糖尿病醫療給付改善方案對不同教育程度患者自我照顧成效探討-以南投某地區醫院為例

背景及目的：南投縣人口結構老化嚴重及教育水準平均低於他縣，欲了解糖尿病醫療給付改善方案介入照護與賦能自我管理之關係。本研究目的欲探討南投地區不同教育程度之糖尿病患，經由糖尿病照護方案介入之自我照護成效。方法：採立意取樣，回溯病例分析南投某地區醫院收案滿三年共300名病尿病患者。分教育程度(≦6年，53人)與(＞6年，247人)兩組比較，以加入「全民健康保險糖尿病醫療給付改善方案」之初診資料為基點，分析及比較此300名個案加入照護後一至三年期間HbA1c淨差異值變化情況與HbA1c <7%及LDL <100mg/dl及BP <130/80mmHg為ABC達標準則，採用次數分配統計、達標率，與獨立樣本t檢定分析兩組間生化指標變化差異顯著性。結果：由第一年至第五年HbA1c之變化情形，各年度之間都有明顯著差異(p<0.05)。教育程度≤6年相較於教育程度>6年個案有較好的ABC治療目標達成率，第一年(12.0%；8.0%)、第三年(17.2%；8.7%)。結論：現行的糖尿病醫療給付改善方案整合式介入，對不同教育程度患者皆有成效，且教育程度≤6年個案接受照護三年期間皆維持下降之成效，其平均值低於教育程度>6年個案。針對教育程度≤6年個案提升自我效能短期積極控制及維持長期自我照護更有其必要性。

Background and purpose: In Nantou , there are more old people than other cities. The educational level is also lower than others. We want to known is it work for the diabetic patients with different educational levels in Nantou via the Diabetes medical improvement program management Method: It is a prospective study .Between May 2004 to July 2009, a total of 300 diabetics patients were enrolled in this study. They all completed the Diabetes medical improvement program treatment . We separated the data into 2 groups via the different educational years . One group is including 53 patients with less than 6-year educational level and the other is including 247 patients with more than 6- year educational level . We collected and analyzed these data including the first , second, fourth and fifth year. We checked the HbA1c variation in these different year.. We also set the ABC goal witch met the ADA goals including HbA1c less than 7%, LDL less than 100 mg/dl and BP less than 130/80 mmHg. We used the paired T test to calculated these differences Result: From these analysis around 5years, HbA1c showed a significant difference in every year ( P< 0.05). We also found that lower educational level diabetic patients got the better outcomes to reach the ABC goal in the first year( 12.0% vs 8%) and the third year( 17.2% vs 8.7%) after the diabetes medical improvement program management. Conclusion: The diabetes medical improvement program is work to our diabetic patients with different educational level in Nantou. But we also found it is more effective for the lower educational level diabetic patients after 3 year treatment and management .