民眾對醫院與社區藥局慢性病連續處方調劑服務的觀感

The Public’s Perception Towards Chronic-Illness Refill Prescriptions: Community vs. Hospital Refill Services

本研究探討地方衛生機關、區域醫院與專業團體間共同合作推動民眾認識慢性病連續處方箋（簡稱慢箋）的努力成效，及民眾對社區與醫院藥事服務滿意度比較。研究設計採橫斷面、問卷調查方式，進行期間自2005年3月7日至4月15日，以某醫院特定院區持慢箋領藥民眾為對象，共回收358 份有效問卷。結果顯示，在慢箋使用認知上，分別有287 位（80.2％）、208 位（58.1％）知道持慢箋可至社區藥局領藥及免支付藥品部分負擔，正確比例均高於先前觀察；然而，有關學名藥替代問題則僅46 位（12.8％）有正確認識，比例與以往研究相當。而有關慢箋使用訊息來源，本研究發現藥師（33.3％；含諮詢站、醫院、社區）首度成為與醫師（31.8％）並重的最主要資訊來源提供者。受訪者中有社區藥局慢箋調劑領藥經驗者達176位（49.2％），遠高於先前之約僅一成。進一步就專業形象、專業服務、藥品品質等三面向，瞭解民眾對藥事服務之觀感，則發現除個人化服務的項目得分較低外，其餘之滿意度均超過六成。如就同時有社區與醫院藥局慢箋調劑領藥經驗者分析，則發現民眾對社區與醫院所提供之藥事服務，在認同或滿意度上具顯著差異（p < 0.05）。整體而言，以醫院所獲認同較高，社區則在個人化服務上較受肯定。研究亦發現，喜於醫院藥局領藥者主要源自習慣（114 人，63.3％），有社區領藥經驗者則大半考量距離便利（121 人，68.8％），此外，無論民眾有無社區領藥經驗，均關切所獲藥品之品質。透過本研究得知民眾慢箋認知提昇、藥師是使用知識重要來源及社區領藥行為增多，證實地方衛生機關與相關團體合作促進慢箋的模式值得持續推廣；而社區及醫院執業者之執業內容與態度或可互相砥礪學習，以提昇藥師整體形象。

The aim of the study was to assess the impacts of the Promotion of Chronic-Illness Refill Prescriptions, a program jointly led by the city health authority, a City Hospital and its branch hospitals, and the local pharmacists’ association. The public’s experience in both community and hospital pharmacy refill services was also evaluated. The cross-sectional survey of patients with refill prescriptions was conducted in front of the prescription pick-up counter at a municipal hospital during March 7 and April 15, 2005. A total of 358 valid questionnaires were collected from patients or their delegates who had prescriptions refilled for them. The results demonstrated that 287 (80.2%) and 208 (58.1%) persons surveyed had accurate knowledge about the role of community pharmacy in refills and the ensuing exemption of drug co-payment from such refills, respectively. However, generic substitution was correctly perceived by only 46 (12.8%) persons. Moreover, for the first time, pharmacists (33.3%, including at refill consultation booth, hospital pharmacy, and community pharmacy) surpassed physicians (31.8%) to become the primary source of refill information since similar surveys were taken just half year ago. A total of 176 persons surveyed (49.2%), significantly higher than the previously reported 10%, had their refills dispensed at community pharmacies. The study further examined public’s perception towards pharmaceutical care services from aspects of professional image, service quality, and drug reliability. The degree of satisfaction was all above 60% except the two particular items related to individualized services. Intriguingly, those who had received refill services from community and hospital pharmacies rated both sites differently (p < 0.05) in all items. Hospital pharmacies obtained higher ratings on the whole, yet community pharmacies were acknowledged for their better individualized services. The study also revealed that the main reason to use hospital pharmacy was because of familiarity (63.3%) and the major concern for using community pharmacy was distance (68.8%), and that drug quality was a critical concern to most patients. We conclude that the joint promotional model was effective in improving public’s knowledge in certain aspects of prescription refills, pharmacists as information providers, and community pharmacy refill services. The model deserves continual and broader applications. The community and hospital practitioners are encouraged to share professional competencies with each other to further improve the image of the profession.