背景:台灣的慢性腎臟病盛行率、發生率為全世界前三名,每年接受透析治療所需的醫療費用造成健保財務上的重大負擔。慢性腎臟病的照護需要靠長期的控制才能延緩病情的惡化給減少併發症的產生,也才能避免造成社會經濟的負擔。 目的:想瞭解慢性腎臟病病人有無參加整體照護計畫照護成效之差異性。 方法:本研究為比較性研究設計,比較「有參與」與「無參與」慢性腎臟病整體照護計畫之自我照顧行為及年度GFR下降速率差異性。本研究收集有無參加參加整體照護計畫之病人各為118位及117位,利用結構性問卷進行面對面訪談收集資料,包括(1)六位專家的內容效度指數(CVI)值:個人基本資料表為1.00;自我照顧行為量表為0.97。(2)自我照顧行為量表:在總量表Cronbach’sα值為.841;飲食控制次量表為.822;規律運動次量表為. 826;規律服藥次量表為.828;血壓管理次量表為.829;控制體重次量表為.829;避免吸菸次量表為.835。 結果:(1)有參加整體照護計畫之自我照顧行為表現,比無參加整體照護計畫好。參與整體性照護計畫在自我照顧行為中的飲食控制、規律運動與無參與整體性照護計畫者相比,分數皆高於無參與整體性照護計畫者,且有顯著差異。(2)有參與整體照護計畫的病人其GFR下降速率,較無參與照護組緩慢(-0.810 ± 6.380 vs -2.978 ± 8.680 ml/min/1.73m2/ year),兩組有顯著差異(p<.005)。(3)飲食控制行為、控制體重行為、自、照顧行為總分與年度GFR變化速率有顯著負相關(p<.005)。 結論:慢性腎臟病照護計畫的介入可延緩慢性腎臟病病人腎功能的惡化,及自我照顧行為的改善。
Background: Chronic kidney disease (CKD) is a public health issue worldwide. The prevalence and incidence are of CKD are gradually increasing. The medical expenses of maintenance dialysis are the heavy burdens of health insurance cost in Taiwan. Thus, multidisciplinary integrated care may assist in improving clinical outcome for CKD patients and lessening financial stress of the government. Aim: We try to analyze the effect of multidisciplinary integrated care program on CKD progression. Methods: This study used the structured questionnaires to evaluate clinical characteristics and self-management in CKD patients. We also analyzed estimated glomerular filtration rate (eGFR) decline during 1-year follow-up between CKD patients with and without participating in multidisciplinary integrated care program (118 and 117 patients, respectively). Results: The scores of self management questionnaire, including diet control and regular exercise, in patients receiving multidisciplinary integrated care program are higher than those without receiving multidisciplinary integrated care program. The significant difference of eGFR decline was shown between CKD patients with and without participating in multidisciplinary integrated care program (-0.810 ± 6.380 v.s. -2.978 ± 8.680 ml/min/1.73m2/ year, P<0.05). The behavior of diet control and weight control and self care scores were negatively correlated with eGFR decline. Conclusions: Multidisciplinary integrated care program help improving self care and diminishing renal function decline in CKD.