門診藥局對慢性疾病病患藥品使用後續追蹤評估

Assessment of a Pharmacy-Based Drug Use Follow-Up Program for Ambulatory Patients with Chronic Disease

莊美華(Mei-Hua Chuang) ； 王昱豐(Yuh-Feng Wang) ； 林俊龍(Chin-Lon Lin) ； 李紀慧(Chi-Hui Lee)

《慈濟醫學雜誌》 16卷3期 (2004/06) Pp. 173-183

https://doi.org/10.6440/TZUCMJ.200406.0173

摘要

目的：大多數慢性病病患年紀較大、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。不幸的是，基於上述等現象，病患服藥順從性及自我疾病與副作用監控觀念往往不足而無法達到最佳藥物治療效果。此外，有鑑於一些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。本研究主要目的為透過門診藥師對於病患用藥持續性追蹤，改善藥物治療結果。材料與方法：選定5組病患，平均每組100人(共500人)，分別使用下列5種毒性較大且需要定期監控或檢查的藥物，如：carbamazepine、digoxin、methotrexate、phenytoin、theophylline；每組再進一步分為實驗組與對照組。本研究為期一年，藥師以定期電話訪談進行病患使用後續追蹤服務，以藥局藥師為主導的病患用藥教育與監控對於門診病患所產生的影響將加以評估。結果：實驗組定期回診率及服藥順從率高於對照組，且對藥師整體滿意度感覺非常好的患者也高於對照組。結論：對於慢性病病患所提供的照護是一個複雜的過程且可藉由整體醫療專業人員運用不同專業技巧加以完成。藥師藉由病患用藥教育與藥物使用監控的貢獻，尤其是協助分擔藥物治療的責任，不僅可以最佳化病患的藥物治療結果，也可以改善病患與健康相關的生活品質。

關鍵字

慢性病 ； 服藥順從性 ； 藥物不良反應 ； 電話訪談

並列摘要

Objective: Most patients with chronic diseases have a series of common characteristics that are as follows: advanced age, lower education level, comorbidity, a requirement for multiple drug therapy and a requirement for long-term care. Unfortunately, the compliance and self-monitoring ability of these patients for disease and for adverse drug reactions are usually poor and do not achieve the most optimal therapeutic outcome. Another concern is that some patients need to take medications with narrow therapeutic index. So, if patients are treated long term, but can not be followed up appropriately, they may give up their therapy due to the occurrence of adverse drug reactions or a subtherapeutic outcome. These phenomena not only defeat the aim of the patient's treatment directly, but also increases the costs of health care and thus on society indirectly. The objective of this study was to attempt to improve drug therapeutic outcomes by providing pharmacy-based drug use follow-up services for ambulatory patients with chronic disease. Materials and Methods: Five different treatment groups (made up of carbamazepine, digoxin, methotrexate, phenytoin, and theophylline) for a total 500 patients were selected from outpatient clinics. Each group was further divided into either a control or an experimental group. The impact of ambulatory pharmacy-based education and the monitoring of intervention was assessed through a one-year telephone follow-up interview project. Results: The rates of expected clinic returns, compliance, and patient's satisfaction for the experimental group were higher than for the control group. Conclusion: The delivery of care to patients with chronic disease is a complex process that can be improved by using a team of health care professionals with a variety of skills. The pharmacist's contribution to patient care through education and monitoring, and in particular through sharing responsibility for drug therapy, is an approach that can be advocated as a way to optimize drug therapy and improve patients' health-related quality of life.

並列關鍵字

chronic disease ； compliance ； adverse drug reaction ； telephone follow-up interview