目的：為了減少不必要的醫療浪費，健保署於2013 年推出雲端藥歷。本研究主要目的為探討藥師透過雲端藥歷提供門診藥事照護所發現之藥物相關問題型態，次要目的為比較有無雲端藥歷輔助之藥事照護在病人滿意度與藥物相關問題上之差異。
方法：橫斷面前瞻性研究，分為介入組，乃病人在看診前先由藥師透過雲端藥歷查詢病人用藥記錄；對照組則為病人先進入診間看診後再由藥師評估現行用藥，並記錄藥物相關問題。藥物相關問題乃根據歐洲工作小組藥學服務網之藥物相關問題指引6.2 版 (Pharmaceutical Care Network Europe Working group on DRPs; v6.2) 記錄之。病人在完成二次照護後須填寫滿意度問卷。
結果：藥事照護整體滿意度為介入組高於對照組 (4.5 ± 0.6 vs. 3.0 ± 1.6, p <0.01)；藥物治療問題發生率方面藥物使用不符合適應症 (50.0%) 為介入組最高，對照組則為病人配合度差 (55.0%) 最高；在藥物治療問題導因方面介入組以藥物及劑量選擇為主，對照組則以病人對服藥認知為主因。

結論：本研究證實藥師透過雲端藥歷先行審視病人用藥的照護模式較能滿足民眾需求；未來若能將常見的問題資訊化，則可事先防範藥物相關問題的發生。而臨床工作與研究者在選用藥物治療相關問題分類工具記錄藥事服務時，宜考量其前瞻性、可重複性、及與世界接軌之可行性，方能使記錄被有意義的保存。
 

Objective: A cloud data system named National Health Insurance (NHI)PharmaCloud System has been constructed for medical professionals to access to prescription information since 2013. The study aimed to analyze and characterize the data regarding the prevalence and types of out-patient drug-related problems (DRPs)and to evaluate if the patient satisfaction for pharmaceutical care differed after NHI PharmaCloud System was used.

Methods: A cross-sectional prospective study was conducted. Patients in study group went to pharmacists in the pharmacy care unit for the on-line inquiries for prescription data in the NHI PharmaCloud System before they went to the OPD, and patients in control group went to OPD first and then to pharmacy care unit for the evaluation of prescription data. DRPs were probed and recorded according to PCNE DRP v6.2 guideline (Pharmaceutical Care Network Europe Working group on DRPs).Satisfaction questionnaire was offered to all patients who had finished pharmaceutical care service.

Results: The overall satisfactions was higher in the study group than in the control(4.5 ± 0.6 vs. 3.0 ± 1.6, p < 0.01). “Indication didn’t meet” (50.0%) for the study group and “poor compliance” (55.0%) for the control group are the most frequently seen DRPs. The most frequent factors to cause DRPs in both groups were “drugs and dose selection” and “drug recognition,” respectively.

Conclusions: With help of PharmaCloud system, patient receiving pharmaceutical care before doctor visit demonstrated higher degree of satisfaction. Tools with characteristics of repeatability and readiness for use are thought appropriate for pharmacists to well document DRPs and to prevent their re-occurrence.