背景： 腎臟移植是腎病末期病人的治療 選擇之一。腎移植患者必須長期 使用多種藥物以維持免疫抑制的 功能以及治療既有的慢性疾病如 高血壓、高血糖、高血脂等。多 種藥物合併使用易發生藥物交互 作用與藥物不良反應，也可能使 病人服藥的疑慮增加，順從性下 降，甚至導致排斥反應的發生。 由於醫師處方的藥物有些具有狹 窄的治療指數，因此建立良好的 藥物治療照護是相當重要的。
方法： 本研究為探討藥師參與腎臟移植 門診提供藥事照護對醫師處方用 藥及病人治療結果之影響。研究 自 2005 年 5 月至 2006 年 8 月， 以在某醫學中心腎臟移植特約門 診 作 術 後 追 蹤 之 病 人 為 收 案 對 象。藥師於移植門診時段先行與 看診病人進行訪談，同時將病人 主訴與臨床建議記錄於「藥事評估建議表」，透過病歷傳達給醫 師，醫師則參考建議事項、根據 病人現況開立醫囑。我們將藥事 建議事項之品質依臨床重要性分 成 6 個等級，並追蹤記錄醫師對 建 議 接 受 度 與 病 人 疾 病 之 改 善 度，作為評估藥事照護對醫師處 方與治療結果影響之參考。
結果： 研究期間共追蹤 37 位腎臟移植病人，提供醫師 55 次藥物治療建議，建議事項之品質有 81.8%為具臨床意義以上之等級，建議之藥物類別以心血管藥物、免疫抑制劑及抗代謝藥物居多，分別為 31.8%、25%、25%。有 94.5%的建議事項為醫師所接受，接受藥 師 建 議 且 修 改 醫囑的 案 例 中有 94.2%的病人病況改善。
結論： 研 究 結 果 顯 示 藥 師參與 腎 移 植門 診 藥 療 照 護 對 醫師處 方 用 藥及治療結果具有正面的影響。
Renal transplantation is an established treatment for patients with end-stage renal disease. Renal transplant patients require long-term therapy with multiple medications for immunosuppression as well as to treat concomitant chronic diseases such as diabetes, hypertension, and hyperlipidemia, those can increase the rate of drug interactions and adverse drug reactions, decrease the patients’ compliance, and even develop the allograft rejections. Since some medications prescribed for these patients have narrow therapeutic ranges, optimal pharmacotherapy is vital.
The purpose of this trial is to investigate the impact of pharmaceutical care intervention for patients in renal transplant clinics. The patients who visit renal transplant clinic in the medical center from May 2005 through August 2006 were included. The pharmacist was to interview patients, review medication regimens and make therapeutic recommendations which were recorded in a standard form called “pharmacotherapy evaluate-recommendations”,the physician prescribing something for patients according to the standard form and patient’s conditions. We divided the pharmacist recommendations to 6 scales according to clinical potential impact. The acceptance rate for the pharmacist’s recommendations and patients’ outcomes were evaluated.
There were 55 pharmacotherapy recommendations to be making for 37 renal transplantation patients during the period of trial. The 81.8% of recommendation’s quality was classified to clinical significant. The drug classes most commonly involved were cardiovascular medications, immuno-suppressants and antimetabolite agents (31.8%, 25% and 25%, respectively). The acceptance rate of physician for the pharmacist’s recommendations was 94.5% and 94.2% of patients’ outcome were improved. We concluded that the pharmacist joint pharmaceutical care in renal transplant clinic had a positive potential impact on prescriptions and patients’ outcome.
