| 摘要: | 摘要
背景及目的：飲食習慣及生活型態的轉變，現代人罹患慢性疾病機率大增，糖尿病更是常見於中老年族群。糖尿病雖無法痊癒，過去文獻仍指出，積極自我控制及良好醫病溝通有助於病情控制，進而節省龐大醫療成本。有鑑於此，衛生署於2001年11月施行「全民健康保險糖尿病醫療給付改善方案試辦計畫」，使糖尿病患者能接受「完整性門診照護」，進而提昇病患之遵醫性；本研究遵醫性採用已建立之糖尿病患遵醫性監測指標（病患報導服用藥物、自我照護、 控制情形）加以衡量。文獻指出飲酒行為將降低病患之遵醫性，考量飲酒之成癮性特質，本研究加入具備同樣特質之抽菸行為，目的為探討抽菸、飲酒行為與遵醫性之關係；另進一步分析遵醫性的改變是否對血糖的控制產生影響。
方法及資料來源：本研究資料來源為中部某醫學中心糖尿病照護網資料庫檔（2002年8月至2005年7月），診斷代碼以ICD-9-CM碼為250、由臨床醫師診斷為第2型糖尿病患者、完成完整照護（照護期間回診4次以上）、病程為1年以上者為研究對象，符合研究標準之對象共計2,156人，進行單一族群回溯性分析。
研究結果：
有抽菸行為相較於無抽菸行為之男性、女性病患，其自我照護遵醫性平均得分降低0.045（P<0.05）、0.139（P<0.01）分；男性病患於8% <9%血糖控制不良模式中，相對於 <7%血糖控制良好族群，有飲酒行為者，其 控制情形不良的勝算是沒有飲酒行為者的1.77倍（P<0.05）。
男性病患有抽菸行為相較於沒有抽菸行為者，其 值增加0.21%（P<0.05）。男性病患研究起始點病患報導服用藥物遵醫性為完全遵醫性相較於不完全遵醫性者，其 值降低0.57%（P<0.01）；男性病患研究起始點自我照護遵醫性平均得分1分相對於0分者，其 值降低0.3%（P<0.05）。女性病患研究起始點自我照護遵醫性平均得分1分相對於0分者，其 值增加0.26%（P<0.05）。
關鍵字：糖尿病、糖尿病照護網、遵醫性
Abstract
Background and purpose: The prevalence of chronic diseases, such as diabetes mellitus (DM), increases, because of the change of lifestyle and eating behavior. Although DM is not curable, a positive attitude toward controlling DM can control the progression of this disease and further reduce the medical cost for this disease. In November, 2001, Nation Health Insurance Administration implemented one policy of “Diabetes Case Management Program” which aim is to improve the integrated care of DM patients. Therefore, the main purpose of this thesis is to use the dataset of this program to examine the effect of cigarette smoking and alcohol drinking on the medical compliance (taking the medicine, caring oneself, glucose control) as well as the control of blood sugar measured by HbA1c among the DM patients.
Materials & Methods: The study population was the DM patients (ICD9 code: 250) who were enrolled in the Diabetes Case Management Program in one medical center of the central Taiwan. The inclusion criteria for this study was that patients had to have at least 4 times of follow-up records in this program at least 4 times between August, 2004, and July, 2005. In total, 2,156 eligible subjects were analyzed.
Results:
The mean scores of compliance for caring oneself for male and female patients with smoking is lower than those without no smoking by 0.045 point (p<0.05) and 0.139 point (p<0.01). The odds of having bad glucose control, 8% HbA1c<9%, relative to good glucose control, HbA1c <7%, drinking for male patients with drinking behavior is 1.77 times of that for male patients without drinking behavior (p<0.05).
The mean value of HbA1c at endpoint for male patients with smoking increases by 0.21% compared with male patients without smoking (p<0.05). Male patients who reported complete compliance for taking the medicine at baseline has mean value of HbA1c at endpoint is lower by 0.57% (p<0.01) than those who did not. The mean value of HbA1c at endpoint for male patients with 1 point in compliance for caring oneself reduced by 0.3% (p<0.05) compared to those with 0 point in compliance for caring oneself. The mean value of HbA1c at endpoint for female patients with 1 point in compliance for caring oneself increase by 0.26% (p<0.05) compared to those with 0 point in compliance for caring oneself.
Key word: Diabetes mellitus, Diabetes Case Management Program,
Compliance. |
