糖尿病醫療給付改善方案對病人血糖控制之成效分析──以南部地區教學醫院為例

Effectiveness of the Diabetes Medical Payment Improvement Program on Blood Sugar Control: A Study from A Southern Teaching District Hospital

目的：糖尿病控制不良易產生慢性併發症及耗費龐大醫療資源，且長年高居台灣前十大死因之一。因此，本研究主要探討病人加入「糖尿病醫療給付改善方案」後，其整體照護之成效。方法：本研究採回溯性研究。期間自2016年01月至2018年12月，納入接受口服降血糖藥物治療的第2型糖尿病病人，並參與「糖尿病醫療給付改善方案」達12個月者進行研究，收集並分析病人基本資料、檢驗報告（糖化血色素，HbA1c）及自我照顧行為之紀錄。使用SPSS統計套裝軟體執行描述性統計及運用One-Sample Wilcoxon Signed-Rank Test進行推論性統計。結果：3年共204人在持續介入衛教後，其2016年與2018年之HbA1c自9.21±2.24%降至6.75±0.64%，達顯著差異（p < .01）。而自我照顧行為方面，如自備餐情形、有規律運動及有按時服藥，皆對病人之血糖控制達顯著差異（p < .01）。結論：加入「糖尿病醫療給付改善方案」對病人血糖控制及自我照顧行為具有良好之成效，故建議醫療機構應積極推動糖尿病共同照護方案以提供病人完整的照護措施。

Purpose: Poorly controlled diabetes is a major contributor to chronic complications and places a considerable burden on health-care resources. It has consistently ranked among the top ten leading causes of death in Taiwan for many years. Therefore, this study primarily investigated the overall effectiveness of patient participation in the Diabetes Medical Payment Improvement Program. Method: This retrospective study included patients with type 2 diabetes who received oral antidiabetic therapy and participated in the Diabetes Healthcare Improvement Program for at least 12 months between January 2016 and December 2018. Patient data, including data on their demographic characteristics, laboratory reports (glycated hemoglobin [HbA1c]), and self-care behaviors, were collected and analyzed. Descriptive statistics were analyzed using SPSS software, and a one-sample Wilcoxon signed-rank test was used for inferential statistics. Results: Over the 3-year study period, 204 patients received continuous health education interventions. Their HbA1c levels significantly decreased from 9.21%±2.24% in 2016 to 6.75%±0.64% in 2018 (p < .01). Significant improvements were also observed in self-care behaviors, such as meal preparation, regular exercise, and medication adherence, which contributed to better blood sugar control (p < .01). Conclusion: Participation in the Diabetes Medical Payment Improvement Program improved patients’blood sugar control and self-care behaviors. Therefore, health-care institutions should actively promote collaborative diabetes care programs to provide comprehensive care for patients with diabetes.