藥師介入獨居老人用藥行為之成果分析-以雲林縣為例

因為時代的變遷，經濟的快速成長，造成人口在鄉村與都市間流動，在人口朝都市集中影響下，愈來愈多老人無法與子女同住，而成為獨居老人。本研究目的是在探討獨居老人的健康狀況與用藥問題以及之間的關係，希望藉由藥師的介入來建立獨居老人正確的藥物資訊及提供用藥指導，進而提升長者的用藥安全並能達到明確的治療目標。本研究是採取自我比較（Self-controlled）的研究。訪視調查時間為99年5月1日∼99年10月31日，每個月一次共6次的訪視，主要對象為雲林縣的獨居老人。訪視時，會針對長者的用藥問題進行指導與建議，並分析藥事服務內容。資料以SPSS 14.0 for windows 套裝軟體進行編碼建檔及統計分析，以百分比、平均數、標準差、獨立樣本t檢定、單因子變異數分析、配對樣本t檢定等進行統計分析。總共訪視204位獨居老人，平均年齡為77.35歲，有64.7%的女性。在健康狀況方面，平均每人罹患2.54種慢性疾病，且罹患的疾病當中以高血壓、糖尿病、骨關節炎(包含骨質疏鬆症)為最多。在服用處方藥方面，每人每日平均服藥筆數為5.16筆。在服用非處方藥方面，有76位老人有在使用非處方藥，平均每人每日服用1.51筆的非處方藥，每人每月平均花費金額為1731.28元。在藥事服務內容中，藥物治療建議項目最多者為1-2級交互作用，占51.4％；其次是重複用藥，占13.7％。用藥指導項目最多為解說藥品之禁忌症或注意事項，占19.9％。藥師的介入使得每人每日服藥的總筆數由5.52筆減少為4.96筆 (p=0.001)。在非處方藥的花費金額方面，每人每月平均花費金額減少為790.53元 (p=0.001)。整體而言，藥師提供獨居老人的藥事照護成果，對獨居老人而言，都是有帶來正面的效果。

關鍵字

獨居老人；用藥問題；藥事照護

並列摘要

As to the increasing of the economy, lead to population concentrated to the city. Under the changes of social and family structures, more and more elderly people cannot live together with their children, and become the elderly people living alone. The purposes of this study were to examine the health status, problems with medication and their relationships among the elderly living alone in community. The problems with medication, includes both misleading medical information and wrong medication which lead to ineffective treatment. Elderly people who live alone were established the correct medication knowledge and medication guide by pharmacists intervention, and thus enhance the safe medication and propose policies for the community-elderly people living alone. The project is a self-controlled study. Pharmacists visited these elderly people living alone at home once a month along from May 1, 2010 to October 31, 2010. The cases were chosen from the list of elderly people who live alone in Yunlin County. During visits, we provide pharmaceutical services and drug-related health education services. In addition, we also analyzed the service contents. Data were analyzed by percentage, mean, standard deviation, independent samples t-test, One-Way ANOVA, paied samples t-test. Total 204 elderly subject (the mean score of age was 77.35, 64.7% female) data were collected. In their health conditions, participants had 2.54 kinds of disease and hypertension, diabetes mellitus, and arthritis ranked (contains osteoporosis) the first three. With regards to prescription medicines, used a mean of 5.16 prescription medicines. With regards to non-prescription medicines include health care products, OTC and Chinese medicinal drugs, 76 elderly (37.3％) had used a mean of 1.51 non-prescription medicines. The average expense was ＄1731.28. The most therapeutic problem in prescriptions is the major- moderate drug-drug interactions, accounting for 51.4％, followed by repeated prescription, accounting for 13.7％. The most frequent medication guide is to explain the drug contraindications and other informations. After pharmacists intervention, with regards to total medicines, each personal medication was reduced from 5.52 to 4.96 items (p = 0.000). With regards to non-prescription medicines, each person the average expense was reduced to＄790.53 (p = 0.000). Pharmacists provide pharmaceutical care for elderly people living alone, this is not only reducing medication items to the elderly people, but also correcting their wrong behaviors of medicine use and providing proper concepts to them.