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研究生:葉爵榮
研究生(外文):Jerry-Juezong Yeh
論文名稱:以藥師執行客製化糖尿病衛教模式對患者健康識能與疾病預後指標之影響
論文名稱(外文):The Assessment Study: The Effect of Customized Health Education by Pharmacist on Health Literacy and Prognosis Indicator of DM Patients
指導教授:邱瓊萱邱瓊萱引用關係
口試委員:石崇良湯澡薰
口試日期:2015-06-23
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:醫務管理學研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:中文
論文頁數:125
中文關鍵詞:糖尿病藥師藥事照護健康識能糖化血色素
外文關鍵詞:diabetes mellituspharmacistpharmaceutical carehealth literacyHbA1c
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前言:糖尿病控制穩定不外乎飲食調控、規律運動及常規藥物治療,三者須有計畫的落實於生活中,病人配合度是關鍵,而良好支持體系,才是陪伴病人持續照護計畫執行的原動力,根據國外在糖尿病照護的觀察,社區藥局藥師相較其他醫療照護者能提供多7倍的時間給病人,國內現行醫療環境,多數病人於醫療院所就醫後,仍集中於院區內門診藥局領藥,設置藥事照護門診近似於國外社區藥局藥師所提供之疾病管理服務型態,由藥師專責提供慢性疾病藥事照護,有較充裕時間進行病人用藥評估及提供適切衛教指導,以達個人化諮詢服務之目的。
目的: 評估門診糖尿病患者接受藥師運用客製化衛教模式執行個案管理輔導,探討介入前後個案對疾病識能影響及年度代謝指標改善程度。
方法: 本試驗採前瞻性雙世代研究,由新陳代謝科醫師轉介有意願接受藥事照顧的20歲~80歲成年已接受藥物治療之第2型糖尿病人 (排除孕婦、身心障礙病人、精神病人、非使用本國通用語言溝通者),共收案120人,分配為A、B兩組,以三個月為間隔,執行兩階段糖尿病照護能力教育,每次施行教育前進行糖尿病健康識能問卷評量及血液生化值檢測,以觀察病人疾病識能及血糖、血脂等代謝相關生化指標之改變量。第1階段教育內容包含認識糖尿病、藥品資訊提供及指導正確藥品使用,第2階段教育內容包含急症應變處理能力、學習自我血糖監測、基本飲食原則、基本運動原則;適切的藥事照護服務涵蓋雲端藥歷檢核、處方適當性評估、藥品交互作用篩檢、副作用及不良反應預防及發生處置,依需要聯絡開方醫師提供藥品項目或劑量調整建議,前後追蹤至少六個月。A組(60人),於第一次糖尿病識能評量後即開始進行第1階段糖尿病疾病及正確用藥知識教育,三個月後執行第2階段糖尿病自我照護能力知識教育,再間隔三個月執行最後一次糖尿病識能評量後給予糖尿病識能衛教手冊。 B組(60人),第一次只進行糖尿病識能評量,不介入教育,三個月後第二次回診,才開始與A組相同之兩階段糖尿病照護能力教育。
結果與結論: 本研究已成功運用中文化糖尿病健康識能評量工具連結病生理生化檢驗數據,建立糖尿病衛生教育介入相關成效之量測評估模式,研究結果顯示,糖尿病人在疾病概念及正確用藥教育介入後,對糖尿病認知及健康、藥物資訊閱讀判斷識能均有顯著提升,整體識能分數由70.3%進步至78.4% (p <0.001),進而改變自我照護行為,忘記服藥之情形減少,提高治療配合意願,而在糖尿病自我照護知識教育介入後,更有效提升疾病認知、用藥資訊閱讀判斷識能及糖尿病知識三大健康識能構面,整體識能分數由78.4%進步至86.7% (p <0.001),增加病人在接受藥物治療、健康飲食、適度運動及自我照護行為面向的配合度,並有效改善長期血糖控制指標,六個月追蹤期間,糖化血色素平均達0.5%降幅。
Background. Diet control, exercise and medication therapy are three main treatment regimens for diabete mellitus. To ensure all three are properly fulfilled, patient compliance behavior is a key factor. Moreover, a good support system is one of the motivational factors for patient to continuously involve in treatment. According to other foreign studies, community pharamacist can provide septuble the time compare to other healthcare provider. In Taiwanese healthcare environment, most of the patient gathered in the pharmacy section after seeing a doctor. Introduction of pharamacuetical outpatient unit provides another way for disease treatment in the foreign countries. Furthermore, the sufficient time will allow pharmacist to provides thorough pharamacuetical care and health education for chronic diseases.
Purpose. This aim of this study is the effect of pharmacist on disease knowledge and to evaluate the level of disease improvement after pharmacist involvement.
Method. This study was prospective and double cohort.There were two groups of participants. Each group is consisted of 56 persons and each group received two stages of intervention. Group A was initially evaluated using the health literacy tool and stage 1 intervention was provided.3 month later, patients were firstly evaluate and followed by stage 2 intervention. 6 month later, final evaluation was given. For group B, patients were initially evaluated and no intervention given. 3 months later, patients were firstly evaluated and followed by stage 1 intervention. 6 month later, patients were firstly evaluated and followed by stage 2 intervention. Both groups were evaluated for their health literacy, disease knowledge, and compliance.

Result and Conclusion. Disease knowledge and health literacy were significantly improved after pharmacist involvement, the overall literacy scale improve from 70.3% to 86.7 (p <0.001). The mean of HbA1c were decrease by 0.5%.
目錄
致謝 II
中文摘要 IV
Abstract VI
目錄 VIII
表目錄 X
第一章、 緒論 1
第一節、 研究背景 3
第二節、 研究動機 5
第三節、 研究目的 6
第四節、 研究的重要性 7
第二章、 文獻探討 8
第一節、 糖尿病及其合併症 8
第二節、 我國糖尿病照護政策及法令依據 10
第三節、 我國糖尿病照護模式 11
第四節、 藥事照護 13
第五節、 藥師介入糖尿病照護模式之發展需求 15
第六節、 健康識能 1
第三章、 研究方法 5
第一節、 研究架構、設計與流程 5
第二節、 研究變項及其操作型定義 10
第三節、 研究假設 15
第四節、 對象及資料來源 16
第五節、 統計及分析方法 17
第六節、 人員訓練與研究應用工具 18
第七節、 藥事照護門診發展與收案過程 23
第四章、 研究結果 26
第一節、 糖尿病健康識能評量問卷信效度 26
第二節、 描述性統計分析 27
第三節、 推論性統計分析 62
第五章、 討論 80
第一節、 研究結果與討論 80
第二節、 研究限制 84
第六章、 結論與建議 85
第一節、 結論 85
第二節、 建議 86
參考文獻 88
附件 95
附件1、藥師公會全國聯合會藥師判斷性服務編碼表 95
附表2、糖尿病人焦點團體訪談資料 98
附表3、健康識能評量問卷之專家效度名單 103
附件4、前導性測驗(Pilot test)試測樣本結構統計表 104
附件5、問卷 112
附件6、IRB核准函 125
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