背景：氣喘病盛行率及醫療資源耗用有逐年升高的趨勢。國外的研究顯示,加強氣喘病的治療管理,將可有效地控制醫療資源的耗用。本研究整合各領域專家成立氣喘管理照顧中心,以衛生署發行之「氣喘診療指引」作依據,對氣喘病患進行病患教育與用藥療效監測。
方法：本研究以北部某醫學中心向健保局申報的門診就診資料庫做分析,以醫院管理者的立場,評估氣喘病患在接受氣喘照顧前後,對健保門診醫療資源耗用的影響。氣喘教育與療效監測是在氣喘門診醫師診間旁之氣喘管理診間進行,護士及藥師接受醫師轉介之氣喘病患,進行介入活動與追蹤。氣喘病患被推薦至氣喘管理診間後,會被隨機分為 A, B, C 三組。組 A 是控制組。組 B 病患接受護理師的衛教。組 C 病患接受護理師衛教及藥師的用藥教育與藥事照顧。成本利益分析是以組 A控制組為對照組,比較 BC 兩組的照顧方法,探討那一組較符合成本利益。氣喘照護研究期間為 91 年 7 月至 92 年 12 月。
結果：組 C 的門診病患,於研究後每人每月的用藥日數有顯著增加。組 C 的照顧是符合成本利益的,與研究前比每投入 1 元的氣喘管理成本,可獲得 2.3 元直接醫療費用的節省。
結論：組 C 的氣喘照顧是較符合成本利益。在此氣喘病患人數以及醫療資源耗用持續增加的狀況下,本結果將提供醫界多一種有效治療氣喘的照顧模式。

Purpose: Department of Health published “National Bronchial Asthma Treatment Guidelines” in 2000 in Taiwan. The guidelines are currently considered the standard of care for patients with asthma. A multi-discipline integrated team proposed to establish the center for asthma management in a medical center. The purpose was to investigate the impact of interventions on asthma medical resource utilization and treatment expense. 

Method: The project was a randomized, controlled, repeated measures trial design. Study subjects were ambulatory asthmatic patients of a medical center from 2002/07-2003/12 in Taipei, Taiwan. Subjects with age older than 80 and younger than 18 and with cardiac vascular or psychiatric or liver disease were excluded. The data collection was from a hospital perspective. Physicians received asthma care education using treatment guideline as the teaching materials. Asthmatic patients received interventions (education and outcome monitoring) in a separate room just beside the physician’s office. Study subjects were divided into three groups. Group A was the control group, without any intervention from education by nurse or monitoring by pharmacist. Group B received only education delivered by a nurse. Group C patients received both educations by a nurse and pharmacist's individual consultation and medication problems and therapeutic outcome monitoring. Health insurance claimed database was used to analyze the medical resource utilization and expense to compare the outcome. Intervention cost and average total treatment expense per patient per month (PPPM) before and after intervention were compared. 

Result: There is no age difference among three groups; however, female is almost 10 years older than male. Patients in the group C have decreased number of outpatient visits (from 1.43 to 1.21) and increased prescription days (from 16 to 27) PPPM, which indicated that their conditions were more stabilized than patients in other groups after the asthma care. The expense of total treatment and medications PPPM were decreased in group C after intervention, while in other two groups increased. The difference of total treatment expense before and after intervention in group C was NT$1110 dollars less than that of group A. For every NT$1 dollar investment in group C versus group A, NT$ 2.3 dollars in the total treatment expense saving was obtained. 

Conclusion: In the hospital outpatient setting, nurse cooperates with pharmacist to provide patient education and medication therapy management was the most cost-beneficial than nurse alone or no intervention. The value of nurse and pharmacist practitioners in the ambulatory care is much needed in a society when the costs and asthma prevalence continue to rise.