某社區醫院門診處方釋出作業模式

An Innovative Model for Releasing Outpatient Prescriptions from a Community Hospital

國立台灣大學醫學院附設醫院為了保障就診患者所獲得之藥事服務與處方藥品的品質，以增進醫師釋出處方之意願，另外，也為了考量病患於住家附近就近領藥之便利性，以提升患者選擇持交付處方領藥之接受度，院方特別成立評選委員會，以公開招標方式甄選了一家連鎖藥局，租用本院新設立公館院區的一個獨立空間，提供社區健保藥局服務。此種為配合政府政策、鼓勵門診處方釋出而規劃設置之方案與多項配套措施，在醫療與行政人員的協同努力下，門診處方釋出作業已順利地運作一年。在實施特別措施、協助醫師釋出門診處方箋的一年期間，平均處方釋出率達83.0%，未釋出者為處方中含有承租藥局未備藥品（50.3%）、病患選擇或醫師指示（42.7%）、檢查或手術內含藥品或已於就診使用（7.0%）。問卷調查顯示，就醫者對持交付處方至出租藥局領藥反應多屬良好，特別是對藥師用藥指導或諮詢、服務親切度、藥袋標示內容、等候領藥時間、領藥指引說明或標示等五項，均只有低於5%的就醫者表示不滿意。相對地，診療費與藥品部分負擔之分開收取、承租藥局內外部空間設計與陳列供零售項目較少等，則有較高比例之就醫者不滿意。期待本院實務運作所累積的經驗，可帶動國內醫療院所釋出處方、社區藥局承接交付處方與民眾調整就醫領藥習慣的風氣。本文亦同時針對如何提升處方釋出，提出討論與建言，或堪為政府機關制定政策之參考。

The National Taiwan University Hospital (NTUH), abiding by the policy of the Department of Health, has implemented an innovative model at the new NTUH-Kungkuan site for encouraging physicians to release outpatient prescriptions to community pharmacies rather than the outpatient pharmacy within the Hospital. A committee was set to select publicly a chain pharmacy store to rent a discrete location at NTUH-Kungkuan for providing National Health Insurance (NHI)-contracted community pharmacy services (rental pharmacy). To transform physicians and patients from conventional prescription-prescribing and-filling behaviors within the same hospital to a new model, special measures such as demanding the rental pharmacy to provide sufficient and adequate drugs and pharmaceutical care services of NTUH-equivalent quality were instituted to enhance physicians’enthusiasm in releasing prescriptions. These measures also guide patients toward the acceptance of filling their prescriptions at community pharmacies close to their own residence in the future. This new model has been running smoothly for a whole year. During the period, the rate of prescription release reached 83.0%. Reasons for being dispensed at our outpatient pharmacy were drugs not available at the rental pharmacy (50.3%), patients’or physicians’preference (42.7%), and drugs included in packages or had been administered at our clinics (7.0%). The vast majority of patients who filled their prescriptions at the rental pharmacy responded well to the new model. Only less than 5% of patients expressed unsatisfactory to questionnaire items such as drug information consultation, pharmacists’service attitude, information shown on drug labels, prescription-filling time, and directions to rental pharmacy. In contrast, a higher percentage of patients expressed unsatisfactory to items such as the separate billing of diagnosis fee and drug co-payment, the interior and exterior design of the rental pharmacy, and the paucity of shelf items for sale at the rental pharmacy. We hope that the experiences learned from the study would be helpful for our society to overcome the current obstacles encountered at different platforms, such as local clinics or medical institutions, community pharmacies, and the general public. A multifaceted discussion on raising nationwide prescription release rate is also provided.