糖尿病醫療給付改善方案對第二型糖尿病病患之照護成效

THE EFFECTIVENESS OF TYPE 2 DIABETIC PATIENT MANAGEMENT IN THE IMPROVEMENT PROGRAM OF NATIONAL HEALTH INSURANCE PAYMENT FOR DIABETES MEDICAL TREATMENT

本研究目的在驗證糖尿病醫療改善方案對第二型糖尿病病患之照護成效。本研究採方便取樣116位內分泌科門診治療的第二型糖原病病患為研究對象，依有無參與糖尿病醫療改善方案分成對照組及實驗組二組； 對照組共56位接受一般門診護理衛教者，實驗組共60位接受糖尿病醫療改善方案，追蹤時間為回診治療滿一年者。主要研究結果發現:（1）不管有無參與糖尿病醫療改善方案，其個案糖化血色素（HbAlc）及低密度脂蛋白膽固醇（LDL-C） 皆無顯著的差異（p>.05） ;（2）參與糖尿病醫療改善方案個案在減輕體重、BMI值及血壓值有較好的表現（p<.05）。研究結果呈現出糖尿病醫療改善方案對第二型糖尿病照護成效在糖化血色素監測並無顯著差異，但兩組個案糖化血色素都比治療前降低，不過糖化血色素並非單一評價的指標。其血壓、血脂、體重變化皆與疾病控制相關。建議未來能可以設計多元化的衛教模式，提供完整性、可近性的醫療服務，以提昇第二型糖尿病病患健康促進之行為。

The purpose of this research is to examine the caring result of type 2 diabetic patients in the improvement program. The program involved 116 outpatients sampled from the endocrine section. According to whether they participated in the program, the subjects were divided in two groups: comparison group and expermenta1 group. 56 patients in comparison group adopted general treatment.60 patients in experimental group adopted the improvement program. The period of follow-up lasted for 1 year. This study showed: 1. There is no obvious differences in HbAIC, LDL-C between the two groups. 2. The experiment group showed better outcome of weight loss, BMI and blood pressure than the comparison group. ( p<.05). The research showed there is no obvious change in HbAIC of patients who took part in the improvement program, however, both groups showed a decrease in HbAlC after treatment. HbAIC should not be the only evaluation index. Until now, patients' cognition has chiefly been an evaluation tool for outpatient hygienic education system. Now, we recommend using behavioral change as the foundation stone of health education, to renew ways for health education, and to improve the result of caring effects to promote type 2 diabetic patients' hea1th.