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助成対象詳細(Details)

   

2013 研究助成 Research Grant Program  /  共同研究助成A2  
助成番号
(Grant Number)
D13-R-0088
題目
(Project Title)
ヴェトナム・カントー市における脳卒中の高齢者のための継続的なケア·モデルの開発
Development of a Continuing Care Model for Older Adults With Stroke in Cantho City, Vietnam
代表者名
(Representative)
チャン・ティ・ハン
Tran Thi Hanh
代表者所属
(Organization)
カントー医科大学学術調査·国際交流室
Office for Scientific Research and International Relations, Cantho Medical College, Cantho City, Vietnam
助成金額
(Grant Amount)
 4,500,000
企画書・概要 (Abstract of Project Proposal)

脳卒中の高齢者のための熟練した介護技術は退院後には引き継がれず、家族である介護者が、介護の移行に自己対処しなければならない。そのため、彼らの予後を改善する手法を早急に開発することが必要である。本プロジェクトでは、退院後の継続的なケア・モデルを開発し、都市部における脳卒中の高齢者のため、予後の改善をはかる。調査は、地域の病院を退院した数組の脳卒中の高齢者と、その家族介護者を対象に、さまざまな異なる方法を組み合わせて実施される。アンケート、フォーカスグループ、綿密なインタビュー、またフォローアップ調査によりデータ収集を行う。その上で、具体的に、(1)退院計画を実行に移し、(2)家族介護者による介護の実践を支援する。脳卒中の高齢者の予後の改善は、(1)当事者の場合には、QOL、臨床成果、合併症の有無によって、(2)家族介護者の場合は、介護のセルフ・マネジメント能力の向上によって測定され、さらに(3)介護医療費についても検討が行われる。データの分析に当たっては、対応のないt検定とペアt検定を用い、ケア・モデルの有効性を測定する。本プロジェクトの結果、ケア・モデルが実施されることで、脳卒中の高齢者の予後が改善し、モデルの有効性が示されることが期待される。

 Skilled nursing care for older adults with stroke (OAWS) has not been extended beyond hospitals after hospital discharge and the family caregivers (FCG) have to self-manage in coping this care transition. Therefore their stroke outcomes (SOs) need urgent solutions to be improved. The objective of this project is to improve SOs in care for the OAWS in the city through developing a continuing care model for them after hospital discharge. Mixed method research will be used. The participants include dyads OAWS discharged from district hospitals and their FCG. Data collection will be done by surveying, focus group, in-depth interviewing and following up. Main interventions will be: (1) Implementing discharge plan and (2) Supporting FCG's self-management (SM). SOs to be measured are: (1) For OAWS: QoL, Clinical Outcomes and Complications; (2) for FGC: Competences of SM; and (3) Cost of health care. Data analysis will be done using independent t test and Pair t-test at p<.05. After implementing the model, SOs are expected to be improved and the continuing care model proved effective.

実施報告書・概要 (Summary of Final Report)



Background: Post-stroke management in Can Tho City, Vietnam has shown its limitations. Post-stroke care for stroke survivors performed by health professionals has not exceeded beyond hospitals and family caregivers have to take charge of post-stroke care after hospital discharge. Low stroke outcomes of stroke survivors, at which most of them are aging people, is commonly observed in the city. 
Purpose: This research project’s aim is to develop a continuing care model for older adults with stroke (OAWS) in the city. 
Method: The research project was divided into four main phases, at which findings from previous phase were used to develop the next phase. The participants for each phase has some different from the other phase. For the two phases of implementation and evaluation, 94 dyads of OAWS and their family caregiver (FCG) were recruited in the project. The participants were allocated into 49 dyads in control group (CG) and 45 dyads in intervene group (IG). Mixed method research design was applied in the project. More specially, Pre-test Post-test Non-equivalent Comparison group Design was used in two last phases of model implementation and evaluation. OAWS’s Stroke outcomes, consisting of QoL, Neurological deficit, complications from stroke and self-care; FCG’s self-management in post-stroke care, consisting of KAP and satisfaction, were used to explore the model effects. The model effects were evaluated with two ways: Cross-sectional evaluation to compare mean in stroke outcome and self management between CG and IG before model implementation (MI) and after MI, using Independent Samples T Test at p=0.05. Longitudinal evaluation to compare mean’s variation in stroke outcome and self management within CG and IG before-after MI, using Paired Samples T Test at p=0.05
Results: Cross-sectional evaluation: Before MI, the baseline outcomes; including OAWS’s stroke outcomes and FCG’s self-management on post-stroke care; had indicated that the model implementation was departed at the similar circumstances related stroke. After MI the majority of findings compared between the two groups at the point time had showed statistically significant differences. Quality of life, neurological deficit and self-care of OAWS in IG are better than those in CG. Their complications from stroke in IG are more improved than those in CG, except dysphagia and pain. FCG’s self-management on post-stroke care in IC is also better than that in CG, except attitude. 
Results: Longitudinal evaluation: The model’s positive effects were confirmed with evidences. Quality of life, Neurological deficit and Self-care of OAWS in IG were better than that of those in CG. Their complications from stroke, Pain, Falling, Ulcers and Constipation were reduced after MI. FCG’s practice to take care their stroke patients was better after MI. However, the model's effects have shown some limitations. OAWS’s dysphagia; FCG’s family caregiver’s knowledge, attitude and satisfaction on post-stroke care were not improved after MI.
Conclusion: The model made improved OAWS’s Quality of life, Neurological deficit and Self-care but dysphagia; FCG’s practice but knowledge, attitude and satisfaction. 
Recommendation: The model is able to be applied in Cantho City. More researches or regulations supporting stroke in community should be carried out. 

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