提升慢性腎臟病個案門診返診衛教率之專案

A Project to Promote Regular Out-patient Clinic Review and Education for Patients with Chronic Kidney Disease

在慢性腎臟病衛教過程中，發現個案因身體無不適症狀、無法接受自己有腎臟病、或看腎臟科門診要花半天的時間，而不願返診，喪失疾病治療與衛教的最佳時機，期望提升慢性腎臟病門診返診衛教率，以有效延緩腎臟病惡化。專案於2009年6月15日至2010年2月28日實施，經電訪、實地調查、問卷填寫等方式，發現個案無法定期接受衛教原因為：疾病認知不足、疾病心理調適障礙、其他門診就醫、等候衛教時間過久等，提出對策：改善衛教設施及教材教具、提升正向思考能力、建立醫護同仁腎臟防治共識、縮短等候衛教時間。實施後，門診返診衛教率由37.3％升至54％，護病關係亦隨之緊密，期望藉本專案提供其他醫護同仁參考。

Several barriers to regular attendance of out-patient clinic review during health education programs were identified, including patients not experiencing any symptoms, rejection of the disease, and long waiting times for clinic appointments. These barriers meant missed opportunities for treatment and education. It was hoped that through a program for promoting the return rate of chronic kidney disease patients for out-patient clinic review and education would help prevent further deterioration of the disease. This program was conducted through telephone follow-ups, interviews, and surveys from June 15, 2009 through to February 28, 2010. The results indicated that the main factors preventing patients from returning for clinic appointments and participated the education program were: the patients not fully understanding the severity of the disease, psychological rejection of the disease, scheduling conflicts with other clinic appointments, and long waiting times. A number of interventions were introduced in response to these factors including improving education facilities and equipment, promoting positive thinking, reaching a consensus on preventing kidney diseases among doctors and nurses, and reducing the waiting time. As a result, the regular attendance rate of outpatient clinic reviews increased from 37.3% to 54%. The project also had a positive impact on patient-nurse relationships. This project will hopefully serve as a reference for other health care providers such as doctors and nurses.