慢性阻塞性肺疾患者自我管理行為之探討

Exploring Self-Management in Patients with Chronic Obstructive Pulmonary Disease

本研究目的在探討慢性阻塞性肺病COPD患者自我管理行為的現況及其與個案特質、疾病嚴重度的關係。自我管理行為包含醫囑管理（醫囑遵從性）、症狀管理（疾病認知與自我照顧效能）與情緒管理。以立意取樣徵得104位進入南部某醫學中心個案管理的患者同意，進行結構式問卷調查。問卷內容包括醫囑遵從性、疾病認知、自我照顧效能、情緒管理與個案特質。研究結果顯示：有20-30%研究對象無法完全依醫囑服藥，疾病認知答對率為64.4%，僅3.8%患者完全有把握執行自我照顧行為，而有憂鬱狀況者佔7.7%。依據ANOVA的分析結果，獨居或住在養老院患者的症狀管理行為較差，且疾病嚴重度並不是影響自我管理行為的顯著因素。此結果建議臨床上以疾病嚴重度規劃COPD個案管理方案的方式值得再思。

The purpose of this study was to describe chronic obstructive pulmonary disease (COPD) patients' disease management defined as prescription management (medication adherence), symptom management (COPD knowledge and self-care efficacy) and emotional management. A purposive sampling of 104 COPD patients from southern Taiwan enrolled in a case management program was recruited. After agreeing to participate, patients completed a questionnaire describing their medication adherence, self-care efficacy, and emotional state and provided personal demographic information. Medication adherence ranged from 20% to 30%. Mean COPD knowledge, as tested using a specially developed questionnaire, was 64.4%. Very few subjects (3.8%) expressed confidence in performing self-care behaviors. Only eight patients (7.7%) reported significant depression. Analysis of variance determined that COPD patients who lived alone or in assisted living facilities had less symptom management competency. COPD severity was not found to be a determinant of self-management behavior. The findings of this study challenge the widespread belief that COPD case management program should be determined based on disease severity.