個案管理模式於門診高血壓病患照護成效之探討

The Effectiveness of Applying Case Management for Patients with Hypertension at an Outpatient Department

洪芳玲(Fang-Ling Hung)

指導教授 ： 張文英

臺北醫學大學/護理學院/護理學研究所/碩士(2003年)

摘要

由於醫療環境的快速變遷，以及醫療政策的不斷變革，各醫療機構莫不尋求一套有效的管理方法，以控制成本及改善照護品質，如個案管理照護模式。故本研究之目的旨在探討及比較實施個案管理對門診高血壓病患之自我照顧認知程度、日常保健行為及血壓控制成效之差異。 本研究採類實驗性研究設計，以立意取樣方式，依病患門診就診週次之不同，將研究對象交替分配至實驗組與對照組，研究期間自民國92年1月自92年6月，研究樣本為臺北市某區域教學醫院之門診高血壓病患，且符合本研究入選條件者。實驗組患者予施行個案管理方案，而對照組則施行一般常規性照護方式。於實施照護方案前收集兩組之基本資料和前測資料，包括高血壓自我照顧認知、日常保健行為及血壓控制數值，實施照護方案3個月後，採用同一份問卷對兩組病患再進行後測，並查閱病歷收集3個月期間病患按時返診情形及血壓控制等資料，以比較不同照護方案實施成效之差異。資料係以SPSS 10.0 for Windows英文版及SAS for windows 8.0套裝軟體做處理，以卡方檢定及獨立樣本t檢定分析兩組樣本之基本屬性，並以GEEs（Generalized Estimating Equations）之迴歸模式比較兩組照護成效重複測量之前後測差異情形。 本研究共有實驗組30人，對照組25人。結果顯示個案管理實施後，兩組病患之自我照顧認知程度（p=.687），日常保健行為中，飲食行為（p=.802）、運動行為（p＞.05）、服藥遵從行為（p=.160），以及按時門診返診率（p=.493），均無統計上顯著差異，但實驗組病患血壓控制於正常（＜140/90mmHg）之比率高於對照組，且達統計上顯著差異（p=.011）。 本研究之照護模式不但可以提供未來臨床醫護人員在執行高血壓個案管理時之依據，亦可做為其他慢性病門診發展及實施個案管理模式之參考。

關鍵字

個案管理 ； 門診 ； 高血壓 ； 照護成效

並列摘要

With the increasing changes in health care environment and health policies, hospitals need to found effective strategies such as case management care model to control costs and to improve patient care. Therefore, the purposes of this study were to explore and compare the differences among self-care knowledge, daily health behaviors, and blood pressure control between case management group and control group for hypertensive patients at an outpatient department. The design was quasi-experimental using a purposive sampling. The time of weekly outpatient visit was used to assign subjects to case management group or control group. The data collection period was from January to June of 2003. Subjects were outpatient hypertensive patients who met criteria for inclusion in this study and from a district teaching hospital in Taipei areas. The case management care model was only implemented in a case management group. But the usual care model was used in a control group. The demographics of the subjects and pre-test data including the level of self-care knowledge, daily health behaviors, and blood pressure were collected before implementation of care management care model. Post-test data were collected after 3-month of implementation. Regular outpatient visits and blood pressure were collected from patient charts. Data were managed using SPSS 10.0 version for Windows and SAS 8.0 version for Windows and analyzed using Chi-square test and independent t-test for demographics data, and Generalized Estimating Equations (GEEs) to compare the differences between these two groups before and after implementing the case management care model. Thirty subjects were in case management group and 25 subjects were in control group. The results indicated that there was no significant difference among the level of self-care knowledge (p=.687), daily health behaviors (diet; p=.802, exercise; p>.05, and medication compliance; p= .160), and regular outpatient visits (p=.493) between these two groups. However, the ratio of blood pressure control to normal (<140/90 mmHg) was higher in case management group than in control group and showed a significant difference (p= .011). The findings of this study can not only serve as a reference for health care providers to provide case management care for hypertensive patients, but also to develop a case management care model for other chronic diseases at outpatient departments.

並列關鍵字

case management ； outpatient department ； hypertension ； effectiveness of health care

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