隨著我國多重慢性病的盛行率逐年升高，提升民眾安全用藥的照護課題也愈趨重要。

目的： 本文旨在探討如何建置適切的門診藥事照護模式。

方法： 一、推動院內「多重慢性病人的藥事照護」計畫；二、藥師參與跨團隊「門診多重慢性病患藥事照護」；三、開發藥事照護輔助系統；四、多元化行銷推動藥事照護計畫；五、建置評／稽核機制。
結果： 一、多重慢性病人藥事照護的作業時間由改善前的61 分鐘，降低為26 分鐘。藥事照護作業流程的準確達成率由改善前的95.1%，提升為98%。二、藥師門診藥事服務初步成效：門診藥事照護病人數平均8.17 人次／診；病人接受藥事照護次數平均1.34 ± 0.32 次／人；病人接受用藥評估內容平均2.04 ± 0.72 項／人。病人接受藥物衛教後，皆清楚知道藥物治療用途、瞭解正確使用藥物方法，並明白藥物注意事項 ( 如副作用／藥品儲存等)。三、進行民眾正確用藥宣導講座與衛教等活動，平均2.7 場／月，累計109 人次，衛教前後課程瞭解度成長10.5% (81.6% vs. 92.1%)，平均滿意度94.4%。

結論： 藉由藥師參與院內「門診多重慢性病人藥事照護」計畫，建置藥事照護資訊管理平臺，提高門診藥事照護之有效性與及時性，以提升民眾正確用藥遵循率，降低病人非預期用藥問題發生，及減少醫療資源耗用。
 

The prevalence of multiple chronic diseases has increased, and its related medication duplication has been noted.
Objective: This article aimed to reveal the preliminary model of pharmacy service in integrated outpatient services for multiple chronic disease patients and its efficacy.
Methods: 1. Establish the model of care in this implementation. 2. Setting up the Committee of this implement. 3. Developing the computerized physician order entry (CPOE) system. 4. Promotion plan for this implementation. 5. Auditing and evaluating this implementation regularly.
Results: 1. The waiting time of the pharmacy care decreased from 61 minutes to 26 minutes. The correct rate of preparing and dispensing medication increased from, 95.1% to 98%. 2. The average pharmacy service was 1.34 ± 0.32 times/person. The adherence and medication instructions were provided to the patient 2.04 ± 0.72 items/person. 3. There were 2.8 educational activities were conducted by the pharmacists for the public per month.
Conclusions: This model of pharmacy service had a positive effect on improving patient centered care and medication safety.