建構醫院和社區藥師的共同合作模式

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Title:	建構醫院和社區藥師的共同合作模式 Establishment of a Collaborative Model between Community Pharmacists and Hospitals
Authors:	許宮銓
Contributors:	藥物科技研究所劉文雄王四切
Keywords:	潛在性不適當用藥藥品消耗醫療成本居家照護藥事照護健保 Potential inappropriate medications Drug expenditure Home care Intervention Pharmaceutical care Health insurance
Date:	2012
Issue Date:	2013-04-22 16:49:57 (UTC+8)
Abstract:	藥事照護被定義為藥師有責任提供與藥物有關的照顧，且於2007年中華民國藥師法增修為藥師執行業務之一。本研究欲建構醫院與社區藥局藥師共同提供藥事照護模式，了解是否會影響醫療利用狀況且藉此模式減少健保耗用與增進民眾健康，期間共收案66名個案，篩選條件為台南縣市與高雄縣市的三家醫院（台南市立醫院與新樓醫院、高雄長庚醫院）2009年於該院看診次數>50次且該年度下半年看診次數>25次，排除中醫、眼科、復健科與身心科看診次數，共招募17位社區藥師進行個案藥物相互作用、藥物不良事件與潛在不適當用藥等藥事照護，並有15名醫院藥師作為後端學術支援。藥師於2010年3月到2011年8月進行居家訪視。在介入後的後半期（第8到第14月），藥品點數平均每人每月3,358.2點降為2,949.2點（p＝0.0010）；醫療點數平均每人每月5,528.2點降為5,273.9點（p＝0.0086）；總點數平均每人每月8,886.4點降為8,223.1點（p＝0.0042）；看診次數平均每人每月3.2次降為2.9次（p=0.0833），共病指數由2.8降為2.4（p＝0.0431），用藥數量由33.3項降為23.8項（p=0.0000）、潛在不適當用藥品項4.6項降為3.2項（p=0.0044）亦有顯著的減少。本研究證實醫院與社區藥局藥師可共同合作提供藥事照護服務，醫院藥師可提供病人較詳細的醫療資訊與學術支援；而社區藥局藥師則提供完善之居家藥事照護訪視，經研究證實藥事照護可以降低醫療成本，增進用藥品質，更可提供未來台灣藥事照護的合作模式。 The concept of pharmaceutical care has been implemented in the “Pharmacist Law” in the Republic of China (Taiwan) since 2007. It defines and regulates the responsibilities of pharmacists for caring patients in different settings. This prospective cohort study was to investigate the effect of collaborative model that is established to cooperate between community and hospital pharmacists regarding pharmaceutical care. Medical expenditure and usage data was obtained through Bureau of National Health Insurance. Student t-test, Chi-squared test, Mann–Whitney–Wilcoxon (Wilcoxon rank-sum test), multiple linear regressions, and multiple logistic regression were used for statistical analysis. Statistical significant level was set up at 0.05. Total of 66 patients who had over 50 outpatient visits in 2009 and over 25 visits in July 2009 to December 2009, were selected from three hospitals (Tainan Municipal Hospital, Sin-Lau Medical Foundation, and Kaohsiung Chang Gung Memorial Hospital), excluding patients who had rehabilitation, ophthalmic and Chinese medicine visits. Seventeen trained community pharmacists reviewed the patients’ drug profile for drug interaction, adverse effects, and the appropriateness of the prescriptions, as well as making recommendation for their medication usage. Fifteen hospital pharmacists were served as supporting pharmacists. Average monthly drug expenditure decreased from 3,358.2 to 2,949.2 Relative Value Unit (RVU) per person (p=0.0010)；average monthly medication expenditure decreased from 5,528.2 to 5,273.9 RVU per person (p=0.0086)；average monthly overall expenditure decreased from 8,886.4 to 8,223.1 RVU per person (p=0.0042)；the average monthly frequencies of physician visits decreased from 3.2 to 2.9 per person (p=0.0833). Not only decreased in expenditures but also decreased in the severity of disease (comobility numbers, 2.8 to 2.4, p=0.0042) and items of medication (33.3 to 23.8, p=0.0000), as well as items of potentially inappropriate medication (4.6 to 3.2, p=0.0044). This study concluded the collaborative model between hospital and community pharmacists was cost effective, efficient, and successful.
Relation:	校內一年後公開，校外永不公開，學年度：100，115頁
Appears in Collections:	[Dept. of Pharmacy] Dissertations and Theses

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