藥師參與藥品交互作用偵測之評估

Evaluation of Pharmacist's Participation in the Detection of Drug Interactions

近年來藥品交互作用所衛生的療效不彰或不良反應漸受重視，臨床上，極需系統性方法及醫療團隊各成員之通力合作，以便能及早偵測與避免之。本研究於三個月之研究期間內，收錄一百五十二名精神科病患，由藥師針對其住院用藥，偵測藥歷中潛藏之藥品交互作用組合，並參酌文獻，擬定含相關訊息之特定藥品組合評估單張，供照顧病患之醫師參考及評估臨床反應，此期間，藥師亦定期參與臨床醫藥討論。研究顯示，精神科住院處方中常隱含藥品交互作用危險性（52.0%），而藥歷中含潛在性藥品交互作用之病患群，其併用藥品品項數較多（6.4 ± 3.1 vs. 4.6 ± 2.1項），且總住院日數亦較長（36.9 ± 20.3 vs. 29.2 ± 16.8天）。隨著研究期間的增長，含交互作用組合處方之案例數有降低之趨勢，自第一個月的63.9%，降至第二及第三個月的44.7%與53.4%。且第二個月含交互作用組合的藥歷數明顯較第一個月少（勝算比 = 0.46；95% 信賴區間 =0.25-0.85），顯見藥師之參與有助於減低潛在性藥品交互作用組合之開方。因醫療團隊對藥品交互作用警覺性之提昇，相關可疑事件皆能加以事先預防或及時處理之，研究期間，並無因藥品交互作用而導致之嚴重或死亡案例發生。本研究並依據研究結果，整理出精神科病房常見之藥交互作用組合參考表，期盼可供類似病房參考使用。

Treatment failure or adverse reactions caused by drug-drug interactions (D-DIs) has attracted the attention of medical societies in recent years. To prevent or monitor D-DIs promptly, the use of systemic approaches and the close collaboration of different professionals in the healthcare teams are essential. The three-month study, performed in tow psychiatric wards, demonstrate the effects of pharmacist's participation in the primary care teams for the detection of D-DIs. By reviewing 152 patients' medication profiles during their hospital stay and by attending regularly clinical discussions of each team, 33 frequently prescribed drug interaction pairs were detected. Monographs containing information on each drug interaction pair were carefully constructed according to appropriate literature. Primary care physicians were then provided with relevant monographs for monitoring and evaluation their patients' response. Study results showed that psychiatric inpatient prescriptions are at substantial risk for D-DIs (52.0%). Patients with medication profiles containing D-DI potential were using more drugs than those without (6.4 ± 3.1 vs. 4.6 ± 2.1) and the dys of hospital stay were longer (36.9 ± 20.3 vs. 29.2 ± 16.8). the percentage of patients that were prescribed with D-DI pairs declined as the study period extended, from 63.9% in the first month to 44.7% and 53.4% in the second and third months, respectively. Moreover, medication profiles with D-DI potential in the second month was significantly less than those in the first month (OR = 0.46 ; 95% CI:0.25 - 0.85), demonstrating that pharmacists would be helpful in preventing and monitoring prescriptions of drug interaction potentials. Because of the enhanced awareness of D-DIs by healthcare teams, most suspected events were prevented or managed timely. No interaction-induced serious drug reactions or mortality occurred during the study period. A table of frequently encountered drug reactions or mortality occurred during the study period. A table of frequently encountered drug interaction pairs in psychiatric ard is also assembled for quick reference by clinicians.