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研究生:趙明哲
研究生(外文):Ming-Che Chao
論文名稱:探討基層醫療院所於長者整合性照護指引實務執行上之優劣勢及效能— 以苗栗縣某診所為例
論文名稱(外文):Explore the Advantages and Effectiveness in the Execution of Integrated Care for Older People (ICOPE) in Primary Medical Clinic Setting
指導教授:白佳原白佳原引用關係
指導教授(外文):Jar-Yuan Pai
口試委員:鄧雅凌洪至仁
口試委員(外文):Ya-Ling Teng
口試日期:2023-06-19
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:國際健康產業經營管理碩士在職專班
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:2023
畢業學年度:111
語文別:中文
論文頁數:62
中文關鍵詞:長者整合性照護指引基層醫療院所健康老化長者整合性照護試辦計畫
外文關鍵詞:ICOPE
DOI:10.6834/csmu202300097
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研究背景:人口結構高齡化於全球經是不可逆之世界趨勢,便連帶影響社會需求的改變。隨著人均壽命延長,因能力衰退而需要他人照顧日常生活的人數將會不斷增加,故世界衛生組織(World Health Organization,以下簡稱 WHO)近年不斷提倡健康老化,這些興起的健康老化的概念給予了針對高齡的醫療照護一個新的焦點。而衰弱及老年人口可能特別受益於整合性照護,因其隨著年齡增加而身體及精神狀況之不確定性,世界衞生組織於2017年出版名為"Integrated care for older people: Guidelines on community-level interventions to manage declines in intrinsic capacity (ICOPE)"的指引,旨在改善、維持或減緩65歲以上長者之內在能力的下降。在這項研究中,我們旨在希望藉由探討基層醫療院所於ICOPE實務執行上之優劣勢及效能,進而了解及增進高齡長者照護之品質。
流程與方法:本研究主要以苗栗市某診所之個案作為收案對象,共哪入308為個案。符合收案條件如下:1. 65-74歲之民眾,原住民55-74歲,且至少有一項慢性疾病,例如心血管疾病、糖尿病、高血脂症、心臟病、腦中風、退化性神經病變慢性腎臟病、精神疾病、慢性阻塞性肺部疾病(COPD)、癌症等。2. 75歲以上民眾。排除條件如下:1. 本年度已由其他醫療院所施測過長者功能評估者。2. 已失能者(失去生活自理能力)。3. 失智症患者。4. 長期臥床者。本研究之工具主要為國健署依照WHO (2017):Integrated care for older people: Guidelines on community-level intervention to manage declines in intrinsic capacity (ICOPE)長者整合性照護指引發展之評估工具進行研究。
結果:此篇研究以台灣苗栗地區來探討ICOPE之執行優劣勢及成效。在收案期間九個月(2022年03月01日至2022年11月30日)內,篩選出過半的長者評估結果異常。ICOPE評估結果,在308人當中,初評無異常 95人,佔30.8%,女性58人,男性37人。需複評但無須轉介 39人,佔12.6%。需轉介 174 人,佔56.4%。而其中又以行動功能異常者共124人佔最大宗。結果顯示果半數以上個案皆有提早發現問題,並進行轉介,由此可見ICOPE於基層醫療院所用於及早預防之成效顯著。
結論:ICOPE評估於基層醫療院所執行成效十分顯著,可篩選出大部分長輩之潛在問題並及早為其安排合適的介入方案及計畫。數據顯示,評估之結果與收案場域的民眾生活型態息息相關,未來之評估及介入計畫亦可由此下手。
Background: Aging population is an irreversible global trend that affects social demand. As life expectancy increases, the number of people who require daily care due to declining abilities will continue to grow. Therefore, the World Health Organization (WHO) has been advocating for healthy aging in recent years. The rising concept of healthy aging has given a new focus on medical care for the elderly. The elderly and frail population may benefit from integrated care as their physical and mental conditions become more uncertain as they age. In 2017, the WHO published a guideline called "Integrated Care for Older PEople: Guidelines on community-level interventions to manage declines in intrinsic capacity (ICOPE)" to improve, maintain, or slow down the decline of intrinsic capacity in older people aged 65 and above. In this study, we aim to explore the advantages, disadvantages, and effectiveness of ICOPE in primary care clinics and to understand and improve the quality of care for the elderly.
Methods: This study mainly focuses on cases from a clinic in Miaoli City, with 308 cases. The inclusion criteria are as follows: 1. People aged 65-74, Indigenous people aged 55-74 with at least one chronic disease, such as cardiovascular disease, diabetes, hyperlipidemia, heart disease, stroke, degenerative nerve disease, chronic kidney disease, mental illness, chronic obstructive pulmonary disease (COPD), cancer, etc. 2. People aged 75 and above. The exclusion criteria are as follows: 1. Elderly whom another clinic had assessed during the current year. 2. Those who have lost their ability to live independently. 3. Dementia patients. 4. Long-term bedridden patients. The evaluation tool used in this study was the assessment tool developed by the National Health Administration based on the "Integrated care for older people: Guidelines on community-level intervention to manage declines in intrinsic capacity (ICOPE)" of the WHO (2017).
Results: This study investigated the advantages, disadvantages, and effectiveness of ICOPE in the Miaoli region of Taiwan. During the nine-month enrollment period (March 1, 2022, to November 30, 2022), more than half of the elderly assessed had abnormal results. Of the 308 people evaluated by ICOPE, 95 (30.8%, 58 women and 37 men) had no abnormalities on the initial assessment. Thirty-nine people (12.6%) required re-evaluation but did not need a referral. One hundred seventy-four people (56.4%) required a referral. The largest group needing referral was those with mobility impairment, totaling 124 people. The results showed that more than half of the cases had problems detected early and were referred appropriately. This study suggests that ICOPE is effective in early prevention in primary care clinics.
Conclusion: The ICOPE assessment has significant effectiveness in primary care clinics and can screen most elderly people's potential problems and arrange appropriate interventions promptly.
誌謝 I
中文摘要 II
英文摘要 IV
目次 VI
第一章 緒論 1
一、前言 1
二、研究目的 3
三、論文架構安排 4
第二章 文獻探討 5
一、我國試辦長者功能整合性照護計畫的經驗 7
二、 長者整合性照護試辦計畫各國執行經驗 8
三、 ICOPE評估量表背景及意義 11
第三章 研究流程與方法 20
一、 研究對象 20
(一)收案條件: 20
(二)收案方式: 21
二、 研究工具 22
第四章 研究結果 23
一、 研究對象之人口學特性 23
二、 研究對象之評估結果 24
第五章 討論 30
第六章、結論與建議 40
附錄 44
參考文獻 55
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