Factors Associated with Asthma Patients Dropping Out from Outpatient Clinic Follow-Up

門診氣喘病人輟原因之探討

洪崇仁(Tsung-Jen Hung) ； 李政宏(Cheng-Hung Lee) ； 陳炯睿(Chiung-Zuei Chen) ； 朱遠志(Yuan-Chin Chu) ； 薛尊仁(Tzuen-Ren Hsiue)

《胸腔醫學》 18卷6期 (2003/12) Pp. 474-480

摘要

氣喘病人的照顧，需要病人本身的自我照顧以及規則地由醫師追蹤監測。然而，關於病人自行中輟門診追蹤的研究報告，大都集中在精神科及兒科，僅有少數報告針對氣喘病人。這些自行中輟門診追蹤的病人，可能無法接受必須的醫療照顧並承受一些原先可避免的發病以及死亡。這篇研究的目的即是在探討門診氣喘病人的中輟率、原因以及預測因子。所以我們回顧研究168位從1978至2002年間，曾在本院某一固定胸腔科問診治療過的氣喘病人的病歷資料。並對自行中輟之病人以電話訪談的方式，了解其中輟原因。結果顯示中輟率為58.9%，具有相當高比率（46.5%）的病人是在前六個月中輟追蹤。中輟最常見的三個原因分別是症狀改善、看診不便以及轉至其他醫院追蹤。中輟的預測因子為女性及同時有其他慢性病存在。我們相信針對病人所提出的原因，來對應施行的改善方案，如加強衛教及提供一些避免看診不便的方法是有用的。而早期辨識出可能中輟的病人應可以降低中輟率增進對氣喘病人的照護。

關鍵字

氣喘 ； 中輟 ； 門診

並列摘要

Asthma requires long-term self-management with regular physician support and surveillance. However, most studies of patients who drop out from treatment or follow-up of their condition have focused on psychiatric and pediatric patients, and there have been relatively few studies on patients with asthma. Patients who drop out may not receive adequate medical care, and place themselves at risk of unnecessary morbidity and mortality. The purpose of this study was to determine the percentage of asthma patients who drop out during follow-up, and the reasons and predictive factors for this dropping out. The medical records of 168 patients with asthma, who had attended a chest special clinic from 1989 to 2002 at our hospital, were analyzed. A telephone survey was performed to determine the reasons for dropping out. The overall dropout rate was 58.9% of the 168 patients attending the clinic during the study period, and a high percentage (46.5%) of these drop-outs occurred during the first 6 months. The three most common reasons for dropping out were symptom improvement, inconvenient consultation, and patient decision to use other hospitals. The predictive factors for dropout were female gender and the presence of coexisting chronic diseases. According to the patient-generated complaints, some strategies to ensure patient education, and intervention to ease the inconvenience of follow-up, might be helpful. Early detection and intervention for patients at high risk of dropout might improve the management efficiency of patients with asthma.

並列關鍵字

Asthma ； Dropping out ； outpatient clinic