Publication: The comparison of cross-sectional indicators with sequential indicators to evaluate the intermediate outcomes of type 2 diabetic patients cared for by the family physician in a community hospital
| dc.contributor | Lai, Mei-Shu | en |
| dc.contributor.author | Huang, Hsin-Yang | en |
| dc.creator | Huang, Hsin-Yang | en |
| dc.date | 2009 | en |
| dc.date.accessioned | 2010-06-02T02:54:20Z | |
| dc.date.accessioned | 2018-06-29T17:58:05Z | |
| dc.date.available | 2010-06-02T02:54:20Z | |
| dc.date.available | 2018-06-29T17:58:05Z | |
| dc.date.issued | 2009 | |
| dc.description.abstract | Background: Diabetes mellitus (DM) is one of the top ten causes of death in Taiwan. The medical care for DM patients is getting more and more depending on the cooperation of multidisciplinary teams, frequent health educations, and regular follow-up for complications. Few studies have been focused on the effectiveness of DM intervention programs executed by family physicians. In addition, studies in the literature evaluated the effectiveness of DM intervention programs using cross-sectional indicators. None of them evaluated the effectiveness of DM intervention programs using sequential indicators.bjectives: Cross-sectional indicators and sequential indicators were used to evaluate the effectiveness of structured care (SC) for type 2 DM patients in a community hospital in Taitung by family physicians as compared to those who received usual care (UC). ethods: This is a retrospective cohort study. Patients were recruited between October 1, 2007 and January 31, 2008. After patients’ consents were provided, the patients who were regularly followed up for three months or longer in the outpatient clinics of family medicine before recruitment were assigned to the SC group. Others were assigned to the UC group. All patients were followed up for one year after they were assigned to the SC group or the UC group. Bivariate analysis was performed to explore the association between an independent variable and the dependent variable using Chi-square test (or Fisher’s exact test) for dichotomous independent variables or Student’s t test for continuous independent variables. Multivariate logistic regression analysis was also performed to explore the associations between the independent variables of interest and the dependent variables.esults: One hundred and twenty patients were assigned to the SC group and 99 patients were assigned to the UC group.he accountability (process indicator of diabetic care) in SC group is significantly better compared with UC group: more patients (99.2%) in the SC group had annual foot exam than UC group（24.2%）(p-value <0.001); more patients (90%) in the SC group had annual dilated eye exam than UC group（55.6%）(p-value <0.001); more patients (43.3%) in the SC group ever received pneumococcal vaccination than UC group（21.2%）(p-value＝0.001)；more patients (100%) in the SC group had biannual check up of HbA1C than UC group（96%）(p-value＝0.04) .hree cross-sectional indicators were used to compare the two groups before controlling for other confounding variables: more patients (53.3%) in the SC group reach the goal of LDL < 100mg/dL than the UC group (32.3%). (p-value = 0.002); more patients (32.5%) in the SC group reach the goal of HbA1C < 7% than the UC group (21.2%), though the difference is of borderline significance (p-value = 0.062); sixty (50%) participants in the SC group and 40 (40.4%) participants in the UC group reach the goal of SBP < 130 mmHg (p-value = 0.156). As demonstrated by sequential indicators defined as improved or being controlled: 72 (60%) participants in the SC group showed good sequential indicator of HbA1C, while only 42 (42.4%) in the UC group showed good sequential indicator of HbA1C (p-value = 0.010); no significant differences were found between the SC and UC group using sequential indicator of serum total cholesterol (p-value = 1.000) and SBP (p-value = 0.363). After controlling for other confounding variables using multivariate logistic regression analysis, the participants in the SC group were more likely to reach the goal of LDL < 100mg/dL than the participants in the UC group (O.R. = 2.58, 95% C.I. = 1.43 – 4.65, p-value = 0.002); no significant differences were shown between the two groups as indicated by cross-sectional indicator of SBP (O.R. = 1.61, 95% C.I. = 0.91 – 2.83, p-value = 0.101) and HbA1C (O.R. = 1.57, 95% C.I. = 0.75 – 3.29, p-value = 0.235). Sequential indicator of HbA1C, serum total cholesterol (T-CHO), and SBP were used to evaluate the effectiveness of structured care after controlling for other confounding variables: significantly more participants in the SC group resulted in good sequential indicator of HbA1C than those in the UC group (O.R. = 3.35, 95% C.I. = 1.61 – 6.94, p-value = 0.001); no significant differences between the SC group and the UC group were found using the sequential indicator of T-CHO (O.R. = 1.41, 95% C.I. = 0.72 – 2.74, p-value = 0.318) and sequential indicator of SBP (O.R. = 0.93, 95% C.I. = 0.47 – 1.84, p-value = 0.839).igher proportion of participants（83.3%）in the SC group had better adherence, defined as medication possession rate (MPR) greater than 0.8, than those in the UC group（65.7%） (p-value = 0.003). SC group was significantly associated with good MPR as compared to the UC group after controlling for other confounding variables (O.R. = 2.27, 95% C.I. = 1.15 – 4.46, p-value = 0.017).onclusion: The structured care significantly has better accountability of process of diabetic care and improves the intermediate outcome of type 2 DM patients as indicated by sequential indicator of HbA1C, though the effect did not appear if cross-sectional indicator of HbA1C is used to evaluate the effectiveness of the program. Furthermore, MPR demonstrate that the structured care is significantly associated with better adherence. | en |
| dc.description.tableofcontents | 第一章 前言 4二章 文獻回顧 6一節 美國糖尿病照護現況 6二節 台灣糖尿病照護策略與研究 6三節 慢性疾病之照護模式 12 慢性病照護模式 12 共同照護照護模式 15四節 糖尿病之照護模式研究 16五節 不同介入方式對糖尿病照護影響 19 多專業的共同照護 19 電腦提示系統促進糖尿病照護改善 20 醫療服務流程重新設計 22六節 遵醫囑行為（ADHERENCE）與血糖控制 23七節 糖尿病照護成效橫斷性與連續性指標之研究 24三章 研究目的 28四章 研究材料及方法 29一節 研究設計與對象 29二節 研究方式與資料蒐集 31 結構式照護組之實施方式 31 資料收集 32 研究變項與定義 32三節 研究假說與統計方法 35五章 結果 38一節 人口變項、藥物使用、收縮壓與生化值分析 38二節 併發症、身體質量指數與照護過程的專業盡責度 39 糖尿病併發症、後測身高、體重與身體質量指數分布 39 糖尿病照護過程的專業盡責度 39三節 糖尿病照護成效 40 經介入後，橫斷性指標分析結果 40 經介入後，連續性指標之分析 40四節 糖尿病用藥遵醫囑行為之分析 41五節 複邏輯回歸調整共變項，糖尿病照護成效結果分析 41 橫斷性指標之結果 41 連續性指標之結果 42 糖尿病用藥遵醫囑行為 42六章 結論與討論 51一節 結論 51二節 討論 52三節 研究之特點與限制 64七章 建議 65考文獻 67表目錄 1慢性病照護模式 14 2 研究架構圖 30 3 研究期間與資料蒐集日期 31 4 組內前後測糖化血色素比較 60 1國內糖尿病衛教臨床成效相關臨床研究 10 2兩組人口變項與藥物使用之分布 44 3兩組前測血壓之分布 44 4兩組前測生化值之分布 45 5研究期間糖尿病併發症之分布 45 6民國98年1月至3月兩組身高與體重之分布 46 7研究期間糖尿病照護過程盡責度指標分析 46 8後測生化值橫斷性指標相關性分析 47 9照護成效連續性指標相關性分析 4710用藥遵醫囑行為指標相關性分析 47 11 調整共變項，結構式照護組糖化血色素<7％的勝算比 48 12調整共變項，結構式照護組SBP<130MMHG的勝算比 48 13調整共變項，結構式照護組LDL <100MG/DL的勝算比 48 14調整共變項，結構式照護組血糖控制良好或獲得改善的勝算比 49 15調整共變項，結構式照護組收縮壓控制良好或獲得改善的勝算比 49 16調整共變項，結構式照護組總膽固醇控制良好或獲得改善的勝算比 49 17調整共變項，結構式照護組較佳糖尿病用藥遵醫囑行為的勝算比 50 | en |
| dc.format | application/pdf | en |
| dc.format.extent | 525720 bytes | |
| dc.format.mimetype | application/pdf | |
| dc.identifier.other | U0001-2707200910025200 | en |
| dc.identifier.uri | http://ntur.lib.ntu.edu.tw//handle/246246/184874 | |
| dc.identifier.uri.fulltext | http://ntur.lib.ntu.edu.tw/bitstream/246246/184874/1/ntu-98-R96846001-1.pdf | |
| dc.language | zh-TW | en |
| dc.language.iso | en_US | |
| dc.subject | diabetes mellitus | en |
| dc.subject | sequential indicator | en |
| dc.subject | cross-sectional indicator | en |
| dc.subject | structured car | en |
| dc.subject | adherence | en |
| dc.subject | accountability | en |
| dc.subject.classification | [SDGs]SDG3 | |
| dc.title | The comparison of cross-sectional indicators with sequential indicators to evaluate the intermediate outcomes of type 2 diabetic patients cared for by the family physician in a community hospital | en |
| dc.type | thesis | en |
| dspace.entity.type | Publication |
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