高血壓疾病管理之臨床結果及醫療費用評估

Disease Management Clinical Outcomes and Cost of Treating Hypertension

王俊雄(Chun-Hsiung Wang) ； 紀櫻珍(Ying-Chen Chi) ； 吳振龍(Chen-Long Wu) ； 施奕仲(Yi-Chung Shih) ； 薛亞聖(Ya-Seng Hsueh)

《北市醫學雜誌》 3卷3期 (2006/03) Pp. 248-259

https://doi.org/10.6200/TCMJ.2006.3.3.07

摘要

目的：疾病管理近年來逐漸受到重視，被認為是提昇醫療照護品質及效率的重要方法之一。根據相關的研究顯示，高血壓為目前已開發國家中引起心臟血管疾病及死亡的重要原因，其發生率約佔國人成年人的15-20%，與高血壓相關的中風、心臟病、糖尿病等疾病又名列國人十大死因的前五名。良好的控制血壓，可以降低中風、心臟病、腎衰竭及週邊動脈疾病等發生率。故本研究旨在探討法：本研究以一家區域層級醫院心臟內科門診就診的高血壓病人為研究對象，以類實驗介入的研究方法評估兩組別個案在疾病管理執行前、後之差異。實驗組為接受高血壓疾病管理之77例個案，以未執行疾病管理，接受傳統照護的同科別的66例個案作為對照組。統計方法採用差異中之差異(Difference-in-Difference)、無母數分析等統計方法，評估兩組個案在疾病管理介入前後血壓控制、心血管併發症及醫療費用面向之影響。結果：實驗組方面，經疾病管理後，血壓控制良好的面向從50.65%升到62.33%；在心血管併發症面向的評估，對照組的心血管併發症高於實驗組；門診的醫療費用評估，實驗組的醫療費用低於對照組。以上各面向之評估雖均無顯著之差異，或許是實驗介入的時間太短使然，但趨勢均是一致的，實驗組比對照組的臨床結果較佳，費用較低。結論：本研究對政策制訂者建議，高血壓疾病管理之醫療團隊執行於社區之慢性疾病，可以得到較好的臨床結果，並避免許多嚴重的併發症及死亡率，減少耗用更多的醫療資源；疾病管理的介入對於高血壓病人的應用及發展是符合我國醫療社會經濟狀況。亦向醫療提供者正面的建議呼籲，疾病管理的介入乃藉由醫療團隊的協調合作，對病人施以標準化的診斷及治療流程，在臨床結果方面，得到正面的效果，注重於預防性的治療並可避免合併症的發生，以致於使得病況更惡化、更難治癒，而造成個人、家庭及社會整體的損失，疾病管理的制度是值得推廣的。爾後研究者若能以更多的個案及更長的時間來追蹤，將更能印證長期的疾病管理介入後的臨床效果和併發症的發生率及整體醫療費用的減少。

關鍵字

疾病管理 ； 高血壓 ； 醫療費用

並列摘要

Background and Purpose: Disease Management refers to the use of an explicit systematic population-based approach to identify people at risk, intervene with specific programs of care, and measure clinical and other outcomes. Hypertension affects approximately 15~20% of adult individuals in Taiwan, The relationship between BP and risk of cardiovascular disease events is continuous, consistent, and independent of other risk factors. To investigate the impacts of Disease Management on clinical outcomes and costs for patients with hypertension. Methods: This study was carried out in a community hospital in Taipei City. Individuals of hypertension were defined, according to JNC-7 definition. The intervention group received scheduled screening tests and education, provided by cardiologist, nurses and dietician. The control group was given usual medical care. Results: There were a total of 77 subjects in intervention group and 66 subjects in control group. In the intervention group, BP with well control changed from 50.65% to 62.33% after intervention. On the contrary, BP in control group with well control, changed from 63.63% to 65.15%. By comparing the results before and after intervention, the control group had more cardiac events than that the intervention group had (CHF: 6.06% V.S. 1.30%, Hypertension crisis: 6.06% V.S. 1.30%, Hemorrhage stroke: 1.52% V.S. 0%). Comparing the outpatient costs of these two groups, although the intervention group expense was less than that of the control group in average, it was not significant statistically. Conclusion: Disease management for hypertension outpatient clinic in a community hospital showed an improvement of blood pressure control and reduction of the cardiac events, although the expense of the patients were not different statistically in the short term follow-up. Based on these findings, this research offered some suggestions on the future researches and policy making.

並列關鍵字

disease management ； hypertension ； medical cost