社團法人臺灣臨床藥學會

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【原著】某醫學中心民眾自我照護之氣喘藥物教育成效分析
The Outcome Analysis of Asthma Education for Outpatients Self-Care in a Medical Center
氣喘、自我照護、藥事服務、尖峰呼氣流速計、 Asthma, self-care, pharmaceutical care, peak-flow meter Corresponder: Hue-Yu Wang
王慧瑜Hue-Yu Wang1 、陳憲煜Hsien-Yu Chen1 、蘇慧真1 、呂瑾立2 、陳麗芳Agnes L.F. Chan1
1奇美醫學中心 藥劑部 、2奇美醫學中心 醫研部
背景:兒童氣喘在全世界的流行率有逐漸增加的趨勢。根據美國肺臟協會(American Lung Association, ALA)在1998年的統計資料顯示:87%的病童父母及84%的成人患者認為氣喘對其生活品質有負面影響;36%的病童父母、23%成年患者因氣喘而失去工作;Smith 等人在1994年所作的統計發現,氣喘所耗費的間接成本主要是因為氣喘控制不良所致。過去已有對照研究證實經氣喘衛教者其生活品質及自我照護能力比未經衛教者佳,因而本研究主要為探討經藥師介入氣喘藥物教育後病患氣喘生活品質與自我照護能力是否提昇。
方法:1. 病患條件:收集經醫師診斷為氣喘分級第2-3級,年齡在5歲以上之氣喘病童及成年病患,有能力完成「氣喘生活品質」及「氣喘常識認知」問卷並持續記錄氣喘日誌3個月。2. 研究方法:經篩選之病患由臨床藥師藥教其氣喘相關知識,氣喘病患並於藥教前後分別填寫「氣喘生活品質」及「氣喘常識認知」問卷,比較藥教前後二者是否有差異;根據平均尖峰呼氣流速變異度及日誌記錄之氣喘用藥頻率評估病患氣喘症狀及肺功能改善度。3. 統計方法:問卷結果以Wilcoxon signed-rank test來分析藥師介入前後生活品質之差異、平均尖峰呼氣流速變異度之差異。
結果:藥教後之「氣喘生活品質」問卷的平均得分較藥教前低,表示生活品質受氣喘的影響度有意義的降低;「氣喘常識認知」的問卷中發現,93%(40/43)的病患經過氣喘藥教後才了解尖峰呼氣流速計的使用目的;「平均尖峰呼氣流速變異度」較第一個月下降13.8%(平均自25.3降至11.5 %,p值<0.01, n=25),每月平均用藥頻率也有下降趨勢;但確實完成氣喘用藥記錄者僅約10人,原因可能與臨床藥師之追蹤技巧及民眾對藥教的認知度不夠,導致配合度不佳有關。
結論:藥師介入氣喘藥物教育,確實改善了氣喘病患的生活品質與自我照護的能力,但臨床藥師對病患之追蹤技巧宜再加強,才能使氣喘病患得到持續性的照護。

Background: The prevalence of asthma was estimated to be 6% in adults and 10% in children of the world’s population. In a survey conducted by the American Lung Association (ALA)—87% of parents and 84% of adult patients reported that asthma has had a negative impact on their child’s lives; 36% of parents of asthmatics and 23% of adult patients missed work because of their asthma. The study by Smith et al. concluded that most indirect costs for asthma treatment are associated with uncontrolled asthma.  Many studies have shown that asthma education would improve patients’ self-management skills and total quality of life. In this present study, we sought to investigate the outcome of implementing an outpatient asthma-education program in a medical center.
Methods: Fifty-five patients—39 children (aged 5 years or older) and 16 adults, with asthma of severity degrees 2-3—were recruited in an educational program in which pharmacists educated the enrolled patients about asthma knowledge, the techniques for the use of inhaled medication and a peak flow meter.  In the end, 25 patients were able to complete the asthma diary chart for 3 months. Patient’s quality of life and asthma knowledge were assessed with questionnaires.  The variability in peak expiration flow and the reduction of frequency of drug administration were used to evaluate patients’ pulmonary function.  Wilcoxon signed-rank test was used to compare the difference of quality of life and the variability in peak expiratory flow (PEF) before and after pharmacist intervention.
Results: The impact of asthma on quality of life decreased significantly after pharmacist intervention (p<0.001, n=55).  Furthermore, patient’s asthma knowledge improved significantly—93% of patients (40/43) understood the purpose of the use of a peak flow meter; the average variability of PEF reduced from 25.3% to 11.5% (p<0.01, n=25); the frequency of using a bronchodilator inhaler also decreased. 
Conclusions: Pharmacist intervention in asthma education may improve patient’s quality of life, self-care skill, and their pulmonary function.
 
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