運用醫病共享決策提升門診減重病人體重管理之成效

The Effect of Shared Decision Making on Improving Weight Management in the Obesity Outpatients Who Want to Lose Weight

減重病人常因多種因素影響減重動機與中斷持續追蹤，而共享決策為個別化和醫療決策核心，藉此鼓勵病人與醫療人員保持合作關係，達成符合雙方共識的治療計畫。本專案收集18－65歲門診肥胖病人共23位，運用醫病共享決策提升門診減重病人體重管理之成效，以改善病人肥胖帶來的相關風險與併發症及提升動機與追蹤率，為期九個月的品質改善活動。結果顯示，門診肥胖病人收案三個月後體重減少5％，達標率由68.2％上升至82.6％，且體位減少一個位階達標率由18.2％上升至39％、回診追蹤率由37％提升至69％、病人對醫病共享決策輔助工具的滿意程度平均為4.9分、輔助工具於醫療決策滿意度平均89.6％滿意及飲食行為100％改變為良好。綜合上述，透過此專案改善，門診減重病人整體體重減少達標率、回診追蹤率及病人飲食行為改變皆達到成效。

There are many factors affecting the motivations of losing weight and follow-up. Shared decision making (SDM) is the core of individualization and medical decision making, which could encourage the collaboration between patients and health care providers and achieve a consensus for treatment plan. The present study recruited 23 obesity outpatients aged 18- 65 years for 9 months to investigate the effect of SDM on improving weight management and motivation and follow-up for obesity-related risk and complications. Our results showed that the percentage of reaching losing weight for 5% at 3-months' follow-up in the obesity outpatients was 68.2% in the pre-intervention period and increased to 82.6%, the percentage of reaching losing weight for one level was 18.2% in the pre-intervention period and increased to 39%, the percentage of follow-up was 37% in the pre-intervention period and increased to 69% after the implementation of SDM. The patients had a mean score of 4.9 points for SDM and 89.6% of satisfaction level for assist tools in SDM. All the patients had an improvement for diet behavior. In conclusion, SDM is a useful method for improving obesity outpatients for losing weight, follow-up, and diet behavior.