不同專科別對糖尿病腎病變照護結果差異性之探討-以照護行為為中介變項

Exploring Variation in Outcome of Diabetic Nephropathy Care among Different Medical Specialties

吳亭儀(Ting-Yi Wu)

指導教授 ： 羅英瑛

義守大學/醫學院/醫務管理學系/碩士(2015年)

https://doi.org/10.6343/ISU.2015.00171

摘要

研究背景與目的：糖尿病是全球最重要的慢性疾病之一，同時也是造成末期腎臟病常見的原因，除了會使患者病情加速惡化也會增加死亡率。醫療照護越趨專科化，各專科醫師的照護方式及結果都有所差異。本研究欲針對不同專科別的照護行為是否會影響第二型糖尿病患者進展至腎病變之照護結果進行探討。
研究方法：本研究屬次級資料分析，使用全民健康保險研究資料庫取得第二型糖尿病患就醫相關資訊。以2004年第二型糖尿病新發生個案為研究對象，探討於發病七年後是否會因不同專科之照護行為影響腎病變發生之結果。
研究結果：(1)於內科就診之患者最多(49.0%)、內分泌科最少(11.2%)；罹患腎病變之病患為9.6%；有使用ACEI或ARB類型藥品之病患為30.8%；每年皆有執行檢查檢驗之病患只有6.3%。(2)有使用ACEI或ARB類型藥品罹患腎病變機率較高、微白蛋白尿檢驗次數越高罹患腎病變的機率越高；內分泌科患者執行微白蛋白尿檢驗的機率最高、內科患者有使用ACEI或ARB類型藥品的機率最高；內分泌科患者罹患腎病變機率最高。
結論：各專科醫師於照護行為上皆有所差異，若能藉由專科醫師的教育與訓練過程，提升照護品質的一致性、減少專科間差異，就能提高糖尿病患接受照護的完整性。定期檢驗微白蛋白尿是檢測腎病變的重要指標，但各專科落實比例低，應針對高風險族群實施定期檢測的相關措施，減少患者進入洗腎治療時期的機率。本研究僅探討發病後七年是否罹患腎病變，故可能無法完全掌握腎病變發生之結果，建議延長觀察時間及探討導致末期腎臟疾病或洗腎治療作為照護結果。

關鍵字

糖尿病 ； 腎病變 ； 專科 ； 照護

並列摘要

Background and purpose: Diabetes is one of the most important chronic diseases in the world. Additionally, diabetes is one of the leading causes of ESRD. In conclusion, diabetes cannot only worsen the condition of a patient with kidney diseases but also increase the patient’s mortality. However, as departments of hospitals becomes more specialized, each specialist may utilize different treatments. The purpose of this research is to examine the effect of various treatments utilized by different specialists on the development of Type 2 Diabetes Mellitus to Diabetic Nephropathy.
Methods: This research is a secondary research. We obtained the data of diabetic patients from National Health Insurance Research Database. This research focused on patients who start suffering from Type 2 Diabetes Mellitus in 2004. We observed the effect of various treatments on the incidence of nephropathy seven years after the occurrence of diabetes.
Results:(1) Most patients visit Medical Department (49.0%) while only 11.2% visit Endocrinology.9.6% of all the patients suffer from Diabetic Nephropathy, only 6.3% of them make an examination every year, and 30.8% of them take ACEI and ARB.
(2) Patients who take ACEI and ARB medication and make more ACR inspections have a higher probability to suffer from diabetic nephropathy. Patients, who visit Endocrinology, make ACR inspections most constantly. Furthermore, patients from Medical Department take ACEI and ARB medication most constantly. Finally, patients who visit Endocrinology have the highest probability to suffer from diabetic nephropathy.
Conclusion: Each specialist provides different treatments to patients. By providing educational and training programs to each specialist, it might reduce the difference of treatments given by each specialties and improve the quality of care. Additionally, it is very essential to make ACR examinations periodically for early detection and diagnosis. However, only few specialists require patients to make the examinations. Consequently, to reduce the chance for diabetic patients to undergo kidney dialysis, it should implement a policy that forces patients, who are predispose to nephropathy, to take the examination regularly. This research is to examine the outcome of incidence of nephropathy seven years after the occurrence of diabetes, it might couldn't forecast completed. Finally, it is recommended to use longer time to examine the outcome of incidence of end-stage renal disease or taken hemodialysis as outcome.

並列關鍵字

diabetes mellitus ； nephropathy ； specialties ； care

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