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標題: | 醫院社會責任的實踐:以氣喘疾病管理為例 Fulfilment of Hospital Social Responsibility Focusing on Asthma Management |
作者: | Hao-Chien Wang 王鶴健 |
指導教授: | 陳家麟 陳家麟(cchen026@ntu.edu.tw) |
關鍵字: | 醫院社會責任,氣喘疾病管理,SABA過度使用,溫室氣體排放,C-SOP分析, Asthma management,SABA overuse,Green House Gas emission,Carbon foot print,Hospital Social Responsibility,ESG,C-SOP, |
出版年 : | 2022 |
學位: | 碩士 |
摘要: | 企業社會責任(corporate social responsibility; CSR)是企業在貢獻經濟發展的同時,承諾遵守道德規範、改善員工及其家庭、當地整體社區、社會的生活品質。聯合國全球協議2004年首次提出 ESG的概念:環境保護(Environment; E)、社會責任(Social; S)、公司治理(Governance; G)。ESG幾乎涵蓋及反映公司在社會和環境營運的所有可能要素,以及營運模式是否達到具備“永續”和“社會責任”的要求。醫療保健行業,如果能制定強而有力的ESG方法,包括氣候行動計劃(Climate Action Plan; CAP),除了可以減少這些影響,同時還可以支持許多醫療保健組織的目標:建立更健康的社區、幫助弱勢群體。氣喘是一種普遍的全球性疾病,都市化及工業化的發展使得氣喘罹病人數逐年增加。氣喘是一種氣道慢性發炎性的疾病,但是在良好的控制下,可避免症狀的發生,達到良好的生活品質。控制不佳時,往往增加急性惡化發作的頻率,除了造成病人的生活品質惡化及增加住院、死亡風險外,也造成醫療資源負擔增加。氣喘的藥物治療可分為(1)症狀緩解型藥物(主要為氣管擴張劑)可以快速緩解支氣管收縮現象及其伴隨的咳嗽、喘鳴、胸悶等症狀,短效乙二型刺激劑(Short Acting Beta-receptor Agonist; SABA)是其主要藥物;(2)症狀控制型藥物,主要為吸入型類固醇(Inhaled corticosteroid; ICS),能減少支氣管黏膜的發炎反應,可以減少氣喘惡化,屬於治本、保養的藥物。治療氣喘的藥物除了口服、針劑之外,主要都採用吸入劑型(吸入器搭配吸入藥物)的藥物。吸入型藥物有很多種,一般可以歸類為三個類別:含推進劑(propellant)的壓力定量吸入劑(Pressurized metered dose inhaler; pMDI);和另兩種不含推進劑的乾粉吸入劑(Dry powder inhaler; DPI)及緩釋型氣霧吸入器(Soft mist inhaler; SMI)。壓力定量吸入劑內含的推進劑是一種液化的壓縮氣體,擔任霧化而載送藥物的功能。最早被使用的推進劑是氟氯碳化物(chlorofluorocarbons; CFC),它們是很強的溫室氣體,兼具消耗臭氧層的特性,被蒙特羅公約所禁止。取而代之的推進劑為氫氟烷化合物(hydrofluoroalkane; HFA),雖然它們不會消耗臭氧層,但依然是具有較高的全球暖化潛勢(global warming potential; GWP)的溫室氣體。全球每年使用HFA的壓力定量吸入器約6億3千萬支,造成1千3百萬噸的二氧化碳排放,約等於2百萬歐盟人口的碳足跡。 經由文獻回顧發現現行氣喘疾病管理的焦點問題有:(1)SABA過度使用的氣喘病人比例偏高(38%);(2)病人非處方自行購買SABA的比例偏高(17.6%);(3)SABA過度處方會增加40%氣喘急性惡化發生率;(4)SABA過度處方會增加氣喘控制不佳的比率;(5)SABA過度使用會有較高的死亡風險;(6)過度使用SABA的病患排放大量的溫室氣體。我們嘗試以C-SOP管理模式,來分析氣喘疾病管理之焦點問題,並提出可能解決方案。結論:醫院和其他企業一樣,除了要善盡社會責任外,也要追求永續發展。ESG的各項目標,可被用來檢視醫院經營的成效。醫院和所有的利害關係人都要建立ESG的觀念。氣喘是一種普遍全球性疾病,臨床上已有GINA診療指引,提供具有證據醫學的最佳照護建議。遵循指引建議的氣喘疾病照護管理,可以使氣喘達到完善的控制,病人可以享有良好的生活品質,避免急性惡化、住院及死亡的風險,也減少醫療資源的耗費。避免病人過度使用SABA除了讓病人可以有較佳的氣喘控制,也可以減少不必要的溫室氣體排放,這些新觀念和作法,希望能在醫療體系各個層級建立和執行,也提供醫院在整體照顧氣喘病人中達成ESG的實踐。 CSR (Corporate Social Responsibility) is the continuing commitment by business to behave ethically and contribute to economic development while improving the quality of life of the workforce and their families as well as of the local community and society at large. The categories of ESG (Environment, Social, Governance) have covered all the requirements for a corporate to operate and preparation to achieve both the sustainability and social responsibility. In the fields of healthcare industry, especially for hospital, set up the goals for ESG including climate action plan will not only avoid the influences but also facilitate the achieving the goals such as build-up much healthier community, assist the vulnerable groups. Asthma is a common disease globally, urbanization and industrialization causing the incidence of asthma increase annually. Although asthma is a chronic airway inflammatory disease, but well control patients could lead a symptomless and high quality of life. Patients with uncontrolled asthma would have frequent exacerbation result in poor life quality, increased risk of hospitalization and mortality. They also increased the possibility of healthcare resource utilization. Inhalation medication for asthma include(1)reliever(bronchodilators)for rapid relive of symptoms by reverse bronchoconstriction. Short Acting beta-receptor agonist (SABA) is the key drug.(2)Controllers (mainly inhaled corticosteroid, ICS) have anti-inflammatory effect on bronchial mucosa and could reduce acute exacerbation. Inhalation medications is the cornerstone of asthma management. There are variety of different inhalers which could be grouped into three main categories:(1)breath-actuated or pressurized metered-dose inhaler (pMDI) ,(2)dry powder inhalers (DPIs) and(3)soft mist inhaler (SMI) . MDIs contain propellants, liquified gases providing the force to generate the aerosol cloud. Until early 1990s, MDIs contained chlorofluorocarbon (CFC) propellants, which were ozone-depleting substances, and were therefore phased out under Montreal Protocol. Pharmaceutical companies developed CFC free MDIs, replacing CFC with hydrofluoroalkane (HFA) propellants, a greenhouse gases (GHG) , have high global warming potential (GWP) . Globally, 630million HFA-based pMDIs are used annually resulting in an estimate CO2e burden of 13 million tCO2e, equal to the carbon footprint of 2 million EU citizen. Through literature review, there are several key issues concerning asthma care were found:(1)high percentage of SABA over-user (38%) among all asthmatics;(2)high percentage of over-the-counter purchasing of SABA (17.6%) ;(3)SABA over-user had increased risk of acute exacerbation by 40%;(4)SABA over-user had poor asthma control;(5)SABA over-use had higher risk for mortality;(6)SABA over-user had high green gas emission. We plan to apply C-SOP model to analyzed these key issues & try to offer the practical solutions. Conclusions Hospitals, like other industries, need to fulfil the social responsibility and seek for sustainability. The categories of ESG could be used to evaluate the performance of hospitals. Hospital administrative and all the associated stockholders should built-up their ESG concept by themselves. Asthma is a common disease globally, we already have GINA guideline to provide evidence-base medicine for clinical reference. Compliance to the recommended management for asthma patients will result in good asthma control, better quality of life, avoidance of acute exacerbation, reduced risk of hospitalization and mortality. Compliant with guideline will also result in preventing the healthcare resource utilization. Avoidance of SABA overuse not only rendered patients a better asthma control but also reduced GHG emission and carbon footprint. These new concepts and practices should be conveyed to all the hospital administrative and the associated stockholders. Through the comprehensive care of asthma patient, we could also achieve the goals for fulfilment of ESG. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/85729 |
DOI: | 10.6342/NTU202203731 |
全文授權: | 同意授權(全球公開) |
電子全文公開日期: | 2022-09-30 |
顯示於系所單位: | 商學組 |
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