目的： 藉由藥師居家訪視評估臺北縣個案的用藥情形，針對用藥問題給予專業的諮詢及指導，並統計分析其結果，做為日後藥師提供長期照護居家個案用藥諮詢服務之參考。
方法： 以2010年1月1日至12月31日，整理個案的訪視資料「臺北縣政府長期照顧服務個案評估量表」，經個案同意後，藥師進行訪視和填寫「用藥紀錄及用藥適當性評估」。探討個案基本資料、罹病分布及用藥情形，並分析其接受藥師訪視之情形。
結果： 個案經藥師訪視分別有一、二、三次，依序為206、84、21人。六成領有身心障礙手冊，以重度最多。ADL平均46.1分。就診科別最多為神經科，藥物用量最多為nervous system, cardiovascular system, alimentary tract and metabolism，疾病以高血壓、心臟病及糖尿病居多。接受藥師訪視一次及二次的身心障礙等級(p = 0.041)及ADL分組(p = 0.008)，顯示極重度身心障礙及ADL高分易接受藥師二次訪視，會隨著其等級越重及ADL越高分而有增加的趨勢。經二次訪視個案之各項平均數減少的有處方藥物品項數0.5項及口服總頻次1.0次，總藥物品項數0.7項及口服總頻次1.1次。
結論： 由藥師的訪視提供居家個案正確用藥，確實能降低個案用藥的處方品項數及口服總頻次、總藥物品項數及口服總頻次。從前十大疾病、前五大看診科別及用藥類別，此結果可作為加強居家藥事照護的用藥諮詢參考。

Objective: The aims were to assess the appropriateness of home medication use by pharmacists in home-care cases in Taipei County (TC) as a means to provide valuable resources for future home medication review (HMR) and to provide better pharmaceutical care in home.
Methods: This study reviewed the pharmacy profiles of the cases from January 1 to December 31, 2010 according the sheets of “Case Assessment of Long-term Care of TC Government,” sorted out by TC Government for HMR. After agreeing on which selected cases, pharmacists then conducted individual HMR and documented their “Medication Records and Medication Appropriate Assessment” which were further analyzed and evaluated.
Results: The most cases specialty in the study was neurology. The HMR included nervous system, cardiovascular system, alimentary tract and metabolic drugs ossociated with the major chronic diseases hypertension, heart disease and DM. Evaluation of cases that required pharmacist-intervention for their first and second visits associated with severe disability (p = 0.041) and higher ADL (p = 0.008). A marked reduction of drug items and frequency prescribed by physicians between first and second visit by pharmacists were observed.
Conclusions: This study showed that frequency of pharmacist-interventions and home-visits can definitely provide home-healthcare givers with an importance guidance for correct medication use through HMR process. Based on the review of the top ten disease states, the top five medical specialties, and drug categories, pharmacists’ intervention in a home-care setting can definitively cut down the frequency and numbers of an inappropriate medication use in home-care cases, thereby further lowering total medical cost.