影響慢性腎臟病患定期回診因素及定期回診對病程變化的效益

The Impact of Regular Revisits by Patients with Chronic Kidney Diseases

何玉瑛(Yu-Ying Ho) ； 葉德豐(Te-Feng Yeh) ； 張育嘉(Yu-Chia Chang) ； 陳呈旭(Cheng-Hsu Chen) ； 陳錦華(Ching-Hua Chen)

《醫務管理期刊》 13卷3期 (2012/09) Pp. 147-161

https://doi.org/10.6174/JHM2012.13(3).147

摘要

目的：台灣末期腎臟病盛行率為全世界第一，醫療資源的耗用成為健保財務上一大負擔，政府於2003 年起致力於慢性腎臟病照護防治計畫並要求病患需定期回診，但迄今仍少有研究探討定期回診的實施成效，本研究擬探討影響慢性腎臟病病患定期回診之相關因素及定期回診對其病程變化的效益。方法：本研究採回溯性調查，收集中部某醫學中心2006年至2009年參與慢性腎臟病照護網之病患共876位，根據病患基本資料、回診情形與疾病病程進行研究。統計分析方法包括卡方檢定、邏輯斯迴歸及複迴歸分析。結果：影響病患定期回診的因素包括腎臟病分期、年齡及追蹤時間。病患定期回診對於腎絲球過濾率（GFR）及肌酸酐（Cr）變化速率呈現顯著差異，定期回診者的GFR下降速率較不定期回診者緩慢；相反的，不定期回診者的Cr上升速率較定期回診者增加。結論：慢性腎臟病病患配合照護計畫定期回診，可有效控制GFR及Cr的變化速率，減緩疾病惡化。

關鍵字

慢性腎臟病 ； 慢性腎臟病照護計畫 ； 定期回診

並列摘要

Objectives: The prevalence of end-stage renal disease (ESRD) in Taiwan is the highest in the world. The high medical utilization by these patients has become a major burden on the healthcare system. In order to prevent and treat the disease, the Chronic Kidney Disease (CKD) care program which encourages patients to revisit regularly was launched in 2003; however, the outcome of regular visits has rarely been evaluated. In this study, we explored possible factors which may have influenced regular revisits by CKD patients as well as the clinical benefits of such behaviors.Methods: A total of 876 patients who joined the CKD care program from 2006 to 2009 at a medical center in Central Taiwan were retrospectively examined in terms of their basic characteristics, revisits and clinical progress.Results: Factors which contributed to regular revisits by patients with CKD included the stage of CKD, age, and follow-up period. Significant differences in the glomerular filtration rate (GFR) and serum creatinine level (Cr) were also found. For patients who revisited regularly, the rate of descending speed of their GFR was slower than that of those who did not and the Cr values of patients who were not followed-up periodically rose more rapidly.Conclusion: Regular revisits are beneficial for patients with CKD in order to effectively control GFR and Cr and delay the progression of disease.

並列關鍵字

End-stage renal disease ； CKD care program ； regular revisits

參考文獻

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