以個案管理模式提升門診結核病完治率

A Project for Increase the TB Complete Treatment Rates in Out-patient Service

結核病是全球重要健康問題之一，病患如未完成治療會增加防疫與治療上的困難。分析本院2007年門診結核病患看診現況發現：個管師人力不足、缺乏合適衛教工具、欠缺標準衛教流程與衛教空間的不合適，導致衛教無法落實；政策面則因缺乏就醫管理流程及個案追蹤管理資訊系統的不完善，使得本院2007年結核病完治率僅69.4%，其與WHO期望目標85.0%相距甚遠。有鑑於此，專案小組成員除了依據疾管局政策說服醫院增加個管人力外，另藉由建立就醫管理追蹤流程、制訂教工具、規劃衛教空間、建立個案管理資訊系統等措施，最終使得疾病認知由42.5%提升到97.0%，完治率由69.4%提高到90.5%。於維持期，完治率成效更提高至90.8%，進步率達30.8%，顯示專案成效良好。

Tuberculosis (TB) is an important health problem in the world. TB-infected patients without compete treatment will increase the difficulties for infection control and subsequent treatment. We analyzed the TB-infected patients in out-patient service of Kaohsiung Medical University Hospital in 2007 and we found the associated factors of poor health education outcome, including: inadequate manpower of case managers, lack of appropriate health education tools, standard protocol and health education space and incomplete case tracing protocol and computerized case management system. These factors caused the TB complete treatment rates in our hospital in 2007 were only 69.4% far from the goal of the World Health Organization (85%). According to the regulation of the Center of Disease Control in Taiwan, we added the manpower of TB case managers. We also apply the case management model to establish the case tracing protocol and computerized case management system and to develop health education tools and space. The disease recognition rates increased from 42.5% to 97.0%. TB completed treatment rates increased from 69.4% to 90.5% and 90.8% in the maintenance phase.