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標題: | 建構新型態之藥事照護 – 抗凝血門診 Establishment of a Novel Pharmaceutical Care – an Anticoagulation Clinic |
作者: | Hao-Cheng Kang 康皓程 |
指導教授: | 沈麗娟(Li-Jiuan Shen) |
關鍵字: | 藥師門診,抗凝血藥品,藥事照護, ambulatory care,anticoagulation clinic,pharmaceutical care,warfarin, |
出版年 : | 2014 |
學位: | 碩士 |
摘要: | 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。 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. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/55625 |
全文授權: | 有償授權 |
顯示於系所單位: | 臨床藥學研究所 |
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