心臟內科門診使用alprazolam之回溯性評估

Retrospective Evaluation of Alprazolam in Internal Cardiology Outpatient Department

在本醫學中心門診使用Benzodiazepines（BZDs）類的藥物中，以alprazolam的耗用量佔該類藥品的大部份，但使用科別卻以心臟內科門診居多。為了了解該科的藥物使用合理性，故進行回溯性評估此藥在心臟內科的使用情形，以提供日後更合理、更有效益的用藥參考。利用電腦篩選自89.1-90.3期間，正在使用alprazolam並且超過四個月之心臟內科門診病患為調查對象。其DUE評估項目為病人用藥合理性、有效性、安全性。另外再調查服藥的順從性、醫病關係的溝通度..等，進行電話訪談並統計分析。病患相關資料、診斷和適應症狀，皆以病歷所登錄的資料為依據。有效樣本數共205人，其中使用alprazolam超過一年者有73.2%（150/205）。用藥合理性者佔51.2%（105/205），病患自覺症狀改善佔71.4%（75/105），但無法評估安全性。病人服藥順從度88.3%（181/205）。有自行另外併用其它鎮靜安眠藥者佔14.6%（30/205），醫病關係有充分溝通者74.1%（152/205），病患自覺可不須服用alprazolam但仍繼續處方佔11.7%（24/205）。在這次的調查中，凸顯之問題包括：病人可不需服藥但仍然繼續處方、藥物使用不符適應症、病人衛教問題、病人和醫師溝通度及用藥合理性等，仍有待改進再改進。因此如何在臨床療效和經濟效益兩者兼顧下，做到醫療品質不降低與醫療成本不浪費的目標，是本評估研究宗旨。建議：對BZDs藥物使用之安全合理性應加強落實，推廣和繼續追蹤。

The largest volume of out-patient prescription of Benzodiapezine and in particular, alprazolam most oftenly prescribed in internal cardiology outpatient department. The aim of this study is intended to evaluate the appropriate use and effectiveness of alprazolam at mentioned outpatient department. Using a hospital information system, we developed computerized program to identify all outpatients who visited at the internal cardiology outpatient department and used alprazolam for more than 4 months from Jan 2000 to Mar 2001. The items of drug use evaluation (DUE) program included the appropriateness, safety and effectiveness of use of alprazolam. The compliance of patients, the communication relationship between physicians and patients were also included in our study. Two hundred and five patients were analysed, 73.2%(150/205) patients used alprazolam over one year. The appropriateness of prescription was 51.2%.The improvement of symptoms by patient's self-evaluation was 71.4%. The percentage of patient compliance was 88.3%. 14.6% patients used alprazolam concurrently with other sedatives and hypnotics without phsicians notification. The successful communication relationship between physicians and patients was 74.1%(152/205). For twenty four patients(11.7%), alprazolam was still prescribed but discontinued by patients themselves. The results of our study showed that problems needed to be explored and improved were the necessity of continuous prescription, drug use without indication, patients education, communication relationship between physicians and patients and the appropriateness of drug use. To find the possible way to maintain the clinical efficacy and economic effectiveness simultaneously, improvement of medical quality and proper use of medical resources are the main purpose of our study. We suggest that a continuous evaluation and monitoring of safety and appropriateness of use of BZDs should be fulfilled, expanded and continuously followed up.