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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 沈麗娟(Li-Jiuan Shen) | |
dc.contributor.author | Hao-Cheng Kang | en |
dc.contributor.author | 康皓程 | zh_TW |
dc.date.accessioned | 2021-06-16T04:13:25Z | - |
dc.date.available | 2019-10-15 | |
dc.date.copyright | 2014-10-15 | |
dc.date.issued | 2014 | |
dc.date.submitted | 2014-08-20 | |
dc.identifier.citation | [1] Ageno W, Gallus AS, Wittkowsky A, et al. Oral Anticoagulant Therapy Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST Journal 2012;141:e44S-e88S.
[2] Kliethermes MA, Schullo-Feulner AM, Tilton J, et al. Model for medication therapy management in a university clinic. Am J Health-Syst Pharm 2008;65:844-856. [3] Epplen K, Dusing-Wiest M, Freedlund J, et al. Stepwise approach to implementing ambulatory clinical pharmacy services. Am J Health-Pharm 2007;64:945-951. [4] Holbrook A, Schulman S, Witt DM, et al. Evidence-Based Management of Anticoagulant Therapy Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST Journal 2012;141:e152S-e184S. [5] Ansell JE, Oertel LB, Wittkowsky AK. Managing Oral Anticoagulation Therapy: Clinical and Operational Guidelines 3rd Edition. Ed., St. Louis: Wolters Kluwer Health, 2009. [6] Oake N, Jennings A, Forster AJ, et al. Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis. CMAJ 2008;179:235-244. [7] Lee VW, You JH, Lee KK, et al. Factors affecting the maintenance stable warfarin dosage in Hong Kong Chinese patients. J Thromb Thrombolysis 2005;20:33-38.[8] Holbrook AM, Pereira JA, Labiris R et al. Systematic overview of warfarin and its drug and food interactions. Arch Intern Med 2005;165:1095-1106. [9] Morgan CL, McEwan P, Tukiendorf A et al. Warfarin treatment in patients with atrial fibrillation: observing outcomes associated with varying level of INR control. Thromb Res 2009;124:37-41 [10] YouJH,ChanFW,WongRS,etal.IsINRbetween2.0and3.0theoptimallevel for Chinese patients on warfarin therapy for moderate-intensity anticoagulation? Br J Clin Pharmacol 2005;59:582-587. [11] GulsethMP,GriceGR,DagerWE.Pharmacogenomicsofwarfarin:uncoveringa piece of the warfarin mystery. Am J Health Syst Pharm 2009;66:123-133. [12] Lin LJ, Cheng MH, Lee CH, et al. Compliance with antithrombotic prescribing guidelines for patients with atrial fibrillation – a nationwide descriptive study in Taiwan. Clin Ther 2008;30:1726-1736. [13] Wallentin L, Yusuf S, Ezekowitz MD, et al. Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial. Lancet 2010;376:975-983. [14] YuHC,TsaiYF,ChenMC,etal.Underuseofantithrombotictherapycausedhigh incidence of ischemic stroke in patients with atrial fibrillation. Int J Stroke 2012;7:112-117. [15] Willey ML, Chagan L, Sisca TS, et al. A pharmacist-managed anticoagulation clinic: six-year assessment of patient outcomes. Am J Health Syst Pharm 2003;60:1033-1037. [16] Poon IO, Lal L, Brown EN, et al. The impact of pharmacist-managed oral anticoagulation therapy in older veterans. J Clin Pharm Ther 2007;32:21-29.[17] Fang MC, Machtinger EL, Wang F, et al. Health literacy and anticoagulation- related outcomes among patients taking warfarin. J Gen Intern Med 2006;21:841-846. [18] Wofford JL, Wells MD, Singh S. Best strategies for patient education about anticoagulation with warfarin: a systematic review. BMC Health Serv Res 2008;8:40. [19] RosendaalFR,CannegieterSC,vanderMeerFJ,etal.Amethodtodeterminethe optimal intensity of oral anticoagulant therapy. Thromb Haemost 1993;69:236- 239. [20] Schulman S, Kearon C. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3:692-694. [21] Witt DM, Sadler MA, Shanahan RL, et al. Effect of a centralized clinical pharmacy anticoagulation service on the outcomes of anticoagulation therapy. Chest 2005;127:1515-1522. [22] Chen YW, 'Outcome assessment of a pilot warfarin pharmacist clinic,' M.S. thesis, National Taiwan University, Taipei, Taiwan R.O.C., 2012. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/55625 | - |
dc.description.abstract | 口服抗凝血藥品 warfarin 是臨床上用於預防血栓發生的重要藥品,也是高風險 藥品,若藥量不足可能發生栓塞,過量則易有瘀青或出血的副作用, 並且容易受到 許多複雜因素的影響,因此應定期監測 PT/INR 來確保療效及監控副作用。在臺灣 warfarin 的開方率偏低,且 INR 值大多未達目標範圍,缺血性中風的發生率偏高。 為保障病人安全使用 warfarin,並考量臨床醫師門診之負擔,歐美發展藥師主導的 抗凝血門診已十多年,也有許多研究證實其成效良好。然而臺灣以往並未有正式 營運的藥師門診服務。
抗凝血藥品照護管理服務應包含以下基本要素:以主動追蹤取代被動就醫、 具專業學識的照護管理服務提供者、有組織的追蹤系統、快速可靠的 INR 檢測法、 良好的醫病溝通及用藥教育。本研究以這 5 大要素為目標,並以結構(structure)、 過程(process)及結果(outcome)三大面向為架構來建置新型態藥事照護服務 – 抗凝 血門診。 建置該服務之結構面主要包括文獻蒐集、專業訓練、團隊組成、需求確立、 硬體建置、經費來源、行政支援等步驟;過程面包括流程再造及標準化、病歷紀 錄及管理追蹤系統電子化、用藥教育及醫病溝通等方向之標準及流程制定;結果 面則包括服務量及成效評估等服務品質指標。 以藥劑部為主導,與內科部、外科部、神經部及檢醫部在品管中心的協助下 組成一跨科部團隊,結合醫師、藥師、醫檢師之醫療專業與資訊技術,透過長期 的合作、溝通及定期會議,逐步完成空間整建、藥師訓練、資訊系統建置及行政 流程確認,成功於 2012 年 2 月開辦全國首創的抗凝血門診。 | zh_TW |
dc.description.abstract | Warfarin is one of the most important oral anticoagulants, which is clinically used to prevent thromboembolic events. Warfarin is also one of high hazard medications. Underuse of warfarin may result in treatment failure, and overdose of warfarin would cause bruising or bleeding. The anticoagulatory effect of warfarin is easily influenced by many complicated factors, so PT/INR should be monitored regularly to ensure the efficacy and prevent the adverse effects.
The prescription rate of warfarin is low in Taiwan, and the INR is usually not within the therapeutic range, so the incidence rate of ischemic stroke is higher than other countries. In order to keep the safety in the use of warfarin and to share the burden from physicians, the pharmacist-assisted anticoagulation clinic have been developed for decades in western countries, and the efficacy has been confirmed by many studies. However, there was no any official pharmacist-assisted ambulatory care in Taiwan. An anticoagulant management service should have the following essential elements: active rather than passive management, a knowledgeable provider whose primary responsibility is to manage therapy, an organized system of follow-up, rapid and reliable INR monitoring, and good patient communication and education. To achieve these elements, we use the Donabedian model as a framework via the three categories: structure, process, and outcome to set up the new prototype of pharmaceutical care – anticoagulation clinic Structure includes references collection, personnel training, team building, needs assessment, hardware setup, reimbursement mechanisms, and administrative support. Process includes process reengineering and standardization, electronic medical record and case management system, patient communication and education. Outcome includes service volume and effectiveness evaluation. A multidisciplinary team consisting of Department of Pharmacy, Department of Internal Medicine, Department of Surgery, and Department of Neurology with the assistance of Center of Quality Management, combines the information technology with the medical professions of physicians, pharmacists, and medical laboratory scientists. Through long-term cooperation, communication and regular meetings, we gradually accomplish the space renovation, pharmacist training, information systems setup and administrative processes and successfully launched the first anticoagulation clinic in Taiwan in February 2012. | en |
dc.description.provenance | Made available in DSpace on 2021-06-16T04:13:25Z (GMT). No. of bitstreams: 1 ntu-103-R98451005-1.pdf: 6598686 bytes, checksum: b9c6da5af79059ea14b7eed6a7a51e11 (MD5) Previous issue date: 2014 | en |
dc.description.tableofcontents | 口試委員會審定書................................................................................................#
中文摘要...............................................................................................................i ABSTRACT.......................................................................................................... ii 內容目錄.............................................................................................................iv 圖次................................................................................................................. vii 表次................................................................................................................. viii 第1章 前言..........................................................................................................1 第2章 文獻探討...................................................................................................2 2.1 口服抗凝血藥品 warfarin ...............................................................................2 2.2 理想的 PT/INR 目標值範圍.............................................................................3 2.3 臺灣 warfarin 使用情形 .................................................................................3 2.4 抗凝血門診...................................................................................................4 第3章 研究目的 ..................................................................................................6 第4章 研究方法 ..................................................................................................7 4.1 結構面 (structure).........................................................................................7 4.1.1 文獻蒐集 ...................................................................................................7 4.1.2 專業訓練 ....................................................................................................7 4.1.3 團隊組成 ....................................................................................................7 4.1.4 需求確立 ....................................................................................................8 4.1.5 硬體建置 ....................................................................................................8 4.1.6 經費來源 ....................................................................................................8 4.1.7 行政支援 ....................................................................................................8 4.2 過程面 (process)...........................................................................................9 4.2.1 流程再造及標準化 .......................................................................................9 4.2.2 病歷紀錄及管理追蹤系統 .............................................................................9 4.2.3 用藥教育及醫病溝通: ...................................................................................9 4.3 結果面 (outcome).........................................................................................9 4.3.1 服務量 .......................................................................................................9 4.3.2 成效評估 ..................................................................................................10 第5章 研究結果 ............................................................................................... 11 5.1 結構面(structure).........................................................................................11 5.1.1 專業訓練 ................................................................................................. 11 5.1.2 團隊組成 ................................................................................................. 11 5.1.3 需求確立 ..................................................................................................12 5.1.4 硬體建置 ..................................................................................................13 5.1.5 經費來源 ..................................................................................................14 5.1.6 行政支援 ..................................................................................................14 5.2 過程面 (process).........................................................................................15 5.2.1 流程再造及標準化 .....................................................................................15 5.2.2 病歷紀錄及管理追蹤系統 ...........................................................................16 5.2.3 用藥教育及醫病溝通: .................................................................................18 5.3 結果面 (outcome).......................................................................................19 5.3.1 服務量 .....................................................................................................19 5.3.2 成效評估 ..................................................................................................19 第6章 討論 .......................................................................................................22 6.1籌備團隊之組成..................................................................................................22 6.2尋求合作醫師.....................................................................................................22 6.3抗凝血門診與傳統門診藥事服務之差異..................................................................23 6.4藥療照護管理費與藥事服務費之差異......................................................................24 6.5 研究限制............................................................................................................25 第 7 章 結論......................................................................................................26 參考文獻............................................................................................................37 附錄 .................................................................................................................40 | |
dc.language.iso | zh-TW | |
dc.title | 建構新型態之藥事照護 – 抗凝血門診 | zh_TW |
dc.title | Establishment of a Novel Pharmaceutical Care – an Anticoagulation Clinic | en |
dc.type | Thesis | |
dc.date.schoolyear | 102-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 林淑文(Shu-Wen Lin) | |
dc.contributor.oralexamcommittee | 林慧玲(Fe-Lin Lin Wu),黃織芬(Chih-Fen Huang),王繼娟(Chi-Chuan Wang) | |
dc.subject.keyword | 藥師門診,抗凝血藥品,藥事照護, | zh_TW |
dc.subject.keyword | ambulatory care,anticoagulation clinic,pharmaceutical care,warfarin, | en |
dc.relation.page | 40 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2014-08-20 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床藥學研究所 | zh_TW |
顯示於系所單位: | 臨床藥學研究所 |
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