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題名：The Effectiveness of Hospital-Based Diabetes Case Management: An Example from A Northern Taiwan Regional Hospital
書刊名：The Journal of Nursing Research
作者：張煥禎／張玉坤／李淑美／陳美芳／黃美菁／彭竟琳／顏慶雲
作者(外文)：Chang, Huan-cheng／Chang, Yue-cune／Lee, Su-mei／Chen, Mei-fang／Huang, Mei-ching／Peng, Chin-lin／Yan, Ching-yun
出版日期：2007
卷期：15:4
頁次：頁296-309
主題關鍵詞：Diabetes；Hospital-based case management；Regional hospital；糖尿病；醫院式個案管理；區域醫院
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(2) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:2
  • 共同引用共同引用:17
  • 點閱點閱:96
本研究目的在規劃、執行區域醫院式糖尿病個案管理照護第二型糖尿病患並評值成效，分析受試者實驗室結果和自我照顧行為改變情形，以探討疾病管理成效。研究設計以全民健康保險糖尿病醫療給付改善方案試辦計畫和美國糖尿病協會(American Diabetes Association, ADA)2003版糖尿病照護標準為藍圖，建立符合區域醫院體制之糖尿病照護團隊和臨床指引；同時編製符合在地居民特性的糖尿病自我照顧手冊。採前瞻性研究且追蹤受試病患一年。病患成效以實驗室檢驗和自我照護行為評量。資料收集包括收案日以及一年內的4次追蹤測試結果。本研究分別採用GEE統計方法之多變項線性迴歸與邏輯斯迴歸處理重複測量資料並調整影響因素之效應。共計60位第二型糖尿病患（平均罹病期3.25年）為研究樣本，皆為已婚、年齡介於23-84歲（平均52.5歲）、男性(58.3%)稍多於女性、其中65%為本省客家籍。六類自我照顧認知與行為達成率分別為：自主服藥91.3%（藥物認知正確率25.4%）、低血糖處理23.3%、血糖監測相關行為46.7%、運動35.8%、飲食管理51.7%和足部護理92.8%。依照ADA糖尿病照護標準呈現統計上成效的檢驗值包括：糖化血色素(p<.0001)、空腹血糖(p<.01)、三酸甘油脂(p<.05)。本研究結果顯示整合臨床指引、政府健康部門策略、自我照護手冊而成的「醫院式糖尿病個案管理」能提供綜合性照護並能有效地達成照護目標和改善糖尿病患自我照護行為。
The aim of this study was to design, implement and evaluate disease outcomes at a regional hospitalbased case management program of care for patients with type 2 diabetes. Amedical team and practice guidelines were established in line with the health insurance strategy of Taiwan's Bureau of National Health Insurance (BNHI) and American Diabetes Association (ADA) Standards of Care for Diabetes (2003 edition). Also, a set of self-care booklets was designed suitable for use by the subject group. The study was prospective and followed the patients from enrollment to one year. Patient outcomes were determined based on laboratory examinations and recorded self-care behavior. Data were collected at enrollment and over 4 follow-up times within a one year period. Generalized Estimating Equation (GEE) multiple linear regression and logistic regression were used for repeated measurements and adjustments of the effects of specific prognostic factors. Sixty subjects diagnosed with type 2 diabetes (mean duration 3.25 years) were recruited. All participants were married with a mean age of 52.5 years. A majority (58.3%) was male and 65% were ethnic Hakka. Self-care knowledge and behavior accomplishment rates were: taking medications by oneself, 91.3% (knowing medicines, 25.4%); hypoglycemia management, 23.3%; monitoring blood sugar, 46.7%; exercise, 35.8%; diet management, 51.7% and foot care, 92.8%. Significantly improved ADA diabetes care standard items included HbA1C (p<.0001), fasting glucose (p<.01) and triglycerides (p<.05). The study incorporated evidence-based guidelines, public health insurance strategies and self-care booklets into a protocol to provide comprehensive care. The implemented diabetes program achieved diabetes care goals and improved patient self-care.
期刊論文
1.林紹雯、陳明琪、柯碧玲、張雅芬、陳素娥(20031200)。糖尿病共同照護網實施成效：中部某區域醫院為例。健康促進暨衛生教育雜誌，23，55-66。new window  延伸查詢new window
2.Stratton, I. M.、Adler, A. I.、Neil, H. A. W.、Matthews, D. R.、Manley, S. E.、Cull, C. A.、behalf of the UK Prospective Diabetes Study Group(2000)。Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): Prospective observational study。British Medical Journal，321(7258)，405-412。  new window
3.周碧瑟、董道興、李佳琳、莊紹源、林敬恆、楊南屏(20020400)。臺灣地區糖尿病流行病學。臺灣公共衛生雜誌，21(2)，83-96。new window  延伸查詢new window
4.American Diabetes Association(2002)。Standards of medical care for patients with diabetes mellitus。Diabetes Care，25(1)，S33-S49。  new window
5.魏榮男、莊立民、林瑞雄、趙嘉玲、宋鴻樟(20020600)。1996∼2000年臺灣地區糖尿病盛行率與住院率。臺灣公共衛生雜誌，21(3)，173-180。new window  延伸查詢new window
6.Liang, Kung-yee、Zeger, Scott L.(1986)。Longitudinal Data Analysis Using Generalized Linear Models。Biometrika，73(1)，13-22。  new window
7.曾櫻枝、陳淑如、張文英、鄭綺(2002)。手部運動對第2型糖尿病患者血糖反應影響之探討。護理研究（英文版），10(3)，187-194。  延伸查詢new window
8.魏榮男、宋鴻樟、林瑞雄、李中一、莊明雄、王博仁、周劍文、童瑞年、莊立民(2002)。各級醫院糖尿病慢性合併症住院現況探討。臺灣公共衛生雜誌，21(2)，115-122。new window  延伸查詢new window
9.朱真一(2004)。臺灣各族群糖尿病之高盛行率。臺灣醫界，47(11)，33-35。  延伸查詢new window
10.Holtrop, J. S.、Hickner, J.、Dosh, S.、Noel, M.、Ettenhofer, T. L.(2002)。"Sticking to it - Diabetes Mellitus": A Pilot Study of an Innovative Behavior Change Program for Women with Type 2 Diabetes。American Journal of Health Education，33(3)，161-166。  new window
11.Chau, Y. S.、Shiu, A. T. K.、Ma, S. F.、Au, T. Y(2005)。A Nurse-led Walking Exercise Program for Hong Kong Chinese Diabetes Patients: Implications for facilitating Self-efficacy Beliefs。Journal of Clinical Nursing，14(10)，1257-1259。  new window
12.Biltri, J. M.、Davis-Smith, Y. M.、Zayas, L. C.、Shallen-berger, S.、Seale, J. P.、Blalock, T. W.(2006)。Developing a Church-based Diabetes Prevention Program with African Americans。The Diabetes Educators，32(6)，901-909。  new window
13.Larme, A. C.、Pugh, J. A.(2001)。Evidence-based Guidelines Meet the Real World。Diabetes Care，24(10)，1728-1733。  new window
14.Harris, M. I.(2001)。Frequency of Blood Glucose Monitoring in Relation to Glycemic Control in Patients with Type 2 Diabetes。Diabetes Care，24(6)，979-982。  new window
15.Stern, E.、Benbassat, C. A.、Goldracht, M.(2005)。Impact of a Two-arm Educational Program for Improving Diabetes Care in Primary Care Centers。International Journal of Clinical Practice，59(11)，1126-1130。  new window
16.Del Prato, S.、Felton, A.-M.、Munro, N.、Nesto, R.、Zimmet, P.、Zinman, B.(2005)。Improving Glucose Management: Ten Steps to Get more Patients with Type 2 Diabetes to Glycaemic Goal。International Journal of Clinical Practice，59(11)，1345-1355。  new window
17.Polonsky, W. H.、Earles, J.、Smith, S.、Pease, D. J.、Macmillan, M.、Christensen, R.(2003)。Intergrating Medical Management with Diabetes Self-management Training。Diabetes Care，26(11)，3048-3053。  new window
18.Renders, C. M.、Schellevis, F. G.、Valk, G. D.、Eijk Van, J. TH. M.、Franse, L. V.、Van Der Wal, G.(2001)。Long-term Effectiveness of a Quality Improvement Program for Patients with Type 2 Diabetes in General Practice。Diabetes Care，24(8)，1365-1370。  new window
19.Ko, S. H.、Song, K. H.、Kim, S. R.、Lee, J. M.、Kim, J. S.、Shint, J. H.(2007)。Long-term Effects of a Structured Intensive Diabetes Education Programme (SIDEP) in Patients with Type 2 Diabetes Mellitus - A 4-year Follow-up Study。Diabetes Medicine，24(1)，55-62。  new window
20.Egede, L. E.、Michel, Y.(2006)。Medical Mistrust, Diabetes Self-management, and Glycemic Control in an Indigent Population with Type 2 Diabetes。Diabetes Care，29(1)，131-132。  new window
21.American Diabetes Association National Institute of Diabetes and Digestive and Kidney Diseases(2004)。Prevention or Delay of Type 2 Diabetes。Diabetes Care，27Suppl. 1)，47-54。  new window
22.American Diabetes Association(2006)。Third-party Reimbursement for Diabetes Care, Self-management Education, and Supplies。Diabetes Care，29Suppl. 1)，68-69。  new window
會議論文
1.Zamudio, V.(2005)。7 Self-care Behaviors: A New Paradigm for Diabetes。0。  new window
2.Tsai, S. T.(2005)。Diabetes Management in Taiwan。0。  new window
圖書
1.Pencheon, D.、Wright, J.(2002)。Keeping up to Date through Lifelong Learning。The Evidence Base for Diabetes Care。Chichester, UK。  new window
2.Roter, D.、Kinmonth, A.-L.(2002)。What Is the Evidence that Increasing Participation of Individuals in Self-caremanagement Improves the Process and Outcomes of Care?。The Evidence Base for Diabetes Care。Chichester, UK。  new window
其他
1.Bureau of National Health Insurance(2006)。Improving Insurance Patients' Medical Treatment on Trial of Health Insurance (Fourth Recision)，0。  new window
 
 
 
 
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