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Title: | 從病人端及醫療端探索老人安眠藥之使用 An Exploration Study of Hypnotic Use in the Elderly from Patients’ and Clinicians’ Perspectives |
Authors: | Ming-Tsung Li 李明宗 |
Advisor: | 吳佳儀(Chia-Yi Wu) |
Keyword: | 老年用藥,安眠藥,藥物安全,醫病溝通,長期照護,社區健康照護, Elderly,Hypnotics,Medication safety,Doctor-Patient communication,Long-term care,community health care, |
Publication Year : | 2019 |
Degree: | 碩士 |
Abstract: | 研究背景:過去研究調查指出台灣老年族群使用安眠藥的比例約佔50-60%。然而因使用安眠藥後易對老年病患造成危害,故研究與指引皆不建議老年患者使用安眠藥。若需開立安眠藥也須經過審慎評估,並且需要定期監測副作用。不當的開立安眠藥容易造成老人藥物濫用、失智的風險與精神上的危害,或導致不良事件的產生(如跌倒、骨折等);其次,老人也可能對安眠藥存在高度疑慮或錯誤認知,而影響其處方的遵從性,進而無法達到醫師開立藥物的預期治療效果。因此,在使用與不使用藥物之間,病人與醫師均需衡量利弊,再做進一步的調整。分析醫病雙方的用藥與使用經驗,完整描繪出老年患者使用安眠藥的情境,有助於促進醫病溝通與老人用藥安全。
研究目的:本研究目的在探索老人安眠藥的使用經驗,以及醫療端對老人安眠藥處方及安全用藥之影響因素。期待本研究結果作為未來發展老人安全用藥的實務與研究基礎,使第一線醫療人員更了解老人安眠藥使用之現存問題與需求,進一步作為規畫老人藥物安全使用策略時之參考。 研究方法:本研究為質性研究設計,研究者透過一對一深入訪談與焦點團體並藉由半結構式訪談大綱之引導,收集社區和醫院不同求醫經驗的老人之安眠藥使用經驗,並與不同職別醫療人員對於老人安眠藥處置經驗的觀點進行比較。收案場域部分,老年個案來自醫學中心精神科、家庭醫學科、老年醫學科門診/診所以及社區機構(老人公寓與老人相關基金會各一);醫療端則涵蓋醫院與社區醫師、護理師、與藥師的意見。透過內容分析與架構分析法(Framework analysis)將訪談資料拆解成有意義的編碼單位(或稱單元,unit),之後將同類型的單位集合成次主題,找出次主題間之關聯性,接著串聯次主題形成一覽表不斷比對及詮釋,最後再縱貫次主題間之核心概念,彙整而成最終之主題(theme)。 研究結果:研究者共收集了20位目前或近一年內有使用安眠藥經驗的老人,以及17位醫療人員之開藥、發藥與照護經驗。研究結果發現老人的用藥經驗可分為:藥物治療的態度、用藥後評價與服藥行為;醫療人員端則會透過失眠原因的評估、安眠藥用藥原則、用藥期間的安全維護來介入或調整老人的用藥行為,並在用藥期間透過溝通以理解病人用藥需求,以平衡安眠藥的療效與副作用。醫病陳述當中共同浮現的主題為溝通,包含用藥與否、調降藥物之討論與醫病關係的建立與阻礙。 結論與建議:老人的安眠藥使用是醫病互動下的結果,醫療人員在維持安全的原則下開立適當藥物以解決失眠問題,而老人則透過溝通表達自身感受與需求,以使藥物更符合自身狀況。本研究描繪出醫病雙方在開藥、照護與用藥方面之經驗,未來建議老人安眠藥安全使用之議題,宜強化政策、研究、臨床服務與教育訓練等多面向之實證基礎與實務推動。 Background: In the previous survey in Taiwan, the prevalence of hypnotic use is around 50%-60%. However, considering the adverse events after using hypnotics, it is not recommended to prescribe these drugs to the elderly. Hypnotics should be prescribed under prudent evaluation, and supervising the adverse event regularly. Inappropriate prescribing of hypnotics could lead to risks of misuse, dementia, psychiatric symptoms, or other adverse events (ex: fall, delirium, and fracture). On the other hand, the elderly may have incorrect knowledge to hypnotics that affect adherence, resulting in poor therapeutic effects. Therefore, the elderly and clinical practitioners should work together to ensure safety use of hypnotics. As such, analyzing the prescribing experience and hypnotics use history would help facilitate the understanding of therapeutic communication between elderly patients and the practitioners. Purposes: The study aimed to explore hypnotic use experience of the elderly and the practitioners. The purpose of the study was to promote the understanding of elderly needs and medical influence of hypnotic consumptions. Methods: The researcher explored elderly opinions of hypnotics via individual interviews and focus groups and compared the descriptions of both community and clinical elderly patients or practitioners over hypnotic use or prescriptions. The researcher collected the elderly participants from out-patient clinics (including psychiatric, family medicine and geriatrics) and community institutions (including an elderly apartment and a local foundation). On the other hand, the practitioners were collected from clinical staffs (including doctors, nurses and pharmacists) at hospital or community settings. Content analysis and framework analysis were used for data analysis. Through content analysis and framework analysis, the interview data was disassembled into meaningful coding units, and then the same type of units were grouped into sub-themes to reveal the relevance between sub-themes. The series of sub-themes form a list were compared and interpreted continuously. Finally, the researcher gathered the core concepts between the sub-themes to formulate the final topics. Results: Twenty elderly patients who had been using hypnotics in the past year and 17 medical staffs were interviewed. The experience of elderly can be categorized to into four parts: attitude toward pharmacotherapy, evaluation of drug effectiveness and drug-taking behavior. The medical staffs would balance the effectiveness and risk by evaluating the cause of insomnia, principle of prescribing, and protective interventions in order to assure hypnotic use safety. A common topic revealed in all content analysis is communication, including whether to use drugs, discussions on drug reductions, as well as the establishment and obstruction of the doctor-patient relationship. Conclusion & implications: Safe hypnotic use is the result of therapeutic interactions between the medical staffs and elderly patients. Medical staffs administrated the drug under safety use principle, and the elderly expressed their needs to be met. The study filled the knowledge gap by providing evidence-based information regarding doctor-patient communication toward hypnotic use. It is recommended that the safety of elderly consumption of hypnotics be improved through policy-making, research, clinical services, and education. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/74011 |
DOI: | 10.6342/NTU201902143 |
Fulltext Rights: | 有償授權 |
Appears in Collections: | 護理學系所 |
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