藥師衛教介入改善氣喘控制之成效

The Efficacy of Pharmacist-delivered Health Education in Asthma Control

方喬玲(Chiao- Ling Fang) ； 莊淇源(Chi-Yuan Chuang) ； 鄒志翔(Chih-Hsiang Tsou) ； 樓亞洲(Yea-Jou Lou) ； 陳立奇(Lih-Chi Chen)

《北市醫學雜誌》 11卷3期 (2014/09) Pp. 39-53

https://doi.org/10.6200/TCMJ.2014.11.3.05

摘要

目的：全球氣喘創議組織(GINA, Global Initiative For Asthma)治療指引指出，衛教病人正確用藥、認識氣喘疾病、瞭解定時回診追蹤的正確觀念，是有效控制氣喘的方法，本文旨在探討藥師介入氣喘衛教的成效。方法：本研究之研究對象以臺北市立聯合醫院仁愛院區確診為氣喘控制不佳且至少使用一種吸入劑，且願意加入本研究之成年病人。介入成效指標以氣喘控制測驗評估氣喘控制、以問卷評估吸入劑使用的正確性及疾病與用藥知識提升的程度。結果：藥師介入對於吸入劑的使用、氣喘疾病與用藥相關知識皆有顯著的進步。在疾病控制方面，藥師介入後ACT平均分數明顯上升，服藥順從性佳者相較未按時服藥者，ACT分數上升幅度較多。結論：本研究經以病人為中心之跨專業團隊氣喘照護介入後，有以下發現：（一）應再次追蹤病人是否能正確操作吸入劑，對於病人操作常見的錯誤可做為未來藥師於吸入劑衛教時需特別強調的重點。（二）氣喘病人需接受詳細的用藥指導及確認病人學習到正確的用藥知識，可提升服藥順從性及對氣喘控制具有正面的效益。（三）本研究亦驗證藥師協助用藥記錄，確實可幫助醫療人員及早發現不當的用藥情形及適時解決用藥的疑惑。

關鍵字

氣喘 ； 藥師 ； 氣喘控制測驗

並列摘要

Objectives: Achievement and maintenance of a good asthma control is essential in asthma management. However, due to improper use and non-adherence of asthma medications, asthma control is suboptimal in many patients. The aim of this study was to evaluate the effects of a pharmacist intervention on asthma control in adult patients. Methods: This prospective study included outpatients at a general hospital diagnosed with insufficiently controlled asthma and were using at least one controller inhaler. Patients received a pre-defined pharmacist intervention for 3 months. The primary outcome was the level of asthma control, and the secondary outcomes were correct percentage of inhaler using skills, knowledge of asthma and asthma medicine, and medication adherence. Results: A total of 24 patients completed the study. The mean ACT (Asthma Control Test) score (P=0.0001), knowledge of asthma (P=0.0001), inhaler technique (P=0.034), and PEFR (Peak Expiratory Flow Rate) measurements (P＜0.050) were significantly improved after the intervention. In addition, adhesive patients had larger ACT score increments as compared to non-adhesive patients. Conclusion: Our program substantially improved inhalation technique, knowledge on asthma and medication adherence in the patients. The results suggest that participation of pharmacist in the health care team has a positive effect on the level of asthma control in adult asthma patients.

並列關鍵字

Asthma ； pharmacist ； ACT