| 摘要: | 為了糖尿病防治，政府在公共衛生政策上正積極推動「糖尿病共同照護網」，且目前最具體的照護網就只有糖尿病共同照護網，足見其重要性。本研究旨在了解衛生所在參與「糖尿病共同照護網」之用藥模式對照觀察研究，採回顧性之病歷對照觀察，佐以問卷以作資料補充。本研究針對臺南市衛生所參與「糖尿病共同照護網」與未加入之各80位糖尿病人(共160人)，透過訪談及病歷回顧方式收集個案資料，利用Excel及SPSS 12.0套裝軟體進行統計分析。研究結果發現兩組平均年齡各為共照組(67.1±9.7)、傳統組(68.7±10.4)，無性別年齡差異，多屬低社經地位，兩組用藥模式幾乎都只使用口服方式(共照組 98.8% vs傳統組97.5%)。傳統組常以Sulfonylurea為第一線用藥選擇，共照組則常為Biguanide；第二線傳統組常以Biguanide，共照組則常為Sulfonylurea，兩組皆以2種口服藥?用居多，即一如預期以Biguanide +Sulfonylurea之組合為主；至於引用較先進之筆針胰島素已散見兩組(傳統組有2位使用筆針胰島素、共照組1位)。兩組之罹病指數分別為共照組3.8±1.7 vs傳統組2.9±1.4，合併罹病指數(CCI-Q)亦無差異(均1.5±0.7)。其他之用藥若依ATC分類兩?使用情形依序皆以消化道及代謝類最多，其次為心血管類、骨骼肌肉關節用藥；其用藥品項共照組vs傳統組( 3.2±1.3 vs 2.8±1.2)。在重要之糖尿病監控指標HbA1c之共照組vs傳統組之差異性(8.9±2.2 vs 7.7±1.6)，雖尚具統計上之意義(p<0.05)，惟不易論斷之。糖尿病防治瓶頸之一的病患用藥知識方面，兩組仍僅有少部分了解，大部分不了解，並未因共照或傳統而有特異之發現，顯見「糖尿病共同照護網」在基層有必要藥師介入協助，整合監控藥事照護，以落實糖尿病之全人化照護本質，期能獲得更好的改善。
For diabetes prevention, the government on public health policy is actively promoting the "diabetes share care" Among many of the current health care system, diabetes share care is considered the most achievement system, signifying its importance. This study aimed to understand the two primary health care units in whether to participate in "diabetes share care" controlled observation studies on their medication patterns do. In this study, a retrospective chart control observation, coupled with a questionnaire to make supplementary information. In this study, Tainan two primary health care units, a participation in "diabetes share care" and the other one is not joined to each of 80 (total 160). In interviews and medical record review of data collected in these cases, re-use Excel and SPSS 12.0 software package for statistical analysis. The results showed that the average age of each of the two groups shared care group (67.1 ? 9.7), the traditional group (68.7 ? 10.4), no sex and age differences, mostly in the lower socio-economic status, only two oral medication model is almost the way (shared care group 98.8% vs traditional care group 97.5%). Traditional group often Sulfonylurea drugs as a first choice, shared care group often Biguanide. The amount of the second drug in the traditional group is Biguanide, shared care group is Sulfonylurea. Two groups most Merger with two kinds of oral medication, as expected Biguanide + Sulfonylurea is a major partner. As for the use of more advanced pen needle insulin has scattered two groups ( in the traditional group: 2; shared care groups: 1),Mobidity Index 2 groups ofshared care were 3.8?1.7 vs traditional group 2.9 ?1.4,and no difference in Co- morbidity index(CCI-Q) (1.5?0.7). Other types of medication according to ATC code, used in the case of two groups in order, are the largest class in the digestive tract and metabolism, followed by cardiovascular, skeletal muscle and joint medication; their drug items (shared care group 3.2 ? 1.3 vs tradition group, 2.8 ? 1.2). In the important indicators of diabetes monitoring of HbA1c differences (shared care group8.9 ? 2.2 vs traditional group 7.7 ? 1.6), although there are significance (p <0.05) on the statistics, but it is not easy to comment righteousness culvert.One of the bottlenecks for diabetes prevention and treatment is medication knowledge of patients: two groups are still only a small part of the understanding, and most do not know, but there are particular differences not due to shared care or traditional methods. Apparently "common diabetes care network" necessity to intervene to assist pharmacists in primary care system.Pharmacists can integrate and monitor pharmaceutical care to implement holistic nature of diabetes care. On patient care will be better improved. |
