| 摘要: | 為強化藥事人員專業服務功能，輔導高藥品利用病患用藥行為及教育，提升民眾用藥安全與品質，建立更安全的用藥環境，故以嘉南藥理科技大學藥學系為中心，與台南市立醫院、新樓醫院及高雄長庚醫院醫療團隊暨社區藥事人員共同建構完善藥事服務網，增進用藥安全。根據研究，我國民眾就醫自主性高，及高利用民眾常有就醫權益主張；另同時有多項慢性病之病患，通常為年紀較大、教育程度較低、同時患有多種疾病、同時服用多種藥品且需要長期使用藥品等特色。當慢性病患使用治療濃度範圍較狹窄的藥物，若病患需要長期使用但又未能有一個確切的使用後續追蹤服務時，病患甚至可能於服藥期間因為藥物不良反應或病情沒有得到良好控制而放棄治療，直接影響此類慢性病患的醫療結果，間接的造成醫療及社會成本增加。藥物為何無法達到最佳治療效果？是因為病患服藥順從性或自我疾病照顧與藥物副作用監控觀念不足所造成？因此本研究主要目的為透過經專業培訓後的藥師到病患家中或長期照護機構內執行藥事照顧活動。病患的來源由上述合作醫院提供高就診及高藥品利用量的民眾名單與連絡方式，以提供他們額外健保福利的策略，指派藥師去提供用藥諮詢與藥事照顧活動。而藥師的酬勞是以論人計酬方式，以一年照顧病患至少八次為目標，來達到下述成效：一、降低高診次病患就診次數，與前一年比能降低20%醫療花費。二、降低病患藥物使用品項數，與前一年比能降低20%藥費。三、降低藥物治療問題的個數。四、讓更多民眾達到藥物治療目標（用藥符合適應症、有效、安全、配合度提高）。
In order to promote services provided by pharmacy professionals, to provide appropriate medication use care and safety counseling for patients with frequent medical visits, to improve medication safety and quality for the public, and to establish a safer medication use environment, the pharmacy department of Chia-Nan University of Pharmacy and Sciences has coordinated with Tainan Municipal Hospital , SinLau Hospital and Chang Gung Medical Foundation medical teams and community pharmacists to establish a well-rounded pharmacy care network to improve mediation safety. According to the results of recent studies, citizens in Taiwan take an active role in seeking medical care, and they often hold their own beliefs about medical rights. They usually have the following characteristics: patients with many chronic diseases, who are usually elderly, having lower education level, and taking many medications for multiple diseases. When patients of chronic diseases taking drugs with narrow therapeutic index taking long-term medication, and not receiving appropriate follow-up services, they may stop treatment as a result of adverse drug reactions experienced, and/or not reaching the expected control of the diseases. The problems may directly affect treatment outcomes and indirectly incur costs for the medical system and society. Many reasons can be attributed to the problems for patients who cannot reach optimal treatment outcomes with medication use. They may be problems with medication compliance, self-care ability, and drug side effects. Nevertheless, these reasons were not well-studied in populations with frequent medical visits. The objective of the study is to provide medication care and safety counseling for patients with frequent medical visits to enhance self-care ability in patient with chronic disease through the care of pharmacists using medication-safety-oriented care method to patient medication education and drug use follow-ups, and to obtain reasons for over-usage of medications in order to enable patients to reach the desirable treatment outcomes, reduce unnecessary medical visits (outpatient visits, emergency room visits and hospitalizations) and numbers of medications used. Thus, reduce monthly expenditures on medication use. |
