臺灣博碩士論文加值系統

衛生署為了實施醫藥分業，邀請了醫藥界代表經過多次討論與折衝，才勉強發佈醫藥分業階段性實施辦法，使得醫藥政策由過去之雙軌並行式醫藥分業，逐步達成單軌式醫藥分業的共識。然而由於本國醫師診察費偏低、轉診制度並未落實，醫藥分業的實施為醫界帶來之衝擊遠大於獲益，因此導致醫藥界嚴重的對立衝突。
現階段醫界對於醫藥分業採取的因應措施，最普遍者為逕自於診所前設立門診藥局。此種做法雖然沒有違背醫藥分業之法令規範，亦確實符合了衛生署的期望，由藥師專業調劑，大幅提升了醫療品質，然而在現實之經濟效率考量上，卻是醫療資源的浪費。尚且目前不乏一些開設夜間門診之診所，在夜診人數較少的情況下，為了節省藥師聘用成本，在門前藥局的夜間調劑部分仍由非藥師進行，這又是醫藥分業制度下產生之一大漏洞。為了消弭上述各項投機行為，於是本研究希望從另一個角度，探索由醫藥界雙方合作投資聯合藥局的可行性，並以資訊科技建置聯合藥局系統以將聯合藥局與診所連線，在符合實質的醫藥分業制度下，亦可兼顧傳統病患之就醫習性。
本研究開發之系統分為兩大部分。前置部份主要包含訊息偵測主機，透過ADSL連結網際網路至聯合藥局接收主機以進行處方簽訊息傳遞。後置部分則包括網路印表控制器與後處理主機，其中前者可以對於來自不同診所之處方簽進行列印控管，後者則除了進行病人資料庫、藥物資料庫、藥品使用方法資料庫、診所資料庫之建置之外，亦包括資料存檔、更新等管理機能。然而受限於現階段之醫藥環境，本研究之系統實際開發主要強調於前置系統部份之實做。前置系統提供處方簽安全性之確保，使得診所開立之處方簽可透過電子郵件形式經由網際網路傳送至聯合藥局，並列印出與診所相同之處方簽，提供藥師調劑之用。而當病患持診所開立之處方簽領取藥品時，藥師亦可進行處方簽二次查核，間接避免現行之病患單方持有處方簽而衍生的不安全用藥問題。
本系統建置完成之後，首先透過系統之實際測試驗證本系統之可使用性。隨後透過與醫生、藥師之專業訪談，歸納整理出醫藥雙方對本研究與系統之建議。植基於這些建議之下，未來本系統將隨著後續的演進而日趨完善，我們預期除了將可提供醫藥分業環境下醫藥雙方解決方案之參考外，若能透過政策之推廣而加以普及運用，將可使得醫藥分業政策推動更為順利，此乃本研究最終之貢獻所在。

To implement the separation of dispensing practice from medical practice, Department of Health, the Department of Health , Executive Yuan (DOH) invited the representatives of medical and pharmaceutical field to discuss this policy. After lots of discussions and debates, DOH unwillingly released the news that this policy would be phased, and this makes the medicine policy gradually achieve a single track from parallel medical policy.
However, because native doctors’ diagnosis fee is low and transfer system hasn’t carried out, fulfilling this policy brings it the impact to be far larger than benefit, so causes the medical and pharmaceutical field serious appositive conflict.
Regarding this policy, the common measure the medical industry adopts is to establish front door pharmacy. Although this method doesn’t violate the rules about this policy, and it really conforms to the expectation of DOH－ dispensing by the pharmacist. And it does largely promote the medical treatment quality; however, considering the realistic economic efficiency, it really is the medical resources waste.
Besides, some clinics also set up night-OPD, but the number of patients is less; under the condition and for the sake of the economical pharmacist employment cost, the dispensing of OPD is still carried on by the non-pharmacist. This is also a big loophole about this system. For eliminating above-mentioned various speculative behaviors, hence this research hopes from another angle to find out the feasibility that medical and pharmaceutical field cooperates to invest the united pharmacy, and establishes the linkage system by the information technology to combine the united pharmacy and the clinic. At this substantial system, it can also look after the traditional habit of patients in the clinics.
The system of this research is divided into two major parts. The prepositive part mainly contains the information detector unite the pharmacy reception host to transmit the information about prescription by linking the Internet via ADSL.
The postpositive part includes the network India table \ printing controller and the post-processing host. The former can control the printing of prescriptions which come from different clinics. The latter can establish the patient database, drugs application method database, and the clinic database. Besides, it also includes the management functions, such as data backup and update…etc.
However being restricted in the present medicine environment, the development of the system about this research mainly emphasizes the real operation of the prepositive system. The prepositive system can provide the prescription and assure its security. Through the e-mail of the Internet, the prescriptions drawn up by the clinic can be transmitted to the united pharmacy. Through the Internet, the united pharmacy can print out the same prescription as the clinic draws up and provides the pharmacist to dispense.
And when the patients hold the prescription which a clinic draws up to receive drugs, the pharmacist can double-check the prescription and indirectly avoid the patients themselves holding the prescription, which may lead to be insecurely dangerous.
After establishing this system, first through the actual test, we confirm the usability of this system. And then through the professional interview with doctors and pharmacists, we sum up some suggestions about the research and system.
Under these suggestions, this system will achieve perfection along with follow-up evolution in the future. We anticipate that this system can provide the solution to the problem about the separation of dispensing practice from medical practice. If through the promotion of the policy, this system can reach universal usage, then it will be able to make the policy pushed more smoothly. This will be the greatest contribution of this research.

目 錄 I
圖 目 錄 III
表 目 錄 III
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究問題 4
第四節 論文架構 5
第二章 文獻探討 6
第一節 醫藥分業 6
1. 醫藥分業的定義 6
2. 醫藥分業的源起 6
3. 醫藥分業的現況 8
4.台灣實施醫藥分業的過程 9
5.傳統藥局與連鎖健保藥局探討、聯合藥局的導入： 13
第二節 資訊科技於醫藥產業上之應用 15
第三節 資訊科技於醫藥分業上之應用 16
1. 資訊科技對於醫藥分業實行之重要性 16
2. 資訊科技對於醫藥分業實行之效益 17
3. 醫藥分業之相關研究 17
4. 資訊科技應用於醫藥分業之相關研究 18
第四節 小結 19
第三章 系統規劃與架構 22
第一節 系統目標 22
第二節 系統規劃模式 23
第三節 診所與聯合藥局運作流程 23
第四節 系統分析與設計 24
第五節 系統架構 26
第四章 系統實作 30
第一節 功能說明 30
第二節 系統測試 33
1. 系統測試流程 33
2. 實例測試結果 34
第三節 系統效能評估與專家意見 46
第五章 結論與建議 50
第一節 結論 50
第二節 研究貢獻 51
第三節 未來發展方向 51
參 考 文 獻 55

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