某區域醫院建置藥品交互作用警示系統對醫師門診處方行為的影響

The experience of drug interaction alert system established on a regional hospital

侯芳敏(Fam-min HOU)

指導教授 ： 楊漢湶

亞洲大學/健康學院/健康管理研究所/碩士(2006年)

摘要

中 文 摘 要
本研究是在探討醫院的門診醫令系統中，架構藥物交互作用提警示功能，以避免不良反應交互作用的發生，藉由記錄系統上線門診藥物交互作用資料，針對不同科別不同醫師每月的一級交互作用，來分析探討醫師的用藥行為‧問卷調查結果顯示：73.75%醫師知道本院設有藥品交互作用提示，64%認為有此藥品交互作用提示可以減少用藥疏失，而有55.2%醫師認為藥品交互作用提示並不會干擾處方開立，研究結果顯示，醫師之科別、層級、年齡、年資有影響，經過深度訪談，有關藥品交互作用警示，醫師們認為還是需要的，很多醫師開立處方是依據臨床經驗和期刊資料呈現，雖然醫師是依據臨床的經驗，但是偶而還是會疏忽交互作用的發生，所以還是希望能夠有交互作用的警示，來提示相關藥物交互作用的訊息，讓醫師選擇更適當的藥物來治療，並注意病人臨床反應，以防止不良藥物副作用的發生。
藥品檔案分析發現有些藥品會產生交互作用，像心臟科常使用的Digoxin和Nadis，在本院屬於一級交互作用的件數，幾乎佔了全科2/3以上，但是在正確使用與密集監測下並無危險性，Digoxin引起之毒性反應除了與劑量有關外，與離子濃度之高低亦有關係，腎功能的情形亦會影響Digoxin之排泄，所以當兩者併用時，需視腎功能之情形而調整劑量，亦應隨時監測血中電解質的濃度‧隨時知會病人、教育病人，讓病人了解該注意的事項，所以在臨床使用上並不影響病人的治療效果。一級交互作用也以主治醫師最常見，分析結果因為主治醫師長期看門診累積臨床經驗，認為病情需要而繼續開立一級交互作用，在經過介入問卷調查和宣導後，於11月 12月再次分析，發現各醫師交互做用的件數明顯減少很多‧所以在門診醫囑輸入系統建置藥品交互作用警訊，是一改善醫師處方行為之良好工具，可以有效減少用藥疏失之發生，對於醫師、病人，是相當需要之機制，可確保病人之用藥安全‧

關鍵字

藥品交互作用

並列摘要

Abstract
This purpose of this study is to construct a drug interaction alert system for an outpatient Physician Order Entry System, currently executed in an outpatient department, to avoid unwanted side effects due to the reactions of mixing different medicines. From the online records of the reactions among different medicines and the interaction among different doctors in different specialty background, the behaviors of doctors’ prescriptions on medicines can be analyzed. The outcome of a questionnaire indicates that 73.75% of doctors know about the drug interaction alert system applied in this hospital, and 64% of doctors are aware that this drug interaction alert system can help reduce the risks of misusing medicines. Also, 55.2% of doctors confirm that the drug interaction alert system does not interfere their decision making on medicine prescriptions. Further analysis on the outcome of the questionnaire shows that specialty background, age, ranking, and years of practicing are the major factors affecting how a doctor fill in the questionnaire. However, further interviews with doctors confirm that many doctors believe in the necessity of drug interaction alert system. Although many doctors prescribe medicines based on their clinical experiences and data reported in journal articles, misjudgment on the interactions of different medicines happen from time to time. Therefore a drug interaction alert system is appreciated and can offer great help for doctors providing the correct medicine prescriptions to avoid side effects due to medicine interaction.
Some medicines do interact when they are mixed. For example, cardiac medicine Digoxin and Nadis are responsible for 2/3 of the first class medicine interaction cases in this hospital. However, this kind of medicine interaction is not dangerous if the medicine is correctly used, and its reaction is intensively monitored. The toxic reaction of Digoxin is closely related to the doses, concentration of ions, and kidney function, which excretes Digoxin outside our bodies. Therefore, when the two medicines are used together, the doses need to be carefully considered according to the conditions of patient’s kidney, and the ion concentration in blood stream needs to be closely monitored. In the meantime, patients need to be well informed and constantly educated to be aware of some critical issues about themselves. Under the above circumstances, this kind of medicine interaction poses no threat to the treatment of a patient. The situations of the first class medicine interaction are most commonly seen among chief doctors. A research result indicates that according to their long-term clinical experiences, an aggressive treatment by continuously prescribing the first class interaction medicine is essential for some patients. However, another questionnaire analysis done one month later reveals that, after some first-class-interaction medicine propaganda, the number of first-class-interaction-medicine prescriptions has been fallen dramatically. This proves that the drug interaction alert system implemented in the outpatient Physician Order Entry System is very helpful to improve doctors’ medicine prescriptions. It is very effective in reducing cases of ill-prescription of medicine and is very important for doctors and patients alike. This system is an essential mechanism to ensure safe use of medicine, which offers great assurance on the correct medicine prescription for patients.

並列關鍵字

Drug interaction

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