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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 高純琇 | |
dc.contributor.author | Hsin-Hua Lin | en |
dc.contributor.author | 林信樺 | zh_TW |
dc.date.accessioned | 2021-06-13T07:08:43Z | - |
dc.date.available | 2006-08-12 | |
dc.date.copyright | 2005-08-12 | |
dc.date.issued | 2005 | |
dc.date.submitted | 2005-07-26 | |
dc.identifier.citation | 參考文獻
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/35760 | - |
dc.description.abstract | 研究背景
提供有效、正確的藥品資訊,在用藥安全是相當重要的一環。其中,建立有效率的藥品資訊傳遞機制,在現今醫療資訊更新迅速的社會,更是衛生主管機關、藥商、醫療服務提供者的一大挑戰。藥品資訊是如此的多而複雜,各國藥品安全資訊傳遞管道系統也不盡相同,唯有針對醫療人員使用藥品資訊的現況去瞭解,方能對如何建立有效的藥品安全資訊傳遞管道,提出正確的因應策略。 研究目的 藉由問卷調查方式,收集台灣醫師臨床上使用藥品資訊工具的情形,調查影響其獲取藥品資訊途徑的因素;探討藥品廠商提供之藥品仿單及資訊,在醫師執業中,藥品開方扮演的角色;並探討醫師取得最新或更新後藥品資訊的管道。研究結果可供決策者,在訂定用藥安全及建立藥品資訊傳遞系統相關政策之參考。 研究方法 本研究以國內執業醫師作為樣本對象,以非機率抽樣方式,藉由藥商業務聯絡網發出問卷,進行研究調查。問卷內容分為「藥品資訊工具使用情形」、「藥品仿單使用情形」、「取得藥品資訊的管道」與「醫師個人、機構特質」四個部分。回收之問卷進行電腦編碼資料記錄與統計分析。採用SPSS 11.5英文視窗版統計軟體進行敘述性統計,包括次數分配、百分比、平均數、標準差等;以及推論性統計,包括相依樣本t檢定、卡方檢定、因素分析、信度分析等。 結果 共發出2,640份問卷,回收問卷439份(16.6%),剔除無效之問卷10份,總計回收有效問卷為429份(16.3%)。 由研究得知醫師主要以「常用藥品手冊、常用藥物治療手冊、基層醫療保健藥品手冊等工具」(38.7%)作為藥品資訊來源,其中醫師性別和科別會顯著影響藥品資訊工具的選擇。而「內容可信度」(46.2%)、「方便取得」(29.1%)為主要考量藥品資訊工具的因素。分析使用藥品資訊工具頻率,以「一個禮拜一次以上」(60.6%)最多。且平均每次尋找藥品資訊之所耗時間,以「30分鐘以下」(48.0%)最多。藥品資訊獲得途徑在人員上以「醫師同仁」(35.9%)居多,其次則是「廠商人員」(31.2%),且多為「一個禮拜一次以上」(51.0%)。「常用藥品手冊、常用藥物治療手冊、基層醫療保健藥品手冊等工具書」仍是醫師遇到新藥或知道但未曾開方過的藥品時(28.7%),或遇到小兒、老人、孕婦等特殊族群時(31.9%)藥品資訊工具來源。不過,當病人發生藥品不良反應時,有26.3%醫師則主要以「藥品仿單或Physician Desk Reference (PDR)」作為藥品資訊工具來源。 有24.2%醫師認為「Micromedex、UpToDate、MD consult、STAT ref等醫學藥品資料庫」的用藥安全資訊最完整、「國內外醫藥學相關學術研究期刊、雜誌」(21.9%)次之;而資訊的即時性,也是有28.4%醫師認為「Micromedex、UpToDate、MD consult、STAT ref等醫學藥品資料庫」最佳、而「藥品仿單或Physician Desk Reference (PDR)」(17.7%)次之。而且,基層院所的醫師,主要得知最新用藥安全資訊管道為「廠商文件或文宣」;醫學中心則為「醫院內醫藥通訊」。 有47.8%醫師的藥品仿單主要由「廠商人員」提供,其次則是「藥師」(26.1%)。此外,醫師經由藥品仿單獲取藥品資訊的頻率則以「一個禮拜一次以上」(43.1%)為主。絕大部分醫師(66.4%)知道藥品仿單需經過『政府審核通過』。而且,醫師對於藥品仿單的使用偏向於滿意,不過對於藥品仿單的更新速度則相對較不滿意。 在藥品仿單內容方面,不管是原廠藥品還是學名藥品,醫師認為英文版藥品仿單都顯著比中文版藥品仿單內容可信度來的高;而原廠藥品仿單與學名藥品仿單內容可信度則沒有差別。68.8%醫師認為藥品仿單內容中「藥品安全性資料」是最重要,且有63.9%醫師認為它是最需要更新的部分;而「藥品使用資料」(53.6%)則被認為是最常使用藥品仿單的部分。而醫師獲知藥品仿單內容有所變動或更新的管道,在基層院所以「廠商文件或文宣」為主;在醫學中心則為「醫院內醫藥通訊」。 | zh_TW |
dc.description.abstract | Background
To provide correct drug information efficiently is an important key in drug safety. This is a big challenge for health policy authority, license holders of pharmaceutical products, and health providers especially now the new medical information change is so fast. Drug information is so complicated that there is no unique mechanism to deliver drug information efficiently. Understanding how the drug information can be used and can be obtained by medical professionals may be useful to set up strategy to create an effective drug safety information transmission channel. Methods In this research, the medical practitioners in Taiwan were taken as the target of samples. Followed the non-random sampling pattern, questionnaires were sent out through a pharmaceutical manufacture representatives’ network. There are four major parts of the questionnaire:‘The use of drug information tool’, ‘The use of drug package insert’, ‘The ways to obtain drug information’, ‘Personal data and institutional characteristics’. After received the filled questionnaires, they were encoded and keyed in the computer and preceded statistical analysis. Window SPSS 11.5 English edition was used for statistical analysis descriptive statistics of frequency, percentage, average, standard deviation and of inferential statistics of paired-sample t test, the Chi-square test, factor analysis, reliability analysis, etc. Results A total of the 2,640 copies of questionnaires were sent out. There were 439 questionnaires (16.6%) received. After excluding invalid 10 questionnaires, it was 429 valid questionnaires with a response rate of 16.3%. Most of the doctors (38.7%) mainly used ‘The daily drug compendium, the daily drug treatment compendium, the basic level healthcare compendium, and etc. reference books’ as drug information resource. ‘Content credibility’ (46.2%), and ‘Convenience’ (29.1%) were the two major factors for choosing drug information tools. Most of the doctors (60.6%) claimed they used drug information tool ‘More than once a week’, and in most condition (48.0%) the average time to look for drug information each time was ‘Under the 30 minutes’. The main access through personnel to obtain drug information is ‘The doctor colleague’ (35.9%) and followed by ‘company’s personnel’ (31.2%). The frequency of personnel offer drug information was mainly ‘More than once a week’ (51.0%). ‘The daily drug compendium, The daily drug treatment compendium, The basic level healthcare compendium, etc. reference book’ was also the major drug information resource even when prescribed a new drug (28.7%), or when prescribed for children, old people, pregnant women, etc. (31.9%). However, for the condition that the adverse drug reaction occurred to the patient, the most doctors (26.3%) may consider ‘Drug package insert or Physician Desk Reference (PDR)’ as the drug information tool resource. There were 24.2% of the doctors considered ‘Micromedex, UpToDate, MD consult, STAT ref, etc. medical database’ have the most complete drug safety information, followed by ‘domestic and international medical journal’ (21.9%). Most of doctors recognized ‘Micromedex, UpToDate, MD consult, STAT ref, etc.’ as the most updated drug information (28.4%), followed by ‘Drug package insert or Physician Desk Reference (PDR)’ (17.7%). For doctors in clinics, drug safety information channel was mainly form ‘manufacturer’s documents or promotions’. However, for doctors in medical centers were mainly from ‘The medical newsletter inside hospital’. Most of the doctors (47.8%) received drug package inserts from the ‘Company’s personnel’, followed by ‘The pharmacist’' (26.1%). Most of doctors (66.4%) have known that drug package insert need “the governments’ verification”. And the doctors were satisfied with drug package insert, but relatively unsatisfied about the updated speed of drug package insert. No matter brand name drug or generic name drug, doctors considered the content credibility of the drug package insert of English edition significantly higher than that of Chinese edition. ‘The content of regarding drug safety’ was considered to be the most important part in the package insert(68.8%) and need to be updated more efficiently (63.9%). The content of the drug package insert used most frequently was ‘the drug-use materials’ (53.6%). Most of the doctors answered the changes and updates of the drug package insert for a drug through ‘manufacturer's documents or promotions’ in clinics and ‘the medical newsletter inside hospital’ in medical centers. | en |
dc.description.provenance | Made available in DSpace on 2021-06-13T07:08:43Z (GMT). No. of bitstreams: 1 ntu-94-R92451008-1.pdf: 593906 bytes, checksum: e586008e53ab064f078cdb67d73de54b (MD5) Previous issue date: 2005 | en |
dc.description.tableofcontents | 目錄
中文摘要…………………………………………………………………I 英文摘要 ………………………………………………………………IV 目錄……………………………………………………………………VII 圖目錄……………………………………………………………………X 表目錄 …………………………………………………………………XI 第一章 緒論…………………………………………………………1 第二章 文獻探討……………………………………………………6 第一節 藥品資訊的定義和分類……………………………………6 一、藥品資訊的定義……………………………………………6 二、藥品資訊的分類……………………………………………6 第二節 醫護人員藥品資訊工具使用的情形 ……………………10 第三節 影響醫護人員選擇藥品資訊工具的因素 ………………16 第四節 藥品資訊與風險管理 ……………………………………23 第三章 研究目的 …………………………………………………32 第四章 研究方法 …………………………………………………33 第一節 研究假設與架構 …………………………………………33 一、研究假設 …………………………………………………33 二、研究架構 …………………………………………………33 第二節 變數操作型定義 …………………………………………35 一、自變項 ……………………………………………………35 二、依變項 ……………………………………………………36 第三節 研究材料及研究設計 ……………………………………43 一、研究對象 …………………………………………………43 二、研究樣本估算 ……………………………………………43 三、問卷發放及回收 …………………………………………43 四、問卷回收 …………………………………………………44 第四節 統計分析方法 ……………………………………………47 一、敘述性統計分析 …………………………………………47 二、推論性統計分析 …………………………………………48 第四章 研究結果 …………………………………………………51 第一節 醫師個人特質及服務機構特性分析 ……………………52 第二節 藥品資訊工具使用情形分析 ……………………………55 一、一般執業情況 ……………………………………………55 二、特殊執業情形 ……………………………………………62 三、用藥安全相關資訊 ………………………………………63 第三節 藥品仿單使用情形分析 …………………………………68 一、臨床上藥品仿單使用的情形 ……………………………68 二、對藥品仿單內容意見 ……………………………………72 三、藥品仿單使用滿意度分析 ………………………………72 第四節 藥品資訊取得管道分析 …………………………………79 第五節 醫師個人特質及機構特質對問題變項的影響 …………82 一、藥品資訊工具使用情形之交叉分析 ……………………82 二、醫師個人特質及機構特質與藥品仿單使用情形 之交叉分析 ………………………………………………91 三、醫師個人特質及機構特質與取得藥品資訊的管道 之交叉分析 ………………………………………………97 第六章 討論………………………………………………………100 第一節 問卷回覆者之個人特質及服務機構特質………………100 一、個人特質…………………………………………………100 二、服務機構特質……………………………………………104 第二節 藥品資訊工具使用情形…………………………………107 第三節 藥品仿單使用的情形……………………………………119 第四節 研究限制…………………………………………………128 第七章 結論與建議………………………………………………131 參考文獻………………………………………………………………135 附錄一 醫療人員獲取藥品資訊現況調查問卷 …………………140 附錄二 問卷編碼簿 ………………………………………………147 圖目錄 圖2-1 美國FDA醫療產品風險管理系統………………………………………24 圖4-1 研究架構…………………………………………………………………34 圖5-1 醫師臨床上最常使用的藥品資訊工具…………………………………58 圖5-2 醫師臨床上選用的藥品資訊工具時,最主要的考量因素……………58 圖5-3 醫師使用藥品資訊工具的頻率分析……………………………………60 圖5-4 尋找藥品資料平均每次所耗費的時間之分析…………………………60 圖5-5 最常由哪些人員提供藥品資訊的分析…………………………………61 圖5-6 經由人員提供藥品資訊的頻率分析……………………………………61 圖5-7 遇到新藥或知道但未曾開方過的藥品時, 所使用藥品資訊工具之分析……………………………………………65 圖5-8 病人發生藥品不良反應時, 所使用藥品資訊工具之分析……………………………………………65 圖5-9 遇到小兒、老人、孕婦等特殊族群時, 所使用藥品資訊工具之分析……………………………………………65 圖5-10 用藥安全性資訊提供之完整性的分析………………………………… 67 圖5-11 用藥安全性資訊提供的即時性………………………………………… 67 圖5-12 接收到新的藥品安全資訊的頻率分析………………………………… 67 圖5-13 醫師取得藥品仿單的最主要來源之分析……………………………… 70 圖5-14 醫師平均使用藥品仿單獲取藥品資訊頻率之分析…………………… 70 圖5-15 醫師取得藥品仿單容易程度之分析…………………………………… 71 圖5-16 醫師對於藥品仿單需經審核之法規規定之認知分析………………… 71 圖5-17 醫師最常使用藥品仿單內容的分析…………………………………… 74 圖5-18 醫師認為藥品仿單內容最需作更新的分析…………………………… 74 圖5-19 醫師認為藥品仿單中哪一部份資訊最為重要之分析………………… 74 圖5-20 醫師得知最新用藥安全資訊管道之分析……………………………… 81 圖5-21 醫師獲知藥品仿單內容有所變更或更新的管道之分析……………… 81 表目錄 表2-1 三級文獻的種類 …………………………………………………………8 表2-2 醫師遇到各種類型之藥品資訊需求時選擇之藥品資訊途徑………… 11 表2-3 圖書管理員評估回答某臨床問題可運用的資訊來源 與臨床醫師使用來回答臨床問題的資訊來源比較 …………………13 表2-4 牙醫師使用的資訊途徑…………………………………………………14 表2-5 護士使用的健康科學資訊來源…………………………………………15 表2-6 牙科醫師使用資訊來源的選項是“常常”的理由……………………22 表4-1 各地區廠商業務代表預計發放問卷份數………………………………44 表4-2 實際樣本回收情形………………………………………………………46 表4-3 本研究各變項分析所用到的統計方法…………………………………47 表5-1 回收之有效問卷填答人所在縣市分佈…………………………………51 表5-2 回覆者醫師個人特質及機構特質之分佈………………………………53 表5-3 「一般執業情況醫師使用藥品資訊工具」單元 各問題回答結果分析……………………………………………………56 表5-4 「特殊執業情況醫師使用藥品資訊工具」單元 各問題問卷結果之分析…………………………………………………64 表5-5 「醫師用藥安全相關資訊」單元各問題之結果分析 …………………66 表5-6 「藥品仿單使用情形」單元各問題之結果分析 ………………………69 表5-7 「藥品仿單內容」單元各問題之結果分析 ……………………………73 表5-8 「藥品仿單使用滿意度」單元各問題之結果分析 ……………………75 表5-9 依「藥品仿單使用滿意度」總分之分數高低分群之統計表 …………77 表5-10 對於藥品仿單使用滿意度分析………………………………………… 77 表5-11 「藥品資訊取得管道」單元各問題之結果分析 ………………………80 表5-12 醫師個人特質及機構特質與最常使用藥品資訊工具 之交叉分析………………………………………………………………84 表5-13 醫師個人特質及機構特質與選擇藥品資訊工具主要考量因素 之交叉分析………………………………………………………………85 表5-14 醫師個人特質及機構特質與使用藥品資訊工具頻率 之交叉分析………………………………………………………………86 表5-15 醫師個人特質及機構特質與尋找藥品資訊所耗時間 之交叉分析………………………………………………………………87 表5-16 醫師個人特質及機構特質與經由其他人員提供藥品資訊 之交叉分析………………………………………………………………88 表5-17 醫師個人特質及機構特質與經由他人提供藥品資訊頻率 之交叉分析………………………………………………………………89 表5-18 醫師個人特質及機構特質與接收到新的藥品安全性資訊頻率 之交叉分析………………………………………………………………91 表5-19 醫師個人特質及機構特質與醫師取得藥品仿單主要來源 之交叉分析………………………………………………………………92 表5-20 醫師個人特質及機構特質與使用藥品仿單獲取藥品資訊頻率 之交叉分析………………………………………………………………93 表5-21 醫師個人特質及機構特質與取得藥品仿單容易程度 之交叉分析………………………………………………………………94 表5-22 醫師個人特質及機構特質與藥品仿單之法規規定認知 之交叉分析………………………………………………………………95 表5-23 醫師個人特質及機構特質與藥品仿單使用滿意度高低 之交叉分析………………………………………………………………96 表5-24 醫師個人特質及機構特質與得知最新的用藥安全資訊管道 之交叉分析………………………………………………………………98 表5-25 醫師個人特質及機構特質與獲知藥品仿單內容有所變動之管道 之交叉分析………………………………………………………………99 表6-1 本研究問卷回覆者之基本資料與國內執業醫師 年齡暨性別統計之比較 ………………………………………………101 表6-2 問卷回覆醫師不同性別與個人特質交叉分析 ………………………102 表6-3 問卷回覆醫師是否擁有專科醫師執照與個人特質 之交叉分析 ……………………………………………………………103 表6-4 樣本機構特質與行政院衛生署公佈之統計資料比較 ………………104 表6-5 醫師機構特質與個人特質交叉分析 …………………………………106 表6-6 醫師科別與最常使用藥品資訊工具之交叉分析 ……………………108 表6-7 醫師性別、年齡、是否擁有專科醫師執照、科別、主要服務機構 等變項與人員提供藥品資訊途經之交叉分析 ………………………111 表6-8 人員提供藥品資訊頻率與人員提供藥品資訊途徑之交叉分析 ……112 表6-9 醫師科別和遇到新藥或知道但未曾開方過的藥品時, 藥品資訊工具使用情形之交叉分析 …………………………………113 表6-10 醫師科別與病人發生藥品不良反應時,所使用的藥品資訊工具 之交叉分析 ……………………………………………………………114 表6-11 醫師科別與小兒、老人、孕婦等特殊族群使用之藥品資訊工具 交叉分析 ………………………………………………………………115 表6-12 醫師接收新的藥品安全性資訊的頻率和得知最新用藥安全資訊管道 之交叉分析 ……………………………………………………………117 表6-13 醫師性別、年齡、專科醫師執照、科別、主要服務機構等變項與 得知最新用藥安全資訊的管道之交叉分析 …………………………118 表6-14 醫師年齡、科別、主要服務機構等變項與醫師藥品仿單主要來源 之交叉分析 ……………………………………………………………119 表6-15 醫師藥品仿單主要來源與從藥品仿單獲取藥品資訊頻率 之交叉分析 ……………………………………………………………120 表6-16 由醫師取得藥品仿單主要來源與取得容易程度作交叉分析 ……… 121 表6-17 醫師年齡、專科醫師執照、科別、執業年數及主要服務機構等變項 與對藥品仿單法規規定認知之交叉分析 ……………………………122 表6-18 使用藥品仿單獲取藥品資訊頻率與最常使用藥品仿單內容 之交叉分析 ……………………………………………………………123 表6-19 醫師科別、執業年數、主要服務機構與藥品仿單使用滿意度高低 交叉分析 ………………………………………………………………124 表6-20 原廠藥藥品仿單與學名藥藥品仿單內容可信度之比較 ……………125 表6-21 以醫師性別、專科醫師執照、主要服務機構等變項 與廠商文件或文宣及醫院內醫藥通訊之交叉分析 …………………127 表6-22 醫師科別部分未回答者之基本特質 …………………………………130 | |
dc.language.iso | zh-TW | |
dc.title | 藥品資訊傳遞機能之探討-
醫師獲取藥品資訊現況調查 | zh_TW |
dc.title | Study of Drug Information Transmission Mechanism-Survey on Drug Information Retrieving by Physicians | en |
dc.type | Thesis | |
dc.date.schoolyear | 93-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 何蘊芳,沈麗娟 | |
dc.subject.keyword | 藥品資訊工具,傳遞機制,用藥安全, | zh_TW |
dc.subject.keyword | drug information tool,transmission mechanism,drug safety, | en |
dc.relation.page | 149 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2005-07-27 | |
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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