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  • 學位論文

糖尿病藥物及衛生網路教育對病人遵從醫囑服藥的順從行為之研究

Studying effects of Web-based, Integrated Patient Education System on Diabetic Patients' Medication Adherence

指導教授 : 劉建財
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摘要


由於台灣人口的老年人比率逐漸增加,生活環境的變化,因此國人糖尿病的盛行率日漸上升,而糖尿病更高居十大死因的第四名。因為糖尿病病人大都是老年人的關係,因此通常都會使用兩種以上的藥物治療,用藥比例種總和都超過100%,糖尿病患變成用藥高危險群,由此可知藥物衛教對糖尿病病人的重要性。而治療處方需隨相關考慮因素來作適當調整,因此糖尿病病人的醫囑服藥的順從度就顯的格外重要,因為藥物的醫囑服藥的順從度也會影響糖尿病病人的血糖控制和併發症的延後。而隨著科技進步,利用資訊科技來幫助醫療照護,對病患、醫護人員、甚至整個社會都會有極大的效益存在。因此,本研究本研究透過立意取樣的方式,共收案228位病人,分為實驗組與對照組,運用健康信念理論概念,製作一份結構型問卷量表,利用前後測的方法,以病人的角度為出發點,藉由後測的問卷來評估透過此以病人為導向的整合型糖尿病藥物及衛生網路教育系統的糖尿病病人醫囑服藥的順從度改善之成效,透過整合型糖尿病藥物及衛生網路教育系統,針對加強提供糖尿病病人每一次在醫院所做的衛教資訊、藥物方面的訊息,例如每一次在醫院拿的藥物外觀、副作用介紹、使用注意事項、藥物的學名、藥物的商品名、藥物的適應症、藥物的中文名、劑量、劑型、藥物的用法用量、保存方法、藥物的過量處理等資訊。研究結果發現,兩組在前測時候分析發現自覺疾病的易感性之程度為低、自覺疾病的嚴重度之程度不高、採取健康行為的利益之程度高、採取健康行為的障礙之程度高;而在後測分析結果中可以看到實驗組的自覺疾病易感性之程度為對照組高;實驗組的自覺疾病的嚴重度之程度為對照組高,並且兩組的平均數得分相差1.97分,推論實驗組的個案對於可能罹患此疾病所帶來的嚴重程度和危險性患者的認知有不錯的現況; 實驗組的採取健康行為的利益之程度較對照組高,顯示實驗組的個案認同依照醫囑服藥對疾病治癒的機率高,並且對其是有幫住的; 對照組的採取健康行為的障礙之程度較實驗組高,顯示對照組的個案採取健康行為的障礙之程度高。由以上結果可以推論利用系統作介入後,加強了病人在採取健康行為的利益(如:可以不分時段、不受地域影響,持續的獲取糖尿病的相關資訊,讓病人可以隨時複習所需資料,並且提升衛教的成效),和自覺疾病的嚴重度(在系統中教導併發症的危險),採取健康行為的障礙因此便會減低,而在身體檢查報告部分,實驗組病人也有小幅的改進狀況,看出實驗組的病人在使用過系統後,在健康信念量表、遵醫囑行為、病患藥物知識測驗,均有進步的跡象,因此可以推論系統的介入,的確給病人帶來正面的助益。

並列摘要


Diabetes is the fourth leading causes of death in Taiwan. Diabetes mellitus is a complex chronic metabolic disease. Without appropriate treatment complications often occur. Because diabetes patients are mostly the old people, they usually use more than two kinds of medication. Total proportion of medicine exceed 100%. Diabetes patient are the high dangerous group in using medicine. It is therefore imperative for diabetic patients to have good pharmaceutical education in order to have better results in glucose control. So diabetic patients' medication adherence plays an essential role in diabetes. As the Internet becomes more widely available, the general public is beginning to seek medical information and support online. This research has recruited total of 228 subjects, in which each subject has been assigned to either the control or the experimental group. Data was collected by means of interviewing and questionnaire at one endocrine out. The questionnaire was consisted of health belief scale, medication adherence behaviors scale , and medication knowledge scale. The research methods are conducted with pretest-posttest design. After the patient use the web-based, integrated patient education system in the experimental group, the outcomes will be evaluated by the posttest questionnaire. This web-based, integrated patient education system is to provide appropriate drug information by linking their prescribed medicines with their photos, directions of use and instructions to enhance pharmaceutical education in a hospital. Through accessing the on-line pharmaceutical education information, patients can have better knowledge with their medicines, and hence adhere to their orders better. Moreover, the system will also provide an automatic reminder service for medication intake and routine check-ups. From this research we can get the main results as the following: An analysis of pretest questionnaire of outcome in two groups revealed the lower scores of perceived seriousness, perceived susceptibility and the higher scores of perceived benefits, perceived barriers. However, the greater scores of the experimental group increase after intervention. The experimental group increase 1.97 scores than that in the control group. Subjects in the experimental group have a greater increase in medication knowledge test after intervention than the subjects in the control group. This web-based, integrated patient education intervention is positively related to an increase in the perceived efficacy and barriers of diabetes care after intervention. The new system strengthens patients’ understanding of pharmaceutical functions, side-effects and relevant knowledge thus increasing patients’ adherence of medication orders and having better control in their blood glucose levels.

參考文獻


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