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研究生:溫明芳
研究生(外文):Ming-Fang Wen
論文名稱:社區大學健康教育對民眾用藥行為、態度、藥品資訊來源及對藥師認知之影響評估
論文名稱(外文):Effects of a National Health Education Program on Participants’ Medication Behaviors, Attitudes, Drug Information Sources, and Perceptions toward Pharmacists
指導教授:陳瓊雪陳瓊雪引用關係林慧玲林慧玲引用關係
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:臨床藥學研究所
學門:醫藥衛生學門
學類:藥學學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
論文頁數:145
中文關鍵詞:社區大學健康教育藥品資訊來源用藥行為對藥師認知用藥態度藥師
外文關鍵詞:drug information sourcesmedication behaviorsmedication attitudesnational health education programpharmacistperceptions toward pharmacists
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  • 被引用被引用:16
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藥師提供病患用藥指導,能增進病患對藥品的認知,改善病患用藥順從性並改正不適當用藥行為,進而減少藥品相關問題的發生,藥師傳遞藥品資訊之專業角色為病患所認定後,將增加病患對藥師提供藥品資訊的需求。本研究之主要目的為評估「社區教育推展藥學知識」課程對民眾用藥行為、態度、藥品資訊來源、需求、相信程度以及對藥師之認知的影響。
這是一個以藥師介入處置之單一群組自我比較的研究。研究對象為九十二年度九月至九十三年度一月參與全國三十一所社區大學用藥知識課程的民眾。研究方法採用問卷方式評估,前測於民眾參與課程初發放,後測則於課程結束時發放;資料處理以Excel及SPSS/PC進行數據分析,統計檢定方法為McNemar’s test,顯著水準設為0.05。
研究結果顯示,經一學期用藥課程後,民眾「留存剩餘藥品」情形於課後顯著減少(p<0.01),「常常不知道藥品已經過期」的比例亦減少(p<0.05),課程改變民眾處理剩餘及過期藥品方式,傾向於「丟到馬桶沖掉」(p<0.001),對於民眾用藥順從行為無顯著改善,但因「害怕副作用」而用藥順從性不佳的民眾則顯著減少(p<0.05)。用藥態度上,課程顯著增加民眾對各藥品注意事項的注意程度,特別是藥名與藥品的作用。此外,民眾對各項藥品資訊有高度的需求,而課程也顯著改變「藥師」在民眾藥品資訊來源中的角色,民眾由「醫院藥師」、「社區藥師」、「社大課程」獲得藥品資訊的比例顯著增加(p<0.05, p<0.001, p<0.001),課後相信「社區藥師」與「社大課程」所提供之藥品資訊的比例亦顯著提高(p<0.05)。民眾主動詢問藥師用藥問題的比例於課後顯著減少(p<0.001),但曾經詢問藥師者對藥師提供資訊的滿意比例則顯著增加(p<0.01),課後不認同「藥師只需按照醫師處方正確配藥」與「藥師不該質疑醫師開方的藥品」比例亦顯著增加(均為p<0.001)。
以藥師為授課講師對民眾進行基本用藥知識教育,對民眾之用藥行為、態度、藥品資訊來源、相信程度以及對藥師的認知均有顯著影響,但本研究僅為短期評估,課程對民眾用藥順從性之改善及是否能改變民眾與藥師的互動(促進民眾主動向藥師詢問用藥問題),尚待長期觀察與評估。



Literature has showed that counseling provided by pharmacist can increase patients’ knowledge on medications, improve compliance, and reduce inappropriate medication taking and subsequent drug-related mortality and morbidity. Moreover, it is likely that patients will demand more of these services from pharmacists once their professional role in delivering drug information has been established and acknowledged by patients. The main purpose of this study was to evaluate the impact of a national health education program, the Community Education Program on Pharmacy and Medications, on participants’ medication behaviors, attitudes, drug information needs and sources, and trust and perceptions toward pharmacists.
This was a single group, pre- and post- comparison study. The subjects were a group of general public who attended the Community Education Program on Pharmacy and Medications delivered by trained pharmacists at 31 community colleges in Taiwan from September 2003 to January 2004. The study collected data through survey questionnaires. The baseline and post-test surveys were carried out in the beginning and at the end of the education program respectively. Data was recoded in Excel and analyzed by SPSS/PC. The statistical method utilized for hypothesis testing was the McNemar’s test with a significant level of p�T0.05.
The study results indicated that after the education program, there was a significant reduction in number of people who kept leftover drugs (p<0.01) or did not notice the expiration of their medications (p<0.05). In addition, the education program also influenced how people handle their leftover and/or expired medications. Instead of “throwing the drugs away with trash” at the baseline, after the program, more people chose “flushing the drugs down the toilet” as the method to handle the extra medications (p<0.001). However, no significant change was observed in patient compliance.
The education program also increased the participants’ attention and demand on medication-related information. A significantly greater number of people relied on pharmacists as their primary source of drug information, and more had obtained their medication information from “hospital pharmacists”, “community pharmacists” and through “the community college programs” as compared to the baseline (p<0.05, p<0.001, p<0.001, respectively). More people also reported that they trusted information obtained from “community pharmacists” and provided by “the community college programs” (p<0.05 respectively). Although number of people who had asked medication-related questions was less (p<0.001) after the education program, those who did ask were significantly more satisfied with the information given (p<0.01). More people also disagreed with the statements “the only role of pharmacists is to dispense drugs according to the prescriptions” and “pharmacists should not second-guessing the prescriptions written by physicians” (p<0.001) in the post-test questionnaire.
Pharmacy and medication education provided by pharmacists at the community can significantly influence the participants on their medication-taking behaviors, attitudes, sources of and trusts in drug information, and perceptions toward pharmacists. As this study is a short-term evaluation, long term follow-up is required in the future to assess whether the education program can improve the general public’s drug compliance and interaction with pharmacists.


內容目錄
頁數
內容目錄 I
表目錄 III
圖目錄 V
附錄目錄 VI
附錄表目錄 VII
附錄圖目錄 VIII
中文摘要 IX
英文摘要 XI
第一章 前言 1
第二章 文獻探討 3
第一節 用藥安全與藥師傳遞藥品資訊的角色 3
第二節 病患用藥指導及病患用藥順從性 8
第三節 病患藥品資訊需求與來源 13
第三章 研究目的 18
第四章 研究材料與方法 19
第一節 研究假設 19
第二節 研究樣本 19
第三節 研究材料 21
第四節 研究設計 27
第五節 資料處理與分析 29
第五章 結果 31
第一節 反應率 31
第二節 研究對象基本資料 32
第三節 民眾用藥行為 36
第四節 民眾用藥態度 52
第五節 民眾藥品資訊需求、來源及相信程度 57
第六節 民眾對藥師的認知 70
第六章 討論與建議 81
第一節 研究限制 81
第二節 研究樣本 82
第三節 民眾用藥行為 83
第四節 民眾用藥態度 88
第五節 民眾藥品資訊需求、來源與相信程度 91
第六節 民眾對藥師的認知 95
第七節 建議事項 98
第七章 結論 100
參考文獻 102

表目錄
頁數
表2. 1 調查病患藥品資訊需求與取得來源之研究 16
表4. 1 研究工具題項描述………………………………………………. 25
表4. 2 用藥知識課程單元………………...……………………………. 28
表4. 3 統計分析方法……………………...……………………………. 30
表5. 1 研究對象基本資料 33
表5. 2 研究對象與回收之全體樣本卡方檢定結果 34
表5. 3 四區域社大之民眾基本資料比較 35
表5. 4 慢性病種類 36
表5. 5 民眾過去四個月內就醫與使用藥品情形 39
表5. 6 民眾過去四個月內就醫次數 39
表5. 7 民眾過去四個月內用藥順從性 43
表5. 8 民眾過去四個月內贈與他人藥品使用的習慣 45
表5. 9 民眾對剩餘及過期藥品處理方式 47
表5. 10 顯著性分群探討:民眾用藥行為 50
表5. 11 民眾使用藥品時會注意的事項 54
表5. 12 民眾使用藥品時主要會注意的事項 55
表5. 13 藥品注意事項分數 55
表5. 14 顯著性分群探討:民眾用藥態度 56
表5. 15 民眾希望獲得的藥品資訊 59
表5. 16 民眾主要希望獲得的藥品資訊 60
表5. 17 民眾希望獲得的藥品資訊分數 60
表5. 18 民眾藥品資訊來源 62
表5. 19 民眾藥品資訊的主要來源 63
表5. 20 藥品資訊來源相信程度 65
表5. 21 民眾相信的藥品資訊來源 66
表5. 22 顯著性分群探討:民眾藥品資訊需求、來源及相信程度 69
表5. 23 民眾與藥師的互動情形 72
表5. 24 民眾對藥師的看法 76
表5. 25 民眾認同與不認同的藥師看法 77
表5. 26 民眾對藥師的認同分數 77
表5. 27 顯著性分群探討:民眾對藥師的認知 80

圖目錄
頁數
圖4. 1 研究流程與時間表 27
圖5. 1 慢性病種類 37
圖5. 2 過去四個月內民眾使用藥品之種類 40
圖5. 3 過去四個月內民眾使用藥品之取得來源 40
圖5. 4 過去四個月內民眾自行增減用藥劑量或停藥之藥品種類 44
圖5. 5 過去四個月內民眾自行增減用藥劑量或停藥原因 44
圖5. 6 過去四個月內民眾贈與他人使用藥品之種類 46
圖5. 7 剩餘藥品處理方式 48
圖5. 8 過期藥品處理方式 48
圖5. 9 民眾使用藥品時主要會注意的事項 55
圖5. 10 民眾主要希望獲得的藥品資訊 58
圖5. 11 民眾藥品資訊主要來源 63
圖5. 12 民眾相信的藥品資訊來源 67
圖5. 13 民眾詢問藥師用藥問題頻次 73
圖5. 14 民眾對藥師提供之用藥資訊的滿意程度 73
圖5. 15 民眾不曾向藥師詢問用藥問題的原因 74
圖5. 16 民眾認同的藥師看法 78
圖5. 17 民眾不認同的藥師看法 78


附錄目錄
頁數
附錄 一 民眾藥品資訊來源及用藥態度問卷調查表(課前評估) 109
附錄 二 民眾藥品資訊來源及用藥態度問卷調查表(課後評估) 114
附錄 三 民眾用藥習慣與藥品資訊來源問卷調查表(課前評估) 119
附錄 四 民眾用藥習慣與藥品資訊來源問卷調查表(課後評估) 123
附錄 五 預試結果(九十二年度上學期) 127


附錄表目錄
頁數
附表 1 研究對象基本資料 127
附表 2 慢性病 128
附表 3 民眾藥品來源 128
附表 4 民眾藥品主要取得來源 129
附表 5 民眾的服藥順從性 130
附表 6 民眾對剩餘及過期藥品處理方式 132
附表 7 顯著性改變分群探討: 民眾用藥行為 134
附表 8 民眾使用藥品時會注意的事項 135
附表 9 民眾使用藥品時主要會注意的事項 136
附表 10 民眾藥品注意事項分數 137
附表 11 顯著性分群探討:民眾用藥態度 137
附表 12 民眾希望得到的藥品資訊 138
附表 13 民眾主要希望得到的藥品資訊 139
附表 14 民眾希望得到的藥品注意事項分數 141
附表 15 民眾藥品資訊來源 141
附表 16 民眾藥品資訊主要來源 142
附表 17 民眾與藥師的互動情形 143
附表 18 民眾對藥師的看法 144
附表 19 民眾對藥師的看法 145
附表 20 民眾對藥師的認同分數 145

附錄圖目錄
頁數
附圖 1 民眾藥品主要取得來源 130
附圖 2 民眾自行增減用藥劑量或停藥之藥品種類 132
附圖 3 民眾自行增減用藥劑量或停藥原因 132
附圖 4 民眾處理剩餘藥品方式 134
附圖 5 民眾處理過期藥品方式 134
附圖 6 民眾使用藥品時主要會注意的事項 137
附圖 7 民眾主要希望得到的藥品資訊 141
附圖 8 民眾藥品資訊主要來源 143
附圖 9 民眾不常向藥師詢問用藥問題的原因 144
附圖 10 民眾認同的藥師看法 145



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