依據美國糖尿病協會建議，aspirin 可以降低糖尿病併發心肌梗塞發生機率及致死率，只要沒有使用上的禁忌，所有 30 歲以上的糖尿病患，必須每天服用 aspirin 預防心血管疾病。本計畫以台灣東區某醫學中心之內科系住院病人為對象，觀察糖 尿病患之 aspirin 使用率，與對醫師提出加入 aspirin 治療之建議後，aspirin 在糖尿病治療的改善情形。自 2005 年 1 至 6 月，收集 30 歲以上，符合資格之糖尿病患， 總共 371 人次。由臨床藥師訪視後獲取病人基本資料、病人對 aspirin 的認知與實際使用 aspirin 的情形，同時對病人宣導 aspirin 對糖尿病的好處，並向處方醫師提出合併使用 aspirin 之建議。透過 EXCELL 及 SPSS 進行病患資料分析、aspirin 使用率改善之情形。結果，已經在使用 aspirin 之糖尿病患有 71 位（19%），未使用 aspirin者 300 位（81%）。經過臨床藥師建議後，有 177 位在住院期間開始使用 aspirin；
有 3 位在出院帶藥時開始使用 aspirin；有 85 位出院返家後，經過藥師電話提醒， 在回診時才使用 aspirin；研究期間 aspirin 的使用率從 19%提升為 71.4%（265/371）。目前國內糖尿病患者，以 aspirin 預防心血管疾病併發症的情形仍不夠普遍；透過臨床藥師對醫師提出用藥建議後，aspirin 的使用率提升為 71.4%，說明臨床藥師在用藥照護角色之重要性。
Aims ― In 1997, the American Diabetes Association (ADA) published its first recommendations for the use of low-dose aspirin therapy as a secondary prevention strategy or for primary prevention in high-risk diabetic patients . In their January 2000 publication, the ADA explicitly recommended using aspirin as a primary prevention strategy not only for individuals with specific risk factors but for anyone with diabetes who is >30 years of age and has no known contraindications. To promote the aspirin therapy for patients with diabetes, our study examined the practices and the use of aspirin therapy for hospitalized patients in this medical center.
Method ― The study consisted of hospitalized diabetic patients, who were over 30 years old and had at least one diabetes-related ICD-9 code (250.x) or received at least one type of insulin preparations or an oral hypoglycemics during January-June 2005. Recommendations for aspirin therapy (100mg/day) were pharmacy-directed intervention via physicians. The compliance and the effectiveness were examined and analyzed with EXCEL and SPSS program.
Results ― A total of 1,715 patients, excluding those from intensive care unit and surgical department, with diabetes were identified. Among them, 371 hospitalized patients were over 30 years old, but only 71(19%) received additional aspirin therapy. The remaining 300 patients were recommended for clinical pharmacy intervention: 177 started to receive during hospitalization; 3 after discharge and 85 in OPD fallow-up. The rate of aspirin use during study period was 71.4% (265/371). Recent GI bleeding was the most common reasons why doctors did not prescribe aspirin during hospitalization. Doctors from the gastrointestinal medicine ranked first in not recommending aspirin therapy.
Conclusions ― A pharmacy-directed intervention increased prophylactic aspirin therapy in patients with diabetes from 19 % at beginning to 71.4% at the end of the study. Most clinicians agree aspirin as an important treatment for patients with preexisting coronary disease. This intervention provided appropriate assistance to clinicians for the prevention of many cardiovascular events and deaths.
