慢性腎臟病患衛教介入成效與影響因子之探討

The Health Education Effectiveness and its Determinants of Patient With Chronic Kidney Disease

蕭菁菁(Hsaio Ching Ching)

指導教授 ： 藍守仁

亞洲大學/健康學院/長期照護研究所/碩士(2011年)

摘要

2003年開始實施「慢性腎臟病照護網」計劃。研究顯示照護成效會隨著照護時間延長而遞減。如何維持照護成效為重要的議題。故本研究目的在瞭解醫學中心醫院慢性腎臟病患者接受「慢性腎臟病照護網」衛教介入後之照護成效，並探討影響定期回診控制成效之因素。研究採立意抽樣方式自中部一家醫學中心慢性腎臟病患者共1120人。以配對樣本t檢定分析各年間腎絲球過濾率（GFR）之顯著性；ANOVA檢定生化檢驗指標變化之關係；以二元邏輯迴歸分析影響個案定期回診及結案之因素。結果顯示納入「慢性腎臟病衛教網」收案追蹤管理執行一年得收較大的成效。慢性腎臟病整體照護計畫之實施對於有定期回診之患者減緩進入透析有顯著成效，定期回診為維持成效的主要因子。此研究顯示慢性腎臟病整體照護計畫値得繼續推行。

關鍵字

慢性腎臟病 ； 末期腎臟病 ； 慢性腎臟病照護網

並列摘要

Background and objectives: " Integrated Chronic Kidney Disease（CKD）care program " has been implemented in Taiwan since 2003 but its effectiveness on the revisit generally diminishes with time. How to maintain the effectiveness has become a pivotal issue in general care. This study was aimed to examine the effectiveness of the " integrated CKD care program " and the factors impacting the effectiveness of the program in chronic kidney disease patients.
Methods: A total of 1120 patients out from one medical center in middle Taiwan were included in this study . The characteristics of lab data, and the results of revisit of these patients were collected and analyzed .
Results: The results indicate the integrated CKD care program significantly reduced the rate of dialysis at one year follow up. A regular revisit and adhering to the treatment plans appear to be the major factors for preventing the rest of dialysis.
Conclusion：An effective lifestyle education is probably the key in maintaining and extending the beneficial effects of the integrated CKD care program .

並列關鍵字

Chronic Kidney Disease ； End Stage Renal Disease ； Integrated Chronic Kidney Disease care program

參考文獻

王智賢、黃建鐘(2002)．腎臟病的保護療法－多重風險因子介入治療．腎臟與透析，14(3)，136-140 。

王淑麗、蕭仕敏、邱怡文、黃尚志、陳鴻均（2007）‧如何執行慢性腎臟病個案管理：南部某醫學中心為例‧腎臟與透析，19（1），6-11。

李文玄、陳怡穆（2010）。以目標導向觀點探索動機與健康促進生活型態之關聯性。臺灣公共衛生雜誌，29（1），76-86。

李宣緯、葉玲玲、黃達夫（2006）。台灣高血壓門診診療型態之分析探討。臺灣公共衛生雜誌，25（3），201-213。

李文欽、張舜智、黃忠餘、吳明儒（2007）。慢性腎臟病與貧血。腎臟與透析，19（2），81-88。