臺北縣基層藥事執業調劑品質調查研究

A Survey Research on Qualities of Dispensing Services Offered by Primary Care Pharmacists in Taipei County

陳鈴潔(Ling-Jie Chen)

指導教授 ： 何藴芳

國立臺灣大學/醫學院/臨床藥學研究所/碩士(2008年)

https://doi.org/10.6342/NTU.2008.01101

摘要

研究背景：
臺灣自民國86年起，於臺北、高雄兩市率先開始推動醫藥分業，期落實由醫師開立處方、藥事人員評估處方並進行調劑，目的是為使醫師及藥事人員各自發揮專業，共同為病患用藥之有效性及安全性負責。目前臺灣施行醫藥分業為“雙軌狀態”，醫師看診結束可將處方箋釋出給病人至社區藥局調劑，或是聘請藥事人員在醫療院所內為病患的處方進行調劑，基層藥事人員不管在何處執業，同樣都身負民眾用藥安全的重責大任。在醫藥分業議題被廣泛討論的此時，藥事人員之調劑品質因此越來越受到社會大眾的重視。
研究動機：
國內對於社區藥局及診所調劑品質方面的研究有限，藥事人員之調劑作業是介於醫師開立處方與病患用藥之間必備的橋樑，調劑品質的好壞，影響民眾藥品治療效果及用藥安全性甚鉅，也是影響藥事人員形象的重要因素，值得重視。
研究目的：
本研究欲瞭解目前基層藥事人員之調劑作業現況，深入分析及探討藥事人員之調劑品質，包括調劑作業及調劑服務品質，並瞭解不同執業處所之差異。期待經此研究，能提供具體意見與想法，做為增進調劑效率、提昇服務品質、保障用藥安全，及改善執業環境之參考。
研究方法：
為了深入瞭解社區藥局及診所基層執業藥事人員之調劑作業現況及品質，本研究針對臺北縣119家社區藥局用藥照護諮詢站及904家社區藥局，與783家聘有藥事人員執業之診所進行隨機抽樣，採用郵寄問卷調查的方式，並輔以質性研究方法之深度訪談及觀察法，瞭解藥事人員調劑作業現況，分析及比較其調劑作業品質，探訪藥事人員對調劑作業相關政策及法規之意見與看法，並由基層執業藥事人員的角度來看影響調劑作業品質的因素，及其對調劑作業的看法。本研究之分析方法包括：（一）問卷資料採用敘述性統計及多元迴歸分析，描述調劑作業現況及分析調劑作業及調劑服務品質；（二）深度訪談資料先由錄音檔來撰寫逐字稿，後再加以編碼、彙整；（三）實地觀察後寫出觀察摘要及觀察心得，再對此摘要及心得加以分析整理。
研究結果：
研究執行期間為96年4月至10月，共發出960份問卷，回收505份，總回收率52.6%（社區藥局48.1%，診所57.1%）；訪問9位社區藥局及8位診所藥事人員，觀察5家社區藥局與2家診所之調劑作業。
問卷所收集到的資料，使用多元邏輯式迴歸分析來評估健保特約藥局與診所影響調劑作業品質及調劑服務品質的因素。結果發現對於整體基層藥事人員來說，藥局的調劑作業品質較診所好，處方藥品項數愈多、由藥事人員檢查藥品效期、知道藥品儲存條件的比例愈高、調劑作業區坪數及滿意度愈高、固定時間檢查效期，則調劑作業品質愈好；而藥事人員年齡越大、醫師為雇主，對調劑作業品質有負面影響。如針對健保特約藥局分析，調劑區面積大小滿意度愈高，及為社區藥局用藥照護諮詢站，調劑作業之品質較佳，相對地，“門前藥局”的調劑作業品質較差。而在診所，則眼科診所、處方藥品項數愈多、由藥事人員檢查藥品效期，其調劑作業品質較好。
在調劑服務品質方面，調劑作業區坪數愈大、由藥事人員進行盤點作業、有把握知道藥品儲存方式之比例愈高，其調劑服務品質愈好，而泰林次區域、藥事人員為男性、醫師為雇主的話，調劑服務品質較差。在健保特約藥局，調劑區大小滿意度愈高，調劑服務品質愈好，而泰林次區域及門前藥局，其調劑服務品質較差。針對診所而言，內兒科、藥事人員為男性的調劑服務品質較差，而由藥事人員盤點、每週營業時數愈長、泰林次區域、有把握知道藥品儲存方式之比例愈高，其調劑服務品質愈好。
另由質性訪談的結果發現，藥事人員之忙碌程度、執業處所環境、藥事人員本身的態度、知識，處方藥品項數及品質、與醫師的合作關係、處方箋與電腦系統資訊完整性，對於藥事人員之調劑品質會有影響。
結論：
社區藥局與診所藥事人員之調劑品質與以下因素有關：調劑區域大小及環境、是否為社區用藥照護諮詢站、是否為“門前藥局”、診所科別、藥事人員性別及年齡、調劑及工作負荷、電腦資訊系統的使用、處方藥品項數及藥品管理的態度及做法、醫師與藥師互動及合作情形，及藥事人員本身態度與具有的知識及專業能力。未來欲增進調劑品質，藥事人員、政府相關單位，及醫療院所可針對這些方面進行改善，以提升整體藥事服務品質、保障病患用藥安全，並提升整體藥事人員形象。

關鍵字

調劑作業 ； 調劑品質 ； 社區藥局 ； 診所

並列摘要

Background:
The separation of drug prescribing and dispensing was implemented in Taiwan since 1997. Physicians make diagnosis and prescribe medicine for patients, and the patients then take the prescriptions to the pharmacies for dispensing. Pharmacists can practice in community pharmacies or physician clinics in Taiwan. Nomatter in which practice cite, the public pay much attention to the qualities of dispensing of the pharmacist.
Motivation:
There were limited studies focused on dispensing service qualities in community pharmacies and clinics in Taiwan. The qualities of dispensing of primary concern in terms of medication use safety, therapeutic efficacy, and the pharmacists’ professional image in the society.
Objective:
The aim of the study was to investigate the current status and qualities of dispensing practice in community pharmacies and clinics. The dispensing qualities in the study encompassed qualities of dispensing processes and dispensing services.The key factors influencing dispensing qualities were also determined in the study.
Method:
A field survey, including both quantitative and qualitative researches, of pharmacist-in-charge at community pharmacies and practicing pharmacists at physician clinics in Taipei County was conducted. For quantitative research, a survey instrument was constructed and mailed to 960 random samples of community pharmacies and clinics. The qualitative researches included pharmacist interviews and site observations to explore the current status of dispensing practices, and understand pharmacists’ opinion toward pharmaceutical policies and issues relevant to dispensing practices.
Result:
The questionnaire survey was conducted from April to September, 2008. A total of 505 questionnaires were collected (response rate 52.6%; community pharmacies 48.1%, clinics 57.1%). The pharmacists that were interviewed were nine and eight for community pharmacy and physician clinic practitioners, respectively. Five community pharmacies and two clinics were visited.
Results by multiple logistic regression for NHI-contracted pharmacies and all clinics indicated that quite a few factors would influence dispensing qualities. The overall qualities of dispensing processes were better in community pharmacies, with more prescription drugs, regular drug the expiration date check-up by pharmacists, pharmacists confident in storage conditions of medicine in-house, and larger dispensing area. To the contrary, the qualities of dispensing practice were worse for those with characteristics such as older age and hired by physicians. The qualities of dispensing services of NHI-contracted pharmacies and clinics were better if larger dispensing area, pharmacists checked inventories by themselves, and pharmacists confidence in storage conditions of in-house medicines. On the other hand, the qualities of dispensing services were inferior for male pharmacists and employees of physicians, and also in Tai-Lin subarea.
The results from qualitative researches showed that in addition to above-mentioned factors, the qualities of dispensing would also be affected by workload, dispensing area settings, the practice attitude or knowledge of the pharmacists, impacts from doctors, patients, or other related persons, the contents and completeness of physician prescriptions, and the thoroughness and accuracy of drug database built in informative systems.
Conclusion:
To improve the qualities of dispensing processes and dispensing services, all the parties including pharmacists, government, and hospitals/clinics should take respective efforts in promoting quality dispensing services and safeguarding medication use for the society.

並列關鍵字

dispensing process ； dispensing quality ； community pharmacy ； clinic

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