某教學醫院居家護理收案之多重用藥病人用藥問題分析

目的：分析有多重用藥情況的居家護理收案之失能病人處方問題，探討藥師對此型態病人介入必要性。多重用藥定義為處方五種以上口服藥品。方法：針對2015年本院居家護理科服務之失能且有多重用藥個案進行回溯性研究。收集其醫療訪視記錄單，分析家醫科醫師所記錄的疾病相關基本資料及藥師評估處方後發現的藥物相關問題，藥物相關問題依藥師全聯會所制定「藥物治療問題列表」分類統計，並以國內發展的潛在不當用藥(PIMs)準則分析個案使用PIMs情況。結果：納入89名個案，平均83.8 ± 13.8歲；罹患疾病數為4.2 ± 1.3；口服藥品項數7.9 ± 2.1。82%之個案處方中至少有一項藥物相關問題，以「對病人不安全（如：疾病危險因子，老人）」項目，共24件，占所有問題29 為最多。再將所有個案依是否使用PIMs分組比較發現，處方含PIMs病人平均口服藥品項數高於無PIMs者，具顯著差異(p = 0.001)。另外，處方含PIMs病人中15%疑似有藥物不良反應，高於處方未含PIMs者為8.7%，但無顯著差異。結論：有居家照護需求的失能且多重疾病病人，特別當本身多重用藥情況嚴重，有必要由藥師評估其用藥適當性。而如何讓藥師與開立處方醫師間建立有效的溝通管道以傳達藥物相關問題，避免可能發生的不良反應是更為重要的課題，這或許還需要在未來進一步努力克服。

關鍵字

居家照護；多重用藥；藥物相關問題；潛在不當用藥

並列摘要

Objective: To analyze the drug-related problems in the prescriptions of the home care patients with polypharmacy defined as taking five or more oral intake drugs, and to evaluate the need of pharmacist intervention. Methods: We retrospectively enrolled patients with polypharmacy serviced by home nurse care unit in our hospital in 2015. The patients’ profiles recorded by family physicians and prescription assessment finished by pharmacists were collected and analyzed. The results of prescription assessment were categorized by drugrelated problems list developed by Taiwan Pharmacist Association. The potentially inappropriate medications (PIMs) among these patients based on PIM criteria developed in Taiwan were also analyzed. Results: Eighty-nine patients were enrolled and the average age was 83.8 ± 13.7. The mean suffering diseases and oral intake drugs were 4.2 ± 1.3 and 7.9 ± 2.1 separately. Totally, 82% of the cases got at least one problem in their prescription and the major problem was ＂drugs harmful for patients (e.g., aging or specific disease)＂ in proportion of 29%. In the aspect of PIMs analysis, patients with PIMs were prescribed significantly more amount of oral intake drugs than those without PIMs. The incidence of adverse drug reactions in patients receiving PIMs was 15% compared with 8.7% in those not receiving PIMs with no significant difference. Conclusion: It seemed necessary to evaluate the prescriptions of home care patients by pharmacists timely, especially for those with polypharmacy. Besides, how to make an efficient connection between the pharmacist and the out-patient prescribing physician for prevention the adverse events happened to these patients is more important.

並列關鍵字

Home Care ； Polypharmacy ； Drug-Related Problem ； Potentially Inappropriate Medications

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某教學醫院居家護理收案之多重用藥病人用藥問題分析

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