| 摘要: | 我國衛生福利部從民國105年開始推行以病人為中心的醫病共享決策(Shared Decision Making, SDM)，此臨床醫療執行過程兼具知識、溝通、尊重三元素，讓病患能先了解實證醫療結果，再依個人的偏好及價值觀與醫護人員共同進行醫療決策。本研究為南部某醫學中心麻醉術前評估門診，運用醫病共享決策，將數種具有實證醫學證據支持、可使麻醉品質更好的麻醉醫療資訊提供給病患，讓術前焦慮的病患參考選擇與決定使用；再將麻醉前中後所登錄的院內醫療資訊系統大數據整理與統計分析後，從中探討醫病共享決策在術前焦慮與麻醉後醫療品質的相關性結果。
研究對象是民國105年三月到106年八月手術，並執行全身麻醉的住院病患，蒐集醫療資訊系統中的麻醉前評估門診、麻醉中病患資料登錄表以及麻醉術後訪視結果等資料庫中的數據，進行資料彙總、轉換、整理與串聯，並運用統計軟體進行卡方檢定、無母數檢定與羅吉斯迴歸等，探討病患基本資料屬性各變項與術前焦慮、醫病共享決策及麻醉醫療品質間的相關性與預測模型。研究結果發現，術前焦慮除了受到性別與手術經驗的影響外，年齡層、ASA(American Society of Anesthesiologists)麻醉分類以及手術麻醉時間長短等都會造成病患的緊張與焦慮。參與醫病共享決策與表達術前焦慮的病患，對於麻醉醫師提供，具有實證結果的醫療處置，決定使用的意願較高。使用病患自控式止痛的病患，疼痛控制結果較佳。術後噁心嘔吐與性別、年齡層、ASA麻醉分類、手術麻醉經驗、PONV危險因子指數以及麻醉時間長短等都有相關。且醫病共享決策提供的醫療處置並未明顯降低術後噁心嘔吐的發生率。滿意度結果與病患年齡層及ASA麻醉分類有相關，參與醫病共享決策及使用醫療處置的病患整體滿意度較高。經過大數據資料分析後顯示，醫病共享決策對於提升麻醉醫療品質有實質上的助益。
The Ministry of Health and Welfare in Taiwan promoted patient-centered medicine with Shared Decision Making (SDM) since 2016. The SDM is the compositions of knowledge, communication, and respect. Patients are capable of acquiring evidence-based medical knowledge first and then individual preference through further communications. Patients make final decisions altogether with their medical staff. This study was conducted at Pre-Anesthesia Evaluation Clinic (PAEC) in a single medical center located at southern Taiwan. Anxious patients could get critical information of effective strategies in improving quality of anesthesia and make choices corresponded to their worries. All medical records were retrieved from databases of Medical Information System (MIS) before, during and after anesthesia. The associations of integrated SDM in PAEC and postoperative quality of anesthesia were statistically compared and analyzed.
Hospitalized patients scheduled for elective surgery and general anesthesia were enrolled from March 2016 to August 2017. Data were collected from Pre-Anesthesia Evaluation System, Anesthesia Records, and Post-Anesthesia Visits/Tracking System in MIS. The chi-square test, the nonparametric statistics, and the logistic regression were used to explore the correlation between various variables of patient's demographic characteristics and preoperative anxiety, decisions of SDM, and anesthesia medical quality. Several prediction models were also fitted to further analysis.
Patients’ preoperative worries, gender, surgical history, age, anesthesia physical classification (American Society of Anesthesiologists, ASA), and the duration of anesthesia could be influent factors of tension and anxiety. By integration of SDM in PAEC, surgical patients with more preoperative worries had higher willingness to accept medical advices provided by anesthesiologists. Patients had better pain control under patient-controlled analgesia. Postoperative nausea and vomiting (PONV) were related to gender, age group, ASA classification, surgical history, PONV risk factor index, duration of anesthesia. Medical advices provided by SDM did not significantly reduce the incidence of PONV. Patients’ satisfaction was associated with age and ASA classification. The overall satisfaction could be increased by participation of SDM and acceptance of medical advices. In conclusion, SDM can improve the quality of anesthesia and patients’ satisfactions. |
