目的：心衰竭（heart failure, HF）病人是發生藥品相關問題（drug-related problems）的高風險族群，應建立跨專業職類的急性後期醫療整合照護模式（post-acute care, PAC），本研究分析藥師參與HF-PAC 團隊之藥事服務成效。
方法：採前瞻性研究方法。藥事服務介入措施包括指引導向藥物治療（guideline directed medical therapy, GDMT）評估、處方適當性評估、用藥知識正確性評核、用藥衛教、追蹤藥物不良反應（adverse drug reaction, ADR）及左心室射出分率（left ventricular ejection fraction, LVEF）測量值等。
結果：納入本研究對象共61 人。出院後六個月仍然有87.3% 使用血管張力素轉換酶抑制劑／血管加壓素II 受體阻斷劑／血管張力素受體—腦啡肽酶抑制劑類藥品，80.9% 使用乙型阻斷劑（β-blocker）類藥品。藥師發現「嚴重及顯著」等級的藥物治療問題處方，即需要異動處方內容者共18 件，主要發生在出院前的評估階段，處方建議接受度100%。衛教後用藥知識正確性評核分數較衛教前增加2.7 分（p < 0.05）。研究區間共發生6 件ADR，經停藥或換藥後症狀皆改善。出院後六個月LVEF 整體平均提升12.0%（p < 0.05），LVEF ≥ 40% 由8 人增加為30 人。
結論：藥師參與HF-PAC 團隊，及時攔截不適當處方，加強病人的用藥衛教，不但有效提升用藥知識正確性，亦有助於增加醫囑的遵從性。

Objective: Heart failure (HF) is a high-risk group for drug-related problems. An interprofessional integrated care model should be developed. This study analyzed the effectiveness of pharmacist participation in the integrated care model of post-acute care HF (HF-PAC).
Methods: This was a prospective study. The intervention consisted of pharmaceutical services including assessment of guideline-directed medical therapy, prescription appropriateness, and medication knowledge. Medication education, adverse drug reaction (ADR), and measurement of left ventricular ejection fraction (LVEF) were also provided.
Results: A total of 61 cases were included in this study. Six months after discharge, 87.3% still used angiotension-converting enzyme inhibitors/angiotension II receptor blockers/angiotensin receptor-neprilysin inhibitor, and 80.9% used β-blockers. A total of 18 prescriptions were classified as “severe and significant”, and this mainly occurred in the stage before discharge. In these cases, the pharmacist’s recommendations were 100%. The patient’s medication knowledge score increased by 2.7 points after medication education (p < 0.05). A total of 6 cases of ADR occurred. The symptoms improved after withdrawing or changing the medication. Six months after discharge, the overall LVEF increased by an average of 12.0% (p < 0.05), and the number of patients with LVEF ≥ 40% increased from 8 to 30.
Conclusions: Pharmacist participation in the HF-PAC team prevented inappropriate prescriptions and strengthened medication education. The pharmacists not only improved patients’ medication knowledge but also increased medical adherence.