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研究生:葉雨婷
研究生(外文):Yu-Ting Yeh
論文名稱:以個人化用藥照護為基礎的整合性電子病歷系統
論文名稱(外文):Integrated Electronic Medical Record Systems for Empowerment of Personal Pharmaceutical Care
指導教授:劉建財劉建財引用關係
指導教授(外文):Chien-Tsai Liu
口試委員:詹前隆徐建業邱泓文楊騰芳
口試委員(外文):Chien-Lung ChanChien-Yeh HsuHung-Wen ChiuTen-Fang Yang
口試日期:2014-01-23
學位類別:博士
校院名稱:臺北醫學大學
系所名稱:醫學科學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:英文
論文頁數:121
中文關鍵詞:自我管理用藥教育醫囑遵從行為藥學實習藥物交互作用
外文關鍵詞:Self-managementPharmaceutical educationMedical adherencePharmacy internshipDrug-drug interactions
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This study looks to assess personal pharmaceutical care from the perspective of patients, public and medical professionals, and focuses on developing and evaluating patient-oriented integrated electronic medical record system. We take advantage of web technology to extend hospital pharmaceutical education and pharmaceutical care services. Starting from admission, it seeks to keep patients fully informed of their medical treatment, health conditions and self-care strategies, while enabling personal care via the evaluation, analysis, recommendation, and monitoring of drug use provided by well educated/trained clinic pharmacists. In addition, an interdisciplinary checking mechanism is employed to actively detect any problems regarding patient’s pharmaceutical care and support the running of drug management and health education by medical professionals before a patient leaves the hospital.
A web-based, patient-orientated education management (POEM) system was developed and evaluated for extending hospital-based patient education. The system can automatically download a patient’s medical services records, laboratory tests results and his/her patient education materials, and organize them into a folder per visit. It also integrated prescribed medicines and pharmaceutical education to provide patients with opportunities to search on-line for pharmaceutical information and knowledge in need. The on-line patient self management education program and pharmaceutical care information designed by this research team have been proven to be effective in involving patients or patients’ family members to actively search on-line for their medical records as well as for diabetic pharmaceutical educational information so that patients can have more accurate fasting glucose and HbA1C control.
We developed the pharmaceutical knowledge test to evaluate how much do the patients know and a questionnaire to evaluate pharmaceutical knowledge and self-reported pharmaceutical adherence behavior. In results of this study, the patients in the intervention group obtained more advancement than in the control group (the point of intervention group was from 2.62 to 3.64 and the point of control group was from 2.12 to 2.07; total points are five points) and adherence behavior (the point of intervention group was from 21.89 to 27.72 and the point of control group was from 21.38 to 22.31; total points are thirty-two points). There have significantly difference between two groups. It shows POEM system can effective improve patients’ knowledge and adherence behavior.
In the study, we enhanced a commercial eLearning system for clinical pharmacy internship (The clinical pharmacy Internship eLearning System, CPIES). The KAP questionnaire was used to evaluate the performance of group A with the traditional teaching model and group B with the CPIES teaching model. The CPIES teaching model showed significant improvement in interns’ knowledge and practice (p=0.002 and 0.031, respectively). The traditional teaching model only demonstrated significant improvement in practice (p=0.011). The on-line teaching and traditional teaching methods should undoubtedly be blended in a complete teaching model in order to improve learners’ professional knowledge, facilitate correct attitude, and influence good practice.
For patient safety improvement, this study are to enhance a computerized physician order entry system to support drug-drug interaction (DDI) checking based on a patient’s medication history stored in NHI-IC card. For performance evaluation, we developed a transaction tracking log to keep track of every operations on NHI-IC cards. This study showed that: the capacity of an NHI-IC card is adequate to support DDI checking across hospitals when physicians are making prescriptions and provide safer medication care, particularly for patients who receive medication care from different hospitals.
In this study, integrated electronic medical record systems are implemented at medical center with real practice, and proved successfully the findings are related to key elements of empowerment personal pharmaceutical care. We try to provide an easy and inexpensive way to extend hospital-based pharmaceutical education and pharmaceutical services for improving patient medication safety. The results proved integrated electronic medical record systems as a successful assisting tool for medical professionals.
Table of Contents vii
List of Tables x
List of Figures xi
Abstract xii
Chapter I Introduction 1
 1.1 Background 1
 1.2 Motivation 6
 1.3 Purposes 12
Chapter II Review of the Literature 14
 2.1 Improving diabetes self-management through information technology 14
 2.2 Medical adherence behavior for chronic disease 17
 2.3 Supporting System of Pharmaceutical Education for Pharmacy Interns During Internship Program 20
 2.4 Detecting drug–drug interactions for prescriptions from different hospitals 23
Chapter III A Patient-Oriented Education Management System for Diabetes Care 27
 3.1 Development of a patient-oriented education management system for diabetes care 28
 3.2 Evaluation of patient-oriented education management system for diabetes care 36
  3.2.1 Study design 36
  3.2.2 Intervention 37
  3.2.3 Data collection and analysis 38
 3.3 Results 39
  3.3.1 The characteristics of participants 39
  3.3.2 The results of laboratory tests during the follow-up period 41
  3.3.3 Analysis of user logins 43
Chapter IV Evaluating an Integrated Pharmaceutical Education Management System for Diabetic Medical Adherence Behavior 46
 4.1 The instruments of adherence measurement 46
 4.2 Data collection and statistic analyses 48
 4.3 Results 49
  4.3.1 Patients’ characteristics 49
  4.3.2 Pharmaceutical adherence behavior analysis 50
Chapter V An Online Pharmaceutical Education System for Pharmacy Interns in Critical Care Settings 56
 5.1 System functionality Enhanced Clinical Pharmacy Internship eLearning System (CPIES) 57
 5.2 Instructional design and learning workflow 62
 5.3 Evaluation Method 64
 5.4 Results 66
Chapter VI Detection of Potential Drug-Drug Interactions for Outpatients Across Hospitals 69
 6.1 System framework for enhancing DDI checking involving multiple hospitals 69
 6.2 Implementation of potential DDI detection across hospitals 72
  6.2.1 Creation of DDI databases 72
  6.2.2 Detection of potential DDIs involving multiple hospitals 73
  6.2.3 Integration of the potential DDI detection algorithm into outpatient workflows 75
 6.3 Investigation of physicians’ responses to DDIs checking across hospitals: an empirical study 78
Chapter VI Discussion 81
Chapter VII Conclusions 91
References 95
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