【原著】獨居老人用藥安全評估與藥師介入 The impact of pharmacist intervention to
improve medication safety in the community-elderly people living alone
獨居老人、藥物相關問題、藥物評估、居家用藥訪視、藥事服務、健康照護、elderly people living alone, drug-related problem, pharmaceutical care, health care, pharmacy services
目的：了解獨居老人的健康狀況、疾病控制與服藥順從性，建立獨居老人的正確用藥觀念，減少藥物副作用，增加服藥順從性，達到疾病控制及改善生活品質的目的。 方法：計畫進行時間從2009年5月至2010年4月，共12個月，主要對象為台北市士林區獨居老人。進行訪視前，須先取得獨居老人的同意。訪視時，會針對病患的用藥安全知識進行問卷調查，並針對每一位個案進行用藥照護，仔細查看個案是否有藥物相關的問題(Drug related problem 簡稱DRP)，並針對個案的問題進行解決。 結果：總共訪視57位獨居老人(54.4%的女性，平均年齡78 +/- 9.07歲)，平均每人罹患4.4種疾病，服用8種藥物。在服用健康補給品方面，平均每位老人使用2.1種健康補給品，服用三種以上(含三種)的健康補給品者有16位(28.1%)，最多品項者有16種。在用藥安全知識評量調查方面：結果前測平均66.64分，經過一年後，平均分數提高到81.17分。在訪視老人的過程中，總共發現101個DRP。將每一個DRP造冊列管，並參考Hepler/Strand的八大藥物相關問題及PCNE (Pharmaceutical Care Network Europe Foundation) DRP分類規則分析每一個DRP。結果發現：造成DRP的原因以病人居多(70%)，其次為醫師(27%)。藥師介入的方式主要從病人(86%)著手，其次為醫師(8%)。最後總共有80%的DRP解決，但仍有20%屬於沒有解決。 結論：這次的研究計劃主要以個案研究為主。從結果來看，藥師解決了病人八成的DRP，沒有解決的DRP，主要是因為病患或是家屬的疾病治療不積極、對藥師不夠信任或是因為病患死亡的原因造成。雖然仍有兩成的DRP沒有解決，但仍然顯現出藥師在獨居老人用藥問題的解決能力。
In Taiwan, elderly people who live alone are associated with the signs of raising health risk due to long-term social negligence. As a result, these elderly are more susceptible to misleading medical information and wrong medication which lead to ineffective treatment. The purpose of study was to establish a safe medication environment and propose policies for the community-elderly people living alone. Methods
Pharmacist with social worker visited these elderly people living alone after they agreed to sign an informed consent form. The medication knowledge of the participants was evaluated with a questionnaire. We compared differences between pre-test and post-test results from the questionnaire. Drug related problem in the elderly people living alone were identified meticulously by our pharmacists and appropriate solutions were made. Results
Total 57 elderly subject (54.4% female, mean +/- SD, age = 78 +/- 9.07) data were collected. Participants had 4.4 kinds of disease and used a median of eight prescription medicines. With regards to health care products, participants had 2.1 kinds of products. The most frequently used health care products were glucosamine (40.7%), followed by multivitamine (38.9%) and traditional medicine (22.2%). A self-administered questionnaire was used to survey knowledge of medicines. The pre- and post-test scores were 66.64 and 81.17. We found 101 drug related problems (DRPs) in this study. The causes of the DRP might be related to patients (70%), followed by doctors (27%). The drug related problem was intervened from the patient (86%), followed by doctor (8%). The pharmacists solved 80 DRPs. Conclusions
We used case studies to assess their DRPs in our participants. Our pharmacists solved about 80% DRPs. The evaluation demonstrated that pharmacists were able to identify DRPs and to perform follow-ups of the DRPs with the elderly people living alone.