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The opinions and current status about providing pharmaceutical care to the nursing home in the eastern Taiwan surveyed by questionnaire answered by the administrative officer of the facility
No full text研究背景： 護理之家每年一次的督導考核確實已將藥事服務納入評估的標準，但機構對評鑑項目及重點不易掌握。以護理之家之藥事服務相關的文獻也不多，而護理之家的住民依賴藥物的程度又是所有長照機構中最高者，因此藥事服務在未來勢必成為護理之家新興的業務，值得加以探討。
研究目的： 為了瞭解東臺灣（指宜、花、東三縣市）護理之家經營者本身對於藥事服務內涵的意見並探討現況，以期在護理之家中逐步合理地導入適合的藥事照護模式，並探討機構屬性、經營模式、及規模對藥事服務模式、內容、頻率、付費方式的影響。
研究方法： 採用問卷方式調查護理之家經營者有關機構中藥事服務的意見及執行現況，藉此獲得相關資訊，以無母數卡方檢定檢視各依變項與自變項的相關性。
研究結果及討論： 問卷回覆率64.3％（9/14），其中公營的護理之家佔回覆機構的33.33％（3/9），其都一致地認為機構藥師最好採取與醫院合作模式以專任方式任用。在藥事服務頻率方面發現所有公營之護理之家傾向應每週進行一次，由醫療院所附設且經營規模較小（≦50床者）的護理之家則傾向『每月一次』的服務頻率即可，除對服務模式及住民用藥比例的看法與機構屬性相關；藥物治療評估即藥事人員任用模式的看法則與機構經營模式相關之外，其他結果則與機構屬性、經營模式及規模無明顯相關。值得注意的是在此區域之護理之家目前提供藥事服務的頻率的現況調查結果與意見調查結果差異頗鉅。同樣地在現況調查的結果，除費用支付方式與經營模式有關之外，大多數也與機構數性、經營模式、及規模無明顯相關。
結論與建議： 單一機構很少能單獨自聘藥師提供專職藥事服務，應該有健康保險涵蓋各種長期照護的給付，以提昇社區藥局藥師參與的誘因，提昇機構的用藥品質，在服務頻率方面，『每月一次』的要求應可考慮納入評鑑內容。本研究的限制在於此區域之機構數少，故要據此結果推測全臺概況必須相當審慎。Background： Residents of nursing homes rely heavily on medication care, so pharmaceutical care plays an important role in this area of care services. The annual accreditation, which includes pharmaceutical care evaluation, for nursing home has been implemented regularly for a while, but the content and focus of evaluation still needs to be explored. Since relevant articles about pharmaceutical care in nursing home are limited, so it would deserve to be investigated.
Objective： This study surveys the administrative officer’s concept and current status of the pharmaceutical care in the nursing homes in the Eastern Taiwan. Another purpose of this study was trying to introduce a suitable model of pharmaceutical service model into the nursing home. The relationships between independent varibles such as the property of the facility, model of management, and scale of the facility (number of bed) and dependent variables such as pharmaceutical service model, items frequencies, and payment system were analyzed.
Method： Questionnaires regarding the opinions and current status of pharmaceutical services in the nursing home were sent to all of the nursing homes’s administrative offiers. The returned answers were then analyzed by non-parameter statistics about the relationships between independent variables and dependent variables.
Result and Discussion： The overall response rate of the questionnaire in this study is 64.3％（9/14）. Within the 9 responses 3 came from public nursing home, as a ratio of 33.33％. All of the administrative officers of the public nursing homes think that the model of pharmaceutical services delivered by the pharmacist assigned by cooperative hospital is the best model. In regard to frequency of providing pharmaceutical services, “once a week” is the pick of choice. The frequency became however to “once monthly” for the nursing home, which is usually affiliated with a hospital, with lesser beds (≦50). There are no significant relationships between the dependent and independent variables except service model and medication rate of the residents to the property of nursing home, and the item of pharmaceutical care and the model of installing pharmacist to the model of management. It deserved to be notified that the difference between opinion and current status about frequency of pharmaceutical services is significant. The same as in the opinion survey, there are no significant relationships between the most dependent and independent variables except payment to the business model.
Conclusion and Suggestion： Few nursing homes can afford a full-time pharmacist to deliver pharmaceutical services. There should be health insurances covering long term care in nursing home. This increases the incentive of the community pharmacist to participate in pharmaceutical services and improve the quality of medication in nursing home. Monthly pharmaceutical services may serve as an item of accreditation, and can be considered as the requirement for the nursing home. However, one should be cautious in extrapolating results of this study due to its small sampling size.目錄 Ⅳ
圖目錄 Ⅵ
表目錄 Ⅶ
附錄 97
第一章 緒論 1
前言 1
研究背景 2
研究動機 4
研究目的 7
第二章 文獻探討 8
用藥概況 10
用藥不當 12
藥師與醫師在看法上的差異 14
藥師介入的方法 15
藥事介入的好處 21
品質 21
費用 26
藥師介入的意願 30
藥事管理問題 30
藥事服務介入NH所面臨的問題 32
作業 32
給付 34
藥事服務替代方案 36
第三章 研究方法 37
研究假設 38
研究架構 38
問卷設計 40
問卷效度 42
問卷信度 43
統計分析 45
編碼簿（Code Book） 46
第四章 研究結果與討論 52
第一部份-藥事服務內涵的意見 52
機構的特質及藥事服務的模式 52
藥事服務內容 54
藥事服務的頻率 57
藥事服務的費用支付 57
第二部份-藥事服務現況的調查結果 59
藥事服務的模式 59
藥事服務內容 60
藥事服務的頻率 63
藥事服務的費用支付 64
第五章 結論與建議 64
藥事服務模式的意見 66
藥事服務的內容 68
藥事服務的頻率 70
藥事服務的費用支付 71
研究限制 72
研究建議 72
第六章 參考文獻 93
圖 目 錄
圖一、護理之家提供藥事服務內涵調查的研究架構 39
圖二、護理之家提供藥事服務之現況調查的研究架構 40
表 目 錄
表1、東臺灣護理之家名單 3
表2、第一部份問卷信度評估結果（大題部分） 74
表3-（1）、第一部份問卷信度評估結果（各子題部分） 75
表3-（2）、第一部份問卷信度評估結果（各子題部分） 76
表4、第二部份問卷信度評估結果（大題部分） 77
表5-（1）、第二部份問卷信度評估結果（各子題部分） 78
表5-（2）、第二部份問卷信度評估結果（各子題部分） 79
表6、東臺灣護理之家提供藥事服務內涵意見-機構的特質 80
表7、東臺灣護理之家提供藥事服務內涵意見及現況-用藥概況及藥事服務模式 81
表8-1、東臺灣護理之家藥事服務內涵之意見及現況-藥事服務內容 82
表8-2、東臺灣護理之家藥事服務內涵之意見及現況-藥事服務內容 83
表9、東臺灣護理之家提供藥事服務內涵的意見及現況-藥事服務頻率及費用支付 84
表10、東臺灣護理之家藥事服務內涵意見-服務模式vs.自變項-無母數卡方檢定 85
表11、東臺灣護理之家藥事服務內涵之意見-服務內容vs.自變項-無母數卡方檢定 86
表12、護理之家藥事服務之現況-服務模式、頻率vs.自變項-無母數卡方檢定 87
表13、東臺灣護理之家藥事服務之現況-服務的內容vs.自變項-無母數卡方檢定 88
表14、無母數卡方檢定後與機構屬性相關之變項＊ 89
表15-1、無母數卡方檢定後與機構經營模式相關之變項＊ 90
表15-1、無母數卡方檢定後與機構經營模式相關之變項＊ 91
表16、無母數卡方檢定後與機構規模相關之變項＊ 9
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