectiveness of multidisciplinary care in patients with chronic kidney disease by using a systematic literature review. A total of 14,813 patients with chronic kidney disease of eight articles were included in this study, with an average age of 68.65 years. Members of Multidisciplinary care are comprised of nephrologist, other specialists, nurses, nutritionists, pharmacists, psychotherapists or social workers who provide comprehensive medical care for patients with chronic kidney disease. MDC could delay the reduction of glomerular filtration rate, more higher rate of renal replacement therapy, lower incidence of emergent dialysis, and lower burden of annual medical cost of patients with chronic kidney disease. The biomarker indicators revealed that MDC could make patients with CKD better control of calcium, phosphorus and parathyroid hormone, which mean lower risk of mineral-bone disease and cardiovascular disease, and improvement of parathyroidism. The effectiveness of all-cause mortality, blood pressure and medication use rates were inconclusive result.