研究目的:本研究欲瞭解與一般神經科門診相比,整合性記憶門診在失智治療、醫療資源耗用和用藥安全上是否有不同,以及兩個門診之病人和主要照顧者間是否有差異。 研究方法:本研究為非隨機,有對照組之準實驗性設計,採立意取樣之方式,以回溯式研究法收集臨床資料。總共收集整合性記憶門診(51人)和一般神經科門診(58人)共109位失智症病人及其主要照顧者,分別以臨床失智量表(CDR)和簡易智能狀態測驗(MMSE)檢查失智病人,並以SF-36健康量表及Zarit負荷量表收集照顧者的生活品質及負荷資料。統計方法為敘述性統計、Pearson 卡方檢定、獨立樣本t檢定、單因子變異數分析、Pearson積差相關及迴歸分析等來進行。 研究結果:研究發現整合性記憶門診的病人有較高比例有精神症狀,照顧者的生活品質較差,負荷較多。整合性記憶門診的病人有較多的住院及急診次數,顯示出這組病人在照護上比一般門診失智病人更困難複雜。整合性記憶門診的病人有較少的每月門診次數及藥費。而在出現藥物交互作用及重覆用藥的比例也是明顯較少。病人經過整合性記憶門診治療後,其MMSE的分數明顯較一般門診增加。 結論與建議:以病人為中心的整合性照護是現今醫療的趨勢。本研究顯示與一般門診比較,採取專業合作的整合性記憶門診方式,可以提供有精神症狀的失智患者,和生活品質較差、負荷大的照顧者一個全面性、團隊性的治療方式,還可以減少醫療資源耗用及提升用藥安全。
Purpose: The purpose of the research was to understand the difference of dementia treatment, medical resource utilization and drug safety between integrated memory clinic and general neurology clinic. The difference in out-patients and primary caregivers between two clinics was also evaluted. Methods: The research was a non-randomized, quasi-experimental design with control group. The clinical data was collected with purposive sampling approach and retrospective method. There were 109 dementia patients and their caregivers from memory clinic and general neurology clinics. The patients were evaluated with clinical dementia rating (CDR) scale and minimal mental status examination (MMSE). The caregivers’quality of life was test with SF-36 Health Survey Questionnaire, and their burden was test with Zarit caregiver burden scale. Statistical methods included descriptive statistics, Pearson chi-square test, independent sample t test, analysis of variance, Pearson correlation, and regression analysis. Results: The research showed more psychologic symptoms, more times of admission and ER visits in patients of integrated memory clinic. The caregivers of this clinic had poor quality of lifem and more burdens. Integrated memory clinic patients have fewer number of clinical visits per month and drug cost, and drug-drug interactions and the proportion of repeat medication is significantly less. Conclusions and Suggestions: The integrated patient-centered care is a current trend in health care. This research displayed a professional co-operated, integrated memory clinic can provide dementia patients with psychologic symptoms, and caregivers with poor quality of life and more burdens, a comprehensive team of dementia treatment.
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