降低慢性腎臟病人接受「全民健保pre-ESRD預防性及病人衛教計畫」未完成率之專案

To Lower the non-completion Rate of Chronic Kidney Disease Patient Enrolled in National Health Insurance pre-ESRD Health Education Plan

台灣末期腎臟病的盛行率高居世界第一位，醫療體系提供「全民健保pre-ESRD預防性及病人衛教計畫」給慢性腎臟病病人或家屬，以減緩慢性腎臟病人進展為末期腎病的惡化速度。本單位分析2010年「全民健保pre-ESRD預防性及病人衛教計畫」資料，未完成率高達19.6％，故引發執行本專案之動機。分析其原因為缺乏提醒病人機制、缺乏彈性衛教時間機制、病人接受衛教之動機不足、病人缺乏接受衛教之學習興趣、衛教記錄設計不完善。本專案小組目的為降低衛教未完成率，實施病人回診一週前電訪提醒抽血、採彈性預約衛教時間、提供多元化衛教內容，並改變衛教模式引導病人學習動機與意願、修訂衛教評估記錄表等策略，未完成率由19.6％下降至4.0％，達成專案目標值，顯示此專案策略與成效卓越值得應用與推展。

The prevalence of nephropathy in Taiwan is highest in the world and the national health insurance care system provides a “pre-ESRD preventive and patient health program”to slow the progress of chronic kidney disease. The non-completion rate of the “National Health Insurance pre-ESRD health education program”in 2010 in my unit was 19.6% so a task force was set up. The identified issues included the lack of a reminder mechanism, inflexible health education schedule, a lack of patient motivation for health education, a lack of the patient learning interest, and inadequate record-keeping by the health education program. The purpose of this project was to reduce the non-completion rate of health education program. We changed the process to remind the patient to take blood samples a week before visiting the clinic, offer more flexibility on health education time slots, provide diversified health education content, changed the model of health education to boost the patient’s learning motivation and willingness, and modified the health education record-keeping process. After implementing these strategies, the non-completion rate of the health education program was reduced from 19.6% to 4.0% and the project target was achieved. The strategies in this project were therefore shown to be effective and worthy of widespread adoption.