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  • 學位論文

慢性腎臟病衛教對血液透析患者醫療資源耗用之影響

Impact of Chronic Kidney Disease Health Education on Medical Resources of Hemodialysis Patients

指導教授 : 黃偉堯

摘要


目的 美國腎臟資料登錄系統(United States Renal Data System, USRDS, 2010)年報統計,2008年台灣末期腎臟病的發生率與盛行率皆排名為世界第三名和第一名,顯示慢性腎臟病現已儼然成為「台灣新國病」之一。每年因為末期腎臟病花掉大約350億新台幣在透析治療上,造成國家醫療資源耗用沉重的負擔。本研究目的在探討慢性腎臟病衛教對血液透析患者醫療資源耗用的影響,並期望作為未來製定慢性腎臟病防治措施之參考。 設計 本研究為兩階段類實驗之回溯性研究設計。以首次透析日為基準,往前回溯首次透析前與透析後半年之兩階段研究;採實驗對照組作比較。並以pair-t檢定其醫療利用率與醫療費用的影響差異。 資料來源 南部某一醫療機構之「2008年、2009年首次血液透析病患資料檔」、「病歷彙總檔」與醫院健保申報的「門診處方及治療資料明細表檔」、「住院醫療費用清單資料表檔」之次級資料。 研究對象 為血液透析患者。而將與醫療資源有影響的因素,如人口學因子、疾病因子與慢性腎臟病分級納為配對條件。人口學因子歸納為二項,為性別與年齡;疾病因子則採取一項,為糖尿病;慢性腎臟病分級,共分為三項:CKD Stage 3、CKD Stage 4、CKD Stage 5。依此分為實驗對照組二組,實驗組為透析前接受慢性腎臟病衛教的血液透析患者32位;對照組為無接受慢性腎臟病衛教的血液透析患者32位。 結果 分為三個階段分析: 1.透析前醫療資源耗用:(1)醫療資源利用:針對腎臟科門診利用而言,接受衛教患者142次高於無接受衛教患者102次,達顯著差異(p<0.05);而在住院利用上,接受衛教患者53次雖高於無接受衛教患者45次,但統計上無顯著差異(p>0.05)。(2)醫療資源費用:針對腎臟科門診費用而言,接受衛教患者493,000元高於無接受衛教患者228,000元,達顯著差異(p<0.05);但在住院費用上,接受衛教患者4,177,000元雖高於無接受衛教患者2,687,000元,但統計上無顯著差異(p>0.05)。 2.透析後半年醫療資源耗用:(1)醫療資源利用:針對於腎臟科門診利用與住院利用而言,接受衛教患者105次:21次對於無接受衛教患者65次:26次,皆無顯著差異(p>0.05);(2)醫療資源費用:針對腎臟科門診費用與住院費用而言,接受衛教患者172,000元:1,852,000元與無接受衛教患者169,000元:2,264,000元,在統計上亦無顯著差異(p>0.05)。 3.透析前與透析後半年醫療資源耗用:(1)針對腎臟科門診利用而言,接受衛教患者247次高於無接受衛教患者167次,達顯著差異(p<0.05);而在住院利用上,接受衛教患者74次雖高於無接受衛教患者71次,但統計上無顯著差異(p>0.05)。(2)醫療資源費用:針對腎臟科門診費用而言,接受衛教患者665,000元高於無接受衛教患者397,000元,達顯著差異(p<0.05);但在住院費用上,接受衛教患者6,029,000元雖高於無接受衛教患者4,951,000元,但統計上無顯著差異(p>0.05)。 研究結論 接受慢性腎臟病衛教患者,在透析前的腎臟科門診利用與費用,顯著高於無接受衛教患者;且在透析前與透析後半年的腎臟科門診利用與費用上,亦明顯高於無接受衛教患者。所以整體來說:慢性腎臟病衛教介入,並沒有顯著降低總醫療資源耗用。

並列摘要


Objectives. The annual report of United States Renal Data System(USRDS, 2010) shows that the ranks of the incidence and prevalence of End Stage Renal Disease (ESRD) of Taiwan are the world third and first individually in 2008. The Chronic Kidney Disease(CKD) already just becomes “Taiwan new country sickness”. ESRD costs 3,500 million NT dollars for the dialysis treatment per year, and causes the serious burden on the national medical resources. The research objectives are to discussthe impact of CKD education on the hemodialysis medical resources, and provide suggestions for the CKD prevention in the future. Designs. Two-stage Quasi-experimental retrospective study design. The study includes before and after six months the date of the first time dialysis. The experimental group takes health education and the control group doesn’t. And the significance of medical utilization and the medical expense are tested through pair-t test. Data. Secondary data from someone hospital includes the medical record file with hemodialysis patients’ data in 2008-2009 and their NHI claim files. Subjects. Hemodialysis patient. The matching criteria are the demography factors, the disease factor and the class of chronic kidney disease. The demography factors are gender and age; the disease factor is diabetes; and the class of chronic kidney disease includes Stage 3-5. The experimental and control group has 32 patients each other. Results. 1.The medical resources, before the dialysis: (1) The medical utilization: For the renal outpatient visits, the experimental group with 142 visits is more than the control group with 102 visits (p<0.05). For inpatient admissions, the experimental group with 53 admissions is more than the control group with 45 admissions (p>0.05). (2) The medical expense: For the renal outpatient cost, the experimental group with 493,000 dallors is more than the control group with 228,000 dallors (p<0.05). For inpatient cost, the experimental group with 4,177,000 dallors is more than the control group with 2,687,000 dallors (p>0.05). 2. The medical resources, after the dialysis for six months : (1) The medical utilization: For the renal outpatient visits, the experimental group with 105 visits is more than the control group with 65 visits (p>0.05). For inpatient admissions, the experimental group with 21 admissions is less than the the control group with 26 admissions (p>0.05). (2) The medical expense: For the renal outpatient cost, the experimental group with 172,000 dallors is more than the control group with 169,000 dallors (p>0.05). For inpatient cost, the experimental group with 1,852,000 dallors is less than the control group with 2,264,000 dallors (p>0.05). 3. The medical resources, before the dialysis and after for six months : (1) The medical utilization: For the renal outpatient visits, the experimental group with 247 visits is more than the control group with 167 visits (p<0.05). For inpatient admissions, the experimental group with 74 admissions is more than the the control group with 71admissions (p>0.05). (2) The medical expense: For the renal outpatient cost, the experimental group with 665,000 dallors is more than the control group with 397,000 dallors (p<0.05). For inpatient cost, the experimental group with 6,029,000 dallors is more than the control group with 4,951,000 dallors (p>0.05). Conclusions. Before the dialysis, medical utilization and medical expense of patients with CKD health education are more than who without CKD health education,significantly. Before the dialysis and after for six months, medical utilization and medical expense of patients with CKD health education are more than who without CKD health education, too. As a whole, the patients with CKD health education does not reduced the total medical resources.

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