病患評估慢性病照護與健康生活品質之關係

Abstract

背景：慢性疾病成為全球健康十大威脅之一，臺灣又因醫療專業高度分工導致片段式醫療問題，然而透過照護協調性的提升可有效的解決片段式照護問題，進而提升慢性病患之照護結果。目的：採用病患照護評估問卷，探討慢性病患照護評估與健康生活品質之關係。方法：本研究針對20歲以上患有糖尿病、高血壓、慢性阻塞性肺疾病、氣喘、心臟衰竭以及慢性腎臟病中任一種疾病以上滿六個月之慢性病患進行收案。因應COVID-19疫情影響，問卷收集共有兩種方式，紙本問卷的收案於2020年1月12日至2020年2月20日進行，紙本有效問卷115份，疫情爆發前與台北市北投區社區醫療群合作進行收案，疫情爆發後於無法繼續於北投社區醫療群收案，改以訪員居住地新北市新店區進行立意取樣搭配滾雪球的方式收案，針對填寫紙本問卷的對象進行首次收案日後30/90日內的電訪追蹤照護結果；網路問卷的收案疫情爆發後的2020年2月7日至2020年3月1日進行一次性的調查，網路有效問卷200份。本研究使用中文版病人慢性病照顧評估(Patient Assessment of Chronic Illness Care, PACIC)問卷測量病患照護評估，以EQ-5D量表及EQ視覺化量表(Visual Analogue Scale, VAS)測量健康生活品質，及追蹤30及90日健康生活品質，以複線性迴歸探討慢性病患照護評估與健康生活品質之關係，再以逐步複迴歸探討PACIC哪些面向與健康生活品質有關。結果：較高的PACIC分數，有較高的90日EQ-VAS；再者，無論在橫斷性或30/90日追蹤研究中，PACIC問卷中「問題解決」面向的分數愈高，皆有愈高的健康生活品質。結論：慢性病患照護評估與較高的90日健康生活品質有相關。透過病患的觀點了解到，醫療提供者於制定治療計畫時，考慮潛在的障礙，包含了解病人其疾病對日常生活的影響並於制定治療方案時考量病患的價值觀或文化習慣、提供日常生活就能做到的治療方案以及訂定病情加重時的應變措施等，可促進慢性病患之健康生活品質。

Background: Chronic conditions have been listed among the top ten global health threats. In Taiwan, high degrees of work specialization in medical fields have contributed to the existence of fragmented medical care problem. However, by improving care coordination, we can effectively solve the problems of fragmented care and further enhance the outcomes of care for patients with chronic conditions. Objective: We explore the relationship between chronic care assessment and health-related quality of life using patient assessment of chronic care questionnaire. Method: Our research subjects included patients over 20 years of age who suffered from chronic diabetes, hypertension, obstructive pulmonary disease, asthma, heart failure, or chronic kidney disease for six months or more. Due to the COVID-19 pandemic, questionnaires were collected in two manners. First, hard copies were collected from January 12, 2020 through February 20, 2020, with a total of 115 valid responses. However, prior to the outbreak of COVID-19, we partnered with the community medical group in the Beitou District, Taipei City to collect data. However, after the onset of the pandemic, we were unable to continue our original plan. Instead, we collected data from subjects in the Xindian District, New Taipei City, where the interviewer resided, by means of purposive sampling alongside with snowball sampling. For subjects who filled out hard copies, telephone interviews were conducted 30 and 90 days after first data collection to track their care outcomes. After the outbreak of COVID-19, a one-off online questionnaire was conducted from February 7, 2020 through March 1, 2020, with a total of 200 valid responses recovered. In this study, the Chinese version of Patient Assessment of Chronic Illness Care (PACIC) was used to measure patient care assessment, and the EQ-5D and EQ Visual Analogue Scale (VAS) were employed to measure and track the health-related quality of life in 30 and 90 days. Multiple linear regression analysis was performed to explore the relationship between chronic patient care assessment and health-related quality of life; furthermore, stepwise multiple regression analysis was carried out to investigate which aspects of PACIC were related to health-related quality of life. Results: Patients with a higher PACIC score showed a higher EQ-VAS value in 90 days. Moreover, both in the cross-sectional study or the 30/90 day follow-up study, patients obtaining higher scores in the “problem solving” subscale in the PACIC questionnaire all displayed higher health-related quality of life. Conclusion: Chronic care assessment is related with higher health-related quality of life in 90 days. Through the perspective of patients, it can be seen that while formulating treatment plans, it will be helpful in improve the health-related quality of life for patients with chronic conditions if medical providers consider their potential obstacles, which include the impact of the patients’ conditions on their daily lives, while also taking into account of the patients’ values or cultural practices. In addition, providing treatment plans that can be easily executed in their everyday life, as well as devising contingency measures to deal with worsening conditions should also be considered.