藥師介入糖尿病門診病人用藥之效果分析

Evaluation of Pharmacist Intervention on Diabetes Patients in an Ambulatory Setting

吳彧芊(Yu-Chien Wu)

指導教授 ： 何秀娥

共同指導教授 ： 謝安慈(An-Tzu Hsieh)

臺北醫學大學/藥學院/藥學研究所/碩士(2012年)

摘要

研究背景
　　隨著糖尿病盛行率逐年增加，目前台灣地區成人盛行率已接近8.3%左右，如何加強醫療照護以控制病人血糖與降低相關併發症風險成為很重要的議題。美國的Asheville ProjectR藉由藥師介入糖尿病病人用藥，使病人糖化血色素值顯著下降，其他類似的研究計畫也非常豐富，且都有顯著降低糖化血色素的成效，進而減少糖尿病小血管併發症風險。然而，在台灣由藥師介入糖尿病藥事照護與衛生教育的發展以及執行仍有限。

研究目的
　　本研究希望能借取其他國內外藥師介入糖尿病病人藥事照護的成功經驗，針對新陳代謝科門診血糖控制較不好的病人，於每個月至醫院藥局領藥時，進行藥師衛生教育，使病人能得到最佳的藥物治療，進而達到改善病人血糖、服藥順從性及健康生活品質等目標。

研究方法
　　本研究為一前瞻、介入性臨床研究。符合納入條件的糖尿病受試病人從新陳代謝科門診轉介，於每個月接受藥師提供的藥事照護，藥師介入期間一共為六個月。本研究的主要研究目標為病人於藥師介入前後糖化血色素改變量，次要研究目標則有飯前血糖值、飯後兩小時血糖值、低密度脂蛋白膽固醇、身體質量指數，以及病人服藥順從性和健康生活品質的改變量與關聯性。

研究結果
　　共30位病人被納入本研究，其中有5位病人因失去追蹤而被排除。在剩下的25位病人中，平均年齡為54 ± 2歲，有15位為女性，佔60.0%。經過六個月的藥師介入後，受試病人糖化血色素平均從9.1 ± 0.2%下降至8.7 ± 0.2%，減少0.4 ± 0.2%，且達到統計學上顯著差異 (p < 0.05)。受試病人之莫力斯基服藥遵從性敘述量表平均分數從6.1 ± 0.2分上升至7.4 ± 0.1分，增加1.3 ± 0.3分；SF-12v2R健康生活品質問卷之生理健康分數平均從45.48 ± 1.65分上升至52.13 ± 1.31分，增加6.65 ± 1.86分；心理健康分數平均從46.99 ± 1.60分上升至51.21 ± 1.85分，增加4.23 ± 2.04分，三者皆有統計學上顯著差異 (p < 0.05)。

研究結論
　　美國Asheville ProjectR藥師介入以改善糖化血色素的最終目的是希望能降低病人糖尿病相關併發症的風險與醫療花費。經過藥師介入糖尿病病人藥事照護與衛生教育後，本研究結果證實，能顯著降低病人的糖化血色素，並且改善其服藥順從性，進而增進病人生理與心理方面的健康生活品質。所以，藥師應投入更多專業人力於糖尿病藥事照護，進行長時間的追蹤，以期達成上述理想目標。

關鍵字

藥師介入 ； 糖尿病 ； 藥事照護 ； 衛生教育 ； 糖化血色素 ； 服藥順從性 ； 健康生活品質

並列摘要

Background
　　As the prevalence of diabetes mellitus (DM) increases year by year, about 8.3% of adult population in Taiwan have DM. To enhance medical care for blood glucose control and to reduce the risk of complications in DM patients are important. Asheville ProjectR for DM patients in USA shows a significant reduction in glycosylated hemoglobin (HbA1c) following pharmacists’ interventions. Many other similar studies exist to show significant reduction in HbA1c that could lead to decrease in microvascular complications. But developing and implementing pharmacist intervention of DM care are limited in Taiwan.

Objective
　　The present study was to assess for improved glycemic control, treatment compliance and quality of life among DM patients after pharmacist intervention and education in outpatient setting in Taiwan.

Methods
　　This was a six-month prospective, intervention clinical study. Outpatients with DM who met the inclusion criteria were referred to a pharmacist for pharmacist intervention one visit every month. The primary outcome was to determine the changes from baseline in HbA1c level before and after pharmacist intervention. The secondary outcomes included monitoring changes in fasting plasma glucose, post-prandial glucose, low-density lipoprotein cholesterol, body mass index, medication compliance, quality of life and their relationship.

Results
　　Thirty DM patients were included in the study and five patients were excluded due to lose of follow-up. Twenty-five patients with 15 being female and 54 years old in average were included in the data analysis. After a six-month pharmacist intervention for patients, HbA1c levels were decreased significantly from 9.1 ± 0.2% to 8.7 ± 0.2% (p < 0.05). The score of Morisky medication adherence scale was increased significantly from 6.1 ± 0.2 to 7.4 ± 0.1 (p < 0.05). Physical component score of SF-12v2R quality of life questionnaire was increased significantly from 45.48 ± 1.65 to 52.13 ± 1.31 (p < 0.05), and mental component score was also increased significantly from 46.99 ± 1.60 to 51.21 ± 1.85 (p < 0.05).

Conclusion
　　The optimal goal of improving glycemic control by pharmacist intervention in the Asheville ProjectR is to reduce the risk of DM complications and medical expenses. The present results showed that pharmacist intervention with pharmaceutical care and education for DM patients could lead to decrease in HbA1c and increase in patients’ compliance significantly, resulting in improvement of quality of life. Those study results suggest that pharmacist intervention should be provided to long-term care of diabetes patients.

並列關鍵字

pharmacist intervention ； diabetes mellitus ； pharmaceutical care ； education ； glycosylated hemoglobin ； treatment compliance ； quality of life

參考文獻

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