糖尿病及腦中風病患接受出院準備服務差異之探討

Comparing the Discharge Planning Differences between Diabetic Patients and Stroke Patients

本研究之目的在了解接受出院準備服務的糖尿病和腦中風個案在住院日數、收案原因、服務過程、及遵從行為的差異。研究收取某醫學中心住院的腦中風及糖尿病患者，個案經出院計畫篩選表篩選，或由醫療人員評估建議收案。研究結果發現：腦中風個案的平均住院日數多於糖尿病患者，腦中風個案因活動能力降低、意識狀態受損、照顧能力缺乏、需居家及復健轉介而收案；糖尿病患則因需營養轉介、對疾病控制不遵從、需公衛轉介而收案。腦中風個案所接受的出院準備服務項目以導管護理技術衛教，抽痰技術衛教，灌食技術衛教，復健、社工、居家、弘道老人服務轉介為多，其生活需求以要專人照顧最為需要；糖尿病患者所接受的以偶務項目則以胰島素注射衛教、營養衛教、營養及公共衛生轉介為多。糖尿病患所接受的出院用物準備建議以血糖機為多。腦中風個案則以輪椅、四腳手杖、血壓計、蒸氣吸入器為多。個案的儀器準備遵從率為59%，糖尿病患者主動測血糖及腦中風患者主動測血壓行為多為一週一次。建議吾人應建立適合各種疾病的執行核對表單，及充沛社區照顧的資源及轉介管道，使出院準備服務更為便捷。

The purpose of this study was to investigate the differences of discharge planning between diabetes(DM) and cardiac vascular accident(CVA) patients. Samples were assessed through a discharge planning screening instrument. The results revealed that the length of stay(LOS) of CVA patients was shorter than DM patients. CVA cases were involved due to activity impairment, conscious disorder, self care deficiency, home visit and rehabilitation needs. Compared with DM patients, CVA patients received more education on catheter care, suction care, feeding care, and require more rehabilitation referral, social worker referral, home care referral, and life care referral services. DM patients received more insulin injection education, diet education, and public health referral service than CVA patients. Equipment recommended for the discharge patients included one touch meter for DM patients, and sphygmomanometer, steam inhalation machine, wheelchair, and four-leg on sticks for CVA patients. The compliance rate of obtaining these self care equipment was 59% in research samples. Most patients checked BP and BS once a week. We conclude that to investigate discharge planning needs and develop a structured checklist of different diseases for implementation of discharge planning.