臺南市田野調查發現多重用藥及多位醫師看診開藥是當地用藥高危險民眾之特色。為評估藥事照護對於用藥高危險民眾用藥知能提升之影響與效益，從2013年3月至2013年10月為期8個月，由20位社區藥師依據用藥高危險收案條件篩選對象並獲簽署同意後納入研究。以開放式諮詢配合處方判斷性服務評估個案之用藥知識、時間/劑量、劑型使用技巧及是否有藥物治療問題(Medication-Related Problems，簡稱MRPs)，每名需完成3次諮詢。本研究為前瞻性觀察性研究，以Excel及SPSS第12版進行統計與t檢定、ANOVA等多重比較分析。MRPs採Cipolle/Strand分類規則歸類。總計收案207人（女/男：101/106），平均年齡70.6±14.0歲(16-95歲)，完成3次諮詢者184人。在藥師介入後，每人平均用藥品項數從7.4±3.1項減為6.7±2.8項(p=0.016)，無關性別差異(p>0.05)，用藥品項數較多者之改善成效較佳 (Pearson相關：0.71, p<0.01)用藥配合度分數從95.2±7.8分提高為97.7±5.6分(p<0.001)，介入前高齡者之分數較低 (趨勢分析，p=0.012)，藥師介入後進步顯著，已無年齡差異(p=0.471)，配合度問題以用藥時間/劑量的分數最低。無法正確回答問題的個案年齡偏高，尤以不會使用劑型者最大(達80歲)。個案是否有不舒服症狀介入前後無顯著差異(p>0.05)。藥物治療問題分析，發現MRPs 591件(平均2.9件/人)，以用藥配合度不佳最多(53.0%)，藥物安全性問題次之(17.8%)。解決辦法主要從個案著手 (76.8%)，其中84.4%獲得解決；其餘向醫師建議之MRPs，獲醫師接受並調整處方或治療者56.5%，總計460件(77.9%)MRPs獲得解決。藥師介入後，每名個案平均藥費約節省286.7元。本研究顯示社區藥師提供藥事照護能有效提升用藥高危險民眾之用藥知能及減少用藥品項數，並能發現與解決多數藥物治療問題。對於整體個案之用藥時間/劑量，以及年長者特殊劑型之使用技巧是諮詢時最需要加強之重點。 A field survey in Tainan City found that polypharmacy and doctor shopping were common among high risk groups of medication-experience from community dwellers. The aims of this study were to evaluate the outcomes and effectiveness of pharmaceutical care, to analyze medication-related problems (MRPs) identified and solved. This is a prospective study for a period of 8 months from March to October 2013. Participants were selected according to the established criteria. After participants gave signed consent, pharmacists provided community pharmaceutical care (counseling and prospective drug utilization review) for no less than 3consecutive times to assess the outcomes and MRPs. Data were compared and analyzed with Excel and SPSS 12.0 version. MRPs were classified by Cipolle/Strand's classification rules.There were 207 valid participants (female/male:101/106), mean age 70.6?14.0 yrs, 184 participants completed at least 3 times of counseling. The results showed: the number of medications per person reduced ( from 7.4?3.1 to 6.7?2.8, p=0.016), and no significant relationship between gender(p>0.05). Score of medication knowledge and management skills improved (from 95.2?7.8 to 97.7?5.6 , p<0.001), the score of timing/dosage was the lowest one. The age was older than average among those who couldn't answer questions correctly, especially in device operating skills (mean age=80.0). There was no significant difference in the physical discomfort after intervention. 591 MRPs were identified (mean: 2.9 MRPs/person), poor medication adherence accounted for the most of MRPs (53.0%), followed by drug safety problems(17.8%). 76.8% of MRPs intervened from patients, and 84.4% of MRPs were solved. The rest from physicians(23.2%), and 56.5% of physicians received pharmacists' suggestions. A total of 460MRPs (77.9%) were solved. After pharmacist intervention, the average medication cost saving was about NT$286.7 by each person.This study showed that community pharmacists providing pharmaceutical care were able to improve patients' medication knowledge and management skills, reduce the number of medications, and effectively identify and solve medication-related problems on the high risk groups of medication experience among community dwellers.
