目的：臨床藥師的角色已經發展為以病人為中心的藥事服務，並在居家照護團隊中提供居家照護藥事服務。

方法：本研究為前瞻性研究，探討臨床藥師介入居家訪視藥事服務對於糖尿病或高血壓病人之血糖及血壓控制之成效。

結果：共納入70 人，臨床藥師執行居家訪視藥事服務後並經過3 個月的追蹤，發現病人的平均糖化血色素有意義的從7.0 ± 1.5 降低至6.6 ± 1.1% (p = 0.002)，飯前血糖有意義的從135.3 ± 55.2 降低至120.7 ± 39.0 mg/dL (p = 0.020)，飯後血糖有意義的從169.5 ± 63.6 降低至151.0 ± 47.7 mg/dL (p = 0.010)，舒張壓有意義的從74.0 ± 18.0 降低至70.8 ± 13.9 mmHg (p = 0.001)。使用藥物的筆數也有意義的從8.3 ± 3.3 減少至7.2 ± 3.3 筆 (p = 0.002)。

結論：臨床藥師介入執行居家訪視藥事服務，發現糖尿病病人可以有意義改善糖化血色素及飯前、飯後血糖，而併有高血壓病人也可以有意義降低舒張壓，使用藥物的筆數也有意義的下降。

Objective: The roles of clinical pharmacist already evolved into patient-centered care, and provided home visit care pharmaceutical services (HVCPS) in home-care team.

Methods: We initiated a prospective study to evaluate the effectiveness of HVCPS after implementation of clinical pharmacist to achieve blood glucose and blood pressure control targets at a medical center in southern Taiwan.

Results: A total of 70 patients were enrolled. Clinical pharmacist provided HVCPS, after 3 months follow-up, the mean hemoglobin A1c (HbA1c) of subject was decreased significantly from a baseline of 7.0 ± 1.5 to 6.6 ± 1.1% (p = 0.002). The fasting blood glucose decreased significantly from baseline of 135.3 ± 55.2 to 120.7 ± 39.0 mg/dL (p = 0.020). The postprandial blood glucose reduced significantly from baseline of 169.5 ± 63.6 to 151.0 ± 47.7 mg/dL (p = 0.010). The diastolic blood pressure were improved significantly from baseline of 74.0 ± 18.0 to 70.8 ± 13.9 mmHg (p = 0.001). The numbers of prescribed medication also reduced significantly from baseline of 8.3 ± 3.3 to 7.2 ± 3.3 (p = 0.002).

Conclusions: Clinical pharmacist interfered into HVCPS had observed statistically significant improved on HbA1c and fasting blood glucose and postprandial blood glucose control in patients with diabetes mellitus. It also had observed significant improvement in diastolic blood pressure on patients with hypertension. The numbers of prescribed medication had statistically significant reduced.