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研究生:鄭如潔
研究生(外文):CHENG,JU-CHIEH
論文名稱:客製化衛教介入方式對慢性阻塞性肺病門診病人健康結果之成效研究
論文名稱(外文):The Effectiveness of Customized Health Education Strategy for the Health Outcomes in Outpatients with COPD
指導教授:張馨云張馨云引用關係
指導教授(外文):CHANG,HSING-YUN
口試委員:龔建吉楊雯惠
口試委員(外文):KUNG,CHIEN-CHIYANG,WEN-HUI
口試日期:2020-06-03
學位類別:碩士
校院名稱:中臺科技大學
系所名稱:醫療暨健康產業管理系碩士班
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:2020
畢業學年度:108
語文別:中文
論文頁數:79
中文關鍵詞:慢性阻塞性肺病客製化衛教門診病人健康結果
外文關鍵詞:acute exacerbation chronic obstructive pulmonary disease (AECOPD)customized health educationoutpatienthealth results
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研究目的:慢性阻塞性肺病急性惡化(Acute Exacerbation Chronic Obstructive Pulmonary Disease, AECOPD)導致病人呼吸功能急性惡化和增加死亡,於門診介入客製化衛教、加強疾病管理,來探討介入後成效差異。
研究方法:本研究為兩組實驗對象之事前事後比較,採方便取樣以中部某個案醫院肺阻塞個管系統收集105年4月至106年3月之病人介入傳統衛教共95人;106年4月至107年3月介入客製化共160人。客製化衛教組:1.個管師評估mMRC(Modified Medical Research Council, mMRC)及CAT(COPD Assessment Test, CAT) 2.書面或影片資料3.藥物衛教單張、回覆示教,於收案後56天、136天、216天再次衛教;傳統衛教組:1.醫師評估mMRC及CAT 2.口頭衛教藥物使用方式,回診期間如無變化,不再特別衛教。兩組於收案一年後利用SPSS 20.0統計分析軟體,先以描述性統計、卡方檢定(Chi-square test)、獨立樣本t檢定、單因子變異數分析(one-way ANOVA)及皮爾森相關係數及迴歸分析探討各變項有無相關性。
結果與討論:一年後mMRC(-0.43±0.79、-0.15±0.55,p=0.00)及CAT(-5.76±7.02、-2.32±4.16,p=0.00),相較傳統衛教,客製化衛教組呼吸困難分數明顯下降,達統計上顯著差異(p<0.05),表示呼吸困難情形改善。探討慢性阻塞性肺病急性發作次數,客製化衛教組一年內急性發作次數(0.65±1.35)大於傳統衛教組(0.26±0.67),兩組之間具有統計上顯著差異(p<0.05)。肺功能嚴重度分級與健康結果相關值為γ=0.16,其顯著水準為p<0.05,顯示肺功能嚴重分級與健康結果程顯著正相關,肺功能嚴重分級越高則健康結果越差。多元迴歸分析結果顯示影響健康結果最高者為「COPD嚴重分級」,顯示COPD嚴重分級對健康結果具有較高影響力。
結論:運用客製化衛教明顯降低病人錯誤知識,藉以本研究可作為未來衛教人員給予慢性阻塞性肺病病人及照顧者的衛教參考,以改善相關臨床症狀及提升藥物使用正確性。
關鍵詞:慢性阻塞性肺病;客製化衛教;門診病人;健康結果
Abstract
Purpose:
An Acute Exacerbation Chronic Obstructive Pulmonary Disease (AECOPD), can lead to a result of acute deterioration of the patient's respiratory function and increase death rates. The main focus of this study is to evaluate difference in effectiveness after introducing a customized health education intervention in clinics and carrying out reinforcement of disease control.
Method:
This study was to compare two groups of candidates, before and after health education intervention. One group of people, who took traditional health education dated from April 2016 to March 2017, were 95 people chosen conveniently (randomly) from the Chronic Obstructive Pulmonary Disease Management System held in one of the hospitals from central Taiwan. The other group of people, gathered from the same hospital, who took customized health education intervention from April 2017 to March 2018, consisted of 160 people. In the case of customized health education intervention group: 1. there was one case manager to evaluate mMRC (Modified Medical Research Council) and CAT (COPD Assessment Test); 2. preparing documents and film data; 3. preparing medicines’ health education sheet and feedback reply sheet to take intervention course, then re-took health education after 56, 136 and 216 days. In the case of traditional health education group: 1. appointed a doctor to evaluate mMRC and CAT, 2. orally taught how to take medicines; if there was no change after next visit to hospital, health education was halted. One year after two groups’ case were closed, SPSS 20.0, a statistics analysis software, was used to provide information, such as, descriptive statistics, Chi-square test, independent sample t-tests, one-way ANOVA, Pearson Correlation Coefficient and regression analysis to investigate correlation between different variables.
Result:
After one year, mMRC (-0.43±0.79、-0.15±0.55,p=0.00) and CAT (-5.76±7.02、-2.32±4.16,p=0.00), in comparison with traditional health education, Dyspnea scores dropped dramatically with customized health education, reaching statistical significance (p<0.05), indicating improvement of Dyspnea. A discussion was also included on the number of occurrences of Chronic Obstructive Pulmonary Disease (COPD). Customized health education group (0.65±1.35) had a higher number of acute attacks than traditional health education group (0.26±0.67), reaching statistical significance (p<0.05). The relative values between lung functionality (based on Post-Bronchodilator FEV1) and health results were γ=0.16 with significance level of p<0.05, indicating there was a significant positive correlation when FEV1 percentage was decreased and patient’s health result was dropped too. At the same time, multiple regression analysis showed that the highest factor affecting health was “COPD level of severity,” revealing that COPD had higher influence on health results.
Conclusion:
Usage of customized health education can significantly reduce patients’ opportunity to receive wrong information. This study can provide a good reference for health education personnel to teach patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) and caregiver to improve relative clinical symptoms and provide accuracy for taking medicines.
Key words: acute exacerbation chronic obstructive pulmonary disease (AECOPD); customized health education; outpatient; health results

目錄
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 4
第三節 研究問題 4
第四節 名詞解釋 5
第二章 文獻探討 7
第一節 慢性阻塞性肺病現況之探討 7
第二節 客製化衛生教育重要性之探討 17
第三章 研究方法 28
第一節 資料來源與研究對象 28
第二節 研究設計 30
第三節 研究架構 41
第四節 研究假說 41
第五節 統計分析 42
第四章 結果與討論 44
第一節 研究結果 44
一、研究對象人口學特性及同質性檢定 44
二、傳統衛教與客製化衛教介入後之健康結果 47
三、人口屬性與健康結果相關探討 49
四、人口屬性與健康結果迴歸探討 50
五、 研究假說之檢定 52
第二節 研究討論 52
一、人口學特性分佈研究結果 52
二、傳統衛教與客製化衛教介入後對健康結果之影響 53
三、人口屬性與健康結果相關性 54
第五章 結論 56
第一節 研究結論 56
第二節 研究建議 56
參考文獻 58
中文文獻 58
英文文獻 61

表目錄
表 1 客製化應用相關研究文獻 26
表 2 mMRC量表 32
表 3 CAT評估量表 33
表 4 基本人口學特性與同質性檢定 45
表 5 兩組病人嚴重度比較 47
表 6 兩組介入後mMRC及CAT分數差異 47
表 7 介入後影藥物使用正確性差異 48
表 8 介入後發作次數比較 49
表 9 人口屬性與健康結果之相關矩陣 50
表 10 健康結果之多元迴歸分析 51
表 11 研究假說驗證結果彙整表 52

圖目錄
圖 1 慢性阻塞性肺病收案追蹤表 29
圖 2 個案管理系統資料庫頁面 29
圖 3 介入客製化衛教組與傳統衛教組之慢性阻塞性肺病照護流程圖 40
圖 4 研究架構圖 41


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