門診整合照護於多重慢性病人效益之統合分析與臨床應用

Systematic Review and Clinical Application of Integrated Care for Outpatients with Multiple Chronic Diseases

本文旨在瞭解門診整合照護對多重慢性病人的醫療費用、門診次數及藥物品項數之成效，於系統性文獻回顧後再以臨床資料分析應用成效。以4 篇文獻進行統合分析，發現門診整合照護可減少門診次數(SMD = - 0.37, 95% CI [-0.42, -0.32],p < .00001) 以及藥物品項數(SMD = -0.26, 95% CI [ -0.33, -0.19], p< .00001)，但在醫療費用之整體效果不顯著。臨床應用以中部某醫學中心2011 年10 月1 日至2013 年9 月30 日之110 位個案進行回溯性分析，結果顯示接受1 年門診整合照護後，門診次數減少6.15 次 (MD = -6.15, p < .001)。由此證實門診整合照護可降低門診次數，而醫療費用及藥物品項數之效益則可能與醫療費用定義、收案條件與介入措施之差異而異。建議增加藥物諮詢次數，並在醫師調整藥物後電訪關懷，以減少病人之不安全感，並建立醫師通報機制以擴大服務對象。

The purpose of this study was to evaluate the effects of integrated care by reviewing studies and analyzing clinical data. The results indicate that integrated care did not signifi cantly infl uence medical cost (standardized mean difference (SMD) = -0.17, 95% confidence interval (CI) [-0.49, 0.16], p = .031); however, it significantly influenced the number of clinic visits (SMD = -0.37, 95% CI [-0.42, -0.32], p < .00001) and the number of pharmaceutical preparations prescribed (SMD = -0.26, 95% CI [-0.33, -0.19], p < .00001). The data of 110 cases from a medical center in Central Taiwan indicates that the number of clinic visits by the experimental group significantly decreased (MD= -6.15, p< .001). These fi ndings suggest that increasing the frequency of pharmacist consultation and phone calls enhance the confidence of patients in drug regulation. Moreover, a physician contact mechanism should be established to include those in need of integrated care but not included in the list provided by the National Health Insurance Administration.