目的：腎臟移植病人是長期需要全人照護的族群，其中，藥師在擔任指導病人自我照護的角色中有其必要性，本研究藉由腎移植藥事照護門診，協助醫師與病人解決並減少藥物相關的問題，進而促進藥事照護品質，節省醫療資源，提升病人用藥安全。

方法：運用腎移植藥事照護電子系統同步醫囑看診系統，蒐集2010 年1 月至2018 年12 月，專責腎臟移植臨床藥師每週參與腎臟移植照護聯合門診，於病人報到後，與病人會談，瞭解病人用藥問題與檢驗結果，解決病人用藥問題，並藉由腎移植藥事照護電子系統，當醫師看診時，同步顯示藥事建議事項，提供及建議醫師用藥計畫、解決病人用藥問題。

結果：研究期間，門診腎移植病人就診平均每年服務1,251 人次，藥事建議事項共1,980 項，醫師接受度89.4%。藥事照護建議事項：新增或修改藥品品項占38%、修改劑量占17%、檢驗檢查占14%、停藥建議占9%。藥物不良反應相關事件共202件，主要以代謝症候群為主。

結論：腎移植藥師照護門診即為以病人為中心的全人照護模式，利用團隊共同照護，提高病人的服藥順從性，減少藥物相關的副作用，亦可作為醫師與病人之間溝通的橋樑，並增進醫療品質的全贏模式。

Objective: Kidney transplant patients have the long-term need for holistic health care. Pharmacists play an important role in building patients’ capacity for self-care. Through the assistance from transplant pharmacists in the clinic to help physicians and patients solving and reducing drug-related problems (DRPs), this study reviews the improvement in medication safety and quality of medical care, as well as the reduction in medical expense.

Methods: This retrospective trial enrolled subjects who visited the renal transplant clinic for post-renal transplantation, follow-up from January 2010 through December 2018 using the pharmacy information system. During the clinic hour, the system would display pharmacy suggestions, which provide recommendations regarding patients’ DRPs, to help doctors’ treatment plans for their patients, and help solving patients’ DRPs at the same time.

Results: From 2010 to 2018, this pharmacy information had system served 1,251 patients per year and had provided 1,980 pharmacists’ consultation services with the acceptance rate of 89.4%. The consultation services included providing suggestion for additional medication or medication modification (38%), adjusting medication dosage (17%), suggesting lab tests (14%), or discontinuation of medication (9%). There were 202 drug-related adverse events, which are mainly metabolic syndrome related.

Conclusions: Kidney transplant care provided by pharmacistst is patient-centeredholistic-care model. By using the team care model, it has shown to help improving our patients’ quality of life, patient compliance, reducing drug-related side effects and unnecessary medical expenses, reducing medications and reducing medical waste. Transplant pharmacists serve as a communication between physicians and patients with the goal to provide excellent care for patients.