整合式遠距健康照護模式應用於高血壓病人之成效研究

The Integrated Citizen Telemedical Care Service for Hypertension

陳美如(Chen Mei Ju)

指導教授 ： 鄭惠美

國立臺灣師範大學/教育學院/健康促進與衛生教育學系/博士(2012年)

摘要

目的：本論文以「台北市遠距健康照護服務模式」為基礎，透過資訊服務、醫療服務與公共衛生服務之遠距醫療模式結合，提供高血壓病人健康評估、生理量測線上傳送監測、健康諮詢、主動的健康關懷、衛教指導、醫療協助、社福轉介等，促進民眾健康認知與行為改善，欲(1)建立高血壓病人完整的健康管理服務模式以及(2)增進病人血壓監測之成效外，並(3)同時評估其對「遠距專業客服電話衛教諮詢服務」之接受度與滿意度，以作為服務修正與相關政策制定的參考。

方法：本研究採二組重複測量之準實驗研究設計，研究對象採立意取樣200名高血壓病患，對照組(接受一般就醫程序與衛教過程)，實驗組則接受「整合式遠距健康照護服務」模式，以重複測量方式(六、九個月)評價其高血壓控制與居家量測血壓行為之成效；並於九個月時針對實驗組進行接受度與滿意度調查。

結果：本研究之結果顯示「整合式遠距健康照護服務模式」介入後高血壓病人之後測、後後測較前測血壓控制有統計上顯著差異；但是實驗組整體過程中簡訊與外撥關懷服務沒有增加血壓控制之效果與量測血壓之行為；值得注意的是血壓異常者經簡訊通知提醒後，其後測與後後測較前測之血壓控制有統計上差異。服務滿意度部分，大部分的實驗組個案對於整合式健康照護服務模式表示滿意，付費意願部分以500元以下佔九成。另外，本研究之「遠距專業客服電話衛教諮詢服務」建置一個標準化之電話諮詢服務模式。

結論與建議：本研究對於「整合式遠距健康照護服務模式」應用於高血壓個案模式是可行的介入模式。其對於高血壓研究個案之血壓控制有顯著成效，但是對於高血壓研究個案之居家量測血壓行為改變不顯著。本研究之實驗組個案之認知有用性與服務滿意度明顯具相關性。因此在發展與修正遠距健康照護模型時，如何提升照護模型內容之易用性與有用性認知，透過了解居家慢性病個案之需求性，建構適切之資訊照護服務系統，將有利於遠距健康照護模型之成功發展。
關鍵字：遠距健康照護，客服電話衛教諮詢，高血壓控制

關鍵字

遠距健康照護 ； 客服電話衛教諮詢 ； 高血壓控制

並列摘要

Objective: In this study, we developed an integrated service model for hypertension based on the Smart medical services system for managing chronic disease, which is called the Citizen Telemedical Care Service System (CTCS). The CTCS model specifies six domains: biosignal measurement and short-message alert, hypertension risk estimation report and consultation, clinic appointment service, video communication service, health program record, medical assistance referral and health education. This study tried (1) to establish the integrated service model, (2) to empower hypertension patients to allow self-management and improved hypertension control, and (3) to evaluate the acceptance and satisfaction of the CTCS model. Results will be used to reflect upon the services which the government is currently providing, and to determine if further investigation may be required to establish whether or not the service model currently provided succeeds in meeting the needs of hypertension patients.

Method: The study was a quasi-experimental repeatedly designed to investigate measurement behaviors among two groups across different months from Jun. 2010 to Feb. 2011 to ultimately increase the frequency of BP measurement and improve hypertension control. The study included 200 patients who had unstable hypertension in three cardiologists’ clinics and were on antihypertensive medication. Two generalized estimating equations were used for the analysis of BP outcome in various months (6th and 9th) after the study intervention. At the end of the study, the satisfactions and the willing to pay for this service were collected.

Results: After the CTCS model intervention, compared to the control group, the BP control improvement reached the significant differences. In the study process, the intervention group did not change the BP measurement habits. Especially, the abnormal BP subgroup after the short-message intervention, compared to baseline BP, the 9th and 6th average BP was improved. As for the satisfaction, most of the intervention group participants had the high satisfactions, and the willing to pay NT 500 for this service. The study established the standard service model for telehealth education and consultation by the telephone nursing.
Conclusions: The overall findings suggested that CTCS Model interventions show promise as effective modes of treatment for specific health problems. Its remarkable results for blood pressure control of hypertension cases, but for cases of hypertension's home measuring blood pressure behaviour change is not significant. There were significant relationship between the perceiving usefulness and satisfactions. The next step should focus on the needs and demands of the participants for the telehealth that would facilitate the successful development of tele-health care model.

Keyword: telehealthcare, telephone advice nursing, hypertension control

並列關鍵字

telehealthcare ； telephone advice nursing ； hypertension control

參考文獻

劉仲鑫、陳俊廷(2009)。遠距照護系統與網路環境建置。北商學報，16，99-106。

張嘉秀、李世代(2007)。長期照護資訊發展面面觀。長期照護雜誌，11 (4)，331-344。

陸哲駒、陳恆順、鄭伯壎、賴金鑫(2004)。遠距醫療的發展與落實。臺灣醫學，8 (6)，826-831。

姚開屏（2002）。健康相關生活品質概念與測量原理之簡介。台灣醫學，民91， 183-192.

The Taiwan WHOQOL Group. Introduction to the development of the WHOQOL-Taiwan version. Chinese Journal of Public Health 2000;19:315-324.