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研究生:劉千綺
研究生(外文):Liu, Chien-Chi
論文名稱:探討台灣藥事照顧特別門診對病患的影響
論文名稱(外文):Evaluation of the effects of pharmaceutical care model in outpatient setting
指導教授:劉文雄劉文雄引用關係
指導教授(外文):Liou, Wen-Syong
學位類別:碩士
校院名稱:國防醫學院
系所名稱: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:2007
畢業學年度:95
語文別:中文
論文頁數:180
中文關鍵詞:藥事照顧生活品質滿意度需求性抗凝血劑氣喘糖尿病
外文關鍵詞:pharmaceutical careEQ5Dasthmadiabetesanticoagulant
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本研究根據藥事照顧的理念,探討台灣某醫學中心藥師針對口服抗凝血劑、氣喘及糖尿病之門診病患執行藥事照顧執業模式的建立。同時藉此模式探討藥師對於門診病患執行藥事照顧後對病患之臨床效益、生活品質的影響及病患對藥師專業服務的需求性及滿意度。
研究設計是各別將抗凝血劑組、氣喘組及糖尿病組之門診病患隨機分配為實驗組及對照組。以ANOVA、 Student’s t-test與Paired t-test統計方法做檢定。
研究結果在臨床效益方面顯示各組在藥師介入前後未達統計之顯著差異,原因可能是其他組別樣本數太少。病患對藥師門診的需求性、回診意願及對藥師門診的滿意度與藥師整體服務滿意度之組內比較結果大多達統計上顯著差異。根據以上結果證明藥師執行藥事照顧對於門診病患的藥物治療臨床效益及病患對藥師專業服務的滿意度與需求性有正面影響。
Base on the concept of pharmaceutical care, this study investigates the model of hospital pharmacists providing pharmaceutical care to the patients receiving oral anticoagulants, asthma and diabetes medication treatments in outpatient setting at one of the Taiwanese medical centers. The authors also evaluate the impacts of the practice model on the treatments outcomes which include clinical indicators, quality of life, patients needed, and satisfaction to pharmaceutical services.
The model follows the pharmaceutical care process, which are (1) identify, resolve and prevent the drug-related problem; (2)patient education regarding drug-related information and precautions; (3) monitor the outcomes of drug therapy, including clinical indicators and health-related quality of life.
This study is a randomized and controlled design. Each of the anticoagulant, asthma, and diabetes groups is divided into treatment pharmacist intervention and control groups. Statistical analysis is performed by commercial statistical package: Stata and SPSS. The ANOVA and t-test are used at significant level of 0.05.
The results of clinical outcomes did not have statistical significant. It seems due to lack of sufficient subjects enrolled in this study. The satisfaction and need for pharmaceutical services for anticoagulant, diabetes and athsma groups had statistical significance. The results of this study partially fulfill the hypotheses that patients receiving pharmaceutical care demonstrate improved clinical outcomes, and more demand as well as satisfaction from pharmacists.
正文目錄
第一章 前 言 1
第一節 研究動機 2
壹、合理節約、善用健保資源 2
貳、社會人口結構的變遷,藥師專業角色改變 5
第二章 文 獻 回 顧 8
第一節 藥事照顧的理念興起、目的及作法 8
壹、藥事照顧理念的興起 8
貳、執行藥事照顧目的 11
叁、藥事照顧的作法 12
第二節 藥師臨床服務的價值 13
壹、 藥師發揮發現、解決與預防藥物治療問題之執業功能 13
貳、藥師協助病患進行疾病管理 19
第三節 國外相關研究結果 22
第一節、研究目的 27
第二節、研究假說 27
第四章 研 究 方 法 29
第一節 研究設計模式及步驟 29
壹、研究設計模式 29
貳、 病患納入及排除條件 32
第二節 研究流程規劃 33
貳、病患第二次回診時正式執行藥事照顧介入活動 36
叁、對照組病患藥師介入活動內容 38
第三節 評估方法及測量工具 41
壹、收集病患臨床上的療效數據: 41
第四節 資料處理與分析 45
壹、疾病控制情形 45
第五章 研 究 結 果 48
第一節 研究對象 48
壹、病患的分組 48
貳、樣本的特性 49
第二節 藥師介入之結果 52
壹、 藥師介入對病患臨床療效之影響 52
貳、藥師介入對病患的生活品質影響 61
叁、病患對藥師門診的需求性及滿意度 77
第六章 研 究 討 論 90
第一節 研究結果討論 90
壹、藥師介入對病患臨床療效之影響 90
叁、病患對藥師門診的需求性及滿意度 99
肆、綜合討論 100
第二節 研究限制 102
第三節 未來研究的方向 104
第七章 結 論 107


表目錄
表1- 1:全民健康保險西醫門診慢性病醫療申報點數 7
表2- 1:四大治療目標及七大類藥物治療問題 16
表2- 2: 七大類藥物治療問題 18
表4- 1: 實驗組及對照組之區分 40
表5- 1:各組病患基本特性比較 51
表5- 2:抗凝血劑組藥師介入前後組間病患之INR值比較表 53
表5- 3: 抗凝血劑組藥師介入前後實驗組組內INR值比較表 53
表5- 4: 抗凝血劑組藥師介入前後對照組組內INR值比較表 54
表5- 5:氣喘組藥師介入前後組間病患之PEFR值比較表 56
表5- 6: 氣喘組藥師介入前後實驗組組內PEFR比較表 56
表5- 7: 氣喘組藥師介入前後對照組組內PEFR值比較表 57
表5- 8: 糖尿病組藥師介入前後組間病患之HBA1C比較表 59
表5- 9:糖尿病組藥師介入前後實驗組組內HBA1C值比較表 59
表5- 10: 糖尿病組藥師介入前後對照組組內HBA1C值比較表 60
表5- 11: 抗凝血劑組藥師介入前問卷評估實驗組與對照組組間比較 63
表5- 12: 抗凝血劑組藥師介入後第一次問卷評估實驗組與對照組組間比較 63
表5- 13: 抗凝血劑組藥師介入後第二次問卷評估實驗組與對照組組間比較 64
表5- 14: 抗凝血劑組實驗組組內比較 66
表5- 15: 抗凝血劑組對照組組內比較 66
表5- 16: 氣喘組藥師介入前實驗組與對照組組間比較 69
表5- 17: 氣喘組藥師介入後第一次問卷評估實驗組與對照組組間比較 69
表5- 18: 氣喘組藥師介入後第二次問卷評估實驗組與對照組組間比較 70
表5- 19: 氣喘組實驗組組內比較 72
表5- 20: 氣喘組對照組組內比較 72
表5- 21: 糖尿病組藥師介入前實驗組與對照組組間比較 74
表5- 22: 糖尿病組藥師介入後第一次問卷評估實驗組與對照組組間比較 74
表5- 23: 糖尿病組藥師介入後第二次問卷評估實驗組與對照組組間比較 74
表5- 24: 糖尿病組實驗組組內比較 76
表5- 25: 糖尿病組對照組組內比較 76
表5- 26: 抗凝血劑組藥師介入前實驗組與對照組組間比較 79
表5- 27: 抗凝血劑組藥師介入後第一次實驗組與對照組組間比較 79
表5- 28: 抗凝血劑組藥師介入後第二次實驗組與對照組組間比較 79
表5- 29: 抗凝血劑組實驗組前後式比較 81
表5- 30: 抗凝血劑組對照組組內比較 81
表5- 31: 氣喘組藥師介入前實驗組與對照組組間比較 83
表5- 32: 氣喘組藥師介入後第一次實驗組與對照組組間比較 83
表5- 33: 氣喘組藥師介入後第二次實驗組與對照組組間比較 83
表5- 34: 氣喘組實驗組前後式比較 85
表5- 35: 氣喘組對照組前後式比較 85
表5- 36: 糖尿病組藥師介入前實驗組與對照組組間比較 87
表5- 37: 糖尿病組藥師介入後第一次實驗組與對照組組間比較 87
表5- 38: 糖尿病組藥師介入後第二次實驗組與對照組組間比較 87
表5- 39: 糖尿病組實驗組組內比較 89
表5- 40: 糖尿病組對照組組內比較 89


圖目錄
圖1- 1:全民健康保險財務收支分析表 3
圖4- 1:前瞻性研究 30
圖4- 2:藥師特別門診照顧流程 35
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