影響社區式遠距照護藥事安全服務使用之相關因素探討

Examining Factors Related to the Use of Pharmaceutical Care in Community-Based Telecare Services

林欣音(Shin-Yin Lin)

指導教授 ： 陳靜敏

臺北醫學大學/護理學院/護理學研究所/碩士(2009年)

摘要

因應「在地老化」（Aging in Place）理念興起，以「家」為照護資源的概念為目前世界各國照護趨勢，面臨高齡化社會與慢性病高盛行率的影響下，老年人之用藥安全遂成為重要的議題，因此行政院衛生署於2008年推展遠距照護試辦計畫，主要發展機構式、居家式、社區式遠距照護模式與成效指標評估。因老年人為產生用藥問題之高危險群，社區式藥事安全服務乃成為遠距照護中重要的一環。本研究旨為瞭解社區式遠距照護藥事安全服務之現況，瞭解接受社區式遠距照護藥事安全服務個案之安全用藥行為與滿意度，與探討社區式遠距照護藥事安全服務之相關因素。本研究於2008年10月至11月採面訪方式，於試辦計劃社區之社區健康便利站、里民活動中心進行收案。收案對象為參與此試辦計畫且使用藥事安全服務，收案年齡為50歲以上、排除確診失智症患者、長期臥床患者採全部取樣共收132案。研究工具以藥事諮詢次數、內容與個案申請送藥次數報表分析，並以結構式問卷收集使用者特質、安全用藥行為與藥事服務病患滿意度。結果發現藥事諮詢次數、內容與申請送藥到府次數與安全用藥行為、藥事服務病患滿意度皆未達統計上顯著相關；使用者特質中以ADL得分與藥事諮詢次數呈負相關，居住型態與服藥遵從行為有統計上顯著相關，年齡與病患滿意度呈正相關，罹患疾病數與病患滿意度呈負相關。可能因收案條件為使用此服務之會員，因此皆呈現高程度的服藥遵從行為與病患滿意度，使得藥事服務與成效間無顯著意義。建議未來研究能採實驗法，並瞭解介入前後的改變情形，期盼此研究結果能做為其他社區推行遠距照護藥事安全服務模式之參考，以提升整體性老年人用藥安全為目的。

關鍵字

藥事服務 ； 用藥安全行為 ； 病患滿意度 ； 遠距照護

並列摘要

Complying with the rising of the “Aging in Place” concept, home becomes the major resource of care for the elderly all over the world. As the society aging, prevalence of chronic diseases increasing, medication safety becomes an important issue for the elderly care. Thus, Department of Health of Taiwan proceeds the “Telecare” project in 2008. The aims of this project are to develop the care model and to evaluate the outcomes of institutional, home based and community based telecare. Because of the high risk of medication taking problem in elderly, pharmaceutical care in community-based telecare has become an essential part of this project. The purposes of this study are to investigate the current use of pharmaceutical care in community-based telecare, to identify subjects’ medication safety behavior and satisfaction, and to explore factors related to the use of pharmaceutical care in community-based telecare.
This study used face-to-face data collect method in community health post or community center where telecare were proceed between October to November in 2008. Total sampling was conducted to recruit 132 subjects who were members and had used pharmaceutical care in community-based telecare. Members who were dementia, bed-ridden and less than 50 years old were excluded from this study. The frequency and contents of pharmaceutical consultation and medication delivery services were collected from members’ records review. Personal characteristics, medication safety behavior and satisfaction were collected using self-developed questionnaire survey. Results of this study show the frequency and contents of pharmaceutical consultation and medication delivery services were not significantly related to medication safety behavior and satisfaction statistically. Clients’ADL level was negatively correlated with the frequency of pharmaceutical consultation use. Living status and prescription adherence behavior had significant correlation. Age was positively correlated with service satisfaction, and the number of diseases was correlated negatively with it. Probably because all subjects were members of the service and had used telecare service, it would result in better prescription adherence behavior and high satisfaction, and caused no statistically significant between pharmaceutical care and outcomes in behavior and satisfaction. It is recommended that future study to develop an experimental design and with pre-and post-tests comparisons to explore the effectiveness of this service. Results of this study may assist the community to develop the pharmaceutical care in community-based telecare to enhance medication safety in elderly.

並列關鍵字

pharmaceutical care ； medication safety behavior ； patient satisfaction ； telecare

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