醫病溝通及關係品質對慢性腎臟病患自我管理行為之影響

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Title:	醫病溝通及關係品質對慢性腎臟病患自我管理行為之影響 The effect of patient-provider communication and relationship quality on self-management behaviors in patients with chronic kidney disease
Authors:	鄭宇綾
Contributors:	醫務管理學系碩士班
Keywords:	自我管理;醫病溝通;關係品質;關係行銷;慢性腎臟病 Self-management;Provider-patient communication;Relationship quality;Relationship marketing;Chronic kidney disease
Date:	2011-07-25
Issue Date:	2011-10-17 16:56:56 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	健保局為了降低末期腎臟病發生率及盛行率，推行「全民健保pre-ESRD 預防性計畫及病人衛教計畫」，透過衛教計畫的實施以延緩慢性腎臟病患者進入透析的時間。本研究從關係行銷的觀點切入，探討醫護人員與慢性腎臟病患之間不同的溝通型態以及二者間關係的建立對病患從事自我管理行為之影響。以問卷調查法，採便利取樣方式選取北、中、南共3家實施慢性腎臟病衛教計畫的區域醫院進行取樣，發放問卷前，由門診慢性腎臟病衛教師篩選符合條件的慢性腎臟病患者，由訪員進行實地的問卷調查，有效樣本共273份。以AMOS17.0軟體執行結構方程式分析，藉以檢定整體理論模式配適性與研究變數關係的顯著性。研究結果發現良好的醫病溝通皆能正向影響病患之醫護關係品質和病患自我管理行為，但醫病溝通型態中只有專業協助溝通能正向影響病患之醫護關係品質；病患之醫護關係品質無法直接影響病患自我管理行為；病患之醫護關係品質並非作為醫病溝通和病患自我管理行為的中介變數。本研究證實醫病溝通在醫病關係的建立和影響病患自我管理行為扮演重要的角色，因此，溝通應對能力應納入醫學培育的核心課程中；研究也顯示醫院衛教課程是病患取得訊息重要的管道之一，需針對不同年齡層患者，採取不同策略強化病患對慢性腎臟病的知識和訊息。 Taiwan has the highest incidence of end-stage renal disease (ESRD) in the world. In 2006, the Bureau of National Health Insurance (BNHI) launched the CKD care program on pre-end-stage renal disease care with the goal of improving patient cognition of CKD by intensive educational intervention, and potentially delay the progression to dialysis initiation. The purpose of the study was use a relationship marketing approach to explore provider-patient communication (empathic and instrumental orientation communication behavior) and quality of the provider-patient relationship factors impact on self-management behaviors in patient with chronic kidney disease. The sample was collected from 273 CKD patients at three regional hospitals located in northern, central, southern Taiwan that has joined the CKD care program on pre-end-stage renal disease care. A questionnaire survey was available for data analysis via Structural Equation Modeling with AMOS version 17.0 statistical software that was employed to test the fitness of overall hypothesized model and significance of hypothesized relationships among studied variables. The quality and effectiveness of provider-patient communication was significantly and positively correlated with both quality of the provider-patient relationship and self-management behavior. Only instrumental orientation communication behavior was significantly and positively correlated with quality of the provider-patient relationship. Quality of the provider-patient relationship didn’t obviously influence to self-management behavior. Furthermore, quality of the provider-patient relationship is not mediator variable between provider-patient communication and self-management behavior.
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