- 期刊
藥師介入對於愛滋病人服藥順服性及疾病控制的影響
Impact of Pharmacists' Interventions on Medication Adherence and Clinical Outcome in Patients with Human Immunodeficiency Virus Infection
摘要
目的：高效能抗愛滋病毒治療（highly active antiretroviral therapy, HAART）是否能有效控制血漿病毒量、提高CD4淋巴球數，降低伺機性感染、腫瘤及死亡風險，取決於病人服藥順服性。本研究主要在評估藥師進行藥事照護，對於愛滋病感染者服藥順服性、疾病控制以及藥品相關知識正確性的影響。方法：第一階段在2010~2011年納入門診所有HAART個案，每三個月衛教一次病人，為期半年，藥師介入前後利用問卷評估藥品使用知識正確性、藥品持有率（medication possession ratio, MPR）及CD4淋巴球數值的差異，並記錄期間藥品相關副作用及交互作用。第二階段在2012~2013年納入相同條件個案，每次回診時透過藥師衛教評估半年後CD4淋巴球數值及血漿病毒量的變化，並紀錄期間藥品相關副作用。結果：第一階段29位個案在藥師介入前後半年，藥品持有率顯著改善（0.962 ± 0.067 vs. 0.997 ± 0.010, p=0.04）、藥品使用知識正確性得分在藥師介入後3~6個月也有顯著提升。第二階段62位個案在介入後半年，CD4淋巴球數值（353.81 ± 176.15 vs. 489.97 ± 186.04 cells/mm^3, p=0.002）及血漿病毒量低於40 copies/mL的人數皆顯著增加。結論：透過藥師介入定期追蹤衛教有利於增加病人服藥順服性及持續並有效地控制疾病。
並列摘要
Purpose: The effectiveness of treating human immunodeficiency virus (HIV) is mainly determined by patients' adherence to highly active antiretroviral therapy (HAART). Suboptimal adherence can lead to virological failure, opportunistic infection, drug resistance, and even death. The aim of this study is to evaluate the effect of pharmacists' intervention on the correlation of HIV-infected patients' medication adherence, knowledge about medication regimen, and clinical outcome. Methods: During the first phase, pharmacists provided intervention to all patients who are receiving HARRT from the outpatient infectious disease clinic every 3 months, and the total duration was 6 months. The patients were included from 2010 to 2011. The patient knowledge was measured by quesionaires, and other outcomes include medication possession ratio (MPR), improvement in CD4 count, side effects and drug interactions. Phase two was conducted from 2012 to 2013. The inclusion criteria was the same as phase one study. The outcomes measured were improvement in CD4 count and viral load. Any drug-related side effects were also recorded. Results: In phase one, pharmacist provided intervention to 29 HIV patients for six months. Compared to baseline, MPR and patients' knowledge scores improved significantly after receiving pharmacist intervention. 62 patients received pharmacist intervention in phase two. There was significant improvement in patients' clinical outcome: CD4 count and patients with viral load less than 40 copies/mL. Conclusion: This study demonstrated that pharmacist intervention improved patient adherence to medication, knowledge of medication regimen, and clinical outcome. The occurrence of adverse effects also decreased.
延伸閱讀
- 楊欣瑜（2011）。藥師介入對於愛滋病感染者服藥順服性及用藥安全的影響〔碩士論文，臺北醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0007-2007201118001100
- 台灣露德協會（2020）。愛滋感染者與醫師討論用藥狀況之現況探討。愛之關懷季刊，(113)，12-19。https://www.airitilibrary.com/Article/Detail?DocID=a0000410-202012-202110200011-202110200011-12-19
- 林德宇、王甯祺（2022）。愛滋病毒感染者使用抗病毒藥物抑制失敗後治療藥物之選擇。感染控制雜誌，32(3)，179-189。https://doi.org/10.6526/ICJ.202206_32(3).0004
- 林淑惠、陳惇杰、盧柏樑、蔡季君、林俊祐、洪靖慈、林蔚如、陳彥旭（2010）。Surveillance of Antibiotics Prescription for Patients with Upper Respiratory Tract Infection in Outpatient Clinics and Evaluation the Outcome of Intervention。感染控制雜誌，20(1)，1-12。https://doi.org/10.6526/ICJ.201002_20(1).0001
- Young, T. G., Hsu, G. J., & Chou, M. Y. (1995). Clinical Evaluation of the Efficacy, Safety and Tolerance of Intramuscularly Administered Imipenem/Cilastatin in Patients with Mild to Severe Infections. Journal of Medical Sciences, 16(1), 19-24. https://www.airitilibrary.com/Article/Detail?DocID=10114564-199508-201306250003-201306250003-19-24