影響醫院運用國際藥品條碼意願與行為之相關因素

研究背景與目的：近年來各國醫療機構致力於提升病人安全，美國國家科學院國立醫學研究所指出，美國因醫療錯誤導致每年98,000至44,000人死於可預防性的醫療錯誤，為避免醫療疏失的產生，減少醫療成本與提高病人安全之因素，世界各國醫療機構開始導入各類型的醫療資訊系統以降低用藥錯誤，而其中條碼系統為當前成本最低且最有效之自動辨別系統，且醫院推行藥品條碼系統明顯能夠降低用藥疏失及給藥錯誤，也成為藥事作業最優先的選擇，故本研究目的為探討醫院對導入最內層品條碼系統之意願與行為。方法：本研究方法為橫斷性研究，以科技-組織-環境理論架構為基礎，發展結構式問卷，研究對象為全國四百九十七間之醫學中心、區域醫院與地區醫院，指定由藥劑部主管填答，共回收樣本為220份，回收率為44.3%，利用SPSS 18.0與AMOS 18.0版進行描述性統計及結構方程模式（Structural Equation Modeling, SEM）等統計分析。結果：本研究結構方程模式卡方值/自由度為2.115、GFI為0.922、AGFI為0.874、RMSEA為0.071，表示整體有合理的配適度。研究發現僅環境構面對醫療機構最內層藥品條碼有使用意願，總效用為0.55，且對使用行為有正向顯著影響，其總效用為0.184，以環境構面對使用意願有最大的總效用。而在不同層級醫院條碼建置情形中，醫學中心對於藥品條碼系統的使用比例較區域醫院與地區醫院高。結論：國內醫療院所在導入歐美先進國家以錠劑為最內層之藥品條碼系統時，其使用意願會受到環境構面所影響，且進而影響使用行為，因此政府機關需訂定政策並提供足夠誘因，以提高使用意願與行為。

關鍵字

藥品條碼；用藥安全；科技組織環境理論；結構方程模式

並列摘要

Background and Objectives: Many countries have committed to improving patient safety in medical institutions in recent years. A study by the Institute of Medicine illustrated that medical errors cause 98,000 to 44,000 deaths each year. In order to avoid medical errors, reduce medical costs and improve patient safety, hospitals and governments around the world have begun to implement various types of medical information systems to reduce medication errors. Currently, the medical barcode system and automatic identification systems are considered very effective programs. The implementation of medical barcode systems in hospital pharmacies can significantly reduce medication errors. Barcode systems can not only allow for the exchange of patient data with other hospitals and reduce the waste of medical resources, but also can assist integration with the drug suppliers to increase inventory turnover as well as reduce inventory and procurement personnel costs. In so doing, hospitals may improve the quality of healthcare. The purpose of this research is to identify the factors affecting intention and adoption behaviors for using barcode medication administration systems in hospitals Methods: This research utilizes cross-sectional study methods. The structured questionnaire framework is based on the Technology–Organization–Environment perspective. The study addressed the head of the Department of Pharmacy at facilities including academic medical centers, metropolitan hospitals and local community hospitals. A total of 497 questionnaires were distributed and 220 were returned, for a recovery rate or 44.3%. SPSS v18.0 and AMOS v18.0 were used for descriptive statistics and Structural Equation Modeling (SEM). Results: In this study, the SEM chi-square value/degrees of freedom are 2.115, GFI is 0.922, AGFI of 0.874, and RMSEA is 0.071. Environmental frame surface to intention was significant, the total utility is 0.55, and total utility of intention to behavior is 0.184. Different types of hospitals have different levels of medication barcode system usage, and the proportion of drugs using a medication barcode system is higher in academic medical centers than in metropolitan hospitals and local community hospitals. Conclusion: Environmental frame to intention was significant, and intention affects behavior. Government agencies should be required to establish policies and provide adequate incentives to increase the use of medication barcode systems.