慢性腎臟疾病保健推廣業務成果報告 陳殷正 蔡宜潔 李淑慧 陳淑麗 古孟麗 林穎貞 黃道媛 林水龍

1. 工作執行 改善與建議 成果報告 本院很榮幸已連續六年成為腎臟保健推廣的指定機構。隨著國民健康局丶台灣腎臟醫學會及健保局的積極推動,慢性腎臟病的觀念已逐漸的從醫院推廣至社區,本院今年特別著重於社區之推廣,並結合台北縣衛生局,落實腎臟保健的觀念; 以期在社會的各個層面皆能達到早期發現早期預防的目的。期能藉此降低末期腎病的發生率。 引言 慢性腎臟疾病保健推廣業務成果報告 陳殷正蔡宜潔李淑慧陳淑麗古孟麗林穎貞黃道媛林水龍 • 舉辦基層腎臟病防治研討會 (98/11/19): 邀請本院家醫科醫護人員參與，共同加入慢性腎臟病防治工作。 1.團體衛教 • 經院際活動的推廣及各個醫院的努力,目前署立桃園醫院, 署立基隆醫院, 署立新竹醫院等已開始收案;署立樂生療養院及桃園榮民醫院即將開始收案;同時我們也與台北縣衛生局(23家衛生所)擴大合作,加強病人的轉介。 • 收案及追蹤: 截至98年11月收案病患共1085人，結案病患265人，目前仍追蹤個案數819人;97年新收個案數155人，結案63人。病患分析如下: 1 . 團體衛教 ①『 0308全國愛腎護腎、腎利人生』園遊會(98/03/08): 今年度持續響應台灣腎臟醫學會及國民健康局於每年三月所舉辦的衛教園遊會,除了現場民眾外也很感謝本院腎友的熱心參與。 • 1. 已結案之病患當中,有28人進入透析治療 ,82%選擇血液透析,18%選擇腹膜透析。36%的病患未使用暫時性導管透析; • 選擇血液透析之病患有30%在透析前完成A-V Shunt; 70%病患在透析前即開始接受EPO注射。 • 在病患追蹤方面 ,本院今年結合電腦登錄系統及改良的追蹤流程,對於連續三年在本院追蹤之患者資料做分析發現 ,參與慢性腎臟病推廣衛教之患者 ,著實能延緩其進入末期腎病之時機。 • 本院不僅著眼於醫院當地社區的腎臟病衛教 ,尚以大台北縣地區的腎臟保健推廣為念 .今年協助台北縣衛生局取得國健局的腎臟保健計畫, 以推動全台北縣地區居民的腎臟健康為目標 ,藉由對基層院所(特別是各鄉鎮市衛生所)的腎臟病衛教教導及後續的個案討論會及團體衛教 ,逐步建立基層對慢性腎臟病的了解及初步衛教民眾的能力 ,藉以提升民眾對腎臟健康的自覺與重視 ,由目前慢性腎臟病防治慢慢往前推向預防 ,相信假以時日 ,會看到透析及CKD發生率開始下降 ,擺脫世界第一的不名譽 . • ②慶祝88節之尿液篩檢活動(98/08/14): 民眾反應熱烈, 共篩檢149人。 ③“腎臟病會不會遺傳”暨CKD收案病人二等親家屬尿液篩檢: 參加總人數149人, 異常者共51人,占34.2%分布如下: 2. 院內丶院際活動推廣 • 今年本院雖與台北縣衛生局(23家衛生所)擴大合作 ,然也許期間不夠久 ,迄今未看出顯著成效。未來這部份仍有發展之空間。 • 建議將資源集中在有熱忱支持慢性腎臟病防治的醫院 , 可依據今年執行成果優先選擇各地區表現較佳之醫療院所 ,如20-30家醫院 ,補助明年度的計畫 .或是對於今年表現不佳的醫療院所明年不再補助 ,畢竟把有限的資源放在有效率的地方應能達成較佳的成果 。 • 建議如果各院申報金額未達健保局Pre-ESRD預防性計畫預算 ,可採浮動點值增加給付或依據執行成效與品質予以獎勵 ,以鼓勵努力支持健保局Pre-ESRD計劃之醫療院所。 • 未來我們將繼續以本院出發，橫向朝附近社區及相關醫療院所，縱向朝擴大病患家屬之篩檢;期能讓腎臟病患皆能做到早期發現早期治療。

2. Introduction of a New e-Hemodialysis Process: Applying a Mobile Medical Station with an Information System to Simplify the Process of Hemodialysis 導入新e化血液透析流程: 運用配置透析資訊系統之行動治療車簡化血液透析流程 – 某區域醫院經驗探討 Chen Y. C., Tsai I. C., Lee S. H., Lin S.L. 陳殷正, 蔡宜潔, 李淑慧, 林水龍 Objectives In this study we applied a newly designed "Mobile Medical Station" equipped with an integrated hemodialysis information system (HDIS) to initiate a new e-hemodialysis process to improve the patient safety and the effectiveness and efficiency of medical care. paper, space of storage, and time of the delivery of the papered charts. The questionnaire survey showed more than 90% satisfaction among patients and more than 85% satisfaction among staffs in all items. Methods We developed a HDIS, which integrated the in-hospital healthcare information system, the health insurance reporting system, and could produce the patients’ summaries and electronic charts. The system was installed to each "Mobile Medical Station" which is linked to the central server via a wirelessly intranet. The digitalized data of patient’s body weight and blood pressure were also transmitted wirelessly to the central server automatically. Quantitative and qualitative approaches were used to determine the usefulness of the new "Mobile Medical Station" with the integrated HDIS. Focus groups were conducted with physicians, nurses, clerks and patients to better understand the impact of the new system. In-depth interviews, questionnaires and checklists were conducted in this study. Results After the introduction of the new system, the hemodialysis process became more promised, simplified and efficient. We found several benefits in many respects. In patients’ respect, they don’t need to worry about the “wrong” body weight which might induce wrong removal of body water. The safety is assured much. In the physicians’ respect, the new HDIS could output the integrated patients’ summary which helped the clinical treatment. They could also easily search and review the previous patients’ charts via the new system. The effectiveness and efficiency of the medical care improved. In nurses’ respect, the labors and time of recording was lessened for many data was input automatically and some commonly used phrases were applied. The mobile station also helped them stay at the bedside more time and handled most of the erroneous conditions immediately. The medical orders from the physicians could be transformed by HDIS directly into the treatment charts for them. The quality of nursing care and communication between nurses and physicians also improved. In the whole hospital’s respect, the process of registration and the production of the reports for health insurance were simplified. The electronic charts, instead of the papered charts, save much Conclusions The newly designed "Mobile Medical Station" equipped with an integrated HDIS helped improve the patient safety, the effectiveness and efficiency of medical care, and the communication between physicians and nurses. And the new process saved much cost of labors, time and paper. We are still continuously expanding the HDIS to link more digitalized equipments, such as dialysis machines. We hoped to create a new e-hemodialysis process to provide a safer and more efficient hemodialysis treatment.