- 期刊
全民健康保險氣喘醫療給付改善方案改善多數兒童氣喘疾病嚴重度
Government-sponsored Disease Management Program Improves Severity in the Majority of Pediatric Asthma in Taiwan
摘要
目的：近年來國外以疾病管理模式(disease management)照顧氣喘患者獲得良好成效。中央健康保險局循此模式，自2001年11月開始施行氣喘醫療給付改善方案；陸續有少數報告提出，但以成人氣喘及不分年齡氣喘患者為主，並且著眼於醫療經濟及病患滿意度，對於兒童，尤其在氣喘臨床嚴重度(GINA classification)的改變方面，則較少有報告提出。本報告為研究台灣氣喘病童之嚴重度分布，及病童加入氣喘醫療給付改善方案試辦計畫後，氣喘嚴重度改變之情形。 方法：探回溯性個案研究：研究某區域教學醫院兒童胸腔科門診之氣喘病童，加入中央健保局『全民健保氣喘醫療給付改善方案試辦計劃』之個案為研究對象。由兒童胸腔專科醫師及專責氣喘術教師負責疾病管理照護。氣喘病童在疾病管理照護一年期間，依時間順序預約接受共五階段照護評值。紀錄每位病童在每階段照護評值時的氣喘嚴重度，以敘述性統計分析台灣氣喘病童之嚴重度分布，試辦計劃各階段病患回診率及其氣喘嚴重度改變之情形。 結果：自94年3月至95年2月期間共收案700位，並追蹤一年，年紀0-17歲，平均5.7±3.4歲，男∶女=61:39。氣喘嚴重度為間歇性氣喘、輕度、中度、和重度持續性氣喘分別占7.9%、50.9%、41.1%、和0.1%。病童收案後一年內只完成第一階段（初診收案），而未復診接受第二階段照護評值者佔31.4%；只完成至第二階段、至第三階段、至第四階段、和完成至第五階段照護評值（年度評值）者各佔27.3%、17.4%、13.7%、和10.2%。比較每位病童在第一次及最後一次接受階段照護評值時的氣喘嚴重度，結果完成至第二、三、四、五階段的各族群，其氣喘嚴重度改善之病童人數佔各族群比率，分別為22%、37.7%、54.2%、56.3%，顯示病童回診接受管理照護評值復診次數愈多，則氣喘病嚴重度改善的比率愈大。完成年度評估的71位（間歇性氣喘、輕度的中度持續性氣喘）中，病童嚴重度愈高，改善者的比率愈高(P=0.001)，中度持續性的氣喘病童改善的人數比率可達71.8%。 結論：全民健康保險氣喘醫療給付改善方案試辦計畫之照護模式，可使多數氣喘病童的嚴重度得到改善。病童回診接受管理照護評值復診資數愈多，則氣喘病童嚴重度改善的比率愈大。完成年度評估的族群（間歇性氣喘、輕度和中度持續性氣喘）有最多的病童獲得改善，尤其是中度持續性氣喘病童最為顯著。建議應鼓勵病童及家屬配合計畫之進行，按時程回診接受診療及衛教評值，可以使氣喘病童獲得最好的治療成效。
並列摘要
Background: Disease management for asthma obtains good effect in many countries in recent years. Bureau of National Health Insurance (BNHI) in Taiwan implemented a medical amendment (disease management) on asthma since 2001 November. Method: This is a retrospective study by pediatric pulmonologists and asthma educators in a regional teaching hospital. The children from an outpatient pulmonology clinic were expected to receive 5 times of comprehensive evaluation visit (CEV) to classify asthma severity and receive asthma education in 1 year. We analyse the distribution of pediatric asthma severity in Taiwan， and the change of asthma severity in 1 year in the different groups, according to the age, the asthma severity in the beginning, and the times of CEY. Resu1t: 700 asthma children (0-17y/o, mean 5.7±3.4y/o) enrolled from 2005 March to 2007 February. The severity of intermittent asthma, mild, moderate， and severe persistent asthma were 7.9%, 50.9%, 41.1%, 0.l%, 31.4% of the objects only received the first time of CEV in 1 year. Others receiving only 2, 3, 4 and completing 5 times of CEV in 1 year are 27.3%, 17.4%, 13.7%, 10.2%. We compare the asthma severity of the first time to 吐!e last time of CEV. The percentages having improved asthma in the groups receiving 2, 3, 4, and 5 time of CEV are 22%, 37.7%, 54.2%, 56.3%, and positively relative to the times of CEY. Among the 71 children completing 5 times of CEV, group of 7-12y/o or moderate persistent asthma group had the largest possibility to improve asthma severity. Conclusion: The disease management on asthma by BNHI in Taiwan improves asthma severity in the majority of pediatric -asthma. Among the children completing 5 times of CEV (intermittent, mild and moderate persistent asthma groups), children of moderate persistent asthma have the largest possibility to improve asthma severity.
被引用紀錄
延伸閱讀
- 蘇有村、陳施如、劉惠君、史蕙婷（2009）。氣喘醫療給付改善方案應用於兒童氣喘的成效報告。台灣氣喘衛教學會會刊，(17)，4-8。https://doi.org/10.6669/TAAE.2009.17.4
- 林宜柏、徐敏芳、鄭世隆、王鶴健（2008）。“氣喘醫療給付改善方案”實施成效之探討。亞東學報，(28_S)，57-64。https://doi.org/10.30167/JOIT.200812.0007
- 梁牡丹、范圭玲（2015）。降低兒科加護病房非計畫性氣管內管滑脫率之改善專案。護理雜誌，62(3)，39-48。https://doi.org/10.6224/JN.62.3S.39
- Wang, K. Y., Wu, C. P., Ku, C. H., Chang, N. W., Le, Y. H., & Lai, H. R. (2010). The Effects of Asthma Education on Asthma Knowledge and Health-Related Quality of Life in Taiwanese Asthma Patients. The Journal of Nursing Research, 18(2), 126-135. https://www.airitilibrary.com/Article/Detail?DocID=16823141-201006-201011100145-201011100145-126-135
- 鄭淑貞、李欣慈、李威德（2015）。The Effectiveness of a Self-Management Program in Children with Moderate to Severe Persistent Asthma。台灣醫學，19(3)，233-245。https://doi.org/10.6320/FJM.2015.19(3).03