- 期刊
肺阻塞門診疾病分流及循環式個別化照護成效
COPD patient flow reroute and individualized evaluation and action plan
摘要
背景：肺阻塞是一種不可逆性的慢性氣道阻塞疾病，經常反覆急性惡化。醫師門診常常僅重視藥物開立，也影響疾病控制成效。本研究建立肺阻塞門診組合性照護，按疾病症狀分流並提供個別化照護，希望能有效降低急性惡化提升照護品質。研究方法：肺阻塞病人符合收案進入組合式照護。組合式照護分為三大項：（1）疾病分流照護：疾病嚴重度評估和建立疾病分流照護，（2）針對本院病患特質，調整衛教內容，並指導提昇自我照顧學習效能，（3）轉介肺復原照護，並提供初步評估和個別化衛教。研究結果：106.08－107.08月篩選193位病人參與門診組合照護模式，經過衛教指導提升肺復原運動和照護技能概念，前測71.7分、後測92.1分。所有病人接受初級肺復原衛教指導，其中63位（32.6%）接受進階肺復原治療，84位抽菸者成功戒菸22人（26%）。照護後每人每年平均急性惡化由0.54次／人年，降低為0.38次／人年。呼吸困難量表由平均1.2分降至0.3，阻塞性肺病評估量表由平均11.5降至8.7分，顯示呼吸困難症狀減少與生活品質提昇。結論：我們的研究顯示肺阻塞門診疾病分流照護以及藥物和初步個別化肺復原照護衛教能有效降低急性惡化次數、減緩病人呼吸困難症狀，提升病人生活品質。
並列摘要
Background: Chronic obstructive airway disease (COPD) was a progressive, irreversible chronic airway inflammation, which always combined multiple comorbidities, and it required multi-team cooperation and multi-dimensional care plan. Most physician only focus on inhaler or medicine prescriptions, this will lead to higher acute exacerbation rate. Method: Hospitalized or outpatient COPD patients who meet the disease definition was enrolled. Care bundles included (1) patient flow reroute according to disease severity, (2) redesign our education protocol after survey, (3) individualized evaluation and action plan. Result: During August 2017 to August 2018, 193 COPD patients were enrolled for care bundles. After health education, the mean questionnaire score for disease knowledge increased from 71.7 to 92.1. Among all COPD patients, 63 (32.6%) patients were suggested to have advanced pulmonary rehabilitation program. 84 (26%) patient quitted cigarettes smoking successfully. Acute exacerbation rate decreased from 0.54 per person-year to 0.38 per person-year. Symptom score such as mMRC decreased from 1.2 to 0.3, CAT decreased from 11.5 to 8.7. Conclusion: Our study demonstrate that COPD patients reroute, pharmacologic evaluation, combined with individualized pulmonary rehabilitation care plan will reduce the acute exacerbation, relief patient dyspnea symptom and improve the daily life quality of patient effectively.
延伸閱讀
- 鄭世隆、林慶雄、林孟志（2023）。組合式照護治療模式－提升慢性阻塞性肺病醫療照護品質。醫療品質雜誌，17(2)，42-46。https://doi.org/10.53106/199457952023031702007
- 蔡宜宸、江玲玲、李雅婷、曾健華、李昆達（2022）。【論文摘要】全面性評估慢性阻塞性肺病合併阻塞型呼吸中止症之重疊症候群肺復原照護經驗。呼吸治療，21(2)，132-133。https://doi.org/10.6269/JRT.202207_21(2).0041
- 林宜柏、吳肖琪（2015）。慢性阻塞性肺病門診照護連續性之相關因素探討。台灣公共衛生雜誌，34(4)，404-412。https://doi.org/10.6288/TJPH201534103118
- 林惠釧、許重梅、謝慧觀（2011）。全肺切除與惡化的慢性阻塞性肺疾病個案之呼吸照護經驗。呼吸治療，10(2)，43-56。https://doi.org/10.6269/JRT.2011.10.2.04
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