背景：近年來，隨著台灣生活型態的改變及人口老化的上升，慢性疾病已成為國人主要的疾病型態。但對於具有慢性病特徵又有緊急突發可能性之冠狀動脈心臟病(CAD)而言，遠距健康照護介入性研究文獻較一般常見的慢性病如糖尿病、高血壓還來得缺乏。目的：本研究目的為一、建構「遠距健康照護服務模式」之管理服務模式二、探討「遠距健康照護服務模式」介入對於冠狀動脈心臟病患者血壓量測行為之成效三、探討「遠距健康照護服務模式」介入對於冠狀動脈心臟病患者血壓控制之成效。方法：本研究採三組單盲平行分派實驗研究設計，以南部某醫學中心心臟科門診之冠狀動脈心臟病患者為研究對象，採立意取樣196位，樣本群有三組(對照組、衛教組及遠距健康照護組)，追蹤期間自2011年03月至2012年07月，共計9個月，以廣義估計方程式分析追蹤期間之血壓量測數據，進而評估遠距健康照護模式介入的血壓控制成效分析。結果：本研究結果顯示，以三組加入期間進行分析，在血壓自我量測行為方面，量測天數及量測次數皆有達統計上顯著差異。透過GEE分析，在血壓控制上遠距健康照護組及衛教組都顯著優於對照組，其中在遠距健康照護組之血壓量測以加入1~3個月做為比較，在加入10~12個月及加入13~14個月的血壓變化均有統計上顯著差異。結論：透過本研究結果資料分析顯示，對於「遠距健康照護服務模式」介入冠心病個案其血壓控制成效及血壓量測行為皆有顯著成效，驗證了此介入模式是為可行的，對於提高患者接受醫療相關資訊的可近性是有助於加強患者的定期血壓量測行為，有助於未來推廣遠距健康照護模式發展之參考。 Background: In recent years, people suffer from chronic diseases has become a major stream with the lifestyle changes and the raised proportion of the aging population in Taiwan. For the coronary artery disease (CAD) which is characterized both chronically and emergently, it lacks more of intervention researches (especially telehealthcare interventions) from the other chronic diseases like diabetes and hypertension.Objective：This research purposes are: (1)to construct a telehealthcare service model for patients with CAD; (2)to conduct an intervention research to explore the effectiveness of blood pressure self monitoring behavior; and (3)to validate the effectiveness of BP control for patients with CAD.Methods: This study conducted a three-arm parallel assignment experimental study design to test the effectiveness of intervention for patients with CAD in Taiwan. Participants were recruited from outpatients of the cardiology clinic of a southern medical center with having suffered from CAD. With the purposed sampling procedure, 196 participants were validated into the research through follow-up 9 months from March 2011 to July 2012. Data analysis were based on the generalized estimating equation analysis to test the research purposes.Results: Compared to the control group, the test of the BP self monitoring behaviors revealed that the proportion of patients in the models adopting a proper daily BP measuring behavior increased with statistically significance. Similar results showed in the day-time of monthly BP measurement. Meanwhile, the GEE analysis revealed the similar results on the better effectiveness of BP control with the comparison of two experimental groups and control group. Moreover, the effectiveness of BP control showed a statistically drop on the average of monthly BP when comparing the 10-12 monthly period and 13-14 monthly period based on the 1-3 monthly period. Conclusion: This study developed and validated the effectiveness of the telehealthcare model for patients with CAD. We compared the health education group and the control group and found that the telehealthcare model has a better BP self monitoring behaviors and better effectiveness of BP control. This study concluded that the intervention could be effective for the patients with CAD. This study thus provides a reference site for future development of telehealthcare model.
