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納入糖尿病共同照護網後影響病患遵醫囑行為之研究－以某區域教學醫院為例
Impact of Patients' Adherence under the Share Care Disease Management Program for Diabetes-An Example from a Regional Teaching Hospital
摘要
Background: Besides adequate medications, long-term diabetes mellitus (DM) control depends on comprehensive education programs. To enhance delivery of education programs to diabetic subjects in various medical setting, the Bureau of National Health Insurance proposed the Share Care Disease Management Program for Diabetes in November 2001, and expected to slow down diabetes progression and control medical utilization via financial incentives.Purpose: To investigate diabetic patients' adherence after they participated in the program and to study whether this program improved adherence.Methods: A total of 487 subjects were selected via 2-steps from 1,243 patients who had participated in this program for at least 25 months between May 2002 and March 2005. These patients had received at least 684 days (90% of the observed duration) medication and at least 4 periods of education from nurses and dietitians. All the data were collected retrospectively and analyzed with SPSS 10.0 software.Results: Compared to the literature, the baseline characteristics of the study cases included a lower average age, lower education background, majority with less than 5 years history of DM, fewer receiving insulin injections and fewer with severe complications. Further, the duration of data collection was longer (up to 25 months) but the gender ratio and cardiovascular risk factors, such as abnormal body weight, hypertension, hypercholesterolemia and smoking, were similar. Adherence to medication (85.5%) was scored the highest in the adherence evaluation results. Other scored items in sequence were DM passport usage (82%), diet behavior learning (67.2%), diet modification (67%) and exercise (56.5%). With baseline characteristics and education frequency of the patients as independent variables, the dependent variables of medication, exercise and DM passport usage were significant according to multiple regression analysis (p = 0.022, 0.001, ＜0.001).Conclusion: We analyzed 25-months of data from patients after they had enrolled in the Shared Care Disease Management Program for Diabetes. This research found that age, baseline HbA1c, severe complications and education frequency were very important factors for adherence. The older patients and those who had received more diabetic education showed better adherence. Patients with higher baseline HbA1c and those with severe complications showed poorer adherence.
並列摘要
Background: Besides adequate medications, long-term diabetes mellitus (DM) control depends on comprehensive education programs. To enhance delivery of education programs to diabetic subjects in various medical setting, the Bureau of National Health Insurance proposed the Share Care Disease Management Program for Diabetes in November 2001, and expected to slow down diabetes progression and control medical utilization via financial incentives.Purpose: To investigate diabetic patients' adherence after they participated in the program and to study whether this program improved adherence.Methods: A total of 487 subjects were selected via 2-steps from 1,243 patients who had participated in this program for at least 25 months between May 2002 and March 2005. These patients had received at least 684 days (90% of the observed duration) medication and at least 4 periods of education from nurses and dietitians. All the data were collected retrospectively and analyzed with SPSS 10.0 software.Results: Compared to the literature, the baseline characteristics of the study cases included a lower average age, lower education background, majority with less than 5 years history of DM, fewer receiving insulin injections and fewer with severe complications. Further, the duration of data collection was longer (up to 25 months) but the gender ratio and cardiovascular risk factors, such as abnormal body weight, hypertension, hypercholesterolemia and smoking, were similar. Adherence to medication (85.5%) was scored the highest in the adherence evaluation results. Other scored items in sequence were DM passport usage (82%), diet behavior learning (67.2%), diet modification (67%) and exercise (56.5%). With baseline characteristics and education frequency of the patients as independent variables, the dependent variables of medication, exercise and DM passport usage were significant according to multiple regression analysis (p = 0.022, 0.001, ＜0.001).Conclusion: We analyzed 25-months of data from patients after they had enrolled in the Shared Care Disease Management Program for Diabetes. This research found that age, baseline HbA1c, severe complications and education frequency were very important factors for adherence. The older patients and those who had received more diabetic education showed better adherence. Patients with higher baseline HbA1c and those with severe complications showed poorer adherence.
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延伸閱讀
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