應用遠距居家照護在糖尿病病患自我照顧行為之成效研究-以新北市某區域醫院門診病患為例

Abstract

本研究以第二型糖尿病個案為對象，主要目的旨在建構遠距居家照護服務模式，藉由行動數據網路(GPRS)無線傳輸技術，將個案的血糖、血壓生理訊號即時傳輸至雲端健康照護平台，期待本研究能使糖尿病個案提升其自我照顧行為能力，進而提高其健康生活品質。 首先建置「遠距居家照護系統」，再實施「遠距居家照護服務模式」，個案量測血壓血糖後，其生理訊號藉由行動數據網路(GPRS)無線傳輸至雲端健康照護平台，當個案量測生理數據異常時，雲端健康照護平台會立即自動發出簡訊通知個案管理師，並立即進行回饋，訂定符合個人需求之行動策略，如以電話關懷、提供用藥諮詢、運動飲食建議及異常處理。本研究採準實驗研究設計，以立意取樣選取研究對象，研究對象有實驗組56人及對照組61人，進行3個月的遠距居家照護服務模式介入，對照組則接受糖尿病共同照護網衛教。本研究於介入後第4個月進行後測，以了解介入之整體成效。 本研究以共變異數分析進行統計分析，比較實驗組與對照組在自我照顧行為之差異。遠距居家照護服務模式介入後，在整體的自我照顧行為，實驗組的效果明顯高於對照組；然而從層面來看，足部照護及運動自我照顧行為在二組之間沒有達到顯著差異。 研究顯示儘早介入遠距居家照護服務模式的衛教策略，將可強化個案自我照顧行為。未來研究可針對糖尿病的足部照護、運動的健康行為加以深入探討。遠距居家照護服務模式能促進個案自我照顧與延伸健康促進面向之功能，提供立即性的衛生教育與關懷服務，將可做為未來國家健康政策上的重要實證依據，更能據此有效提升個案自我健康照顧行為進而改善個案糖化血色素值，進而提升個案健康生活品質。

The purpose of the study is to examine the effectiveness of theTele-home care system on diabetic self care. The subjects were 117 patients (include 56 at the experimental and 61 at the control group), which recruited from a community hospital in New Taipei city. TheTele-home care system incorporated into the daily care program in the experimental group. A cloud healthcare platform designed for information storage and exchange be constructed and monitored by case managers. Comprehensive care instructions and in-time consultation in case of abnormalities were provided. The patients in control group adopted conventional care program. Self care questionnaires completed by both groups before and after the study. All participants measured before the experiment and at 4 months after. In two-way mixed design ANCOVA, in self care behaviors, there are significant differences between two groups. The outcome of experimental group is superior to the control group both in post –test.However, there is no significant difference between two groups in subscales of foot care and athletics care. Moreover, there is no delayed-effect in self care behaviors of drug adjustment and blood –sugar surveillance. This study revealed early intervention model to the health education strategy, the Tele-homecare could strengthened self-care behavior of the participants. To the future study, we can put emphasis on the Diabetes mellituspatient’s foot care and exercise behavior. The Tele-homecare model isproven to advance the functions of self-care and long distance’s care services in hospital.It can also become the important health care policy for the government based on the results of this evidence-based intervention.