背景： 某醫療院所發展與養護機構建立雙向轉診、行動診間、醫療團隊模式定期至養護機構醫訪，提供整合性的醫療建議與衛教服務。藥師在此模式中能直接有效的與其他醫療人 員、住民及照顧人員溝通，提供藥事服務及藥物相關衛教服務。
方法： 回溯性方法，收集 2008 年 1 月至 2008 年 6 月間，十二家合作養護機構，共 119 個藥事 服務案例，依照「長期照護藥師評估建議表」記錄，發現住民藥品治療問題，提供藥品 治療之建議，並分析服務內容。
結果： 藥師介入的 136 張處方中，發現平均處方藥物總數為 7.70±2.87 種。（一）用藥指導項 目最多者為解說藥品正確儲存方式（上鎖、溫度控制），佔 43.9%、其次為檢視藥品是否 過期或變質，佔 43.3%。（二）主要發現處方中藥品治療問題包含，發現藥物-藥物交互 作用，佔 51.8%、其次為疑似藥物不良反應，佔 11.4%。（三）藥品治療建議項目最多者 為建議使用藥品需定期做檢測（如：TDM、lab data 等），佔 50.9%、建議停用某藥，佔15.2%。
結論： 醫院與社區養護機構建立良好合作關係（一）提供良好雙向轉診制度（二）定期提供臨 床檢驗監測，能有效協助醫療人員進行疾病控制與藥物療效及副作用評估參考（三）提 供完整病歷及藥歷資訊記錄，讓醫療人員方便醫療評估（四）醫療團隊出訪，提供整體 性的衛教及建議（五）以病患為中心，簡化醫療流程，協助社區養護機構及住民有更完 善的醫療環境。藥師在此模式下進行藥事服務，與在醫療院所內相當，可發揮更大的作 用與功能。
Background : A hospital has established bi-directional referral, mobile clinic, and medical team systems regularly to provide integrated medical advice and health education services in the long-term caring institutes. Pharmacists in this mode can directly and effectively communicate with other medical professions, care staff, and patients to provide pharmaceutical services and drug-related health education services.
Method : Retrospective collection a total of 119 cases of pharmaceutical services in 12 cooperated caring institutes from January to June, 2008. In accordance with the “pharmacist evaluation in long-term caring recommendation table”, we found some therapeutic problems in the institute prescriptions and provide suggestions. In addition, we also analyzed the service contents.
Results : In 136 pharmacist-involved cases, the average items of drug per prescription are 7.70±2.87. We found that (1) the most frequent medication guide is to explain the correct storage of medicines (ex: with locked and temperature control), accounting for 43.9%, followed by reviewing whether the drugs are expired or deterioration, accounting for 43.3%; (2) the main therapeutic problem found in prescriptions is the drug-drug interactions, accounting for 51.8%, followed by suspected adverse drug reactions, accounting for 11.4%; (3) the most often recommendations for drug medication is to follow-up routinely during medication, accounting for 50.9%, followed by recommended to stop using a drug, accounting for 15.2%.
Conclusions : Hospitals establish a good cooperative relationship with community caring institutes may (1) provide a good bi-directional referral system; (2) provide regular monitoring of clinical examinations to assist the medical professions for disease control, assessment of drug efficacy and side effects; (3) provide a complete medical and pharmaceutical history to allow medical personnel facilitating the medical assessment; (4) provide comprehensive health education and advice by the routine visiting of medical multidisciplinary team; (5) assist patients and the community caring institutes to have better health care environment by taking patients as the center and simplifying medical procedures. Therefore, pharmacists might provide similar pharmaceutical services as in the hospitals, or play an even greater role in this mode.
