- 學位論文
臺灣胃食道逆流症狀診斷流程之探討
The Research for Diagnostic Process of Gastroesophageal Reflux Disease Symptoms in Taiwan
摘要
背景：隨著胃食道逆流盛行率逐年提高，且其中約有三成病患屬難治型胃食道逆流，該病患族群治療成效不佳一直是國內臨床困境之一。由於病患長期的胃食道逆流可能影響日常生活和降低工作生產力造成社會經濟損失，甚至引發疾病惡性病變，因此確實診斷病因，給予適當治療，對於難治型胃食道逆流患者至關重要。 目的：探討國內胃食道逆流症狀診斷流程，分析難治型胃食道逆流治療成效不佳原因及目前臨床處置上的困難與需求。 方法：研究對象採立意取樣方法招募各醫療層級具兩年以上胃食道逆流處置經驗的臨床醫師進行質性訪談研究。採用半結構式個人深度訪談收集研究資料，並藉由內容分析法進行資料分析。 結果：本研究訪談5位醫學中心醫師、5位區域醫院醫師、4位地區醫院醫師，以及6位基層診所醫師，並依據針對難治型胃食道逆流病患是否有後續執行食道功能性測試分成兩類族群進行探討。研究發現，難治型胃食道逆流治療成效不佳原因，兩類族群皆認為因病患臨床處置配合度不佳所造成，包含生活飲食習慣衛教以及醫囑服從性等，相異之處為第一類族群認為病患對於食道功能性測試接受度不佳及成本效益不足導致執行上的困難，無法達到診斷的完整性。臨床上的未滿足需求可分為三個層面，醫療環境相關困境，兩類族群皆提及食道功能性測試成本效益較低及臨床經驗不足，差異為第一類族群認為目前此診斷結果仍有不確定性及缺少執行人力。健保制度相關困境，多數受訪者認為氫離子幫浦阻斷劑的健保給付制度造成臨床處置流程不便。病患相關困境，臨床處置配合度不佳為共同因素，差異為第一類族群認為食道功能性測試接受度不佳也為目前困境之一。 結論：疾病診斷的完整度及病患處置依從性為影響疾病治療成效的重要因素，因此建議可以加強病患衛教執行以提高治療成效，並增加食道功能性測試的可近性以提升胃食道逆流診斷之精確性及完整度。
並列摘要
Background The prevalence of the gastroesophageal reflux disease (GERD) has consciously escalated worldwide. While 30% of GERD belongs to refractory GERD in Taiwan, the poor treatment outcome of these patients has been a challenge for the society’s health care system. Patients with long term GERD have experienced lower quality of life, lower work efficiency, higher medical utilization, and the potential of developing serious diseases. Thus, the need for improving the diagnosis and therapy of refractory GERD patient is imperative. Purpose This study aim to explore the causes of poor treatment outcome and practical therapy difficulties of refractory GERD. Method Physicians with more than 2-year experience in GERD treatment from each hospital level are recruited via purposive sampling to conduct interview. Semi-structured in-depth interviews are employed to collect the data, and use the content analysis to analyze it. Result This study interview 5 physicians from medical center, 5 physicians from metropolitan hospital, 4 physicians from local community hospital and 6 physicians from clinic, and are divided into two groups according to whether there is a follow-up esophageal function tests (EFTs). This result showed that both groups indicate the causes of poor treatment outcome for the poor clinical management of patients, and group who performed the EFTs also indicate other cause what are diagnosis uncertainty of EFTs and insufficient cost-effectiveness. Both groups indicate the unmet clinical needs, including low cost-effective and insufficient clinical experience, and group who performed the EFTs also indicate other cause, such as poor acceptance of EFTs for patient and manpower shortage. Conclusion：：The completeness of disease diagnosis and treatment adherence are important factors that affect the effectiveness of disease treatment. Thus, it is recommended to strengthen the implementation of patient health education to improve the effectiveness of treatment and accuracy and completeness of gastroesophageal reflux diagnosis by increasing the accessibility of esophageal function tests.