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  1. NTU Theses and Dissertations Repository
  2. 醫學院
  3. 護理學系所
請用此 Handle URI 來引用此文件: http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/7426
完整後設資料紀錄
DC 欄位值語言
dc.contributor.advisor羅美芳zh_TW
dc.contributor.advisorMeei Fang Louen
dc.contributor.author何秀玉zh_TW
dc.contributor.authorHsiu-Yu Hoen
dc.date.accessioned2021-05-19T17:43:23Z-
dc.date.available2024-03-01-
dc.date.copyright2018-10-03-
dc.date.issued2017-
dc.date.submitted2002-01-01-
dc.identifier.citation一、中文部分
朱育增、吳肖琪(2010).回顧與探討次級資料適用之共病測量方法.臺灣公共衛生雜誌,29(1),8-21。
朱育增、吳肖琪、李玉春、賴美淑、譚醒朝(2010).探討共病測量方法於健保次級資料之應用.臺灣公共衛生雜誌,29(3),191-200。
行政院國家發展委員會(2018).107年度2月份重要統計資料手冊-,2018.03.31取自https://www.ndc.gov.tw/Content_List.aspx?n=507E4787819DDCE6
行政院衛生福利部(2016).105年衛生福利統計指標(2018年2月22日更新),2018.03.31取自https://dep.mohw.gov.tw/DOS/lp-2158-113.html
何蘊芳(2004).老人藥品與藥品交互作用.長期照護雜誌,8(4),391-397。
吳祥恩、鄭美玲、盧豐華、張智仁(1995).服藥自我報告:簡易高血壓遵醫囑性方法之評估.中華民國家庭醫學雜誌,5(2),84-91。
杜玉卿、葉淑惠(2007).不遵從之概念分析.高雄護理雜誌,24(2),95-110。
沈德依(2008).社區老年人潛在性不適當用藥盛行率與相關因子之探討.未出版碩士論文.臺北:國立臺灣大學。
林香汶、陳育傑、謝右文、蔡輝彥(2016).優質化老人用藥及藥事照護服務.臺灣臨床藥學雜誌,,24(4),267-281。doi:10.6168/fjcp.2016.2404.02
邱亨嘉、陳怡君、毛莉雯、蕭世槐、劉宏文、黃明賢(1997).中文版多元功能評估問卷之信度效度考驗.臺灣公共衛生雜誌,16(2),119-132。
柯玲晶、譚醒朝、譚家惠(2007).Charlson合併症指數對全民健康保險資料庫適用性之探討.臺灣公共衛生雜誌,26(6),491-498。
紀玫如(2008).中老年人多重慢性病集群型態與醫療服務使用之相關研究.未發表的博士論文.臺北:國立臺灣大學衛生政策與管理研究所。
胡文郁、曾春典、戴玉慈、余玉眉(1996).高血壓患者服藥遵從行為及其相關因素之探討.臺灣公共衛生雜誌,15(4),319-332。
翁康寧、溫瓊容、陳人豪、郭旭格、呂亦樞、邱麗淑、 . . . 詹鼎正(2012).醫師對老年用藥的態度及知識.台灣醫學,16(6),571-578。 doi:10.6320/fjm.2012.16(6).01
馬先芝(2004).冠心症老年患者服藥遵從行為及其相關因素之探討.未發表的碩士論文.臺南:成功大學。
陳姿吟、李季黛、周明岳、薛光傑、杜明勳(2011).簡介老人用藥準則之工具.家庭醫學與基層醫療,26(9),370-376。doi:10.6965/fmpmc.201109.0370
陳曉珮(2011).血液透析老人規律運動、身體功能狀態、憂鬱及生活品質相關性之探討.未發表的碩士論文.臺中:中國醫藥大學。
程金瀛、劉淑娟(2004).預防老人用藥錯誤-護理的角色與功能.長期照護雜誌,8(4),408-414。
黃光華、葉玲玲、洪錦墩、謝儀靜、蔡東翰(2011).慢性病老年人潛在不適當用藥影響因素之研究.臺灣公共衛生雜誌,30(2),180-190。
黃麗玲(2000).社區獨居老人身體、心理及社會功能之探討.未發表的碩士論文.高雄:高雄醫學大學。
楊玨璿(2009).某醫學中心門診高血壓病人服藥遵守行為之探討--自我效能及行動線索之影響.未發表的碩士論文.臺北:國立臺灣大學。
廖素娟 (2011).長者藥平安-居家老人用藥安全.志為護理-慈濟護理雜誌,10(4),28-29。doi:10.6974/tcnj.201108.0028
廖媛璋(2010).「老人用藥安全」你我共同來維護.彰基院訊,27(1),12-12。doi:10.29598/xlzy.201001.0006
戴辛翎(2005).遵從行爲概念分析-血液透析病患之體重控制.腎臟與透析,17(1),69-73。
二、英文部分
Akazawa, M., Imai, H., Igarashi, A., & Tsutani, K. (2010). Potentially inappropriate medication use in elderly Japanese patients. The American Journal of Geriatric Pharmacotherapy, 8(2), 146-160.
Alhmoud, E., Khalifa, S., & Bahi, A. A. (2015). Prevalence and predictors of potentially inappropriate medications among home care elderly patients in Qatar. International Journal of Clinical Pharmacy, 37(5), 815-821. doi:10.1007/s11096-015-0125-0
Alkan, A., Yaşar, A., Karcı, E., Köksoy, E., Ürün, M., Şenler, F., . . . Ergün, H. (2017). Severe drug interactions and potentially inappropriate medication usage in elderly cancer patients. Supportive Care in Cancer, 25(1), 229-236. doi:10.1007/s00520-016-3409-6
American Geriatrics Society (AGS) (2012). American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 60(4), 616-631. doi: 10.1111/j.1532-5415.2012.03923.x
Aronson, J. K. (2007a). Compliance, concordance, adherence. British Journal of Clinical Pharmacology, 63(4), 383-384. doi: 10.1111/j.1365-2125.2007.02893.x
Aronson, J. K. (2007b). Time to abandon the term ‘patient concordance’. British Journal of Clinical Pharmacology, 64(5), 711-713. doi: 10.1111/j.1365-2125.2007.02971_2.x
Basger, B. J., Chen, T. F., & Moles, R. J. (2008). Inappropriate medication use and prescribing indicators in elderly Australians: Development of a prescribing indicators tool. Drugs & Aging, 25(9), 777-793.
Beer, C., Hyde, Z., Almeida, O. P., Norman, P., Hankey, G. J., Yeap, B. B., & Flicker, L. (2011). Quality use of medicines and health outcomes among a cohort of community dwelling older men: An observational study. British Journal of Clinical Pharmacology, 71(4), 592-599. doi: 10.1111/j.1365-2125.2010.03875.x
Beers, M. H. (1997). Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Archives of Internal Medicine, 157(14), 1531-1536.
Beers, M. H., Ouslander, J. G., Rollingher, I., Reuben, D. B., Brooks, J., & Beck, J. C. (1991). Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Archives of Internal Medicine, 151(9), 1825-1832.
Bell, J. S., Airaksinen, M. S., Lyles, A., Chen, T. F., & Aslani, P. (2007). Concordance is not synonymous with compliance or adherence. British Journal of Clinical Pharmacology, 64(5), 710-711. doi: 10.1111/j.1365-2125.2007.02971_1.x
Bissell, P., May, C. R., & Noyce, P. R. (2004). From compliance to concordance: Barriers to accomplishing a re-framed model of health care interactions. Social Science & Medicine, 58(4), 851-862. doi: org/10.1016/S0277-9536(03)00259-4
Ble, A., Masoli, J. A. H., Barry, H. E., Winder, R. E., Tavakoly, B., Henley, W. E., . . . Richards, S. H. (2015). Any versus long-term prescribing of high risk medications in older people using 2012 Beers criteria: Results from three cross-sectional samples of primary care records for 2003/4, 2007/8 and 2011/12. BioMed Central Geriatrics, 15, 146-146. doi:10.1186/s12877-015-0143-8
Buntinx, F., Niclaes, L., Suetens, C., Jans, B., Mertens, R., & Van den Akker, M. (2002). Evaluation of Charlson's comorbidity index in elderly living in nursing homes. Journal of Clinical Epidemiology, 55(11), 1144-1147.
Castelino, R. L., Hilmer, S. N., Bajorek, B. V., Nishtala, P., & Chen, T. F. (2010). Drug Burden Index and potentially inappropriate medications in community-dwelling older people: The impact of home medicines review. Drugs & Aging, 27(2), 135-148. doi:10.2165/11531560-000000000-00000
Chang, C. B., & Chan, D. C. (2010). Comparison of published explicit criteria for potentially inappropriate medications in older adults. Drugs & Aging, 27(12), 947-957. doi: 10.2165/11584850-000000000-00000
Chang, C. B., Chen, J. H., Wen, C. J., Kuo, H. K., Lu, I. S., Chiu, L. S., . . . Chan, D. C. (2011). Potentially inappropriate medications in geriatric outpatients with polypharmacy: Application of six sets of published explicit criteria. British Journal of Clinical Pharmacology, 72(3), 482-489. doi: 10.1111/j.1365-2125.2011.04010.x
Chang, C. M., Liu, P. Y., Yang, Y. H., Yang, Y. C., Wu, C. F., & Lu, F. H. (2004). Potentially inappropriate drug prescribing among first-visit elderly outpatients in Taiwan. Pharmacotherapy, 24(7), 848-855.
Chang, W. T., Kowalski, S. R., Sorich, W., & Alderman, C. P. (2017). Medication regimen complexity and prevalence of potentially inappropriate medicines in older patients after hospitalisation. International Journal of Clinical Pharmacy, 39(4), 867-873. doi:10.1007/s11096-017-0490-y
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Chaudhry, S., Jin, L., & Meltzer, D. (2005). Use of a self-report-generated Charlson Comorbidity Index for predicting mortality. Medical Care, 43(6), 607-615.
Chen, C.-C., & Cheng, S.-H. (2016). Potentially inappropriate medication and health care outcomes: An instrumental variable approach. Health Services Research, 51(4), 1670-1691. doi:10.1111/1475-6773.12417
Chen, F. C., Su, C. M., Li, C. J., Le, W. H., & Kung, C. T. (2009). The use of Charlson Comorbidity Index for patients receiving inhospital unexpected resuscitation by a cardiac arrest team: Clinical outcome and implications. Journal of Emergency Medicine, Taiwan, 11(2), 35-42.
Chen, L. L., Tangiisuran, B., Shafie, A. A., & Hassali, M. A. A. (2012). Evaluation of potentially inappropriate medications among older residents of Malaysian nursing homes. International Journal of Clinical Pharmacy, 34(4), 596-603. doi:10.1007/s11096-012-9651-1
Chin, M. H., Wang, L. C., Jin, L., Mulliken, R., Walter, J., Hayley, D. C., . . . Friedmann, P. D. (1999). Appropriateness of medication selection for older persons in an urban academic emergency department. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine, 6(12), 1232-1242.
Cojutti, P., Arnoldo, L., Cattani, G., Brusaferro, S., & Pea, F. (2016). Polytherapy and the risk of potentially inappropriate prescriptions (PIPs) among elderly and very elderly patients in three different settings (hospital, community, long-term care facilities) of the Friuli Venezia Giulia region, Italy: Are the very elderly at higher risk of PIPs? Pharmacoepidemiology and Drug Safety, 25(9), 1070-1078. doi:10.1002/pds.4026
Counsell, S. R. (2015). 2015 updated AGS Beers Criteria offer guide for safer medication use among older adults. Geriatric Nursing (New York, N.Y.), 36(6), 488-489.
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Cross, A. J., George, J., Woodward, M. C., Ames, D., Brodaty, H., Wolfe, R., . . . Elliott, R. A. (2017). Potentially inappropriate medication, anticholinergic burden, and mortality in people attending memory clinics. Journal of Alzheimer's Disease: JAD, 60(2), 349-358. doi:10.3233/JAD-170265
Cross, A. J., George, J., Woodward, M. C., Ames, D., Brodaty, H., Ilomäki, J., & Elliott, R. A. (2016). Potentially inappropriate medications and anticholinergic burden in older people attending memory clinics in Australia. Drugs & Aging, 33(1), 37-44. doi:10.1007/s40266-015-0332-3
Dalleur, O., Boland, B., Losseau, C., Henrard, S., Wouters, D., Speybroeck, N., . . . Spinewine, A. (2014). Reduction of potentially inappropriate medications using the STOPP criteria in frail older inpatients: A randomised controlled study. Drugs & Aging, 31(4), 291-298. doi:10.1007/s40266-014-0157-5
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de Oliveira Alves, C., Schuelter-Trevisol, F., & Trevisol, D. (2014). Beers criteria-based assessment of medication use in hospitalized elderly patients in Southern Brazil. Journal of Family Medicine and Primary Care, 3(3), 260-265. doi:10.4103/2249-4863.141628
Di Giorgio, C., Provenzani, A., & Polidori, P. (2016). Potentially inappropriate drug prescribing in elderly hospitalized patients: An analysis and comparison of explicit criteria. International Journal of Clinical Pharmacy, 38(2), 462-468. doi:10.1007/s11096-016-0284-7
Dimitrow, M. S., Airaksinen, M. S., Kivela, S. L., Lyles, A., & Leikola, S. N. (2011). Comparison of prescribing criteria to evaluate the appropriateness of drug treatment in individuals aged 65 and older: A systematic review. Journal of the American Geriatrics Society, 59(8), 1521-1530. doi: 10.1111/j.1532-5415.2011.03497.x
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Endres, H. G., Kaufmann-Kolle, P., Steeb, V., Bauer, E., Böttner, C., & Thürmann, P. (2016). Association between potentially inappropriate medication (PIM) use and risk of hospitalization in older adults: An observational study based on routine data comparing PIM use with use of PIM alternatives. Plos One, 11(2), e0146811-e0146811. doi:10.1371/journal.pone.0146811
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Fabbietti, P., Di Stefano, G., Moresi, R., Cassetta, L., Di Rosa, M., Fimognari, F., . . . Corsonello, A. (2017). Impact of potentially inappropriate medications and polypharmacy on 3-month readmission among older patients discharged from acute care hospital: A prospective study. Aging Clinical and Experimental Research. doi:10.1007/s40520-017-0856-y
Fialova, D., Topinkova, E., Gambassi, G., Finne-Soveri, H., Jonsson, P. V., Carpenter, I., . . . Bernabei, R. (2005). Potentially inappropriate medication use among elderly home care patients in Europe. JAMA: The Journal of the American Medical Association, 293(11), 1348-1358. doi: 10.1001/jama.293.11.1348
Fick, D. M., Cooper, J. W., Wade, W. E., Waller, J. L., Maclean, J. R., & Beers, M. H. (2003). Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts. Archives of Internal Medicine, 163(22), 2716-2724. doi: 10.1001/archinte.163.22.2716
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Fiss, T., Thyrian, J. R., Fendrich, K., van den Berg, N., & Hoffmann, W. (2013). Cognitive impairment in primary ambulatory health care: Pharmacotherapy and the use of potentially inappropriate medicine. International Journal of Geriatric Psychiatry, 28(2), 173-181. doi:10.1002/gps.3806
Floroff, C. K., Slattum, P. W., Harpe, S. E., Taylor, P., & Brophy, G. M. (2014). Potentially inappropriate medication use is associated with clinical outcomes in critically ill elderly patients with neurological injury. Neurocritical Care, 21(3), 526-533. doi:10.1007/s12028-014-9985-8
Formiga, F., Ferrer, A., Sanz, H., Marengoni, A., Alburquerque, J., & Pujol, R. (2013). Patterns of comorbidity and multimorbidity in the oldest old: The Octabaix study. European Journal of Internal Medicine, 24(1), 40-44. doi:http://dx.doi.org/10.1016/j.ejim.2012.11.003
Formiga, F., Vidal, X., Agustí, A., Chivite, D., Rosón, B., Barbé, J., . . . Potentially Inappropriate Prescription in Older Patients in Spain Investigators. (2016). Inappropriate prescribing in elderly people with diabetes admitted to hospital. Diabetic Medicine, 33(5), 655-662. doi:10.1111/dme.12894
Frély, A., Chazard, E., Pansu, A., Beuscart, J.-B., & Puisieux, F. (2016). Impact of acute geriatric care in elderly patients according to the Screening Tool of Older Persons' Prescriptions/ Screening Tool to Alert doctors to Right Treatment criteria in northern France. Geriatrics & Gerontology International, 16(2), 272-278. doi:10.1111/ggi.12474
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Gallagher, P. F., Barry, P. J., Ryan, C., Hartigan, I., & O'Mahony, D. (2008). Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers' Criteria. Age & Ageing, 37(1), 96-101.
Gallagher, P., Baeyens, J.P., Topinkova, E. V. A., Madlova, P., Cherubini, A., Gasperini, B., . . . O'Mahony, D. (2009). Inter-rater reliability of STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria amongst physicians in six European countries. Age & Ageing, 38(5), 603-606. doi: 10.1093/ageing/afp097
Gallagher, P., Lang, P., Cherubini, A., Topinková, E., Cruz-Jentoft, A., Montero Errasquín, B., . . . O'Mahony, D. (2011). Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. European Journal of Clinical Pharmacology, 67(11), 1175-1188. doi: 10.1007/s00228-011-1061-0
Gallagher, P., Ryan, C., Byrne, S., Kennedy, J., & O'Mahony, D. (2008). STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. International Journal of Clinical Pharmacology and Therapeutics, 46(2), 72-83.
Galli, T. B., Reis, W. C., & Andrzejevski, V. M. (2016). Potentially inappropriate prescribing and the risk of adverse drug reactions in critically ill older adults. Pharmacy Practice, 14(4), 818-818. doi:10.18549/PharmPract.2016.04.818
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Hanlon, J. T., Fillenbaum, G. G., Kuchibhatla, M., Artz, M. B., Boult, C., Gross, C. R., . . . Schmader, K. E. (2002). Impact of inappropriate drug use on mortality and functional status in representative community dwelling elders. Medical Care, 40(2), 166-176.
Hansen, C. R., Byrne, S., Cullinan, S., O'Mahony, D., Sahm, L. J., & Kearney, P. M. (2018). Longitudinal patterns of potentially inappropriate prescribing in early old-aged people. European Journal of Clinical Pharmacology, 74(3), 307-313. doi:10.1007/s00228-017-2364-6
Heider, D., Matschinger, H., Meid, A., Quinzler, R., Adler, J.-B., Günster, C., . . . König, H.-H. (2017). Health service use, costs, and adverse events associated with potentially inappropriate medication in old age in Germany: Retrospective matched cohort study. Drugs & Aging, 34(4), 289-301. doi:10.1007/s40266-017-0441-2
Holmes, H. M., Luo, R., Kuo, Y.-F., Baillargeon, J., & Goodwin, J. S. (2013). Association of potentially inappropriate medication use with patient and prescriber characteristics in Medicare Part D. Pharmacoepidemiology and Drug Safety, 22(7), 728-734. doi:10.1002/pds.3431
Holt, S., Schmiedl, S., & Thürmann, P. A. (2010). Potentially inappropriate medications in the elderly: The PRISCUS list. Deutsches Ärzteblatt International, 107(31-32), 543-551.
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dc.identifier.urihttp://tdr.lib.ntu.edu.tw/jspui/handle/123456789/7426-
dc.description.abstract研究背景:老人照護是健康照護系統主要的挑戰之一,罹患共病症、多重疾病或多重慢性病除了使老人更容易處於多重用藥的風險,也容易造成潛在不適當藥品使用,不僅增加醫療照護使用,也增加健康照護需求。
研究目的:探討住院老人潛在不適當藥品使用的盛行率與其相關因素。
研究方法:本研究為縱貫式描述性相關性研究,收案時間從2013年8月28日至2015年6月1日,從502位研究對象來自臺灣北部一家醫學中心的二個內科病房,以Charlson共病症指數、簡易心智狀況問卷、多元功能評估問卷之日常生活活動能力面向、服藥遵從行為量表、2015 AGS Beers潛在不適當藥品準則等收集資料,追蹤五個時間點,分別是住院時、住院期間、出院時、出院後第一次回診及出院後三個月,以廣義估計方程式(generalized estimating equation, GEE)做統計分析。
研究結果:最後448位個案完成五個測量時間點的測量,潛在不適當藥品的五種類別中,在五個測量時間點至少有一種潛在不適當藥品的盛行率約6.1%~ 80.9%;最常出現的藥物是metoclopramide和esomeprazole;多變量羅吉斯迴歸分析顯示處方藥種類數量為潛在不適當藥品最常見的預測因子,勝算比為1.811~11.022;在潛在不適當藥品的變動因素方面,處方藥種類數量也是最常見的因素。
結論:本研究結果顯示老人住院期間潛在不適當藥品盛行率是最高的,處方藥種類數量是最顯著的預測因子。因此,醫護人員須負起責任檢視老人藥品,務必力求減少老人藥品。另外,透過加強醫護人員對於老人用藥安全教育和教導老人正確自我藥品管理,以避免老人服藥量過多,以改善老人的用藥品質。
zh_TW
dc.description.abstractBackground: Elder care is one of the major challenges in healthcare. The suffering from multi-morbidities often make the older adults at risk of polypharmacy, and thus likely to cause the potentially inappropriate medication use. The use of medical resources and demand for healthcare will both increase.
Objective: To understand the prevalence and associated factors of potentially inappropriate medication use among older patients after hospitalization.
Methods: Subjects were recruited from two medical wards in a medical center in northern Taiwan. Data were collected from August 28, 2013 to June 1, 2015. The data were collected by the Charlson Comorbidity Index, Short Portable Mental Status Questionnaire, the first part of Chinese-version Multidimensional Functional Assessment Questionnaire, Medication Adherence and Potentially Inappropriate Medication (2015 AGS Beers criteria) on admission, during hospital stay, at discharge, and first visit at outpatient clinic and three months after discharge. The data were analyzed by generalized estimating equation (GEE).
Results: In 448 subjects, data collection was completed at all five measurement time points. Among the five categories of potentially inappropriate medication (PIM), the prevalence of at least one PIM was about 6.1% to 80.9% at five measurement time points. Metoclopramide and esomeprazole were the most common drugs. Multivariate logistic regression analysis showed that the number of prescription drugs was the most common predictor, account for 1.811~11.02 of odds ratio. The number of prescription drugs was also the most common factor in the changing factors of PIM.
Conclusions: The results of this study showed that the prevalence of PIM use during hospital stay is highest. The number of prescription drugs is the most significant predictor. Therefore, healthcare professionals have to take responsibility to review and reduce medications in elderly. In addition, healthcare professionals should enforce educating the elderly about medication safety, and self-medication management to avoid excessive use of medication, and improve the quality of medication use in the elderly.
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dc.description.tableofcontents頁數
口試委員會審定書…………………………………………………………….. i
誌謝……………………………………………………………………………... ii
中文摘要………………………………………………………………………... iv
英文摘要………………………………………………………………………... v
目錄……………………………………………………………………………... vii
圖目錄…………………………………………………………………………... ix
表目錄…………………………………………………………………………... xi
第一章 緒論…………………………………………………………………... 1
第一節 研究背景與動機……………………………………………….. 1
第二節 研究問題與研究目的………………………………………….. 4
第三節 名詞界定……………………………………………………….. 5
第二章 文獻查證……………………………………………………………... 7
第一節 潛在不適當藥品之定義與測量……………………………….. 7
第二節 老人潛在不適當藥品使用之後果與其相關因素…………….. 21
第三節 共病症、多重疾病和多重慢性病症的定義與測量………….. 39
第四節 服藥遵從性之定義與測量…………………………………….. 42
第三章 研究方法……………………………………………………………... 47
第一節 研究架構……………………………………………………….. 47
第二節 研究設計、研究場所與研究對象…………………………….. 49
第三節 研究工具之信度與效度……………………………………….. 50
第四節 資料收集過程………………………………………………….. 54
第五節 維持研究嚴謹度之策略……………………………………….. 56
第六節 研究倫理考量………………………………………………….. 58
第七節 資料統計分析………………………………………………….. 59
第四章 研究結果……………………………………………………………... 61
第一節 研究對象之基本特性、疾病特性、用藥狀況、求醫狀況及PIM使用狀況………………………………………………….
61
第二節 研究對象PIM使用之狀況及其變化………………………… 81
第三節 研究對象PIM使用與基本特性、疾病特性、用藥狀況、求醫狀況之相關性及其重要預測因子………………………….
95
第四節 研究對象PIM使用及其預測因子間的變動關係…………… 119
第五章 討論…………………………………………………………………... 129
第一節 PIM使用之盛行率及變化…….……………….……………… 129
第二節 常見的PIM使用之藥品………………………………………. 135
第三節 PIM使用與自變項的相關性、預測因子及其與預測因子的變動關係…….…………………………………………………
137
第六章 結論…………………………………………………………………... 145
第一節 結論…………………………………………………………….. 145
第二節 建議…………………………………………………………….. 146
第三節 研究限制與未來研究之建議………………………………….. 147
參考文獻………………………………………………………………………... 148
附錄……………………………………………………………………………... 167
IRB通過函……………………………………………………………….. 167
AGS 2015準則使用同意書……………………………………………… 168
服藥遵從性量表使用同意書…………………………………………….. 169
中文版老人多元功能問卷使用同意書………………………………….. 170
本研究問卷表…………………………………………………………….. 171


圖 目 錄
頁數
圖3-1 研究架構……………………………………………………………….. 47
圖3-2 收案流程圖…………………………………………………………….. 48
圖4-1 五個測量時間點的收案數、拒絕與流失狀況……………………….. 65
圖4-2 研究對象「老人潛在不適當藥品」於五個測量時間點之變化……….. 86
圖4-3 研究對象「老人由於藥品-疾病/症候群交互作用應避免的藥品」於五個測量時間點之變化………………………………………………..
87
圖4-4 研究對象「老人需小心使用的藥品」於五個測量時間點之變化…….. 88
圖4-5 研究對象「老人由於藥品-藥品交互作用應避免的藥品」於五個測量時間點之變化…………………………..……………………………
89
圖4- 6 研究對象「老人由於腎功能改變需要避免或調整劑量的藥品」於五個測量時間點之變化………………………………………………..
90
圖4-7 研究對象的認知狀況與功能狀況於四個測量時間點之變化……….. 93
圖4-8 研究對象的診斷數量、共病症指數與處方藥種類數量於五個測量時間點之變化…………………………………………………………..
93
圖4-9 研究對象的服藥遵從性於三個測量時間點之變化………………….. 94
圖4-10 研究對象的求醫狀況於二個測量時間點之變化…………………….. 94
圖4-11 處方藥種類數量與「老人潛在不適當藥品」變動的關係趨勢…….…. 122
圖4-12 共病症指數與「老人潛在不適當藥品」變動的關係趨勢…………..… 123
圖4-13 求診醫院數量與「老人潛在不適當藥品」變動的關係趨勢……….…. 124
圖4-14 處方藥種類數量與「老人由於藥品-疾病/症候群交互作用應避免的藥品」變動的關係趨勢………………………......……………………..
125
圖4-15 診斷數量與「老人由於藥品-疾病/症候群交互作用應避免的藥品」變動的關係趨勢………………………………………………………..
126
圖4-16 處方藥種類數量與「老人需小心使用的藥物」變動的關係趨勢…...... 127
圖4-17 年齡與「老人需小心使用的藥物」變動的關係趨勢………………….. 128


表 目 錄
頁數
表2-1 The basic characteristics of the explicit criteria for potentially inappropriate prescribing evaluated in this review...…………………..
17
表2-2 Evaluation of the criteria for potentially inappropriate prescribing in elder patients…..………………………………………………….……
18
表2-3 Comparison of the criteria for potentially inappropriate prescribing in elder patients…………...………………………………………………
19
表2-4 比較順從性(compliance)和遵從性(adherence)……………………….. 42
表3-1 測量項目及時間表…………………………………………………….. 55
表3-2 本研究主要變項的屬性……………………………………………….. 60
表3-3 統計資料分析方法表………………………………………………….. 60
表4-1 研究對象的基本特性………..………………………………………… 66
表4-2 研究對象的疾病特性………………………………………………….. 67
表4-3 研究對象的用藥狀況………………………………………………….. 67
表4-4 研究對象的求醫狀況………………………………………………….. 68
表4-5 研究對象「老人潛在不適當藥品」狀況……………………………….. 69
表4-6 研究對象「老人由於藥品-疾病/症候群交互作用應避免的藥品」狀況………………………………………………..………………..……..
71
表4-7 研究對象「老人需小心使用的藥品」狀況………………………….. 73
表4- 8 研究對象「老人由於藥品-藥品交互作用應避免的藥品」狀況…… 75
表4-9 研究對象「老人由於腎功能改變需要避免或調整劑量的藥品」狀況.. 77
表4-10 研究對象「老人潛在不適當藥品」之藥品種類狀況………………….. 78
表4-11 研究對象「老人潛在不適當藥品」狀況及變化……………………….. 86
表4-12 研究對象「老人由於藥品-疾病/症候群交互作用應避免的藥品」狀況及變化………………………………………………………………..
87
表4-13 研究對象「老人需小心使用的藥品」狀況及變化………………….. 88
表4-14 研究對象「老人由於藥品-藥品交互作用應避免的藥品」狀況及變化……………………………………………..………………..………..
89
表4-15 研究對象「老人由於腎功能改變需要避免或調整劑量的藥品」的狀況及變化……………………………………..………………..………..
90
表 4-16 研究對象的自變項於五個測量時間點的狀況及變化………………. 91
表4-17 研究對象的自變項在控制時間因素後與「老人潛在不適當藥品」的雙變量與多變量分析………………………………………………..
108
表4-18 研究對象的自變項在控制時間因素後與「老人由於藥品-疾病/症候群交互作用應避免的藥品」的雙變量與多變量分析………..………..
110
表4-19 研究對象的自變項在控制時間因素後與「老人需小心使用的藥品」的雙變量與多變量分析………………………………………………..
112
表4-20 研究對象的自變項在控制時間因素後與「老人由於藥品-藥品交互作用應避免的藥品」的雙變量與多變量分析......................................
114
表4-21 研究對象的自變項在控制時間因素後與「老人由於腎功能改變需要避免或調整劑量的藥品」的雙變量與多變量分析……………......
116
表4-22 研究對象的雙變量與多變量迴歸分析有顯著性結果之彙整……….. 118
表4-23 處方藥種類數量對「老人潛在不適當藥品」動態變化的影響…….. 122
表4-24 共病症指數對「老人潛在不適當藥品」動態變化的影響………….. 123
表4-25 求診醫院數量對「老人潛在不適當藥品」動態變化的影響……….. 124
表4-26 處方藥種類數量對「老人由於藥品-疾病/症候群交互作用應避免的藥品」動態變化的影響..………………………………….……..……..
125
表4-27 診斷數量對「老人由於藥品-疾病/症候群交互作用應避免的藥品」動態變化的影響……………………..…………………..……………..
126
表4-28 處方藥種類數量與「老人需小心使用的藥品」動態變化的影響….. 127
表4-29 年齡與「老人需小心使用的藥品」動態變化的影響……………….. 128
-
dc.language.isozh_TW-
dc.title住院老人潛在不適當用藥與其相關因素zh_TW
dc.titlePotentially inappropriate medications and associated factors among older patients after hospitalizationen
dc.typeThesis-
dc.date.schoolyear106-2-
dc.description.degree博士-
dc.contributor.oralexamcommittee林慧玲;張媚;曾慶孝;詹鼎正zh_TW
dc.contributor.oralexamcommitteeFe-Lin Lin Wu;Mei Chang;Chin-Hsiao Tseng;Ding-Cheng (Derrick) Chanen
dc.subject.keyword老人,潛在不適當藥品,Beers準則,縱貫式研究,zh_TW
dc.subject.keywordolder adults,potentially inappropriate medication,Beers criteria,longitudinal study,en
dc.relation.page178-
dc.identifier.doi10.6342/NTU201804016-
dc.rights.note未授權-
dc.date.accepted2018-08-20-
dc.contributor.author-college醫學院-
dc.contributor.author-dept護理學研究所-
dc.date.embargo-lift2023-10-03-
顯示於系所單位:護理學系所

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