某榮民總醫院糖尿病照護品質之探討

Quality of Health Care for Diabetic Patients in a Veterans General Hospital

洪麗如(Li-Ru Horng)

指導教授 ： 張志欽

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2003年)

摘要

糖尿病已是全球性的健康問題，預估於西元2025年全球盛行率將增至5.4%，雖然不同的國家或族群的盛行率有很大差異，但在世界各地均有增加的趨勢。糖尿病是長期慢性病，需要持續性的醫療照顧和患者自我照護來預防合併症，雖然已有很多國家制定糖尿病照護的指標，但糖尿病仍位居國人第五大死因，因此提升國內糖尿病患的照護品質以降低死亡率仍是醫療照顧者應努力的方向。
本研究的目的是根據美國糖尿病學會對糖尿病照護所制定的標準，從照護的過程及近程結果來探討某榮民總醫院中糖尿病患接受的照護品質，希望透過實證醫學的分析，提供臨床照顧糖尿病患者的參考。
此研究採横斷式研究設計，回顧2001年10月至2002年9月間至高雄榮民總醫院門診就醫之糖尿病患者接受檢驗的記錄，門診主要分為糖尿病專科(新陳代謝科)及非專科(一般內科及家庭醫學科)，研究對象有榮民及非榮民共6,147人。
本研究結果(1)照顧過程面的比較，在專科照顧之糖尿病患者其糖化血色素(HbA1c)、血脂肪年度接受檢查的比例顯者較非專科高，非榮民與榮民身份之年度HbA1c檢查的比例則無顯者差異，整體的照顧過程與美國糖尿病學會的理想目標仍有些差距。(2)近期結果面的比較，在專科門診追踪的患者血糖控制不良之比例較非專科高，且血脂肪控制良好之比例亦較非專科高。而榮民血糖及血脂肪控制良好之比例均較非榮民高。另外在專科中HbA1c年度檢驗頻率之比較，檢驗次數以一次比例最多。
結論，在此榮民總醫院糖尿病專科(新陳代謝科)照顧糖尿病患者的過程中比非專科接近美國糖尿病學會制定的照護品質指標，但血糖控制良好及不佳的患者均以專科門診為多，整體來看糖尿病患者照護的品質未臻理想，但可發現專科照顧的榮民患者比非榮民患者獲得較好的糖尿病照護品質。

關鍵字

照護品質 ； 糖尿病 ； 糖化血色素 ； 近程結果

並列摘要

Diabetes Mellitus (DM) in adults is of a global health concern. its prevalence was estimated to be 4.0% in 1995 and to rise to 5.4% by the year 2025. Although the prevalence varies widely among different populations, the rate has generally increased worldwide. It has become the fifth leading cause of death.
Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent complications. Medical associations in several countries have established practice guidelines for diabetes management. The primary objective of this study was to evaluate the quality of health care for diabetic patients using the indicators of process and intermediate outcomes in a Veterans General Hospital.
This is a cross-sectional study that involved extraction of computerized medical records deposited in the databank of the hospital. A total of 6,688 patients met the inclusion criteria. The outcome study comprised a group of 6,147 patients, which included 2,222 (36%) veterans and 3,925 (64%) non-veterans.
In general, the diabetic care did not meet the goals for process indicators specified by the Diabetes Physician Recognition Program (PRP), i.e., 61% of HbA1c testing (93% PRP), and 27% for lipid testing (86% PRP). As for intermediate outcome measures, the diabetes clinic performed significantly better than the non-diabetes clinic in the following quality of care index: total cholesterol <200mg/ml (53%vs44%, p=0.045), and LDL-c <100mg/dl, (34%vs 25%, p=0.044). In patients treated at the diabetes clinic, there were significantly differences between veteran and non-veterans in term of age, percentage of male, FPG 90-130 mg/dl, mean HbA1c, HbA1c<7%, HbA1c>9.5%, and most of lipid profiles. It was not significantly different between numbers of receiving HbA1c test and intermediate outcomes.
There is considerable variation in the diabetes management. In general, the diabetic care did not meet the goals for process indicators specified by the Diabetes Physician Recognition Program. The most favorable results achieved were observed for veterans treated in the diabetes clini

並列關鍵字

quality of health care ； Diabetes Mellitus ； HbA1c ； intermediate outcome

參考文獻

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