目的：多重用藥日益受到重視除容易導致用藥問題，亦增加健保醫療費用。本研究藉由建構藥品整合資訊系統及主動提供用藥指導，降低多重用藥，提升門診病人用藥安全。

方法：自2013 年1 月起，凡本院已掛號之門診病人，就診前一日即利用SASEG (statistics analysis system enterprise guide) 預先計算過去28 天內門診已開立口服藥品顆粒總數，篩出顆粒總數 ≥ 800 顆／月者，並定義為多重用藥病人。藥品整合資訊系統建構一、即時多重用藥資訊提示；二、藥品明細整合及；三、醫院資訊系統(Hospital Information Systems, HIS) 立案追蹤三個子系統。當病人符合本研究定義之多重用藥者，當日醫師門診看診清單即以黃色註記提醒，並提供其藥品明細整合資訊；藥師可於HIS 立案追蹤多重用藥病人，主動提供用藥指導。比較介入前、後之門診多重用藥個案發生率／月、平均用藥品項數／人／月、平均用藥顆粒數／人／月。

結果：多重用藥資訊提示、藥品明細整合及HIS 立案追蹤系統於2013 年6 月完成上線。以2013 年1 月至6 月（介入前）與2014 年1 月至6 月（介入後）同期作比較：多重用藥個案發生率／月：降低24%，p < 0.001。平均用藥品項數／人／月：由14 項下降至13 項，p = 0.032。平均用藥顆粒數／人／月：由856 顆下降至799 顆，p = 0.004。
結論：運用藥品整合資訊系統，提供醫師多重用藥病人註記提示與病人用藥資訊，藥師主動用藥指導服務，可有效地降低門診多重用藥。
 

Objective: Polypharmacy is receiving increasing attention as a result of increased drug-related problems and medical expenditure. This study aims to reduce polypharmacy and improve the safe use of medication in an outpatient setting by establishing a medication integrated informatics system and active drug instruction.
Methods: Polypharmacy was defined as more than 800 pills being prescribed to one patient within 28 days, calculated from one day before the clinic visit using the SASEG
(statistics analysis system enterprise guide). The medication integrated informatics system were established including 1. the real-time polypharmacy information alert system, 2. the medication integration system, 3. HIS (Hospital Information Systems, HIS) case follow up system. In patients identified as polypharmacy cases, the realtime polypharmacy information alert system notifies clinicians during the clinic visit,the medication integration system provides comprehensive medication information for review, and the pharmacist-directed active drug instruction allows pharmacists to provide proactive counseling and follow up. Monthly incidence of polypharmacy events, number of drug items per case, and number of pills per case will be compared before and after the intervention.
Results: The real-time polypharmacy information alert system, the medication integration system and the HIS (Hospital Information Systems, HIS) case follow up system were established in June, 2013. The intervention outcomes were compared for the period between January and June in 2013 and 2014. After implementation, the monthly incidence of polypharmacy events decreased by 24% (p < 0.001). The mean monthly number of drug items per case decreased from 14 to 13 (p = 0.032). The mean monthly pill count per case decreased from 856 to 799 (p = 0.004).
Conclusions: The medication integrated informatics system could not only alert physicians on polypharmacy events but also notify pharmacists to provide proactive counseling that effectively decreases the occurrences of polypharmacy.