某地區教學醫院糖尿病門診病患個案管理照護之成效探討

An Evaluation of Effectiveness of Case Management for Diabetes Mellitus Outpatients in a Regional Teaching Hospital

郝立智(Lyh-Jyh Hao) ； 馬瀰嘉(Mi-Chia Ma) ； 趙海倫(Hailun Chao) ； 簡崇仁(Chung-Ren Jan) ； 楊純宜(Chwen-Yi Yang) ； 林興中(Hing-Chung Lam) ； 李鎮堃(Jenn-Kuen Lee) ； 奚明德(Ming-Der Shi) ； 葛光中(Kuang-Chung Ko) ； 柴國樑(Kuo-Liang Chai) ； 鄭錦翔(Jin-Shiung)

《中華民國內分泌暨糖尿病學會會刊》 20卷4期 (2007/07) Pp. 11-33

https://doi.org/10.7101/ED.200707.0011

摘要

Background: Diabetes mellitus has become one of the major chronic diseases in Taiwan. Long-term control of diabetes mellitus largely depends on comprehensive education program and regular screening of diabetes related complications in order to achieve optimal control goals. To enhance delivery of education program to diabetic subjects in various medical settings, Bureau of National Health Insurance has proposed a Diabetes Education Improvement Program by providing additional reimbursement as an incentive.
Purposes: To evaluate the effect of diabetes mellitus medical benefit improvement project case management for those outpatient diabetes who completed the annual education program on glycemic control and associated metabolic index.
Methods: Between January 2004 and December 2004, patients with established diabetes mellitus (ICD-9 number 250.0 to 250.93) were referred to a diabetes mellitus educator and were included in this study. Treatments were given and subsequent patient care and follow up were carried out by the diabetes mellitus educator. The educator inquired into patients' education level, medication use ideas, medication discrimination ability, lifestyle, and diet behavior. The educator then provided necessary healthcare education and instruction as well as offering appropriate psychosocial support. In addition, a table with the latest tests and laboratory data, together with any suggested necessary examinations, was created for the doctor to consult at each OPD consultation. Data including the patients′ baseline characteristics, disease type and biochemical laboratory data were also collected. Differences in the before and after management data were compared by using SPSS 10.5 version statistic software (paired t test and linear regression method).
Results: A total of 162 patients were included. The mean age was 67.14 years old, 101 patients were male (62.35%) and 61 patients were female (37.65%). They are all of type 2 diabetes mellitus. The number of patient taking oral hypoglycemic agents was 153 (95%). Of the 162 patients, 67.28% had hypertension and 51.86% had hyperlipidemia. Analysis with a paired t test of the diastolic blood pressure, body weight, fasting plasma glucose, A1C data showed a significant difference between before and after management (P＜0.05).
Conclusion: The intervention results suggested that the diabetes mellitus medical benefit improvement project outpatient case management played a positive role in the improvement of glycemic control and associated metabolic index, especially for those patients who have the higher initial A1C level(≧9%).

關鍵字

糖尿病 ； 糖尿病衛教師 ； 糖尿病醫療給付改善方案 ； 個案管理

並列摘要

Background: Diabetes mellitus has become one of the major chronic diseases in Taiwan. Long-term control of diabetes mellitus largely depends on comprehensive education program and regular screening of diabetes related complications in order to achieve optimal control goals. To enhance delivery of education program to diabetic subjects in various medical settings, Bureau of National Health Insurance has proposed a Diabetes Education Improvement Program by providing additional reimbursement as an incentive.
Purposes: To evaluate the effect of diabetes mellitus medical benefit improvement project case management for those outpatient diabetes who completed the annual education program on glycemic control and associated metabolic index.
Methods: Between January 2004 and December 2004, patients with established diabetes mellitus (ICD-9 number 250.0 to 250.93) were referred to a diabetes mellitus educator and were included in this study. Treatments were given and subsequent patient care and follow up were carried out by the diabetes mellitus educator. The educator inquired into patients' education level, medication use ideas, medication discrimination ability, lifestyle, and diet behavior. The educator then provided necessary healthcare education and instruction as well as offering appropriate psychosocial support. In addition, a table with the latest tests and laboratory data, together with any suggested necessary examinations, was created for the doctor to consult at each OPD consultation. Data including the patients′ baseline characteristics, disease type and biochemical laboratory data were also collected. Differences in the before and after management data were compared by using SPSS 10.5 version statistic software (paired t test and linear regression method).
Results: A total of 162 patients were included. The mean age was 67.14 years old, 101 patients were male (62.35%) and 61 patients were female (37.65%). They are all of type 2 diabetes mellitus. The number of patient taking oral hypoglycemic agents was 153 (95%). Of the 162 patients, 67.28% had hypertension and 51.86% had hyperlipidemia. Analysis with a paired t test of the diastolic blood pressure, body weight, fasting plasma glucose, A1C data showed a significant difference between before and after management (P＜0.05).
Conclusion: The intervention results suggested that the diabetes mellitus medical benefit improvement project outpatient case management played a positive role in the improvement of glycemic control and associated metabolic index, especially for those patients who have the higher initial A1C level(≧9%).

並列關鍵字

diabetes mellitus ； diabetes mellitus educator ； diabetes mellitus medical benefit improvement project ； case management