臺灣博碩士論文加值系統

台北市衛生局與台北市藥師公會有鑑於以往慢性病患對於使用慢性病連續處方箋（以下簡稱慢箋）相關配套措施的不了解，於民國93年8月1日起，於市立聯合醫院各院區藥局前設置「慢箋諮詢服務工作站」，由社區藥師宣導並協助使用慢箋之民眾，於第二、三次前往住家或工作場所附近之社區藥局領藥。藉由本研究對使用慢箋者關於前往社區藥局領藥之認知以及領藥相關因素之探討，並了解民眾對於藥師服務之觀感，以提供日後相關宣導進行的參考。
本研究採用橫斷向及立意抽樣方式，分為預試階段及研究階段。研究工具乃參考國內外有關民眾選擇藥局調劑之決定因素以及對藥師服務滿意度之相關文獻探討與研究，並與多位藥學專家多次討論，所設計的結構性問卷，並根據預試階段的結果，確認民眾填答順利無礙，此外，為確保問卷信效度，使問卷具有應用的價值，並進行專家效度審查以及再測信度測量。正式研究收集自民國94年3月7日至4月15日，由訪員於某市立醫院藥局前辨識持慢箋領藥之民眾，詢問民眾意願，採用面訪方式進行資料的收集。
研究期間，共計387位持慢箋民眾接受訪員之面訪，有效問卷為358份，受訪者平均年齡為59.13 ± 14.6歲（範圍：20-84歲），其中又以60-80歲族群（46.4%）為主，而問卷填寫者中有259（72.3%）位為患者本人。在慢箋使用認知部份，287（80.2%）位民眾知道持慢箋可以到社區藥局領藥；208（58.1%）位民眾知道持慢箋至社區藥局領藥，不用再支付藥品部分負擔；不過，藥品品牌替換方面僅有46（12.8%）位民眾了解。
所有受訪者中，175（48.9%）位民眾表示曾經持慢箋至社區藥局領藥；社區藥局可近性方面，有205（57.3%）位民眾表示走路15分鐘以內可到達離家或工作場所最近之社區藥局。在慢箋使用資訊來源，以醫師（31.8%）為主，其次則是社區藥師（25.5%），不過，曾持慢箋至社區藥局領藥之民眾，主要資訊來源則以社區藥師（36.4%）為主。
此外，研究結果顯示，無論在專業形象或專業服務，民眾對於醫院藥師之認同程度較社區藥師高；民眾認同對醫院藥局「所給的藥品品質有信心」較社區藥局高（90.2%；64.3%）；不過，在藥師提供個人化服務方面，民眾對於社區藥師之認同程度較醫院藥師高：民眾認同社區藥師「會關心或詢問我的健康問題」的百分比較認同醫院藥師者高（41.9%；22.9%）；民眾認同社區藥師「會主動提供針對我個人用藥的諮詢服務」的百分比亦較認同醫院藥師者高（47.9%；33.4%）。
而民眾在選擇調劑場所仍以距離便利（59.8%）為優先考量，而藥品品質（46.6%）及等待領藥的時間（31.8%）則為其次。
藥師是提供用藥諮詢及基本醫藥知識的專業人選，而社區藥師的可近性，亦能提供彈性且時間充裕、說明詳細之服務，因此，社區藥師應藉由慢箋之釋出，充實本身專業知識及溝通技巧，提供民眾完善的藥事服務，加強藥師專業形象之建立。
由本研究結果，建議衛生主管機關應持續進行慢箋相關資訊的宣導和推廣，有效整合現有醫療資源，使更多使用慢箋民眾了解相關配套措施，而社區藥師應提升藥事服務的品質，提供民眾完善的健康維護，加速達到安全用藥和健康維護之目標。

Because the general public are not familiar with chronic-disease refill prescriptions system, Department of Health Taipei City and Taipei pharmacists’ Association started a program to help the release of chronic-diease prescriptions to community pharmacies. They implemented chronic-diease refill prescription counseling sevice counters in front of all municipal hospital outpatient pharmacies. Two hundred and seven community pharmacies volunteered in the activity. The volunteer community pharmacists educated and assisted the public to refill their prescriptions at community pharmacies. Our objectives were to investigate the knowledge, attitude, and determinants of willingness of refill of chronic-diease prescriptions at community pharmacies. This study also assessed perceptions of the general public on pharmacists at hospitals and community pharmacies throuth the process of prescription refill.
This study used cross sectional and purposive sampling method. An anonymous questionnaire containing 21 questions was used. The survey was conducted by face-to-face interviews at one of the municipal hospitals between March 7, 2005, and April 15, 2005. Responses of the people who had chronic-disease prescriptions refilled during the study period were included in the analysis.
Three hundred and fifty-eight people had completed the interview. The average age was 59.13 ± 14.6 years (range, 20-84 years). Many (46.4%) respondents aged between 60 and 80 years. Most respondents (72.3%) had the prescriptions refilled by themselves. Among the knowledge toward refilling chronic-disease prescriptions at community pharmacies, two hundred and eighty-seven (80.2%) respondents had knew that a chronic-disease prescription can be filled at community pharmacies and 208(58.1%) knew that copayment was not needed when the chronic-disease prescription was filled at community pharmacies. Only 46 (12.8%) understood about generic substitution of drugs.
Of all respondents, 175(48.9%) reported they had the experience of chronic-disease refill prescriptions filled at community pharmacies. Two hundred and five (57.3%) respondents reported that it took 15 minutes or less to walk to the community pharmacy that is nearest from home. Many patients (31.8%) obtained chronic-disease prescriptions refill information from physicians, followed by community pharmacists (25.5%). Of people who had had their chronic-disorder refill prescriptions filled at community pharmacies, community pharmacists (36.4%) were the major information source.
Respondents rated their agreement about perceptions of pharmacists within the process of refilling a prescription at the hospital and/or community pharmacies. Overall, respondents had more positive impression of hospital pharmacists than community pharmacists on professionalism and the services that pharmacists provided. Most respondents were more confident in the quality of drugs obtained from hospital than that of community pharmacies (90.2%; 64.3%). However, more respondents agreed that community pharmacists were more concerned about their health than hospital pharmacists（41.9% vs 22.9%）and were more initiative to provide drug counseling (47.9%; 33.4%).
Important determinants of willingness to have chronic-disease prescriptions filled at community pharmacies for those who had such experience include accessibility of pharmacies (68.8%), quality of drugs received (46.6%) and timeliness of prescription refilled (31.8%).
Community pharmacists are in an unique position to help patients to manage chronic disease in term of their expertise, their regular contact with patients, and their accessibility. This study suggested that community pharmacists should improve their quality of sevice and fulfill their responsibility in health promotion and drug safety assurance.
Continuous propaganda and promotion by the authority in the use chronic-disease refill prescriptions and having them refilled at community pharmacies are recommended.

第一章 研究背景 1
第二章 文獻探討 4
第一節 醫藥分業 4
第二節 慢性病連續處方箋簡介 12
第三節 藥師與慢性疾病治療 14
第三章 研究目的 21
第四章 研究材料及方法 23
第一節 研究樣本 23
第二節 研究設計 24
第三節 研究材料 26
第四節 資料處理與分析 32
第五章 研究結果 40
第一節 研究工具評估 40
第二節 反應率 42
第三節 研究對象基本資料 43
第四節 慢箋使用認知 49
第五節 社區藥局可近性與領藥之習慣與次數 55
第六節 慢箋使用資訊來源 59
第七節 對於藥師服務之觀點 62
第八節 選擇領藥場所之考量 80
第六章 討論與建議 83
第一節 研究限制 83
第二節 研究樣本基本資料 86
第三節 慢箋使用認知 87
第四節 社區藥局可近性與領藥之習慣 91
第五節 慢箋使用資訊來源 93
第六節 對於藥師服務之觀點 95
第七節 選擇領藥場所之考量 98
第七章 建議 101
第八章 結論 103
第九章 參考文獻 105

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