背景：糖尿病腎病變照護為慢性腎臟病防治主要策略，如何提昇其照護成效仍有待評估。
目標：探討糖尿病共同照護收案個案，其慢性腎臟病分期變化之影響因素，做為提升照護成效之參考。
方法：本研究取樣自98至101年間，中部某縣衛生所門診糖尿病個案。該縣糖尿病共同照護網在95至97年間逐步導入建立慢性腎臟病照護之標準與流程，故以該導入期間為本研究的基礎期，98至100年為介入期，101年為評估期。研究對象之照護資料來自縣衛生局建置之糖尿病管理資訊系統，接受管理至少2年且分期資料可得者共1620人納入分析。以基礎期慢性腎臟病分期與評估期或介入期最後一年資料作比較，其分期改善為依變項，運用邏吉斯迴歸探討分期變化與人口學特質、生活型態、定期診療、檢驗、衛教及疾病史之相關性。
結果：98至101年期間個案管理持續4年在案者佔51.8%。基礎期舒張壓血壓值≧100mHg且介入期舒張壓改善者，其分期改善之勝算比為8.6 (95%信賴區間(以下略)1.1-66.0)；基礎期分期低於2期者，勝算比3.2 (2.5-4.1 )；介入期糖化血色素檢驗和低密度膽固醇檢驗每年平均次數大於2者，勝算比1.9 (1.2-2.9 )；50歲以上者，勝算比1.6 (1.1-2.5)；介入期BMI平均值<24 kg/m2，勝算比1.5 (1.1-2.1)。
結論：控制血壓為改善慢性腎臟病分期最重要的影響因素，定期就醫檢驗追蹤與控制體重等亦有助於改善分期。分期低於2期者，有較高的可逆性。本研究結果可作為評價慢性腎臟病照護成效之參考。
Background:
Quality care of the diabetic nephropathy is one of the main strategies for the prevention and control of chronic kidney diseases.The effectiveness of the care needs evaluation.
Goal:
To evaluate the chang of the stages of chronic kidney diseases of the cared patients and its associated risk factors, which could help identify the ways of improving its effectiveness.
Methods:
The cases of the diabetes share care program of ChangHua county(CHDSC) receiving treatment at the health stations were selected from 2009 to 2012.The implementation phase of introducing chronic kidney disease care into CHDSC from 2006 to 2008 was regarded as the baseline period . Interventions based on the guidelines and the standard protocol of care for chronic kidney diseases were given to the registrated diabetic patients from 2009 to 2011. The clinical data in 2012 were therefore compared with those of the baseline period .Totally 1620 cases receiving at least 2 years of care was included for evaluation.We use the changes of the stages of chronic kidney diseases of each cases as the dependent variables and apply the logistic regression model to discover their related factors.
Results:
The four-year adherence rate of the diabetic cases to CHDSC was 51.8%. The odds ratios of the related factors for improving the stages of chronic kidney diseases were :the baseline diastolic blood pressure ≧100mHg and lowered after the intervention, 8.6 (95% confidence interval 1.1-66.0); the baseline stage of chronic kidney disease earlier than stage 2, 3.2(95% confidence interval 2.5-4.1); the annual times of the regular check of A1C and LDL higher than 2,1.9 (95% confidence interval 1.2-2.9); aged older than 50 years ,1.6(95% confidence interval 1.1-2.5).; BMI at intervation kept lower than 24 kg/m2,1.5(95% confidence interval 1.1-2.1).
Conclusion:
Control of the diastolic blood pressure was the most prominent factor for improving the stages of chronic kidney disease.Regular check of HbA1c and LDL and weight control were important as well. When chronic kidney disease care was delivered to the diabetic patients,these three points had to be stressed to improve the effectiveness of care.
