社區藥局對於參與清潔針具計畫的意願及其認知與實務經驗

Abstract

靜脈藥癮者因為共用注射針具及相關用品之行為而感染愛滋病是現階段愛滋防治工作的重要挑戰。使靜脈藥癮者能不受限制的獲得清潔針具是一項重要且最符合經濟效益的重要公共衛生措施，我國的減害計畫核心內容之一「清潔針具計畫」於2006年全面推展，以社區藥局為主要執行點，為擴增涵蓋率及提供可近性服務內容，瞭解社區藥局提供或販賣清潔的意願有其必要性；而已在計畫之列的社區藥局在實務操作上所面臨的困難及建議，可以做為政策修正之參考。 本研究目的即在於了解社區藥局對於參與清潔針具計畫的意願及其認知與實務經驗，資料收集時間為97年3月11日起為期4週。利用郵寄方式，回收率為20.8％，以台灣北區四縣市的社區藥局為主要研究對象，利用結構性問卷收集社會人口學、提供或販賣清潔針具給靜脈藥癮者的意願態度、實務經驗、政策認知等資料。應用計畫行為理論（Theory of Planned Behavior, TPB）的概念和架構來初步探討他們的意願；並描述社區藥局對於所提供減害服務的實際執行經驗。 主要發現如下：（1）對於提供或販賣清潔針具給靜脈藥癮者傾向「非常願意與願意」的有43.3％；（2）影響社區藥局意願態度的因素，包括「會降低疾病傳染（例如愛滋病及肝炎）」的認知、「社區鄰居」的看法、「個人對於提供針具予靜脈藥癮者的倫理或道德的主觀感受」的考量；（3）「態度」愈正向、「主觀規範」影響愈小與「覺知的行為控制」考量愈少，則參與意願愈高。（4）「從不曾加入」清潔針具計畫是安全的考量；「曾經加入，後來退出」是店內生意繁忙；社區藥局認為執行最感困難為轉介服務及衞教無法送達、針具回收；建議加強宣導及毒品教育。 根據結果建議：（1）教育與召募：強調清潔針具計畫的公共衛生意義，喚起社區藥局的社會責任和參與的熱情，以擴大涵蓋率；（2）實務輔導：政府與社區藥局建立合作夥伴關係，瞭解其需要、提供訓練與支持，以提升品質；（3）提供誘因，解決社區藥局的社會結構性障礙，例如對安全考量的疑慮。

HIV infection among injection drug users (IDUs) due to sharing needles and syringes poses great challenge for the current HIV prevention tasks, and unlimited provision of sterile needles and syringes to IDUs therefore constitutes the most cost-effective measure of public health. “Needle and Syringe Program”, one of the core programs of the domestic Harm Reduction Program, has been initiated nationwide since 2006. Community pharmacies are chosen to be the main locations to execute the program. To increase the program coverage and provide more accessible services, it is necessary to understand the responses and willingness of pharmacists in proving and selling clean needles and syringes. Of greater significance, barriers encountered by community pharmacists who have ever participated or are participating in the program should be explored to provide feedbacks to current program implementation. Based on the Theory of Planned Behavior, this study aims to examine the perceptions, cognitions, and behavioral characteristics of current program participants, previous participants, and non-participants. Special experiences from previous and current participation were particularly emphasized to respond to current policy. In March 2008, self-administered questionnaires were distributed, mainly through mailing, to employees/employers of community pharmacies located in four counties of northern part of Taiwan. A total of 178 valid questionnaires were collected, which made a final response rate of 20.8%. The main findings are as follows: (1) 43.3% of the surveyed pharmacies were “very willing or willing” to provide and sell sterile needles and syringes to IDUs, (2) The major attitudinal factors affecting participation are “the program can contribute to the reduction of infections such as HIV and hepatitis, “the reactions of neighborhoods”, and “moral and ethic consideration in the provision of needles and syringes to IDUs”. (3) The more positive of the “attitudes” and the less influenced by the “subjective norms” and “perceived behavioral control” the more likely a pharmacist was willing to join the program, and (4) For non participants, safety was their primary concern, and for previous participants, which was “demanding and heavy work load.” The major difficulties encountered in the execution of the program were referral to other areas of services, ineffective delivery of health education, collection of used needles and syringes. They suggested more efforts be made to enhance campaign and drug education. The following aspects of suggestions are proposed based on the above findings: (1) To increase the coverage of the program through more intensive recruitment and training which emphasize public health implications of the program, and by so doing to raise the social responsibility and passion of community pharmacies and. (2) The government should provide supports and consultations, and build partnerships with community pharmacies to understand their needs and improve their quality of services. (3) Incentives should be provided to reduce the socio-structural barriers faced by community pharmacies, such as their concerns of safety.