客製化糖尿病藥事照護服務提升病人健康識能與疾病預後

Customized Health Education by Pharmacist Enhance Health Literacy and Prognosis Indicator of Diabetes Patients

葉爵榮(Jue-Zong Yeh) ； 邱瓊萱(Chiung-Hsuan Chiu) ； 金秦瑩(Chin-Ying Chin) ； 葉明功(Ming-Kung Yeh) ； 李宜勳(I-Hsun Li) ； 謝政智(Cheng-Chih Hsieh)

《臺灣臨床藥學雜誌》 25卷3期 (2017/07) Pp. 210-223

https://doi.org/10.6168/FJCP.2017.2503.04

摘要

前言：糖尿病控制穩定不外乎飲食調控、規律運動及常規藥物治療，落實關鍵在透過教育提升病人配合度，而良好支持體系，更是持續實踐病人自我照護之動力。國人就醫後，多數仍選擇於醫療院所附設門診藥局領藥，設置藥事照護門診，可近似國外社區藥師提供之疾病管理服務型態，專責提供個人化藥事照護。目的：探討糖尿病人接受藥師運用客製化衛教模式執行個案管理輔導，對其健康識能及代謝指標影響。方法：這項研究採前瞻性準實驗設計。經醫師轉介112 位第2 型糖尿病人並分配到A 組和B 組。每組由56 人組成，接受兩個階段的教育介入。A 組，最初使用健康識能工具進行評估，並執行第1 階段介入，這個階段教育內容包括對疾病和藥物正確理解。三個月後，先進行成效評估，然後執行第2 階段介入，這個階段教育內容包括急症處理、血糖監測及自我照護能力。六個月後，進行最終成效評估；B 組，最初僅進行健康識能評量，不介入。3 個月後，先進行成效評估，然後執行與A 組相同之第1 階段介入。六個月後，進行最終成效評估。對兩組的健康識能、疾病知識、行為配合和健康結果進行評估。結果： 兩階段教育後， 顯著提升病人健康識能， 由70.3% 進步至86.7% (p ＜0.001)，進而改變自我照護行為，促進糖化血色素平均降幅達0.5%。結論：成功運用健康識能評量工具連結代謝生化指標，建立糖尿病教育成效評估模式。

關鍵字

糖尿病 ； 藥師 ； 藥事照護 ； 健康識能 ； 糖化血色素

並列摘要

Background: Diet control, exercise and medication therapy are three main treatment regimens for diabetes mellitus. To ensure all three are properly fulfilled, patient compliance behavior is a key factor. Moreover, a good support system is one of the motivational factors for patient to continuously involve in treatment. In Taiwanese healthcare environment, most of the patient gathered in the pharmacy section after seeing a doctor. Introduction of pharmaceutical outpatient unit provides another way for disease treatment in our countries. Furthermore, the sufficient time will allow pharmacist to provide thorough pharmaceutical care and health education for chronic diseases. Purpose: This aim of this study is the effect of pharmacist on disease knowledge and to evaluate the level of disease improvement after pharmacist involvement. Method: This study was prospective and quasi-experimental design. 112 patients with type 2 diabetes were referred by physicians and assigned to groups A and B. Each group is consisted of 56 persons and each group received two stages of intervention. Group A was initially evaluated using the health literacy tool and stage 1 intervention was provided. This stage of education includes contains a correct understanding of disease and medication. 3 month later, patients were firstly evaluate and followed by stage 2 intervention. This stage of education includes emergency treatment concepts, blood glucose monitoring and self-care ability. 6 month later, final evaluation was given. For group B, patients were initially evaluated and no intervention given. 3 months later, patients were firstly evaluated and followed by stage 1 intervention. 6 month later, patients were final evaluation. Both groups were evaluated for their health literacy, disease knowledge, compliance, and health outcome. Result: The overall literacy scale improve from 70.3% to 86.7 (p ＜ 0.001). The mean of HbA1c were decrease by 0.5%. Conclusion: Disease knowledge and health literacy were significantly improved after pharmacist involvement.

並列關鍵字

Diabetes Mellitus ； Pharmacist ； Pharmaceutical Care ； Health Literacy ； HbA1c