應用個案管理模式提昇子宮頸抹片篩檢異常個案之回診追蹤率

Applying Case Management Model to Increase the Followup Rates for Abnormal Pap-Smear Cases

本專案旨在運用個案管理模式提升子宮頸抹片篩檢異常個案之回診追蹤率，以期早期發現癌變徵候、早期採取相關護理介入措施。回溯2004年子宮頸抹片篩檢18, 456個案，結果發現子宮頸抹片篩檢異常者有192人，但其篩檢異常之回診追蹤率低，僅54.2%。分析原因為缺乏監測篩檢異常個案之追蹤回診流程、個案諮詢專線、專責人員及護理指導單張；且個案對子宮頸癌知識不足，得分僅53分。經2005年3月至2006年4月應用個案管理模式後，子宮頸抹片篩檢異常回診追蹤率提升至86.6%，且個案對子宮頸癌癌變知識得分提升至88分。本專案之施行確實能有效提升子宮頸抹片異常個案回診追蹤率，達個案追蹤之實質效果。

The aim of this project was to apply case management to increasing the rate of follow-up for cases with abnormal pap smear and increase the detection of the early signs of cancer so that treatment can take place earlier. After reviewing 18,456 pap-smear screening cases from 2004, 192 abnormal cases were identified. Among these, only 54.2% cases were found to have undergone complete follow-ups. After analysis of the current data, the reasons for the low follow-up rate were found to include a lack of follow-up monitoring procedures, the lack of a patient counseling hot line, the lack of a specifically responsible person, poor nursing instruction sheets, and the fact that the patients only scored 53 points when their knowledge of cervical cancer was assessed. After implementing a case management system, the rate of follow-up for cases with abnormal pap smear was increased to 86.6% and the patient scores for knowledge of cervical cancer had also increased to 88 points. The application of the case management was able to significantly increase the follow-up rate for abnormal pap-smears as well as improving the actual outcomes for the follow-up patients.