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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 | 林慧玲(Fe-Lin Lin Wu),沈麗娟(Li Jiuan Shen) | |
dc.contributor.author | Yi-Wen Chen | en |
dc.contributor.author | 陳以雯 | zh_TW |
dc.date.accessioned | 2021-06-07T17:50:41Z | - |
dc.date.copyright | 2013-03-04 | |
dc.date.issued | 2012 | |
dc.date.submitted | 2012-11-30 | |
dc.identifier.citation | 1. Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G. Oral Anticoagulant TherapyOral Anticoagulant TherapyAntithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST Journal 2012;141:e44S-e88S.
2. Wilson SJ, Wells PS, Kovacs MJ, et al. Comparing the quality of oral anticoagulant management by anticoagulation clinics and by family physicians: a randomized controlled trial. CMAJ 2003;169:293-8. 3. Hafner Jr JW, Belknap SM, Squillante MD, Bucheit KA. Adverse drug events in emergency department patients. Ann Emerg Med 2002;39:258-67. 4. Budnitz DS, Shehab N, Kegler SR, Richards CL. Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007;147:755-65. 5. Fanikos J, Cina JL, Baroletti S, Fiumara K, Matta L, Goldhaber SZ. Adverse Drug Events in Hospitalized Cardiac Patients. The American Journal of Cardiology 2007;100:1465-9. 6. Queneau P, Bannwarth B, Carpentier F, et al. Emergency department visits caused by adverse drug events: results of a French survey. Drug Saf 2007;30:81-8. 7. Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 2011;365:2002-12. 8. Rosendaal FR. The Scylla and Charybdis of oral anticoagulant treatment. N Engl J Med 1996;335:587-9. 9. Conte RR, Kehoe WA, Nielson N, Lodhia H. Nine-year experience with a pharmacist-managed anticoagulation clinic. Am J Hosp Pharm 1986;43:2460-4. 10. DiPiro JT. Pharmacotherapy : a pathophysiologic approach. New York: McGraw-Hill Medical; 2011. 11. AHFS drug information. Bethesda, MD: Published by authority of the Board of Directors of the American Society of Hospital Pharmacists; 2011. 12. Product Information:CoumadinR Tablet, for oral use. Bristol-Myers Squibb Company 2011. 13. Chenhsu RY, Chiang SC, Chou MH, Lin MF. Long-term treatment with warfarin in Chinese population. Ann Pharmacother 2000;34:1395-401. 14. Yu HY, Liu CH, Chen YS, Wang SS, Chu SH, Lin FY. Relationship of international normalized ratio to bleeding and thromboembolism rates in Taiwanese patients receiving vitamin K antagonist after mechanical valve replacement. J Formos Med Assoc 2005;104:236-43. 15. Cheung CM, Tsoi TH, Huang CY. The lowest effective intensity of prophylactic anticoagulation for patients with atrial fibrillation. Cerebrovasc Dis 2005;20:114-9. 16. You JH, Chan FW, Wong RS, Cheng G. Is INR between 2.0 and 3.0 the optimal level for Chinese patients on warfarin therapy for moderate-intensity anticoagulation? Br J Clin Pharmacol 2005;59:582-7. 17. Johnson JA. Ethnic differences in cardiovascular drug response: potential contribution of pharmacogenetics. Circulation 2008;118:1383-93. 18. Hasan SS, Shamala R, Syed IA, et al. Factors affecting warfarin-related knowledge and INR control of patients attending physician- and pharmacist-managed anticoagulation clinics. Journal of pharmacy practice 2011;24:485-93. 19. Ansell JE, Hughes R. Evolving models of warfarin management: Anticoagulation clinics, patient self-monitoring, and patient self-management. Am Heart J 1996;132:1095-100. 20. Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med 1998;158:1641-7. 21. Garton L, Crosby JF. A retrospective assessment comparing pharmacist-managed anticoagulation clinic with physician management using international normalized ratio stability. J Thromb Thrombolysis 2011;32:426-30. 22. Poon IO, Lal L, Brown EN, Braun UK. The impact of pharmacist-managed oral anticoagulation therapy in older veterans. J Clin Pharm Ther 2007;32:21-9. 23. Witt DM, Sadler MA, Shanahan RL, Mazzoli G, Tillman DJ. Effect of a centralized clinical pharmacy anticoagulation service on the outcomes of anticoagulation therapy. Chest 2005;127:1515-22. 24. Young S, Bishop L, Twells L, Dillon C, Hawboldt J, O'Shea P. Comparison of pharmacist managed anticoagulation with usual medical care in a family medicine clinic. BMC family practice 2011;12:88. 25. Chan FW, Wong RS, Lau WH, Chan TY, Cheng G, You JH. Management of Chinese patients on warfarin therapy in two models of anticoagulation service - a prospective randomized trial. Br J Clin Pharmacol 2006;62:601-9. 26. Cortelazzo S, Finazzi G, Viero P, et al. Thrombotic and hemorrhagic complications in patients with mechanical heart valve prosthesis attending an anticoagulation clinic. Thromb Haemost 1993;69:316-20. 27. Locke C, Ravnan SL, Patel R, Uchizono JA. Reduction in warfarin adverse events requiring patient hospitalization after implementation of a pharmacist-managed anticoagulation service. Pharmacotherapy 2005;25:685-9. 28. Bungard TJ, Gardner L, Archer SL, et al. Evaluation of a pharmacist-managed anticoagulation clinic: Improving patient care. Open medicine : a peer-reviewed, independent, open-access journal 2009;3:e16-21. 29. Baker JW, Pierce KL, Ryals CA. INR goal attainment and oral anticoagulation knowledge of patients enrolled in an anticoagulation clinic in a Veterans Affairs medical center. Journal of managed care pharmacy : JMCP 2011;17:133-42. 30. Winans AR, Rudd KM, Triller D. Assessing anticoagulation knowledge in patients new to warfarin therapy. Ann Pharmacother 2010;44:1152-7. 31. Lodwick AD, Sajbel TA. Patient and physician satisfaction with a pharmacist-managed anticoagulation clinic: implications for managed care organizations. Manag Care 2000;9:47-50. 32. Davis NJ, Billett HH, Cohen HW, Arnsten JH. Impact of adherence, knowledge, and quality of life on anticoagulation control. Ann Pharmacother 2005;39:632-6. 33. Platt AB, Localio AR, Brensinger CM, et al. Risk factors for nonadherence to warfarin: results from the IN-RANGE study. Pharmacoepidemiology and drug safety 2008;17:853-60. 34. Tang EOY, Lai CS, Lee KK, Wong RS, Cheng G, Chan TY. Relationship Between Patients' Warfarin Knowledge and Anticoagulation Control. The Annals of pharmacotherapy 2003;37:34-9. 35. Cook-Campbell J, Sefton M. Discharge teaching about warfarin: patient retention of knowledge. Home Healthc Nurse 2010;28:366-74. 36. Rosendaal FR, Cannegieter SC, van der Meer FJ, Briet E. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost 1993;69:236-9. 37. Schulman S, Kearon C. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. Journal of thrombosis and haemostasis : JTH 2005;3:692-4. 38. Abdelhafiz AH, Wheeldon NM. Results of an open-label, prospective study of anticoagulant therapy for atrial fibrillation in an outpatient anticoagulation clinic. Clin Ther 2004;26:1470-8. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/15717 | - |
dc.description.abstract | 研究背景
Warfarin為目前為世界上於預防或治療血栓疾病最廣泛使用之藥品,然其狹窄的治療範圍及藥品及食物交互作用易導致其療效不彰,或易發生出血或栓塞之併發症,導致病人住院或急診,故若要確保病人安全且有效使用warfarin,需要專業醫療人員之用藥教育,並定期監測其INR值。國外之抗凝血藥品藥師諮詢門診已行之有年,亦已有許多研究證實其良好之成效。故臺大醫院於民國100年2月成立抗凝血藥品藥師諮詢門診,希望藥師之介入能提升病人使用warfarin之安全及有效性。 研究目的 本研究藉由評估病人INR值的控制、併發症的發生率、病人在藥師用藥教育前後對warfarin之認知及病人滿意度來了解此藥師諮詢門診之成效。 研究材料與方法 本研究為一前瞻性研究,自民國100年2月抗凝血藥品藥師諮詢門診開診開始收案,收案病人皆為醫師轉介,評估項目分為以下2項: 1.INR值控制與併發症之發生率 收案病人須年滿20歲,於藥師門診介入前後皆須至少使用4個月warfarin,收案期間至少於藥師門診看診2次,並可持續在台大醫院追蹤;藉由電子或紙本病歷收集病人於進入藥師門診前3個月及進藥師門診並經1個月洗脫期後之3個月的INR值,計算其落於理想INR值範圍(1.8-2.4)之時間百分比後作前後比較,另記錄相同期間病人因出血或栓塞導致急診或住院之事件,比較前後發生率之差異。 2.Warfarin認知與用藥行為評估及滿意度 本研究使用之問卷經專家效度評估,共包含9個面向,於藥師用藥諮詢前給予可理解內容之病人或照護者填寫,於藥師門診介入2個月後再填寫一次,計算分數作前後比較;經專家效度評估之滿意度問卷共包含7個面向,在藥師門診介入2個月後一併填寫。 收集之資料亦用於評估病人INR值控制狀況及warfarin認知進步情形與其他因子之相關性。 研究結果 本研究共收入自民國100年2月至5月於藥師門診看診並同意參加試驗之病人,其結果如下: 1.INR值控制與併發症之發生率 共收入25人。藥師門診介入後,病人之INR值落於理想範圍之百分比由介入前的23.4%進步為48.3%,有顯著進步;在介入前3個月支出血事件發生率為0.32件/人年,栓塞事件發生率為0.16件/人年,介入後則無併發症之發生,其發生率有降低之趨勢。 2.Warfarin認知與用藥行為評估及滿意度 自民國100年2月至5月符合收案條件共47人,計算warfarin認知與用藥行為評估問卷之分數,在用藥諮詢2個月後由14.9/26提昇為20.2/26,有顯著進步(p <0.0001),若以70分為及格,則及格人數百分比由藥師門診介入前之48.9%進步至87.2%(p <0.0001),病人對warfarin之認知在藥師門診介入後有顯著進步。病人對藥師門診之滿意度在各面向得4.27-4.78/5分,經濟面向得3.82/5分。 在相關性的分析,INR值控制與warfarin認知進步程度顯著相關,年齡、性別、合併症個數與問卷單題之答對率前後差異則無相關性;warfarin認知程度在年輕病人進步較多,隨年齡增加而減少。 結論 抗凝血藥品藥師諮詢門診介入可達到顯著較好之INR控制、提升對warfarin的認知,併發症發生率亦有降低之趨勢,並獲得良好之病人滿意度。整體而言,抗凝血藥品藥師諮詢門診對使用warfarin的病人有助益。 | zh_TW |
dc.description.abstract | Background
Warfarin is the most commonly prescribed medication worldwide for thromboembolic disease. However, the narrow therapeutic range and the drug-drug or drug-food interactions may lead to poor therapeutic outcome and admission or ER visit due to bleeding or thromboembolic events. To ensure the safety and efficacy of warfarin therapy, patient education and INR monitored by professional health care provider is necessary. Anticoagulation pharmacist clinic has been implemented for years in many foreign countries, and the positive outcome is proved by many studies. Therefore, National Taiwan University Hospital (NTUH) commenced an anticoagulation pharmacist clinic in Febuary 2012 to ensure the safety and efficacy of warfarin therapy. Objective To assess the outcome of pharmacist clinics through comparing INR, incidence of complications, patients’ warfarin-related knowledge, and satisfaction before and after enrollment in the anticoagulation pharmacist clinic. Methods A prospective clinical trial was conducted at the anticoagulation pharmacist clinic of NTUH. Since Febuary, 2012, patients referred by doctors and were willing to enroll in this study were recruited. There are 2 endpoints: 1. Control of INR and incidence of complications Patients aged ≧20 y/o who have used warfarin for at least 4 months before and 4-months after pharmacist’s intervention were included. Those who visited pharmacist clinic less than twice and who cannot be regular followed-up at NTUH during the 4 months study period were excluded. The data were collected from the electronic or paper charts. The INR value collected during the 3 months before enrollment and within 3 months after enrollment, which was proceeded by the one-month wash-out period. The bleeding or thromboembolic events during this period were also collected. The outcome was assessed by the percentage of patient time with INR within the target range (1.8-2.4) and incidence of complications. 2. Warfarin-related knowledge and patient satisfaction The validity of the warfarin-related knowledge questionnaire and patient satisfaction questionnaire were assessed by experts. The former one contained 9 aspects. The pre-test of warfarin-related knowledge questionnaire was conducted before patient education, and the post-test was conducted 2 months after enrollment in the pharmacist clinic. The satisfaction questionnaire had 7 categories, andwas also conducted 2 months after enrollment in pharmacist clinic. Results Patients were recruited during Febuary to May, 2012. 1. Control of INR and incidence of complications There were 25 patients included. After enrolled in the pharmacist clinic, the percentage of patient time with INR in target range increased from 23.4% to 48.3%. The incidence rate of bleeding events and thromboembolis events were 0.32 events/patient-month and 0.16 events/patient-month respectively before enrollment in the pharmacist clinic. There was no complication occurred after enrollment in the pharmacist clinic. 2. Warfarin-related knowledge and patient satisfaction There were 47 questionnaires collected. The average warfarin-related knowledge score was 14.9/26 before patient education, and increased to 20.2/26. The improvement was significant (p < 0.0001). The pass rate rose from 19.1% to 74.5% (p <0.0001) giving 70% as passing score. There was a significant correlation between the improvement of anticoagulation control and the improvement of warfarin-related knowledge score. And there was an inverse relationship between age and warfarin-related knowledge score. Conclusion The pharmacist anticoagulation clinic achieved better INR control, less complication incidence, improvement in warfarin-related knowledge score, and great patient satisfaction. All are statistically significant. | en |
dc.description.provenance | Made available in DSpace on 2021-06-07T17:50:41Z (GMT). No. of bitstreams: 1 ntu-101-R99451005-1.pdf: 1789347 bytes, checksum: a8eef6d3f1c71319d4db9d3f57c16647 (MD5) Previous issue date: 2012 | en |
dc.description.tableofcontents | 中文摘要 ii
Abstract v 內容目錄 viii 圖次 xi 表次 xii 附錄 xiv 中英文對照表 xv 第1章 前言 1 第2章 文獻探討 2 2.1 Warfarin 2 2.1.1 藥理學 2 2.1.2 藥動學 3 2.1.3 臨床治療使用 4 2.1.4 副作用與療劑監測 4 2.1.5 亞洲人之劑量及理想INR範圍 5 2.2 為何需要warfarin藥師門診? 6 2.2.1 Warfarin造成的藥品不良反應易導致病人急診及住院 6 2.2.2 許多因子共同影響療效 6 2.2.3 良好的控制需要良好的溝通 8 2.3 抗凝血藥品藥師諮詢門診之成效 8 2.3.1 改善INR控制與減少併發症的發生 8 2.3.2 對warfarin認知的提昇 9 2.3.3 病人滿意度 10 2.4 Warfarin認知程度與INR控制之相關性 10 第3章 研究目的 12 第4章 研究方法及材料 13 4.1 藥師看診流程 13 4.2 INR控制與併發症發生率之評估 14 4.2.1 研究對象 14 4.2.2 資料收集與定義 14 4.2.3 統計方法 16 4.3 Warfarin認知與用藥行為問卷及滿意度問卷評估 16 4.3.1 研究對象 16 4.3.2 填寫人基本資料收集 17 4.3.3 問卷之收集 17 4.3.4 問卷設計 17 4.3.5 問卷之評分 19 4.3.6 統計方法 19 第5章 研究結果 21 5.1 INR控制與併發症發生率 21 5.1.1 納入之病人 21 5.1.2 病人基本資料 21 5.1.3 INR時間百分比之分佈 21 5.1.4 併發症發生率 22 5.2 Warfarin認知與用藥行為及滿意度評估 22 5.2.1 問卷效度評估結果 22 5.2.2 收案流程 23 5.2.3 填寫人基本資料 23 5.2.4 Warfarin認知與用藥行為評估 23 5.2.5 滿意度 24 5.3 INR控制及認知進步程度與其他因子之相關性 24 第6章 討論 25 6.1 INR控制情形與併發症發生率 25 6.2 Warfarin認知與用藥行為評估 26 6.3 INR值控制與warfarin認知之相關性 26 6.4 問卷改良方向 27 6.5 滿意度調查 29 6.6 研究限制 29 第7章 結論 31 參考文獻 65 附錄 68 | |
dc.language.iso | zh-TW | |
dc.title | 一前驅性抗凝血藥品藥師諮詢門診之成果評估 | zh_TW |
dc.title | Outcome assessment of a pilot warfarin pharmacist clinic | en |
dc.type | Thesis | |
dc.date.schoolyear | 101-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 林香汶(Hsiang-Wen Lin),鄭建興 | |
dc.subject.keyword | Warfarin,藥師門診,INR控制,病人滿意度,認知, | zh_TW |
dc.subject.keyword | Warfarin,pharmacist clinic,INR control,knowledge,patient satisfaction, | en |
dc.relation.page | 86 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2012-11-30 | |
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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