評估藥師介入後對第二型糖尿病病患之糖化血色素及服藥順從性的影響

Evaluation of pharmacist interventions on HbA1c and medication adherence in type 2 diabetic patients

王明媛(Ming-Yuan Wang)

指導教授 ： 陳世銘

臺北醫學大學/藥學院/藥學系(碩博士班)/碩士(2017年)

摘要

背景與目的：糖尿病儼然成為一個盛行率漸增、高健保費用支出的慢性代謝異常疾病。而台灣於2000年至2009年的十年之間，糖尿病的總人口數增加了將近80%。藉由藥師參與糖尿病照護，能夠有效的改善病患之臨床結果以及預防糖尿病相關之急、慢性併發症的發生。本研究之目的即為評估社區藥局藥師的介入，對於第二型糖尿病病患之糖化血色素和服藥順從性的影響。

材料與方法：給予51位符合收案條件的病患進行前、後測之問卷，進行橫斷式的研究。前測問卷包含了病患基本資料、對併發症的認知、自我照護上的困難、糖尿病相關知識和服藥順從性等六部份。爾後，社區藥師將提供受訪者以病患為中心（patient-centered）的個別化衛教，進行四次的面談或電訪式衛教。主要結果為衛教前後糖化血色素的差異，次要結果則為前、後測的糖尿病知識（DKT2）與服藥順從性的分數差異。

結果：51位第二型糖尿病病患中，女性佔了51%；受訪者的平均年齡為64.92 ± 11.24歲；前測糖化血色素 (HbA1c) 之平均值為7.65 ± 1.65%；而BMI >24 kg/m2 (平均值: 27.21 ± 5.06 kg/m2) 的體重過重者佔了68.6%，再以迴歸分析檢定時發現，HbA1c與BMI存在著正相關的關係 (p < .05)。相依樣本t檢定顯示，藥師介入衛教前、後對HbA1c產生明顯的降低 (7.65 ± 1.65% vs. 7.39 ± 1.18%, p = .015)，且在服藥順從性 (5.81 ± 1.89 vs. 6.20 ± 1.27, p = .031) 和DKT2 (11.68 ± 1.67 vs. 9.70 ± 2.40, p = .000) 的分數上亦有提升。

結論：經由社區藥師提供第二型糖尿病病患個別化之糖尿病照護後，能夠顯著的改善病患的糖化血色素、服藥順從性和強化糖尿病相關知識。

關鍵字

第二型糖尿病 ； 藥師 ； 社區藥局 ； 介入 ； 糖化血色素 ； 服藥順從性

並列摘要

Background: Diabetes mellitus is a chronic metabolic disorder with an increasing prevalence which causes an economic burden on health insurance expenditure. In Taiwan, there was a nearly 80% increase in the total diabetic population from 2000 to 2009. Involvement of pharmacists in diabetes care improves clinical outcomes and prevents diabetes-related complications.

Aim: This study was designed to evaluate the impact of the community pharmacists’ interventional activities on glycated hemoglobin and medication adherence in type 2 diabetic patients.

Methods: Fifty-one eligible patients were cross-sectionally assessed using the pre-post questionnaire. The pretest questionnaire consists of six parts to identify the patients’ demographic, awareness of complications, barriers of self-management, knowledge of diabetes and medication adherence. Afterwards, the community pharmacist provided individualized patient-centered diabetes care. Participants received four times educational intervention by face-to-face visits or telephone contacts. Primary outcome was the difference of HbA1c from baseline.
Secondary outcomes were the differences between pre-posttest scores of diabetes knowledge (DKT2) and medication adherence.

Result: Of the 51 type 2 diabetes patients, 51% were female, mean age was 64.92 ± 11.24 years, mean baseline HbA1c was 7.65 ± 1.65% and 68.6% were over-weight with a BMI >24 kg/m2 (mean: 27.21 ± 5.06 kg/m2). Meanwhile, regression analysis showed a positive correlation between HbA1c and BMI (p < .05). Paired t-test showed the pharmacists’ intervention significantly reduced HbA1c (7.65 ± 1.65% vs. 7.39 ± 1.18%, p = .015) and made progress in medication adherence score (5.81 ± 1.89 vs. 6.20 ± 1.27, p = .031), as well as DKT2 score (11.68 ± 1.67 vs. 9.70 ± 2.40, p = .000).

Conclusion: After the individualized diabetes care provided by the community pharmacist, there was a significant reduction in glycated hemoglobin and improvements in medication adherence and diabetes-related knowledge in type 2 diabeteic patients.

並列關鍵字

type 2 diabetes ； pharmacist ； community pharmacy ； intervention ； glycated hemoglobin ； medication adherence

參考文獻

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