某養護機構執行藥物諮詢計畫之成效

Evaluation of the Efficacy of Pharmacist Consultation Program for Patients in an Elder Care Center

本研究以STOPP/START/Beers 三種老年人用藥準則來探討老年人潛在不適當用藥的比率、醫師接受藥師建議後更改用藥的內容型態或未接受建議的原因。分析2010 年6 月至2011 年5 月藥師每月至養護機構，會同機構護理人員及醫師，討論住民用藥問題後所記錄之藥物諮詢建議單，藥師針對住民用藥問題向醫師提出諮詢建議共53 筆，其中有被醫師接受的計有25 筆，接受率為47.2%。合併使用STOPP/START 及Beers 準則來評估本研究中養護機構住民用藥，初步合併發現共有39 筆不當用藥，盛行率為71.4% （28 位病人中有20 位有用藥不當情形）。若單以Beers 準則來評估，有31 筆不當用藥；而單以STOPP/START 來評估，則有36 筆。與台北市衛生局之長期照護平台資料統計結果相較，經由與醫師及護理人員開會討論用藥的跨領域合作方式，大幅提升了醫師接受藥師諮詢建議的比率。

The purpose of this study was to examine the percentage of potentially inappropriate medication prescribed for the elderly by using STOPP/START/Beers criteria. Furthermore, we investigated the percentage of physicians changing orders because of pharmacists' suggestions, and the reasons why physicians did not accept the suggestions. Pharmacists, nurses of the elder care center, and physicians held meetings monthly to discuss patients' medication problems. We collected and evaluated consultation response sheets from June 2010 to May 2011 and found that physicians accepted 25 out of 53 suggestions made by pharmacists, and the acceptance rate was 47.2%. Pharmacists noticed 39 potentially inappropriate medications by using STOPP/START and Beers criteria, the prevalence rate was 71.4% (20 out of 28 patients). There were 31 and 36 potentially inappropriate medications examined by using Beers criteria and STOPP/START criteria alone, respectively. Comparing with the long-term care statistical results from the Department of Health, Taipei City Government, our study shows that meetings with other members of the health care team can increase physicians' acceptance rate.