慢性阻塞性肺疾病(COPD)個案管理系統對患者日常生活品質(HRQOL)之影響研究 － 以南部某醫學中心病患為例

Evaluation of COPD(Chronic Obstructive Pulmonary Disease )Disease Management Program on HRQOL (health-related quality of life)-base on a medical center hospital in south Taiwan

葉振國(Chen-Kou Yeh)

指導教授 ： 李麗說

崑山科技大學/商業管理學院/企業管理研究所/碩士(2009年)

https://doi.org/10.6828/KSU.2009.00042

摘要

本研究藉由了解慢性阻塞性肺疾病床(Chronic Obstructive Pulmonary Disease COPD)病患在加入某醫院之疾病管理模式後，進行接受照護管理時之生理層面改變、心理層面改變與生活品質的改變之相互關係，以提供醫療院所實施時之参考及修正。
本研究方法是藉由文獻探討、透過醫療專業人員對病人的訪談、實地觀察的方式進行，獲得與慢性阻塞性肺疾病患者相關的生理、心理及生活品質資訊。本研究是以南部某醫學中心胸腔內科門診加入『慢性阻塞性疾病個案管理計畫』之慢性阻塞性疾病患者為樣本，分析患者進入個案管理計畫前後，其生理、心理、生活品質等三個層面之相互關係。
研究工具包括：患者MMRC問卷(Modified Medical Research Council Scale)、TGDS問卷(Taiwan Geriatric Depression Scale)、SGRQ問卷(St. George`s Respiratory Questionnaire)等幾個部份。
研究結果發現:大部分的構面在進入個案管理後比在進入個案管理前具有顯著的改善。再者是透過迴歸分析結果顯示，患者生理層面及心理層面對其日常生活品質有顯著的影響。第三進入個案管理後患者生理層面對其日常生活品質有顯著的影響。第四迴歸分析結果也發現患者之心理層面，對生活品質的症狀之生活衝擊部分有顯著影響。心理層面對於患者在活動力部份之影響則不顯著，這可能的原因分析是隨著個案管理人員的照護及對疾病的知識了解增加，使得患者心理對生活品質的症狀及生活衝擊程度有明顯改善，但隨罹病時間的增加疾病嚴重程度也跟著增加，患者心理感覺日常生活的活動力是沒有顯著改善。第五是比較患者在進入個案管理前後日常生活品質的改變, t檢定結果顯示，日常生活品質的三個構面均有顯著差異。最後病患進入個案管理前後生理及心理層面之改變，以獨立t檢定結果發現生理層面個案管理前後未達統計上顯著的不同，主要原因可能來自於慢性阻塞性肺疾病是一個漸進式且不完全可逆性的肺部組織破壞疾病，患者隨罹病時間的增加其嚴重程度也跟著增加，造成患者雖有進入個案管理但對於生理前後的改善差異不大。另外在心理層面個案管理前後卻有達統計上顯著的意義,表示患者對於進入個案管理後心理層面確實有所改善。

關鍵字

慢性阻塞性肺疾病(COPD) ； 日常生活品質(HRQOL) ； 日常生活品質問卷(SGRQ) ； 生理呼吸困難問卷(MMRC) ； 心理憂鬱問卷(TGDC)

並列摘要

The objective of this research consists of analyze COPD (Chronic Obstructive Pulmonary Disease) patients. Once integrated in the medical care system of a certain hospital, these patients would show obvious reactions on physical, psychological, and life quality dimensions, and this research aim at inter-relations among these three dimensions, its result could be useful for medical institutions for their management and reform.
Through documents analysis, interviewing medical personnel as well as patients, and field observation, this research collects very useful information about CPOD patients. The samples are COPD patients participated in a COPD case management project conducted by a major medical center in Southern Taiwan.
This research also applies multiple questionnaire tools including MMRC, TGDS, and SGRQ.
Result of this research reveals several major phenomenons. First, positive improvements are obvious on almost every major dimension, comparing before and after integrated in the medical care and management system. Secondly, through regression analysis upon factors of physical, psychological, and living quality of patients before integrated in medical care system, it is shown that physical and psychological factors have significant impact on patients living quality. Third, the same impacts importance also shows in analysis on patients after integrated in medical care system, notably on the impact of physical factors on living quality. Fourth, upon psychological and living quality. Analysis show a very significant impact from patients`, psychological factors on living quality, where as no impact has found from psychological factors on patients mobility. A possible response is that patients tend to better accepting psychologically the life quality under illness as medical personnel offer good caring and complete information about the illness. But as the illness goes worse and longer, patients tend to feel less mobility in daily life. Fifth, improvements are found on all three dimensions of life quality comparison before and after integrated in medical care system. Sixth, when applying independent factors evaluation on physical and psychological dimensions, no statistically difference was found on physical dimension between ‘before and after’ integrated in medical care system. A possible response is that COPD is a long term illness and its destruction on lungs is not entirely reversible, so that as illness goes worse, patients would not feel any major improvement on physical dimension after integrated in medical care system. But on the contrary, essential difference was found on psychological dimension, patients feel major improvement after integrated in medical care system.

並列關鍵字

COPD(Chronic Obstructive Pulmonary Disease ) ； HRQOL (health-related quality of life) ； SGRQ(St. George`s Respiratory Questionnaire) ； MMRC(Modified Medical Research Council Scale) ； TGDS(Taiwan Geriatric Depression Scale)

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