[[alternative]]Integrated Care and Self-management In Type 2 Diabetes Nephropathy Elderly Patients – Longitudinal Research

[[abstract]]目的: 全球罹患糖尿病 65 歲以上人口發生率比例明顯增加，病人平時做好自我 管理的行為極為重要。本研究目的為探討 1.第二型糖尿病合併腎病變高齡老人的 人口學與疾病特性及生理指標、整合照護及與自我管理的相關性與差異。2.比較 常規組與整合照護組兩組間自我管理差異。3.找出影響自我管理的預測因子及追 蹤自我管理長期變化趨勢。方法: 收案樣本數 84 人，採重複測量病例控制研究 設計，方便取樣。以基本資料表、病人整合照護經驗問卷、自我管理量表、身體 功能狀態量表為監測工具，於 2016 年 6 月 1 日至 2017 年 11 月 30 日期間，於收 案時、第三個月、第六個月以結構式問卷進行資料收集。資料統計分析使用 SPSS 20.0 軟體，以獨立 T 檢定、皮爾森積差相關分析基本資料、整合照護與自我管理 的相關與差異，多元階層線性回歸模式分析自我管理之預測因子，以相依樣本重 複測量變異數分析及事後比較分析、混合線性模式分析自我管理長期變化差異與 趨勢。結果: 本研究發現第二型糖尿病合併腎病變高齡老人(1)病人整合照護經 驗感到同意的前三名為治療過程中醫病關係變得更好、知道更多疾病健康照護的 專業知識、身體狀態整體上獲得改善。(2)性別、身體活動功能狀態、罹病時間 及整合照護經驗與自我管理相關性達統計顯著差異。(3)常規組與整合照護組兩 組不同時間的自我管理分數不同，整合照護組第三個月及第六個月分數較高且達 統計顯著差異。(4)整合照護經驗及身體活動功能狀態為自我管理表現程度的預 測因子。(5)不同時間點監測自我管理分數達統計顯著差異，隨著時間變化會影 響自我管理表現行為，但是比較兩組並沒有達顯著統計差異。 結論:第二型糖尿病合併腎病變高齡老人在自我管理表現程度與參加糖尿病整合 照護未達統計顯著差異，但時間會影響自我管理的長期變化趨勢。本研究結果可 提供臨床醫療人員了解二型糖尿病合併腎病變高齡老人整合照護及自我管理表 現程度的參考。[[abstract]]Purposes: The incidence of Diabetes in increasing worldwide. Self-management is animportant behavior. The purposes of the study were to: (1) examine the demographic characteristics, disease characteristics, and physiologic indicators in diabetes elders with nephropathy; (2) compare the differences of self-management of diabetes elders with nephropathy who was a case group received integrated care and a control group received usual care; and (3) explore the factors associated with self-management and longitudinal change patterns were investigated in the two groups. Methods: Thisstudy was repeated measures, case-control study with consecutive sampling. Datawere collected using structure questionnaire with demographic information form, Integrated Care Experience Questionnaire, The Partners in Health scale, and Karnofsky Performance Status Index. There were 84 subjects enrolled in this study from June 1st, 2016, to November 30th, 2014. Patients were assessed at three time points: baseline assessment (T0), and then at 3 and 6-months (T1 and T2) after participating in the study. Data was conducted by using SPSS Version 20. Independent t test, chi-square, and Pearson's correlation coefficient test were used to examine the correlation and differences of integrated care and self-management. Hierarchicallinear model was used to reveal the factors related to self-management. Repeated-measurement ANOVA with post-hoc were mixed model were used for determining longitudinal change patterns of self-management. Results: The results showed that: (1) The top agreement experiences of integrated care were as: better physician-patients relationship, understand more knowledge about illness health care, and improvement of physical condition; (2) Sex, physical performance, time sinceDM diagnosis, and experiences of integrated care correlates with self-management; (3) Patients in case group had higher self-management compare to patients in controlgroup at 3 and 6-months (T1 and T2) after participating in the study; (4) Experiences iiof integrated care and physical performance physical performance self-management; and (5) change patterns of self-management following time, without statistically significant differences in both groups. Conclusion: No statistically significant differences in the mean scores of self-management between groups, but change patterns of self-management following time. The results of this study can provide clinical health providers as references for integrated care and self-management among type II diabetes elders with nephropathy