| Summary: | 碩士 === 中國醫藥大學 === 醫務管理學研究所碩士班 === 95 === Abstract
Background and purpose: The prevalence of chronic diseases, such as diabetes mellitus (DM), increases, because of the change of lifestyle and eating behavior. Although DM is not curable, a positive attitude toward controlling DM can control the progression of this disease and further reduce the medical cost for this disease. In November, 2001, Nation Health Insurance Administration implemented one policy of “Diabetes Case Management Program” which aim is to improve the integrated care of DM patients. Therefore, the main purpose of this thesis is to use the dataset of this program to examine the effect of cigarette smoking and alcohol drinking on the medical compliance (taking the medicine, caring oneself, glucose control) as well as the control of blood sugar measured by HbA1c among the DM patients.
Materials & Methods: The study population was the DM patients (ICD9 code: 250) who were enrolled in the Diabetes Case Management Program in one medical center of the central Taiwan. The inclusion criteria for this study was that patients had to have at least 4 times of follow-up records in this program at least 4 times between August, 2004, and July, 2005. In total, 2,156 eligible subjects were analyzed.
Results:
The mean scores of compliance for caring oneself for male and female patients with smoking is lower than those without no smoking by 0.045 point (p<0.05) and 0.139 point (p<0.01). The odds of having bad glucose control, 8% HbA1c<9%, relative to good glucose control, HbA1c <7%, drinking for male patients with drinking behavior is 1.77 times of that for male patients without drinking behavior (p<0.05).
The mean value of HbA1c at endpoint for male patients with smoking increases by 0.21% compared with male patients without smoking (p<0.05). Male patients who reported complete compliance for taking the medicine at baseline has mean value of HbA1c at endpoint is lower by 0.57% (p<0.01) than those who did not. The mean value of HbA1c at endpoint for male patients with 1 point in compliance for caring oneself reduced by 0.3% (p<0.05) compared to those with 0 point in compliance for caring oneself. The mean value of HbA1c at endpoint for female patients with 1 point in compliance for caring oneself increase by 0.26% (p<0.05) compared to those with 0 point in compliance for caring oneself.
Key word: Diabetes mellitus, Diabetes Case Management Program,
Compliance.
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