尿路結石疾病管理效果之評價

An Evaluation Study on the Disease Management of Urolithiasis

陳淑惠(Su-Huei Chen) ； 管連胡(Lien-Hu Kuang) ； 蔡麗伶(Lee-Lin Tsai) ； 李素真(Su-Jen Lee) ； 柯昭英(Chao-Ying Ko)

《醫保研究雜誌》 1卷1期 (2005/03) Pp. 63-73

https://doi.org/10.29827/YBYJZZ.200503.0007

摘要

本研究旨在評價尿路結石疾病管理之成效；在醫師方面以每位醫師實施體外震波碎石術(ESWL)每月平均減少次數及醫療費用申報爲指標；在病人方面則比較病人尿液比重值之差異情形。實施期間自90年11月至91年12月，評價採兩組前後測設計，研究樣本分爲實驗組（高屏地區6家醫院之尿路結石病患98人及泌尿專科醫師25人）及對照組（5家醫院之尿路結石病患131人及泌尿專科醫師22人）。介入措施包括：召開尿路結石疾病管理研討會、病人衛生教育、持續性促進及改善措施。研究工具包括審查指引及尿路結石病人照護卡。結果顯示：(1)實驗組每位醫師每月實施體外震波碎石(ESWL)之平均次數及平均醫療費用較對照組明顯減少；即每月減少0.176次，平均醫療費用下降6.5萬元。(2)實驗組病人之尿液比重雖有下降趨勢，但其降幅並未顯著高於對照組。建議：(1)健保局應持續推動該尿路結石疾病管理模式；(2)建立尿路結石病人長期資料庫，以利追蹤醫師醫療行爲及病人自我照顧行爲。

關鍵字

尿路結石 ； 疾病管理 ； 評價 ； 體外震波碎石術

並列摘要

The effectiveness of disease management program on the extracorporeal shock wave lithotripter (ESWL) was the purpose of this study. A quasi- experimental design was implemented to evaluate the outcome indicators; average ESWL performance frequencies and reimbursement per physician monthly, patinets' specific gravity of the urine. The were 98 urolithiasis patients and 25 urologists in 6 hospitals of the Kao- Ping area recruited as the experimental group another 131 patients and 22 urologists in 5 hospitals of the same area recruited in the control group. Research data was collected from November 2001 to December 2002. Seminars on strategical action to reduce over supply of ESWL surveillance on medication behaviors of pysicians and patients' health education was provided in the intervention programs. Comparisons between those two groups were analyzed by using the generalized estimating equations. Results revealed that the average ESWL performance frequencies and reimbursement per physician monthly in the experimental group showed a significantly greater reduction than control group There were averagely 0.176 frequencies of ESWL and NT$ 65,000 of reimbursement decreased per physician every month in the experimental group however, there were no significant difference between two groups in terms of specific gravity of the urine which means that the self care behaviors of patients could not be efficiently changed by this education program. This research provides evidence for the effectiveness of disease management program on the ESWL.

並列關鍵字

urolithiasis ； disease management evaluation ； ESWL