- 期刊
漫談臺灣社區藥師執行判斷性服務的臨床效益
The Introduction of Cognitive Service Provided by Community Pharmacists in Taiwan
摘要
背景：判斷性服務是藥師調劑醫師處方箋時，發現有疑似藥物治療問題，負責地與醫師溝通並解決問題的專業服務。2014年食品藥物管理署辦理「用藥安全繁星計畫」，提供專業服務之研究費用，鼓勵藥師執行判斷性服務，社區藥師開始以專業服務保護民眾的用藥安全。目的：探討社區藥局內藥師執行判斷性服務之臨床效益。方法：由藥師公會全聯會規劃與執行培訓課程教導藥師執行判斷性服務，並建立網路化登錄以AABBCC編碼系統做服務記錄。AA碼紀錄藥師發現的藥物治療問題、BB碼紀錄藥師提出哪類建議、CC碼紀錄醫師回覆的結果。結果：184家社區藥局，共190位藥師發現1,047個問題並對醫師提出建議，其中以藥品不良反應比例最高(26.6%)，其次為應刪除不需要用藥(26.3%)。醫師對藥師建議回應率為75.3%，接受率為42.8%。藥物治療問題的解決率為42.8%。每筆服務平均可節省69.8元藥費。藥師提供判斷性服務僅計算藥費的節省，服務之成本利益比為1:0.35。結論：判斷性服務不僅節省單次與未來藥費並發現解決藥物治療問題，同時也保障了病人的用藥安全，此服務值得擴大推廣執行。
並列摘要
Backgrounds: Cognitive service aims to identify, resolve and prevent drug therapy problems (DTPs) related to physician prescribing during pharmacist dispensing. In 2014, Taiwan FDA provided research funding to encourage community pharmacists to provide cognitive service while dispensing to protect patient drug safety. Objective: The study goal was to evaluate the clinical value of providing cognitive service by community pharmacists in Taiwan. Methods: A web-based computerized documentation system was developed by Taiwan Pharmacist Association to record every cognitive service provided. Pharmacists need to be qualified then recruited in this study and document the cognitive service using AABBCC coding system to record DTPs identified (AA code), recommendations given (BB) and follow up the drug therapy changes by physician (CC). Results: With 190 pharmacists from 184 community pharmacies identified 1,047 DTPs while dispensing, most of the problems were ＂adverse drug reaction＂ (26.6%), and the second one is ＂delete unnecessary drug therapy＂ (26.3%). Around 75.3% of the recommendations to physicians were replied and 42.8% accepted, with 42.8% resolved. In average, NT$ 69.8 drug expenditure was saved by each DTP identified and resolved. Calculating the drug cost saved, providing cognitive service has a cost benefit ratio of 1:0.35. Conclusions: Cognitive service protected patient drug safety by identifying and resolve drug therapy problems as well as saves drug expenditure for future dispensing. Cognitive service while dispensing is a worthwhile and valuable pharmacy practice which should be encouraged by the whole society.