糖尿病照護成效與影響因素之探討：以台東某區域醫院糖尿病共同照護網為例

The Outcomes and Factors Associated with Diabetes Care: The Diabetes Shared Care Program in a Regional Hospital in Taitung, Taiwan

黃憶玫(Yi-Mei Huang) ； 張慈桂(Tzu-Kuei Chang)

《台灣公共衛生雜誌》 30卷1期 (2011/02) Pp. 19-28

https://doi.org/10.6288/TJPH2011-30-01-03

摘要

Objectives: The aim of this study was to assess 3-year outcomes and factors associated with those outcomes in type 2 diabetic patients who joined the diabetes shared-care program in Taitung, Taiwan. Methods: 242 type Ⅱ diabetic patients in a Taitung regional hospital were enrolled in this study and completed 4 follow-up measures. The principal measure was the patient's mean HbA1c at baseline and at each annual follow-up. A logistic regression model was used to examine the factors associated with poor glycemic control. Results: (1) The mean HbA1c level showed the greatest reduction in the first follow-up year. The level gradually increased over time (the mean values for HbA1c at baseline, 1(superscript st), 2(superscript nd), and 3(superscript rd) years were 9.12%, 7.93%, 8.20%, and 8.27% respectively, p＜0.05); however, the 3(superscript rd) year level of HbA1c was still a significant improvement over baseline. (2) Age＜65, aborigines, a higher HbA1c level at baseline, a longer duration of illness, and higher doses of medication were significantly associated with poor glycemic control. Conclusions: Our study demonstrated the long-term efficacy of a diabetes shared- care program in HbA1c control. Age, ethnicity, initial HbA1c level, duration of illness, and medication used were significantly associated with poor diabetes control. It would be helpful in improving the quality of diabetes-care among the Taitung population if case management were combined with community resources.

關鍵字

台東地區 ； 糖尿病 ； 共同照護網 ； 糖化血色素

並列摘要

Objectives: The aim of this study was to assess 3-year outcomes and factors associated with those outcomes in type 2 diabetic patients who joined the diabetes shared-care program in Taitung, Taiwan. Methods: 242 type Ⅱ diabetic patients in a Taitung regional hospital were enrolled in this study and completed 4 follow-up measures. The principal measure was the patient's mean HbA1c at baseline and at each annual follow-up. A logistic regression model was used to examine the factors associated with poor glycemic control. Results: (1) The mean HbA1c level showed the greatest reduction in the first follow-up year. The level gradually increased over time (the mean values for HbA1c at baseline, 1(superscript st), 2(superscript nd), and 3(superscript rd) years were 9.12%, 7.93%, 8.20%, and 8.27% respectively, p＜0.05); however, the 3(superscript rd) year level of HbA1c was still a significant improvement over baseline. (2) Age＜65, aborigines, a higher HbA1c level at baseline, a longer duration of illness, and higher doses of medication were significantly associated with poor glycemic control. Conclusions: Our study demonstrated the long-term efficacy of a diabetes shared- care program in HbA1c control. Age, ethnicity, initial HbA1c level, duration of illness, and medication used were significantly associated with poor diabetes control. It would be helpful in improving the quality of diabetes-care among the Taitung population if case management were combined with community resources.

並列關鍵字

Taitung area ； Diabetes mellitus ； diabetes shared care program ； HbA1c

參考文獻

Chang, H.C.,Chang, Y.C.,Lee, S.M.(2007).The effectiveness of hospital-based diabetes case management: an example from a northern Taiwan regional hospital.J Nurs Res.15,296-309.

Tang, P.L.,Yuan, W.L.,Tseng, H.F.(2005).Clinical follow-up study on diabetes patients participating in a health management plan.J Nurs Res.13,253-62.

徐慧君、翁慧卿、林育慈(2004)。糖尿病患介入疾病管理在經濟面、臨床面及滿意度成效評估之初探—以南部某區域醫院糖尿病病患為例。醫務管理期刊。5，222-42。

陳都文、王俊毅(2009)。糖尿病共同照護網對偏遠地區中老年患者健康狀況之成效。台灣衛誌。28，334-43。

台東縣政府：台東縣台東市人口統計，2003。http://web2.taitung.gov.tw/department/m1/1401.htm。引用2008/03/24。Taitung County Government. Population statistics in Taitung city. Available at: http://web2.taitung.gov.tw/department/m1/1401.htm. Accessed March 24, 2008.[In Chinese]