衛生所第二型糖尿病患加入糖尿病共同照護計畫後代謝指標的變化分析

Changes to metabolic indices of patients who have type 2 diabetes and are included in the Diabetes Shared Care Program administered in a public health center in Taiwan

10.6288/TJPH.202106_40(3).110010

楊雅惠(Ya-Hui Yang)；王俊毅(Jiun-Yi Wang)

糖尿病共同照護計畫 ； 衛生所 ； 第二型糖尿病 ； 糖化血色素 ； Diabetes Shared Care Program ； public health center ； type 2 diabetes mellitus ； glycated hemoglobin (HbA1c)

台灣公共衛生雜誌

40卷3期（2021 / 06 / 28）

306 - 318

繁體中文

目標：糖尿病醫療給付改善方案自2001年實施至今，文獻中探討衛生所執行糖尿病共同照護計畫的研究相當少。本研究以中部某衛生所的糖尿病共照計畫個案資料，分析患者加入糖尿病共照計畫後，代謝指標的長期變化。方法：以回溯性世代研究法進行資料收集及分析，擷取台灣某衛生所「糖尿病共同照護服務管理系統」2002年5月至2008年12月加入共照計畫的個案為研究對象，每位個案自初診後追蹤至多8年，平均追蹤6.2年。使用廣義估計方程式，分析患者加入糖尿病共照計畫後各項代謝指標的變化。結果：共133位納入分析。在前二年分析中，糖化血色素以第4季下降幅度最大（β=-0.41, p=0.003）；在長期8年的分析中，糖化血色素≥9％的比率，自初收案的28.6％，至第1年底及其後各年度均維持在20％以下。舒張壓在短期有顯著下降；長期而言，血壓控制良好的比率有逐年上升的趨勢。結論：衛生所推動糖尿病共照計畫，使就診病患能獲得良好的照護。加入共照計畫的患者，血糖及血壓的控制整體而言可獲得逐步改善。建議未來能持續招募糖尿病患加入共照計畫，以提升整體照護率及代謝指標之改善。

Objectives: Taiwan established the Diabetes Shared Care Program (DSCP) in 2001, but few studies have discussed the DSCP's implementation by public health centers (PHCs) in the community. Thus, this study aimed to analyze the changes to the metabolic indices of patients who had type 2 diabetes and joined the DSCP through a PHC in Central Taiwan. Methods: Participants were enrolled retrospectively from a DSCP database of outpatients who had diabetes mellitus and visited a PHC in Central Taiwan at any period between May 2002 and December 2008. After enrollment, the participants were tracked for up to 8 years, with the average follow-up period being 6.2 years. Due to the use of repeated measurements, generalized estimating equations were applied to evaluate the changes to the examined indices over time. Results: The data of 133 patients were analyzed. In the first 2 years of follow-up, HbA1c significantly decreased in the fourth quarter (β = -0.41, p = 0.003). For the 8-year long-term follow-up, the percentage of patients with HbA1c ≥ 9% decreased from 28.6% to 20% or lower in the years following DSCP intervention. The patients' diastolic blood pressure significantly decreased in the short term. The percentage of patients with well-controlled blood pressure increased gradually in the long term. Conclusions: The DSCP implemented by PHCs provides a good quality of care, and it can help patients to continually improve their HbA1c and blood pressure. The DSCP should be promoted among patients with diabetes to improve their metabolic indices.

1. 吳淑靜, SC,黃俊豪, JH(2013)。糖尿病共同照護對病患糖化血色素、健康信念與健康行為之影響。台灣衛誌，32，537-550。
   連結：
2. 林民浩, MH,郭年真, RN,陳威全, WC,溫在弘, TH(2016)。剖析台灣民眾的就醫流動：利用引力模式評估就醫距離與醫療資源分布的影響。台灣衛誌，35，136-151。
   連結：
3. 陳都文, TW,王俊毅, JY(2009)。糖尿病共同照護網對偏遠地區中老年患者健康狀況之成效。台灣衛誌，28，334-343。
   連結：
4. 傅彥儒, YR,邱銘心, MH(2014)。新北市平溪區銀髮族居民資訊需求與資訊行為特性。大學圖書館，18，106-125。
   連結：
5. 彭少貞, SJ,湯麗君, LC(2019)。鄉村高齡糖尿病個案的自我管理教育。護理雜誌，66，13-19。
   連結：
6. 黃鈞奕, CI,陳慧姍, HS,張嘉恬, CT,吳肖琪, SC(2015)。探討社經地位對血管支架置入病患死亡風險之影響。台灣衛誌，34，37-49。
   連結：
7. 黃憶玫, YM,張慈桂, TK(2011)。糖尿病照護成效與影響因素之探討：以台東某區域醫院糖尿病共同照護網為例。台灣衛誌，30，19-28。
   連結：
8. 羅琦, C,黃建寧, CN,郭青萍, CP,黃秀梨, SL,廖玟君, WC(2017)。第二型糖尿病患者的睡眠品質與血糖控制之相關性探討。台灣衛誌，36，497-510。
   連結：
9. Azami, G,Soh, KL,Sazlina, SG(2018).Effect of a NurseLed Diabetes Self-Management Education Program on glycosylated hemoglobin among adults with type 2 diabetes.J Diabetes Res,2018,4930157.
10. Baranwal, JK,Maskey, R,Chaudhari, RK,Sherchand, O(2020).Assessment of achievement of American Diabetes Association (ADA) targets in patients with type 2 diabetes mellitus at a tertiary care centre in Eastern Nepal.Diabetes Metab Syndr Obes,13,2959-2964.
11. Chen, CH,Ma, SH,Hu, SY(2018).Diabetes Shared Care Program (DSCP) and risk of infection mortality: a nationwide cohort study using administrative claims data in Taiwan.BMJ Open,8,e021382.
12. Chiou, ST,Lin, HD,Yu, NC(2001).An initial assessment of the feasibility and effectiveness of implementing diabetes shared care system in Taiwan-some experiences from I-Lan County.Diabetes Res Clin Pract,54(Suppl 1),S67-S73.
13. Ciardullo, AV,Daghio, MM,Brunetti, M(2004).Audit of a shared-care program for persons with diabetes: baseline and 3 annual follow-ups.Acta Diabetol,41,9-13.
14. Flood, D,Mux, S,Martinez, B(2016).Implementation and outcomes of a comprehensive type 2 diabetes program in rural Guatemala.PLoS One,11,e0161152.
15. Goderis, G,Borgermans, L,Grol, R(2009).Start improving the quality of care for people with type 2 diabetes through a general practice support program: a cluster randomized trial.Diabetes Res Clin Pract,88,56-64.
16. Graber, AL,Elasy, TA,Quinn, D,Wolff, K,Brown, A(2002).Improving glycemic control in adults with diabetes mellitus: shared responsibility in primary care practices.South Med J,95,684-690.
17. Hao, LJ,Tien, KJ,Chao, H(2011).Metabolic outcome for diabetes shared care program outpatients in a veterans hospital of southern Taiwan.J Chin Med Assoc,74,287-293.
18. Hsu, CC,Tai, TY(2014).Long-term glycemic control by a diabetes case-management program and the challenges of diabetes care in Taiwan.Diabetes Res Clin Pract,106(Suppl 2),S328-S332.
19. International Diabetes Federation (IDF). 2019 diabetes atlas. Available at: https://diabetesatlas.org/en/resources/. Accessed March 7, 2020.
20. Liou, JK,Soon, MS,Chen, CH(2014).Shared care combined with telecare improves glycemic control of diabetic patients in a rural underserved community.Telemed J E Health,20,175-178.
21. Smith, S,Bury, G,O’Leary, M(2004).The North Dublin randomized controlled trial of structured diabetes shared care.Fam Pract,21,39-45.
22. Taniguchi, D,LoGerfo, J,Pelt, M(2017).Evaluation of a multi-faceted diabetes care program including community-based peer educators in Takeo Province.Cambodia,1-14.
23. Wang, CY,Tu, ST,Sheu, WHH(2018).National survey of ABC (A1C, blood pressure, cholesterol) of Diabetes Health Promotion Institutes in Taiwan: 2002-2018.J Formos Med Assoc,117,952-954.
24. Wu, SF,Tung, HH,Liang, SY,Lee, MC,Yu, NC(2014).Differences in the perceptions of self-care, health education barriers and educational needs between diabetes patients and nurses.Contemp Nurse,46,187-196.
25. 朱桂美, KM(2008)。台中=Taichung，亞洲大學長期照護研究所=Department of Healthcare Administration, Asia University。
26. 社團法人中華民國糖尿病衛教學會=Taiwanese Association of Diabetes Educator(2019).台灣糖尿病年鑑.台北=Taipei:社團法人中華民國糖尿病衛教學會=Taiwanese Association of Diabetes Educator.
27. 社團法人中華民國糖尿病學會=Taiwanese Association of Diabetes Educator(2018).2018糖尿病臨床照護指引.台北=Taipei:社團法人中華民國糖尿病學會=Taiwanese Association of Diabetes Educator.
28. 莊豔妃, YF,宋惠娟, HC,林麗萍, LP(2005)。偏遠礦區老人健康狀況及健康醫療資源使用之調查研究。慈濟護理雜誌，4，34-41。
29. 許崇民, CM,黃寶萱, PH,王璟璇, JS,黃詩媛, SY(2007)。社區第二型糖尿病患自我管理行為之評估。南台灣醫學雜誌，3，76-83。
30. 劉羿宏, YH(2015)。嘉義=Chiayi，嘉南藥理大學藥學系=Department of Pharmacy, Chia Nan University of Pharmacy and Science。
31. 衛生福利部中央健康保險署：全民健康保險醫療品質資訊公開網。https://www.nhi.gov.tw/mqinfo/SearchPro.aspx?Type=DM&List=4。引用2020/12/17。 National Health Insurance Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). National Health Insurance medical quality information public network. Available at: https://www.nhi.gov.tw/mqinfo/SearchPro.aspx?Type=DM&List=4. Accessed December 17, 2020. [In Chinese]
32. 衛生福利部中央健康保險署：全民健康保險糖尿病醫療給付改善方案。https://www.nhi.gov.tw/Content_List.aspx?n=95611DD9DDCAF987&topn=D39E2B72B0BDFA15。引用2020/06/30。National Health Insurance Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Pay-for Performance Program for Diabetes under National Health Insurance. Available at: https://www.nhi.gov.tw/Content_List.aspx?n=95611DD9DDCAF987&topn=D39E2B72B0BDFA15. Accessed June 30, 2020. [In Chinese]
33. 衛生福利部國民健康署：國民營養健康狀況變遷調查2013-2016年成果報告。https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=3999&pid=11145。引用2020/10/15。 Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Nutrition and Health Survey in Taiwan (NAHSIT) 2013-2016. Available at: https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=3999&pid=11145. Accessed October 15, 2020. [In Chinese]
34. 衛生福利部國民健康署, Ministry of Health and Welfare, R.O.C. (Taiwan)(2017).糖尿病共同照護工作指引手冊.台北=Taipei:衛生福利部國民健康署=Health Promotion Administration, Ministry of Health and Welfare.
35. 衛生福利部統計處：107年度全民健康保險醫療統計年報。https://dep.mohw.gov.tw/DOS/lp-4648-113.html。引用2020/03/04。 Department of Statistics, Ministry of Health and Welfare, R.O.C. (Taiwan). 2018 National Health Insurance medical statistics yearbook. Available at: https://dep.mohw.gov.tw/DOS/lp-4648-113.html. Accessed March 4, 2020. [In Chinese]
36. 衛生福利部統計處：死因統計108年度死因統計年報。https://dep.mohw.gov.tw/DOS/cp-4927-55571-113.html。引用2020/12/17。 Department of Statistics, Ministry of Health and Welfare, R.O.C. (Taiwan). Annual report on the cause of death statistics in 2019. Available at: https://dep.mohw.gov.tw/DOS/cp-4927-55571-113.html. Accessed December 17, 2020. [In Chinese]