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題名：高膽固醇血症患者主動式電話介入之成效
作者：林益卿
作者(外文)：I-Ching Lin
校院名稱：亞洲大學
系所名稱：健康產業管理學系健康管理組
指導教授：劉俊昌
學位類別：博士
出版日期：2015
主題關鍵詞：電話介入；衛生教育；高膽固醇血症；Telephone intervention；Health education；Hypercholesterolemia
原始連結：連回原系統網址new window
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前言與研究目的：在台灣，心血管疾病是主要死因之一，而高膽固醇血症是心血管疾病主要危險因子之一。藉由更健康的生活型態以降低膽固醇是減少罹患冠狀動脈疾病風險的首要之務。本研究的目的是評估主動式電話介入計劃對於高膽固醇血症患者的知識、態度、行為以及血中膽固醇值改善的效益。
材料與方法：本研究為一隨機控制之試驗，於2012年3月至2013年12月，於中部某醫學中心家庭醫學科門診共收納126位，年齡介於20-65歲，血中膽固醇值大於200mg/dl的受試者。所有受試者根據電腦產生的隨機亂數表被隨機分派到實驗組及對照組。介入方式為每月一次的主動式電話衛教諮商，總介入期間為1年。排除標準包括病人無法做運動以及試驗期間所服用之降血脂藥物劑量有變動者。二位訓練良好的護理師分別負責每月一次的主動式電話衛教以及門診衛教。控制組不給任何的電話介入，僅提供門診衛教。所有受試者於介入前以及介入一年後填寫問卷以評估受試者對高血脂的知識、態度以及行為，同時也測量介入前後血中膽固醇的濃度。研究結果採立意治療分析。
研究結果：117受試者(包含59位介入組以及58位對照組)完成此試驗。本研究發現不論是介入組或對照組對於高血脂的知識、態度與行為的得分都有明顯增加，但是在二組之間知識、態度與行為的前測 (p=0.573、p=0.539、p=0.085)、後測 (p=0.827、p=0.879、p=0.896)、得分差值 (p=0.758、p=0.491、p=0.239) 並無顯著差異。知識的改變與態度的改變有正相關 (C.I. 0.000 - 0.303, p=0.049) ，但是這二者與行為改善並不具有統計上顯著的相關性。運動行為在介入組有明顯改善 (p=0.016)，但是在對照組並沒有顯著差異 (p=0.346)。在生化指數方面，介入組在總膽固醇與低密度脂蛋白膽固醇的前後測的差值相較於對照組有更顯著的改善，電話介入的效益大約可以讓總膽固醇及低密度膽固醇分別多下降 18.3 mg/dl (C.I. = -25.0 - -11.7, p < 0.001) 及18.6 mg/dl (C.I. -27.9- -9.3, p< 0.001)。然而，知識、態度與行為三者的改善與膽固醇的改善不具有統計學上顯著的相關性。多變項廻歸分析顯示電話介入對於膽固醇的改善有顯著效益 (C.I. -23.647 – -7.297, p<0.001)，對於收案時年紀愈大 (C.I. -9.133 – -1.053, p= 0.007) 以及收案時膽固醇愈高者 (C.I. -2.422 – -0.885, p< 0.001) 膽固醇的改善程度愈高。
結論與建議：綜合以上結果顯示主動式電話介入可以改善高膽固醇血症患者的知識、態度、行為與總膽固醇。由於電話衛教介入一種低成本且沒有距離障礙的方式，依據上述研究成果，主動式電話衛教諮商介入應為一種可以推廣的方式，醫療院所可依據此研究成果，執行良好的健康照護遞送系統服務。
Background and Aims: Hypercholesterolemia is a major risk factor for cardiovascular disease (CVD), which is a leading cause of mortality in Taiwan. Lowering cholesterol levels by lifestyle modification is the primary approach for reducing the risk of coronary heart disease. The aim of this study was to assess whether an active intervention via a telephone education program for patients with hypercholesterolemia is an effective method to improve patients’ knowledge, attitude, behavior, and blood cholesterol levels.
Material and Methods: This study was a randomized controlled trial. From March, 2012 to December, 2013, 126 participants aged 20 to 65 with blood cholesterol levels above 200 mg/dl were recruited at a medical center in central Taiwan. Participants were randomly assigned to intervention or control group by using a computer-generated random table. Active intervention via telephone education and counseling was delivered monthly, and participants were followed for 1 year. Exclusion criteria included participants who were incapable of exercise and who were taking different dose lipid-lowering agents during the trial. Two well-trained educators were in charge of the active telephone education once monthly and education at clinics, respectively. The control group was given education at clinics but not telephone intervention. All participants were evaluated for knowledge, attitude, and behavior using a developed questionnaire and for blood cholesterol levels at baseline and 1 year after the initiation of the program. An intention-to-treat analysis was used.
Results: One hundred and seventeen participants (59 in the intervention group and 58 in the control group) completed this trial. It was found that both groups showed significant improvement in knowledge, attitude, and behavior scores, and there was no significant difference between the intervention group and control group for pre-test scores of knowledge (p=0.573), attitude (p=0.539), and behavior (p=0.085), post-test scores of knowledge (p=0.827), attitude (p=0.879), and behavior (p=0.896), and difference of knowledge (p=0.758), attitude (p=0.491), and behavior (p=0.239) between pre-test and post-tests. Although change in knowledge positively correlated with change in attitude (95% C.I. 0.000 - 0.303, p=0.049), changes in knowledge or attitude had no correlation with the behavior improvement. Exercise behavior in the intervention group (p=0.016) significantly improved, but no significant differences were observed in the control group (p=0.346). In terms of the results of the biochemistry indices, compared with control group, the difference between pre-test and post-test for total cholesterol and LDL-C showed a more significant improvement in intervention group. The effectiveness of telephone intervention can be seen in the decrease of total cholesterol and LDL-C of more than 18.3 mg/dl (95% C.I. = -25.0 - -11.7, p<0.001) and 18.6 mg/dl (95% C.I. -27.9 – 11.3, p<0.001), respectively. However, neither knowledge, attitude, nor behavior was significantly correlated with the improvement of blood cholesterol level. Multi- regression analysis revealed that telephone intervention (95% C.I. -23.647 – -7.297, p<0.001) was significantly related to the difference between pre-test and post-test cholesterol. The analysis also showed correlations between the increasing improvement in the difference between pre-test and post-test cholesterol and 1. the increasing age of participants (95% C.I. -9.133 – -1.053, p= 0.007) and 2. higher blood cholesterol levels in the pre-test (95% C.I. -2.422 – -0.885, p< 0.001).
Conclusion and Recommendation:
Based on the above results, it showed significant improvement in knowledge, attitude, behavior, and blood cholesterol level by active intervention via telephone in patients with hypercholesterolemia. This study provides evidence that telephone intervention for health education and counseling, which is inexpensive and overcomes distance barriers, is an active approach for patients with hypercholesterolemia that appears to be an efficient way for medical institutes to deliver effective healthcare service.
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