| 摘要: | 慢性腎臟病為不可逆之疾病，進展到末期腎臟病除了腎臟移植外，需配合長期的透析治療才能延續生命，這不僅造成長期透析患者的心理痛苦，更是造成國家財政上的沉重負擔。目前台灣在關於除了一般的門診護理衛教外增加寄送醫師提醒信函與電話追蹤的介入方式對改變患者病情與不利病情的生活型態，進而做疾病的控制等文獻缺乏，因此本研究的目的乃欲比較此兩種模式介入的成效；此外也欲檢視衛教介入方案的的成效。
以立意取樣的方式選取中部某醫學中心腎臟科門診尚未長期透析且從未接受腎臟疾病相關衛教者為研究對象，採類實驗的研究設計以隨機分派並進行腎病分期的匹配方式收案，對照組有22人，實驗組有26人。對照組僅接受一般的傳統衛教，-而實驗組接受傳統衛教外再有醫師提醒信函與電話追蹤的介入，介入前以問卷蒐集可能影響腎絲球過濾率及腎病者健康行為之相關因素，經三個月的介入後再施測藉評估腎絲球過濾率變化和與病情有關的健康行為、行為改變階段與疾病認知程度之變化等以探討本研究的衛教方案之效果。
研究結果發現：以醫師提醒信函及護理師定期電訪之衛教模式在腎絲球過濾率改變上未較一般衛教成效佳(P=0.830）。但是在飲食行為的改善上對某些有助病情的食物類攝取是有較佳的效果，即〝低氮主食〞攝取量增加（P=0.043）、〝新鮮魚類〞攝取量減少（P=0.005），然而卻反見〝非低氮澱粉點心類〞攝取量增加（P=0.036）。分析各組組內衛教介入的成效發現兩方案各自對該組病患某些不利於病情的某些飲食類別與攝取量有顯著減少 (對照組前後變化: 〝新鮮肉類〞和〝內臟類〞；實驗組前後變化: 〝新鮮肉類〞和〝加工蔬菜〞)。〝低氮主食〞、〝低脂牛奶〞、〝低氮澱粉點心〞類而有利病情的有顯著增加的效果(實驗組前後變化: 〝低氮主食〞、〝低脂牛奶〞、〝低氮澱粉點心〞類)。雖然對照組的方案對該組病患在〝非低氮澱粉點心〞類的攝取量上有反效果的增加情形，但整體的結果顯示，不論哪一組的介入，衛教的實施對改善病患的飲食行為是有效果的，而且實驗組組內的有正向改變的飲食類別攝取量較對照組的組內變化多。除了飲食行為外，在介入後實驗組組內的有正向改變的健康行為尚包括量血壓的自我照顧與規律運動的行為，但對照組組內卻未見顯著改變。
根據結果，增加醫師提醒信與電話訪視的介入模式在eGFR的效果未較僅有一般護理衛較佳，然在改善某些不利於病情的飲食行為上是有較好的效果。不論哪一種衛教方案對病患飲食行為的改善皆有一定程度的效果。
關鍵字：慢性腎臟病、腎絲球過濾率、健康行為、衛教介入、醫師提醒信函
Abstract
Studies have demonstrated the traditional program of health education in clinical settings effective for some health behaviors and patients’ knowledge to the disease. The traditional program is mainly conducted by nurses with face-to-face interviews with patients. The effectiveness of the additional use of physicians’ reminder letters and nurses’ telephone counseling to increase the screening rates for breast cancer has been proved. But there is no evidence indicating its effectiveness for patients with CKD. Therefore, the purpose of this study was to examine whether the additional use could have better health outcomes in CKD patients than the only use of traditional program. In addition, this study also attempted to examine the effectiveness of the health programs for both the traditional and the additional-use models.
This study adopted a quasi-experimental design. A purposive sampling method was used to recruit study subjects from a medical center in the middle of Taiwan. By using random assignment and matching the patients’ stage of CKD, this study finally obtained eligible cases of 26 in the experimental and 22 in the control groups, who had complete information in both pretest and posttest results. The information of estimate glomerular filtration rate (eGFR) was collected from the analyses of blood and urine specimen in the center’s laboratory, and other heath behavior and attitude information such as eating, regularly doing exercise, measuring their own body weight and blood pressure were collected by personal interviews with questionnaires. The traditional health program plus physicians’ reminder letters and nurses’ telephone counseling was applied to the experimental group, and the control group was accepted the only traditional model. The intervention period persisted three months.
After the intervention, the results showed no significant differences in the change of eGFR, doing exercise, self-caring behaviors of measuring weight and blood pressure, attitudes corresponding to the health behaviors and disease knowledge, except eating behavior between two groups. The significant differences in the increased amounts of low nitrogen staple food and decreased amounts of fresh fish indicated that the traditional with additional use model had more effectiveness than the traditional model in changing some food intakes for CKD patients. And the results for examining the intervention for each group also showed better outcomes in reducing the amounts of fresh meats and internal organs for the control group, in reducing fresh meats and non-natural vegetables and increasing low nitrogen staple food, low fat milk, and low nitrogen starch dessert for the experimental group.
Keywords: CKD, eGFR, health behavior, health education program, physicians’ reminder letters |
