以個人化用藥照護為基礎的整合性電子病歷系統

Integrated Electronic Medical Record Systems for Empowerment of Personal Pharmaceutical Care

葉雨婷(Yu-Ting Yeh)

指導教授 ： 劉建財

臺北醫學大學/醫學院/醫學科學研究所/博士(2014年)

https://doi.org/10.6831/TMU.2014.00028

摘要

無資料

關鍵字

自我管理 ； 用藥教育 ； 醫囑遵從行為 ； 藥學實習 ； 藥物交互作用

並列摘要

This study looks to assess personal pharmaceutical care from the perspective of patients, public and medical professionals, and focuses on developing and evaluating patient-oriented integrated electronic medical record system. We take advantage of web technology to extend hospital pharmaceutical education and pharmaceutical care services. Starting from admission, it seeks to keep patients fully informed of their medical treatment, health conditions and self-care strategies, while enabling personal care via the evaluation, analysis, recommendation, and monitoring of drug use provided by well educated/trained clinic pharmacists. In addition, an interdisciplinary checking mechanism is employed to actively detect any problems regarding patient’s pharmaceutical care and support the running of drug management and health education by medical professionals before a patient leaves the hospital.
A web-based, patient-orientated education management (POEM) system was developed and evaluated for extending hospital-based patient education. The system can automatically download a patient’s medical services records, laboratory tests results and his/her patient education materials, and organize them into a folder per visit. It also integrated prescribed medicines and pharmaceutical education to provide patients with opportunities to search on-line for pharmaceutical information and knowledge in need. The on-line patient self management education program and pharmaceutical care information designed by this research team have been proven to be effective in involving patients or patients’ family members to actively search on-line for their medical records as well as for diabetic pharmaceutical educational information so that patients can have more accurate fasting glucose and HbA1C control.
We developed the pharmaceutical knowledge test to evaluate how much do the patients know and a questionnaire to evaluate pharmaceutical knowledge and self-reported pharmaceutical adherence behavior. In results of this study, the patients in the intervention group obtained more advancement than in the control group (the point of intervention group was from 2.62 to 3.64 and the point of control group was from 2.12 to 2.07; total points are five points) and adherence behavior (the point of intervention group was from 21.89 to 27.72 and the point of control group was from 21.38 to 22.31; total points are thirty-two points). There have significantly difference between two groups. It shows POEM system can effective improve patients’ knowledge and adherence behavior.
In the study, we enhanced a commercial eLearning system for clinical pharmacy internship (The clinical pharmacy Internship eLearning System, CPIES). The KAP questionnaire was used to evaluate the performance of group A with the traditional teaching model and group B with the CPIES teaching model. The CPIES teaching model showed significant improvement in interns’ knowledge and practice (p=0.002 and 0.031, respectively). The traditional teaching model only demonstrated significant improvement in practice (p=0.011). The on-line teaching and traditional teaching methods should undoubtedly be blended in a complete teaching model in order to improve learners’ professional knowledge, facilitate correct attitude, and influence good practice.
For patient safety improvement, this study are to enhance a computerized physician order entry system to support drug-drug interaction (DDI) checking based on a patient’s medication history stored in NHI-IC card. For performance evaluation, we developed a transaction tracking log to keep track of every operations on NHI-IC cards. This study showed that: the capacity of an NHI-IC card is adequate to support DDI checking across hospitals when physicians are making prescriptions and provide safer medication care, particularly for patients who receive medication care from different hospitals.
In this study, integrated electronic medical record systems are implemented at medical center with real practice, and proved successfully the findings are related to key elements of empowerment personal pharmaceutical care. We try to provide an easy and inexpensive way to extend hospital-based pharmaceutical education and pharmaceutical services for improving patient medication safety. The results proved integrated electronic medical record systems as a successful assisting tool for medical professionals.

並列關鍵字

Self-management ； Pharmaceutical education ； Medical adherence ； Pharmacy internship ； Drug-drug interactions

參考文獻

113. KaoYang, Y.H., Kuo, C.W., Hung, H.J., & Jia, S.W. (2002). Classification of Pharmaceutical products reimbursed by National Health Insurance by the ATC system. The Chinese Pharmaceutical Journal, 54(4), 283-290.

6. Hesse, B. W., Nelson, D. E., Kreps, G. L., Croyle, R. T., Arora, N. K., Rimer, B. K., & Viswanath, K. (2005). Trust and sources of health information: The impact of the Internet and its implications for health care providers: Findings from the first Health Information National Trends Survey. Archives of Internal Medicine, 165, 2618-2624.

7. Cotten, S. R., & Gupta, S. S. (2004). Characteristics of online and offline health information seekers and factors that discriminate between them. Social Science & Medicine, 59, 1795-1806.

8. Lesar, T.S., Lomaestro, B.M., Pohl, H. (1997). Medication-prescribing errors in a teaching hospital. A 9-year experience. Archives of Internal Medicine, 28;157(14): 1569-76.

10. Joint Commission, National Patient Safety Goals. (2011). Retrieved October 13, 2013, from http://www.jointcommission.org/