現行醫療體制下醫療人員對重症加護藥師認知與滿意度之研究

Recognition and Satisfaction of Health-Care Professionals Toward the Clinical Practice in Intensive Care Units Provided by Pharmacists

詹前彥(Chian-Yan Jan)

指導教授 ： 徐鳳麟 ； 簡淑真

臺北醫學大學/藥學院/藥學研究所/碩士(2002年)

摘要

中文摘要 藥師進入重症加護病房提供臨床服務已在美國執行有三十年之久了，其所能提供的貢獻也早已由各種相關的研究證實。但就台灣而言，民國84年因藉加護病房評鑑的要求，藥師在重症加護病房提供臨床服務才首度制度化。不過，執行之初並未明確定義其應提供的服務內容及具體之成效指標，而且各醫院之執行情況不一，故更難對其成效做測定。若想克服上述問題，需先瞭解目前藥師在重症加護病房服務現況，與醫、護人員對藥師在重症加護病房的認知看法及臨床服務的滿意度，所以開始了進行本次以醫、藥、護三種專業身份的調查研究。 本研究為橫斷性研究（Cross-sectional research）現況調查，研究對象為服務於區域醫院級以上之重症加護醫師、藥師及護理人員。以郵寄問卷的方式進行，研究工具是以國內外期刊所列符合研究主題之題目及與具有經驗的線上工作者共同討論決定而成的問卷，題目採Likert’s量表及closed-end的問句方式設計，並進行所需的折半信度與專家效度。 研究期間，有299份問卷回收成功樣本（醫師：59份，護理人員：125份，藥師：115份）。研究結果顯示，需求方面，重症加護醫、護人員都對藥師能提供的問卷上的臨床服務感到需求，但再對目前藥師所提供的現況滿意度上，則僅TDM、TPN及DUE此三者的看法沒有明顯統計上的差異（P＞0.05），而所有人皆對巡房表達最能彰顯臨床藥師功能，表達一致認同的看法。另外，對重症加護的態度認知方面，醫、護人員皆對有重症加護藥師的相關議題有表示同意的看法（Median＞4），但藥師方面則是對需有執行CPR的能力及對藥物治療成本負責這兩題，出現保持中立的看法（Median＝3）。現況方面，重症加護藥師目前以提出建議的時機以巡房及醫護要求為主，形式則是面對面居多，接受度已有八成以上；而對臨床時間（非調劑）所佔一日比例，也略少於醫藥人員的看法；所有問題在排除沒接觸重症藥師經驗的樣本後，皆呈現對此人員有良好的看法與評價。 本研究僅為現況調查之研究，在未考量施行成本的情形下，其結果仍可顯示出醫、護人員對重症加護藥師功能是抱肯定的看法，但對需求與滿意度這個測量執行現況成效的題組，卻呈現仍有其需加強之處。所以對先以制度面建立出重症加護藥師的台灣現況而言，其現實面所呈現的結果，除顯示出各醫院的服務程度不一致與醫、護人員尚未完全瞭解其角色功能外，更是看出醫院藥局需再加強藥師臨床服務的資源與能力，以提升醫、護人員對目前藥師在重症加護病房的滿意度。

關鍵字

藥師 ； 重症加護 ； 滿意度 ； 加護病房

並列摘要

Abstract It was more than 30 years for pharmacists providing clinical services in ICU, and the contribution has been well documented in the United States but much less in Taiwan. In 1995, Taiwan ICU accreditation was the first regulation to ask pharmacists provide clinical service in ICU. As so far, there are no reports or studys about the recognition and satisfaction of health-care professionals toward the clinical practice in ICU provided by pharmacists. It is necessary to understand the satisfaction and recognition of clinical services provided by pharmacists in ICU to strengthen and improve the relationships between the physicians and nurses. The objectives of this study are （1） physicians’ and nurses’ recognition and satisfaction about clinical services provided by pharmacists and （2） their attitude toward pharmacists’ advantages which has been written from journals. This study is a cross-sectional survey research. The inclusion criteria are physicians, pharmacists and nurses who work in ICUs of regional and center hospitals, and mailed questionnaires to them in March 2002.The Likert’ scales and closed-end questions are used in those questionnaires which designed by ourselves. All questionnaires were asked to mail back within two weeks. 299 questionnaires were responded to the survey （Physicans: 59; Nurses: 125; Pharmacists: 115）. It is higher needs than satisfication in clinical services provided by pharmacists among physicians and nurses. And , there are no differences in physicians, pharmacists, and nurses in TDM, TPN and DUE （P＞0.05）. All people agree that grand rounds in ICUs is the most representative clinical services. Physicians and nurses have positive attitude of issues about pharmacists in ICUs（Median＞4）. But pharmacists express neutral attitude about CPR and haveing responsibility in drug cost（Median＝3）. Physicians and nurses become more positive after they contact with pharmacists. Although this study just a survey for the status of critical care pharmacists at present, the result has shown that phycians and nurses has postive attitude toward clinical services provided by them. But the needs of clinical services provided by critical care pharmacists is over their satisfication. There is some room for pharmacists to enhance clinical services in Taiwan.

並列關鍵字

Pharmacist ； critical care ； Satisfaction ； ICU

參考文獻

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