居家藥事照護成效分析研究

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標題:	居家藥事照護成效分析研究 Effectiveness Analysis of Home Pharmaceutical Care 臺灣社會越趨老化，伴隨而來的各種用藥相關問題是藥師介入藥事照護的機會。本研究想了解臺灣接受居家藥事照護個案之多重用藥與潛在性不適當用藥之現況，並探討臨床面的貢獻。本研究亦試圖比較兩種照護模式在結果面之差異，並討論其原因。本研究以回溯性觀察性研究，使用中華民國藥師公會全國聯合會之2017年藥事照護系統（Hcare）資料庫，擷取居家藥事照護之高診次族群計畫與高危險族群計畫個案，以Beers criteria 2015年版檢測潛在性不適當用藥使用，多重用藥定義為5種藥品以上，再以Excel及SPSS進行統計。在高危險計畫中，共對1,085位個案執行了2,914次訪視；在高診次計畫中，共對4,518位個案執行了24,526次訪視。女性人數皆顯著高於男性，年齡都以老人居多。高危險計畫多重用藥盛行率為73.8%，高診次計畫為73.17%。高危險計畫潛在性不適當用藥盛行率為72.9%，高診次計畫為74.9%。高危險計畫之個案平均用藥數量少於高診次計畫。兩計畫個案之用藥數量與潛在性不適當用藥數量皆呈現正相關。藥師介入前後用藥品項數高危險計畫沒有顯著差異（p=0.21）；但高診次計畫者多2.21個藥品（p<0.001）。潛在性不適當用藥數高危險計畫少了0.16個（p<0.001）；而高診次計畫多了0.42個（p<0.001）。藥師介入的次數越多，個案的用藥數量與潛在性不適當用藥數量反而增加。高危險計畫中藥師減少了個案之潛在性不適當用藥，但高診次計畫反而增加。本研究發現藥事照護之臨床面成效與預期相反。因此本研究建議藥師端應對其照護記錄負責、公會端應重新思考藥事照護的定位與指標、教育端應在養成教育中及早連結藥事照護與長照領域以及政策端應以專業差額給付制度引導鼓勵藥師投入高品質的藥事服務。如此一來，才有機會延續與創造讓民眾有感的服務價值。 Taiwanese society is getting older, and the various drug-related problems are opportunities for pharmacists to intervene in pharmaceutical care. The purpose of this study is to understand the current status of polypharmacy and potentially inappropriate medications in home cases in Taiwan, and to explore the clinical contribution of community pharmacists to pharmaceutical care. This study also attempts to compare the differences in outcomes between the two care models and discuss their causes.This study is a retrospective observational study, data is conducted from the pharmaceutical care recording system （Hcare） database in 2017, and commissioned by the Taiwan Pharmacist Associations. To retrieve the frequent users of outpatient services and the high risk of drug related problems population, medication recodes are coded with the Beers criteria 2015 edition to detect the potentially inappropriate medication, poly pharmacy is defined as more than 5 medications, and the subsequent statistical steps are performed with Excel and SPSS.In the high risk project, 2,914 visits were performed on 1,085 cases;in medical resource high user project, 24,526 visits were performed on 4,518 cases. The ratio of women to both projects was significantly higher than that of men, and the majority was older people. The prevalence of polypharmacy by the high risk project is 73.8%, and the medical resource high user project is 73.17%. The prevalence of potentially inappropriate medications by the high risk project is 72.9%, and the medical resource high user project is 74.9%. The average number of medications per the high risk project is less than the medical resource high user project. There was a positive correlation between the number of medications used in both cases and the number of potentially inappropriate medications. The high risk project that there was no significant difference in the number of drugs used by pharmacists before and after the intervention （p = 0.21）;however, the medical resource high user project instead significantly increased the number of drugs by 2.21 drugs （p <0.001）. The high risk project for the last intervention was significantly less than the first intervention by 0.16 potentially inappropriate medications （p <0.001）;while the medical resource high user project the last intervention to be significantly more effective than the first intervention by 0.42 potentially inappropriate medications （p <0.001）. The greater the number of pharmacist interventions, the greater the number of medications and potentially inappropriate medications in both cases. The high risk project for pharmacists reduced potential inappropriate medications but the medical resource high user project increased.This study found that the clinical results of pharmaceutical care are contrary to expectations Therefore, this study suggests that the pharmacist should be responsible for his pharmaceutical care records, the pharmacist associations should rethink the positioning and effectiveness indicators of pharmaceutical care, school education should link the field of pharmaceutical care and long-term care as early as possible in the development education, and the policy should guide the pharmacists to invest in high-quality pharmacy services with a professional differential payment system. In this way, we will have the opportunity to continue and create service values that make people feel.
作者:	許博程
貢獻者:	藥學系王四切陸海林
關鍵字:	社區藥局居家藥事照護多重用藥潛在性不適當用藥 community pharmacy home pharmaceutical care polypharmacy potentially inappropriate medications
日期:	2020
上傳時間:	2022-10-21 10:26:52 (UTC+8)
關聯:	電子全文公開日期：2025-01-31 學年度：108， 126頁
顯示於類別:	[藥學系(所)] 博碩士論文

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