| 摘要: | 隨著永續發展意識覺醒，人們越來越關注醫療保健產業的可持續性。由於透析治療在台灣醫療保健業的重要性，對於腎臟病末期患者，透析治療是重要維持生命的醫療策略。全球的腎臟病患者高達8.5億，慢性腎臟病的患病率約10.4%-11.8%，治療腎臟疾病和腎功能衰竭對全球醫療保健預算造成沉重的經濟負擔。其中，台灣2020年台灣的末期腎臟病透析發生率居全球之冠，急性腎衰竭及慢性腎臟疾病也高居健保支出第一名。以台灣末期腎臟病患高人數、高盛行率、高看診次數、高度醫療資源使用，以及產生高量的醫療廢棄物而言，關注透析治療與環境影響之間的平衡, 對於末期腎臟病患者福祉與醫療產業的可持續性至關重要。
作為醫療保健專業人員和病患，我們更加關注治療與環境影響之間的平衡。我們可以對流程和路線圖做出改變，以重組醫療服務部門，打造一個更清潔、更環保的未來。故本研究目的為 1. 訪談腎臟科醫師探討醫療專業者對透析醫療服務永續之看法， 2. 應用患者旅程模型探討醫療經驗和可持續發展的觀點，以及 3. 提出我們的框架和建議，以實現醫療專業人員和醫療保健領導者的可持續發展。
本研究採質性訪談，受訪者對象為三位腎臟科專科醫師。質性訪談內容採用主題分析法，研究過程包含準備、資料蒐集、資料分析和論文撰寫階段。採用Lincoln與Guba提倡的判準構念，確保研究的可信性與可靠性。研究倫理方面著重於身分保密、尊重參與者和呈現真相。亦透過患者個人資料及就醫資料，進一步分析影響存活之相關因素。同時應用患者旅程模型customer journey canvas進行透析治療病患就醫治療歷程分析。
當我們從永續觀點看腎臟病末期病患透析治療時，我們彙整台灣教學醫院醫師對於透析治療永續發展上的意見，不同透析方式之短期結果並沒有顯著差異。當受訪者們論及血液透析和腹膜透析兩種不同的腎臟替代治療方式時，受訪醫師間看法並不盡相同。血液透析被強調其可固定或可調整的透析參數，適用於多數患者，但也提到可能引起血壓下降和注射疼痛的問題。相對地，腹膜透析被形容為更具自主性的方式，容許患者在家中施行，避免頻繁就醫，然而，需考慮自行更換透析液和維護衛生環境的挑戰。受訪者進一步討論了選擇治療方式時需考量的因素，如生活方式、工作環境、家庭支持、教育程度和共病症等。總括而言，他們強調兩種透析方式在治療場所、頻率、血壓控制和自主性等方面的區別，凸顯選擇治療方式需綜合考慮患者的個體差異和生活情境。若從永續觀點分析，以患者旅程模型分析，則會看見腹膜透析則會大幅降低碳足跡/醫療廢棄物/里程交通，我們認為，第一步是喚起醫療專業人員對患者治療與可持續性之間平衡的認識，並建議未來能持續討論與提出醫療專業人員和醫療保健領導者的行動願景和戰略框架與應用建議。
Abstract
As the awareness of sustainable development grows, there is an increasing focus on the sustainability of the healthcare industry. Due to the significance of dialysis treatment in the healthcare sector in Taiwan, particularly for end-stage renal disease (ESRD) patients, dialysis therapy is a critical life-sustaining medical strategy. Globally, the number of kidney disease patients reaches up to 850 million, with an incidence rate of 10.4%-11.8% for chronic kidney disease. Treating kidney diseases and renal failure imposes a significant economic burden on global healthcare budgets. In 2020, Taiwan held the highest global incidence rate of end-stage renal disease requiring dialysis, with acute kidney failure and chronic kidney diseases also ranking as the top contributors to National Health Insurance expenditures. Given the high number of ESRD patients, prevalence rates, frequent medical consultations, intensive use of healthcare resources, and the generation of substantial medical waste in Taiwan, the balance between attention to dialysis treatment and its environmental impact is crucial. This balance is of utmost importance for the well-being of end-stage renal disease patients and the sustainability of the healthcare industry.
As healthcare professionals and patients, we are increasingly concerned about finding a balance between treatment and its environmental impact. We can make changes to processes and flowcharts to restructure healthcare service departments, creating a cleaner and more environmentally friendly future. Therefore, the objectives of this study are: 1. To interview nephrologists and explore their perspectives on the sustainability of dialysis medical services, 2. To utilize the patient journey model to examine healthcare experiences and views on sustainable development, and 3. To present our framework and recommendations for achieving the sustainable development of healthcare professionals and healthcare leadership.
This study adopts a qualitative interview approach, with three nephrology specialists as participants. The qualitative interview content is analyzed thematically, encompassing the stages of preparation, data collection, data analysis, and thesis writing. Lincoln and Guba's criteria are employed to ensure the credibility and reliability of the research. Ethical considerations focus on identity confidentiality, participant respect, and truth representation. Additionally, patient personal and medical data are utilized to further analyze factors influencing survival. Simultaneously, the patient journey model, specifically the customer journey canvas, is applied to analyze the treatment process of dialysis patients.
Looking at end-stage renal disease (ESRD) patients undergoing dialysis from a sustainability perspective, opinions from physicians at teaching hospitals in Taiwan were compiled. Short-term outcomes did not significantly differ between different dialysis methods. When interviewed physicians discussed hemodialysis and peritoneal dialysis, opinions varied. Hemodialysis was emphasized for its fixed or adjustable dialysis parameters, suitable for most patients, but concerns were raised about potential issues such as blood pressure drops and injection pain. In contrast, peritoneal dialysis was described as a more autonomous method, allowing patients to perform it at home, avoiding frequent hospital visits. However, challenges related to self-changing dialysis fluid and maintaining a hygienic environment were acknowledged. Participants further discussed factors to consider when choosing a treatment method, including lifestyle, work environment, family support, education level, and comorbidities. In summary, they highlighted differences between the two dialysis methods in terms of treatment location, frequency, blood pressure control, and autonomy, emphasizing the need to comprehensively consider individual patient differences and life circumstances when selecting a treatment method.
From a sustainability perspective and analyzing with the patient journey model, peritoneal dialysis significantly reduces carbon footprint, medical waste, and transportation miles. We believe the first step is to raise awareness among healthcare professionals about the balance between patient treatment and sustainability. Additionally, we suggest continuous discussions and proposals for the action vision, strategic framework, and application recommendations for healthcare professionals and healthcare leadership in the future. |
