藥師對一般外科病患提供藥事照顧之探討

Providing Pharmaceutical Care to Patients under General Surgery by Pharmacist

譚延輝(Yen-Huei Tarn) ； 郭錦璋(Chin-Chang Kuo) ； 回德仁(Der-Zen Hwei)

《Journal of Medical Sciences》 18卷6期 (1998/06) Pp. 376-389

摘要

“藥事照顧”是國內藥學界新提倡的執業理念。本研究基於此理念為出發點，來探討在醫院病房內由藥師提供“藥事照顧”服務後對住院病患的藥費、住院天數、及總住院花費的影響。本研究由一名藥師與一般外科某位主治醫師合作。研究進行時間分藥師介入前（84年5月至85年2月），與藥師介入後（85年3月至85年10月）。統計分析是此主治醫師與其他醫師在藥師介入前後與平行時期之病患數據的比較。病患的選擇為進行疝氣修補手術、乳房病灶部切除手術、單側擴大單純乳房切除手術、急性闌尾炎未提及腹膜炎之闌尾切除手術、腹腔鏡膽囊切除手術的病人，排除有次要診斷或次要手術的病人後才成為研究比較的對象。研究結果顯示藥師介入後在疝氣修補手術上，此主治醫師之病患的藥費由740.5元降低為467.1元；乳房病灶局部切除手術上，藥費由737元降低為388.5元，統計結果均有顯著的差異。在住院天數、住院總花費、及藥費比例方面，各手術都有下降的趨勢。本研究發現此主治醫師的用藥模式與其他醫師群不同，若一般外科醫師在上述五種手術中，能採用較經濟的藥物治療模式，在不考慮其他醫療資源使用的節省或降低住院花費或預防藥物副作用發生的情形下，僅這五種手術病人群最保守的估計每年將可節省藥物成本兩百萬元。因此，若聘請人位藥師在一般外科服務（一年成本約七十萬元），鼓勵推廣安全、合理、經濟、有效的藥物治療模式，則可以得到非常高的經濟效益。證明“藥事照顧”在國內是一項可行且值得推廣的服務。

關鍵字

藥事照顧 ； 一般外科手術 ； 預防性 ； 抗生素 ； 成本節省 ； 住院天數

並列摘要

There are very few published papers evaluating the value of pharmacists' services in Taiwan. Based on the concept of pharmaceutical care, this study investigated the impact of hospital pharmacist providing pharmaceutical care for the patients under general surgery on the cost of drug therapy, length of hospital stay, and total hospital charges. In the study, by working together with a surgical attending physician, a pharmacist provided pharmaceutical care to all of the physician's patients. The study was divided into two phases. Phases I (without a pharmacist) was from May 1995 to February 1996, and phase II (with a pharmacist) was from March 1996 to October 1996. Longitudinal and parallel comparisons were made to analyze the dependent variables. Surgical patients eligible for inclusion in the comparison analysis were under herniorrhaphy, local excision of lesion of breast. Unilateral extended simple mastectomy, simple appendectomy laparoscopic cholecystectomy. Patients were excluded from the study if they had secondary diagnosis or secondary surgery. The results demonstrated that the cost of drug therapy for the herniorrhaphy reduced from 740.5 to 467.1 NT dollars, and for the local excision of lesion of breast reduced from 737 to 388.5 NT dollars after pharmacist's intervention. Both statistics were significantly different. The length of stay, total hospital charges, drug cost to total charge ration for all kinds of surgeries showed a reduced tendency. The study also found that the drug use pattern for this attending physician is different form that of others, and if all surgical doctors used more economical drug therapy model, the cost of drug therapy for these five clean or clean-contaminated surgeries will save around 2 million NT dollars per year. Evidences showed that providing pharmaceutical care by a pharmacist to general surgical patients is cost beneficial and worthwhile propagation.

並列關鍵字

pharmaceutical care ； general surgery ； prophylaxis ； antibiotics ； cost saving ； length of stay