藥師介入高齡中期照護藥事服務成效分析評估

Analysis and Evaluation of the Effect of Pharmacists Intervening in the Geriatric Intermediate-Care Services

馬國芳(Kuo-Fang Ma) ； 游翁斌(Weng-Ping Yu)

《臺灣臨床藥學雜誌》 27卷1期 (2019/01) Pp. 48-59

https://doi.org/10.6168/FJCP.201901_27(1).0007

摘要

目的：中期照護為整合性醫療模式，某區域教學醫院已執行多年，其任務特殊性收治病患均為高齡化榮民，藥師介入高齡整合照護計畫從中建立藥事服務運作模式，探討分析執行成效。方法：本文以某區域教學醫院2017年期間中期照護住民為對象計102人，追溯資料分析臨床藥師整合評估用藥及指導等作為，運用「相關係數分析」、「簡單線性迴歸分析」進行顯著性檢定，驗證藥事服務成效。結果：統計分析「藥物評估」及「用藥指導」二自變數與activities of daily living (ADL)進步程度之相關性及顯著性，僅針對住民本人藥事服務並無法彰顯成效，結合照護者，均達到得到顯著性正相關，檢定相關係數為r = 0.337，t = 3.581，p ＜ 0.001；臨床藥師以MICROMEDEX資料庫及臨床治療經驗，調整使用副作用較低之藥品及服用頻次等，有效降低住民跌倒風險，結案時St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY)評量風險可明顯降低，並呈現成效之正相關，檢定相關係數為r = 0.299，t = 3.135，p = 0.002。結論：中期照護藥師介入住民藥事服務，為一項整合性及系統性的工作，藉由(1)照護者強力衛教；(2)高齡者適切用藥評估；(3)發現多重用藥與潛在不當用藥並予以調整；(4)藥品交互作用分析與處置作為，對於高齡病患具相當顯著的成效，此模式亦可運用於全民健康保險急性後期整合照護計畫。

關鍵字

中期照護 ； 藥事服務 ； 相關係數分析 ； 顯著性檢定

並列摘要

Objective: The intermediate care is an integrated medical model, and has been implemented by a regional teaching hospital which residents are elderly veterans. The pharmacists have involved in this plan, and established a pharmacy service mode. Methods: The subjects are 102 intermediate care patients in 2017. The clinical pharmacists used the retrospective data analysis to evaluate drug use and guidance. We used ＂correlation coefficient analysis＂ and ＂simple linear regression analysis＂ to do significance test and verify the effectiveness of pharmacy services. Results: When analyzing the relationship of two independent variables of ＂drug evaluation＂ and ＂medication guidance＂ with the relevance and significance of progress of activities of daily living (ADL), however, when combined with caretakers, it has achieved satisfied positive correlation. The correlation coefficient test: r = 0.337, t = 3.581, p ＜ 0.001. Pharmacists used the MICROMEDEX data base and clinical treatment experiences to find the lower side effects of drugs and adjust the frequency of drug use. The risk of St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) assessment had been significantly reduced, and so was positively relative to the performance. The correlation coefficient test: r = 0.299, t = 3.135, p = 0.002. Conclusions: Pharmacy services can be implemented through (1) powerful health education to caretaker, (2) evaluation of proper drug use for the elderly, (3) adjusting multiple medications and potential inappropriateness medications, and (4) analysis and disposal of drug interactions. It has a significant effect for elderly patients. This model can also be applied to the post-acute care (PAC) plan of the National Health Insurance.

並列關鍵字

Intermediate Care ； Pharmacy Service ； Correlation Coefficient Analysis ； Significance Test