社區用藥配合度諮詢服務對病人用藥管理能力的影響評估

The Effects of Counseling by Community Pharmacists on Patients' Medication Management Capacity

本研究目的在探討一項新發展之社區式藥事照護－用藥配合度諮詢對於用藥高危險病人用藥管理能力之影響。此前瞻性觀察性研究於2013年3月至10月期間進行，由20名通過用藥配合度諮詢培訓並獲認證之社區藥師依據用藥高危險收案條件篩選病人，獲病人簽署同意後，提供每月1次，至少連續3次之諮詢。總計完成3次諮詢者184人（女/男：91/93），平均年齡71.8±12.4歲（27~95 歲），65歲以上老人佔73.4%。藥師介入後，用藥管理能力分數提高，從 5.2±7.8分增為97.7±5.6 分（p<0.001），平均用藥品項數從7.4±3.1項減為6.7±2.8項（p=0.016），且用藥品項數較多者之改善成效較佳（Pearson相關：0.71，p<0.01），藥師之介入可為每名病人節省藥費約286元。整體個案之用藥管理能力分數中以「用藥時間與劑量」之表現較差；分析回答問題之表現，顯示老人於「辨識藥品」乙項不正確率為一般族群之近3倍（Odds Ratio: 2.99; 95%CI: 1.05-8.48; p=0.036），且用藥管理能力分數亦較低，但於藥師介入有顯著性的改善，並接近一般族群。值得注意的是，不論藥師介入前或介入後，有關「是否有不適情形」及「是否需要其他資訊」等兩項問題，老年人相對於一般族群之風險值均較偏低，顯示老人可能較不善表達自己的病痛且較不主動提出需求。綜合以上結果，本社區式藥事照護能有效提升用藥高危險病人之用藥管理能力，並改善多重用藥情形，進而減少藥費支出。病人的「用藥時間與劑量」為諮詢時之重點，對於老年人需加強「辨識藥品」之教育，並審慎評估是否有不適症狀。

The aim of this study was to evaluate the outcomes and effectiveness of a newly developed community pharmaceutical care service for high risk groups with medication related problems. This prospective study was conducted for a period of eight months from March to October 2013. Participants were selected according to the established criteria. After participants gave signed consent, 20 certified pharmacists provided community pharmaceutical care (counseling and prospective drug utilization review) for at least three consecutive sessions, after which the outcomes were assessed. Data were compared and analyzed with Excel and SPSS software. There were 184 valid participants (female/male: 91/93), with a mean age of 71.8±12.4 years and an age range of 27-95 years. Participants aged 65 years or over accounted for 73.4% of the sample. The results showed: the participants' mean scores for medication knowledge and management skill improved (from 95.2±7.8 to 97.7±5.6, p<0.001), the number of medications per person decreased (from 7.4±3.1 to 6.7±2.8, p=0.016), there was a positive correlation between the number of medications used and the effectiveness of the counselling (Pearson correlation: 0.71, p<0.01), and the average medication cost saving was about NT$286.7 for each person. Analysis of the participants' answers to specific questions showed: the scores for ' timing/dosage' were the lowest; and the rate of incorrect answers to questions about 'medication knowledge' by elderly participants was nearly three times that of the general population (Odds Ratio: 2.99; 95%CI: 1.05-8.48; p=0.036). The scores for medication knowledge and management skills were lower among elderly participants, but improved significantly after intervention. There was no significant difference in the variables 'physical discomfort' and 'need additional information' before and after intervention, and the Odds Ratio was lower among the elderly, showing the elderly may be less inclined to express their discomfort and less likely to mention their needs. Based on the above results, it is concluded that this community pharmaceutical care service was able to improve patients' medication knowledge and management skills and reduce the number of medications in polypharmacy cases, thereby reducing expenditure on medication. 'Timing and dosage' of medication was the focus of the counseling, but it is clear that for elderly patients 'medication knowledge' needs to be strengthened and 'any discomfort related to medication problems' needs to be carefully assessed.