個案管理對心臟衰竭患者之成效－以台灣某醫院為例

Effects of case management for patients with heart failure: a hospital-based study in Taiwan

蕭伊祐(I-Yu Hsiao) ； 陳嘉民(Chia-Min Chen) ； 陳志暐(Chih-Wei Chen) ； 陳秋媛(Chiu-Yuan Chen) ； Hanoch Livneh ； 林庭光(Tin-Kwang Lin) ； 蔡宗益(Tzung-Yi Tsai)

《安泰醫護雜誌》 24卷1期 (2018/06) Pp. 15-25

摘要

目的：個案管理是一有助於激發慢性病患者行為改變以提升預後之照護模式。但對於台灣心臟衰竭患者之成效仍未趨定論。本文旨在探討個案管理對該組群之成效。方法：採單組重複測量研究設計。以立意取樣招募2011-2012年至台灣某醫院就醫之100位心臟衰竭患者，個案管理介入則包含一系列的衛教課程與電話諮商等服務內容，並利用結構式問卷與病歷回溯等方式收集介入後和介入後六個月的成效指標，再以廣義估計方程式評值成效。結果：個案管理介入雖對心臟衰竭患者之血壓與高密度脂蛋白雖無明顯改善效果，但可有助強化個案的生活品質和我照護行為，亦能降低膽固醇，三酸甘油脂，空腹血糖和低密度脂蛋白等代謝指標（p ＜.01）。上述指標於介入後六個月仍具顯著成效，結論：個案管理對台灣心臟衰竭患者有顯著成效，可作為改善其疾病調適和臨床預後之照護參考。

關鍵字

心臟衰竭 ； 個案管理 ； 廣義估計方程式

並列摘要

Purpose: Case management Purpose: Case management (CM) has been recommended as a way of inspiring measurable changes in individual behaviors and improving clinical outcomes for patients with chronic diseases. However, data on its effectiveness for Taiwanese patients with heart failure (HF) are limited and inconclusive. So this study aimed to determine the long-term effectiveness of CM for Taiwanese HF patients. Methods: One group repeated measures design with purposive sampling recruited one hundred HF patients from a hospital in Taiwan during 2011-2012. CM program was composed of health education sessions and follow-up telephone consultations over a six-month period. A review of medical records and structured questionnaires yielded data about patient demographics and disease characteristics, and included Chinese version of the SF-36 and the European Heart Failure Self-Care Behavior Scale. A comparison of the long-term effectiveness of the CM program was made using generalized estimating equation. Results: Although no significant differences were observed in blood pressure or high density lipoproteins between pre- and post-CM, CM did improve self-care behaviors and quality of life, and reduced the values of patient metabolic parameters such as total cholesterol, triglycerides, fasting blood glucose and low density lipoprotein (all p＜0.01). Notably, these parameters remained significantly improved for six months following completion of the CM program. Conclusion: This study supported the long-term effectiveness of CM for Taiwanese patients with HF, and may be a reference for healthcare providers in facilitating the provision of appropriate interventions to improve the adaptation processes and clinical outcomes for them.

並列關鍵字

Heart Failure ； Case Management ； Generalized Estimating Equations