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研究生:鄭惠方
研究生(外文):CHENG, HUI-FANG
論文名稱:慢性病病人用藥經驗理論之整合、應用與推廣
論文名稱(外文):Integration, application, and dissemination of medication experience theory among patients with chronic diseases
指導教授:張雅惠張雅惠引用關係
指導教授(外文):CHANG, ELIZABETH H.
口試委員:陳香吟郭俊男張雅惠
口試委員(外文):CHEN, HSIANG-YINKUO, CHUN-NANCHANG, ELIZABETH H.
口試日期:2021-07-22
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:藥學系碩士班
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:2021
畢業學年度:109
語文別:英文
論文頁數:93
中文關鍵詞:用藥經驗慢性疾病HIV病人全人照護藥事服務溝通技巧繼續教育系統性統合回顧
外文關鍵詞:Medication experienceChronic diseasePeople living with HIVHolistic carePharmaceutical careCommunication skillsContinuing educationSystematic meta-review
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藥事服務專注於病人為中心的原則,因此推動全人藥事照護上,生活品

質與慢性病人用藥經驗是重要的一環。這也帶來用藥經驗與溝通技巧相關藥師

繼續教育的需求。因此,此研究目標為整合慢性用藥經驗的系統性回顧、應用

理論於藥學執業情境以及運用繼續教育課程推廣,評估課程的有效性。

此研究分為兩個階段。階段一使用質性統合回顧及主題式分析來整合慢

性病病人用藥經驗,以人類免疫缺陷病毒感染者為例。階段二利用階段一的結

果及適用於疫情下溝通模型與用藥經驗理論模型的文獻回顧,設計一個線上非

同步的繼續教育課程;並且使用單組前後比較的方法來評估此課程的有效性,

測量學員溝通技巧、用藥經驗之知識與自我效能。

在第一階段,五篇系統性回顧被選定進行後續分析。藉由不斷的分析與

多重檢核,得到了三個重要的主題與十二個次主題:(1.)取得及使用藥品令人挫

折;(2.)使用藥品時,我不孤單;(3.)取回我用藥的主導權。這些分析結果顯示

HIV 病人用藥經驗是動態在改變的,而醫療服務提供者與重要他人的社會支持

對於提升病人的用藥行為非常重要;此外,當病人逐漸獨立後會發展出對於汙

名與用藥問題的解決之道。

在第二階段,納入 115 位學員進行分析,其中 13 人是藥學生。分析資料

顯示儘管在知識測驗學員未能取得高分,此溝通教育課程能夠有效地提高藥師

在疫情下提供以病人為中心服務的自我效能 (p < 0.0001)。此外,學員也願意將

課程上所學的內容應用在藥事服務裡。

這個研究顯示了融合了慢性病人用藥經驗的全人藥事服務模型,可以提

升藥師在困難情境下提供以病人為中心的服務之自我效能。藥師需藉由病人用

藥經驗與有效的雙向溝通,來認同病人全人概念以提升病人的自我管理。
Understanding medication experience among patients with chronic diseases

is an important step to improve holistic care in pharmacy service. There is an urgent

need for pharmacists to equip better understanding of medication experience and

communication skills through training on patient engagement. As such, this study

aimed to integrate medication experiences of chronic diseases, apply the theory to

practical pharmacy contexts, and disseminate the findings via a continuing education

program.

This study included two phases. In phase 1, we adopted a qualitative meta-

review to synthesize medication experience through thematic analysis, with a focus

on people living with HIV (PLWH) as an example. In phase 2, we designed an

asynchronous online communication education program based on findings of phase

1, literature reviews and theoretical frameworks about medication experience and

communication in COVID-19 pandemic context. We applied a one-group pre- and

post-test method to evaluate the effectiveness of education program. Outcomes

included knowledge and self-efficacy of communication skills and medication

experience.

In phase 1, five systematic reviews were identified. Through iterative analysis

and triangulation, there were three overarching themes in this meta-review with

twelve subthemes: (1.) Accessing to and taking medicine could be worse and

frustrating; (2.) I’m not alone when taking medicine; (3.) Taking back my control over

medicine. These syntheses showed medication experience among people living with

HIV (PLWH) was dynamic. Social support from health care providers and significant

others was imperative to promote medication-taking behaviors. Further, PLWH

become independent to cope with stigma and medication-related problems.

In phase 2, there were 115 participants included into final analysis, 13 of which

were pharmacy students. In spite of participants’ getting low knowledge scores, the

data revealed communication education was effective for pharmacists and pharmacy

students had significantly higher self-efficacy (p < 0.0001) in providing patient-

centered care during COVID-19 pandemic. Besides, participants had great willingness

to apply the material of the program to pharmacy practice.

This study revealed important concepts of medication experience theory

based on integration and application of experiences among patients with chronic

diseases, and the continuing education program was effective in enhancing self-

efficacy in providing patient-centered care in the pandemic context for pharmacists.

Acknowledgement of the wholeness of patients to promote self-management

through medication experience, as well as effective two-way communication can be

helpful in improving patient-centered care.
Table of Contents

List of Tables ........................................................................................................................ IX
List of Figures........................................................................................................................ X
List of Appendices ............................................................................................................... XI
List of Abbreviations ........................................................................................................... XII
CHAPTER 1 INTRODUCTION .................................................................................................. 1
1.1 Background ................................................................................................................. 1
1.2 Research objectives .................................................................................................... 3
1.3 Significance of this study............................................................................................. 4
CHAPTER 2 LITERATURE REVIEW .......................................................................................... 5
2.1 Holistic and patient-centered care .............................................................................. 5
2.2 Medication experience ............................................................................................... 7
2.3 Communication competence ...................................................................................... 9
2.4 Summary of literature review ................................................................................... 11
CHAPTER 3 METHODS (phase 1) ......................................................................................... 12
3.1 Overall Study design ................................................................................................. 12
3.2 Phase1: Systematic review and synthesis of qualitative evidence (PRISMA) ............ 12
3.2.2 Search Strategy and Eligibility for inclusion ........................................................... 13
3.2.4 Data synthesis (thematic analysis/frameworks) .................................................... 17
CHAPTER 4 RESULTS (phase 1) ............................................................................................ 18
4.1 Phase1: ..................................................................................................................... 18
4.1.1 Study selection, study characteristics and quality appraisal .................................. 18
4.1.2 Synthesis of results ................................................................................................ 29
Theme 1 Accessing to and taking medicine could be worse and frustrating ................... 29
Subtheme 1-1 Stigma is discouraging.......................................................................... 30
Subtheme 1-2 Navigation in health care is costly and exhausted ............................... 31
Subtheme 1-3 Normal daily life is gone ...................................................................... 32
Subtheme 1-4 Adverse events are bothering .............................................................. 33
Subtheme 1-5 Could medicine help me ...................................................................... 34
Theme 2 I’m not alone when taking medicine ................................................................ 35
Subtheme 2-1 Live for my significant others ............................................................... 35
Subtheme 2-2 They are professionals and friends ...................................................... 36
Subtheme 2-3 I have faith in God................................................................................ 40
Theme 3 Taking back my control over medicine ............................................................. 40
Subtheme 3-1 It’s my life ............................................................................................ 41
Subtheme 3-2 Is there any alternative to existing medication .................................... 41
Subtheme 3-3 I don’t take medicine unless I’m sick ................................................... 42
Subtheme 3-4 Some solutions made me feel better ................................................... 42
CHAPTER 5 METHODS (phase 2) ......................................................................................... 44
5.3 Phase 2: Design and evaluation of the communication education program ............. 44
5.3.1 Study design........................................................................................................... 44
5.3.2 Description of the communication education program ......................................... 44
5.3.3 Data collection and Measures ................................................................................ 46
5.3.4 Analysis and Statistics ............................................................................................ 48
CHAPTER 6 RESULTS (phase 2) ............................................................................................ 49
6.3. Phase 2: Design and Evaluate communication education program .......................... 49
6.3.1 Characteristics of study participants ...................................................................... 49
6.3.2 Reliability of the self-efficacy measurement .......................................................... 51
6.3.3 Effectiveness of the communication education program ....................................... 51
6.3.4 Satisfaction of the communication education program ......................................... 61
CHAPTER 7 DISCUSSION ..................................................................................................... 63
7.1 Discussion of findings................................................................................................ 63
7.1.1 Medication experience among PLWH .................................................................... 63
7.1.2 Application and integration of medication experience .......................................... 64
7.1.3 Issue of Quality appraisal ....................................................................................... 66
7.1.4 Communication program for pharmacist and pharmacy students during the
pandemic ........................................................................................................................ 66
7.2 Clinical implication of findings .................................................................................. 68
7.3 Strengths and limitations .......................................................................................... 69
CHAPTER 8 CONCLUSION .................................................................................................... 71
CHAPTER 9 FUTURE RESEARCH ........................................................................................... 72
References .......................................................................................................................... 73
Appendices ......................................................................................................................... 80



List of Tables


Table 1 Inclusion and exclusion criteria of the meta-review .................................. 14

Table 2 Key search terms ........................................................................................ 16

Table 3 Summary of overview of included reviews ................................................ 20

Table 4 Quality appraisal based on adapted R-AMSTAR ........................................ 22

Table 5 Three overarching themes and twelve sub-themes ................................... 29

Table 6 Demographic data of eligible participants ................................................. 50

Table 7 The difference of post- and pre-test........................................................... 53

Table 8 Post- and pre- self-efficacy in domain 1 ..................................................... 54

Table 9 Post- and pre- self-efficacy in domain 2 ..................................................... 56

Table 10 Post- and pre- self-efficacy in domain 3 ................................................... 57

Table 11 Post- and pre- knowledge test ................................................................. 58

Table 12 Multiple regression of self-efficacy and knowledge test .......................... 59

Table 13 Multiple regression of self-efficacy .......................................................... 61


List of Figures

Figure 1 Overall study design .................................................................................. 12

Figure 2 PRISMA flowchart ..................................................................................... 19

Figure 3 Overall study design in phase 2 ................................................................. 44


List of Appendices

Appendix 1 Certificate of TMU-Joint Institutional Review Board ..................... 80

Appendix 2 Study questionnaire in phase 2............................................................ 83


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