請用此 Handle URI 來引用此文件：
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/16456完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 鍾國彪 | |
| dc.contributor.author | Hui-Ju Chan | en |
| dc.contributor.author | 詹惠如 | zh_TW |
| dc.date.accessioned | 2021-06-07T18:15:44Z | - |
| dc.date.copyright | 2012-03-02 | |
| dc.date.issued | 2012 | |
| dc.date.submitted | 2012-02-15 | |
| dc.identifier.citation | 英文文獻：
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/16456 | - |
| dc.description.abstract | 目的：
從病人觀點以階層線性模式分析病患醫病信任及病患積極度的時間變化趨勢因子和不同層次時間軌跡上的差異對殘餘腎臟臟功能關連性。 方法： 本研究採用前瞻性縱貫調查研究設計，非機率抽樣中的立意抽樣方式，以某財團法人醫療體系中，20歲至75歲經醫師首次診斷為CKD stage 3~5之新發生慢性腎臟疾病個案且與接受該位腎臟專科醫師小於三次門診治療的病患作為分析單位，分別追蹤新發生個案於研究計畫開始至研究結束間，連續六個月不同時間點之醫病信任、積極度（三次）及九個月的腎臟功能照護結果（四次）變化。運用多層次統計方法學之階層線性模式（hierarchical linear modeling, HLM）成長模型（growth model）進行研究。 結果： 研究初期收案136人，經收案後追蹤九個月，接受3次訪談，研究6個月期間因不可控因素造成病患失續追蹤52人，而全程參與研究共84人（3次）。初步研究顯示，研究樣本的IPTS有19.6%、PAM有29.5%及MDRDS有94.47%的差異來自於個人層次（ICC）。 經由階層線性模式分析，ITPS、PAM兩者對於時間變項顯著，而隨時間有關的解釋變項具顯著不同。慢性腎臟病病患愈信任腎臟專科醫師（或對自己疾病的態度愈積極），則對自己疾病的態度愈積極（或愈信任腎臟專科醫師）。這兩者關係相互影響顯著，只是疾病積極度亦會明顯受到同一時間單位內的看診時間、自覺健康情形、擔心腎臟病程度及ITPS等變項影響，後續每三個月的PAM變化於慢性腎臟病病患之間皆未呈現顯著變化；病患信任於同一單位時間中，雖只受疾病積極度影響，但各個慢性腎臟病病患對於信任腎臟專科醫師的差異性變化，會直接受到病患的院區別、年齡層、個人帄均月收入變項，存在顯著性差異影響， III 而與時間變項產生顯著交互作用變項有疾病嚴重度、病患所在之院區別和個人帄均月收入等三個變項。 於MDRDS模型中，結果發現本研究關心的ITPS與PAM變項皆未達統計上的顯著性，只有院區別、性別與得知腎臟專科醫師管道三變項持續顯著。 結論： 發現ITPS、PAM與MDRDS皆有時間趨勢變化關係，但三者的時間相關影響因子雖然迥異，卻的確存在個人特徵上的差異。另本研究關心的病患參與腎臟照護計畫與否，並不會隨不同時期IPTS及PAM變化而影響，其殘餘腎臟功能亦同。 | zh_TW |
| dc.description.abstract | Objective：Power in physician-patient relationships is inherently equivalent. Patient activation is a central concept in both the patient-oriented health care approach and the chronic illness care models. To date it remains to be clarified that influences of patient-physician relationships and their behavior changes on CKD patients in prospective studies.
Our study is to test whether patients trust and patient‘s activation growth trajectories in different time points will influence each other, and varies from two levels characteristics of the patients, CKD patients as well as hence produce positively with outcomes of renal function. Design and Methods：We conduct a prospective observational study. Patients aged between 20-75 year-old who do not receive dialysis treatment in the nephrology outpatient clinics at three centers of the Chang Gung Memorial Hospital. During 2010.10.01~2010.12.31 will be enrolled after obtaining informed consent. Using multilevel analysis, we will investigate the CKD program of patient-physician trust, patient activation and clinical outcome. At the same time, the newly diagnosis of stage 3~5 CKD patients (eGFR< 60 ml/min/1.73 m2) and their attending nephrologists will be include in our study. Conculsion：Found the ITPS, PAM and e-GFR, has growth trajectories in different time points, but three time-related impact factor is entirely different, really exist personal difference on the characteristic. Another concern of this study patients involved in renal care plan or not, it is not affect the IPTS and PAM change with the different periods, residual renal function likewise | en |
| dc.description.provenance | Made available in DSpace on 2021-06-07T18:15:44Z (GMT). No. of bitstreams: 1 ntu-101-R96843006-1.pdf: 3456986 bytes, checksum: 708d135aeb43006b1cea27b8efa68a2b (MD5) Previous issue date: 2012 | en |
| dc.description.tableofcontents | 目錄
第一章 緒論 ............................................................................................................ 1 第一節 研究背景與動機 ....................................................................................... 1 第二節 研究問題與目的 ....................................................................................... 4 第二章 文獻探討 ...................................................................................................... 5 第一節 醫病信任相關概念及研究 ........................................................................ 6 第二節 病患積極度概念與目前研究發現 .......................................................... 25 第三節 慢性腎臟疾病概念和相關研究 .............................................................. 37 第四節 綜合討論 ................................................................................................. 44 第三章 研究方法 .................................................................................................... 45 第一節 研究架構 ................................................................................................. 45 第二節 假說 ........................................................................................................ 47 第三節 研究設計與研究對象 ............................................................................. 48 第四節 研究工具 ................................................................................................. 54 第五節 研究變項與操作型定義 .......................................................................... 58 第六節 資料處理與分析方法 ............................................................................. 64 第四章 研究結果 .................................................................................................... 69 第一節 三院區同質性分析 ................................................................................. 69 第二節 全程參與研究與失續追蹤病患分析 ...................................................... 78 第三節 驗證性因素分析與信度分析 .................................................................. 82 第四節 描述性統計 ............................................................................................. 91 第五節 雙變項分析 ........................................................................................... 108 第六節 階層線性模型 ....................................................................................... 130 第五章 討論 ............................................................................................................ 143 第一節 測量工具品質 ....................................................................................... 143 第二節 研究假說驗證 ....................................................................................... 145 VII 第三節 研究限制 ............................................................................................... 150 第六章 結論與建議................................................................................................. 152 第一節 研究結論 ............................................................................................... 152 第二節 研究貢獻 ............................................................................................... 155 第三節 建議 ...................................................................................................... 156 參考文獻 .................................................................................................................. 157 附錄一 臨床實驗證明 ............................................................................................. 166 附錄二 長庚醫學研究計畫 ..................................................................................... 168 附錄三 IPTS、PAM-13問卷認知測詴結果 ........................................................... 169 附錄四 Professor Hibbard‘s suggestion ................................................................... 177 附錄五 訪員訓練指引 ............................................................................................. 180 附錄六 問卷 ............................................................................................................ 183 附錄七 追蹤問卷 .................................................................................................... 188 | |
| dc.language.iso | zh-TW | |
| dc.title | 多層次醫病信任及病患積極度對腎臟功能關係之研究
-以慢性腎臟病患為例 | zh_TW |
| dc.title | Multilevel Research in Physicians Trust, Patient Activation and it‘s Relationship with Renal Function
－Focus on Chronic kidney disease Patients | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 100-1 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 吳齊殷,吳寬墩,董鈺琪 | |
| dc.subject.keyword | 醫病人際信任,病患積極度,慢性腎臟病,多層次分析,成長模型, | zh_TW |
| dc.subject.keyword | Patient-physician trust,patient activation,multilevel analysis,chronic care model (CCM),chronic kidney disease (CKD), | en |
| dc.relation.page | 190 | |
| dc.rights.note | 未授權 | |
| dc.date.accepted | 2012-02-16 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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| 檔案 | 大小 | 格式 | |
|---|---|---|---|
| ntu-101-1.pdf 目前未授權公開取用 | 3.38 MB | Adobe PDF |
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