資訊科技於基層藥事執業之應用

Implementation of Information Technology in Primary Care Pharmacy

資訊科技（information technology，IT）是現代醫療服務重要工具，本研究旨在探討國內基層藥事執業（社區藥局及診所）有關資訊科技之運用現況及執業人員認知。本問卷研究之對象分別為資訊廠家，及臺北縣社區藥局及診所執業藥事人員，並比較社區藥局及診所差異。本研究發出廠家問卷16 份（回收率62.5％）、社區藥局抽樣480 家（回收率48.1％）及診所抽樣480 家（回收率57.1％）。結果顯示，各廠家藥事IT 功能可類分為調劑作業、零售管理、會計管理、庫存管理、統計報表、其他等，其中以調劑作業類子功能項目之建置最為齊全；而藥事人員問卷結果得知，IT 於基層執業處所之運用相當普及（達93.1％），但診所藥事人員使用電腦協助進行調劑作業與查詢病人資料者只達35.8％，另34.3％僅作業區配置印表機供處方列印。如進一步就系統功能及使用頻率分析，發現社區藥局執業者在IT 各功能類別之使用頻率均較診所為高（p < 0.0001），益加呈現診所藥事人員之IT 可近性普遍較不佳。就調劑作業各項子功能之使用而論，社區藥局系統以處方登錄及健保申報兩項最普遍具備（> 90％），且最常被使用（「每次使用」 > 87％）；另一方面，異常處方警示子功能則僅52.0％社區藥局系統具備，然而此功能被「每次使用」頻率仍高達85.9％，值得系統研發者深入開發。社區藥局及診所藥事人員調劑時所依憑之處方箋多屬電腦列印，分別有193 家（97.0％；佔處方箋總量92.2 ± 13.7％）、206 家（76.3％）。處方箋內容登錄方式，社區藥局主要為人工登錄（163 家，82.7％）、診所由開方端即時登錄（201 家，74.4％）（p < 0.0001）。至於新科技如IC卡、二維條碼於藥事作業的應用，社區藥局執業者予以6.3 ± 3.0、6.5 ± 2.9（十分制）審慎評價，然而，社區藥局及診所執業者對IT 於調劑作業品質重要性認知分別達8.2 ± 2.1、7.8 ± 2.1（p = 0.0292），顯示承接處方歧異度高之前者對理想系統期待較深。本研究資料應可供專業人員、工程師及相關領域，瞭解基層藥事IT 之運用現況與需求，期待協力研發創新實用系統，改進執業環境並增進服務品質。

The ever-evolving information technology (IT) has been an essential part of the contemporary medical services. The survey study aimed to investigate the current status of IT applications at community pharmacies and clinics and also pharmacist professionals’ cognition. Respective questionnaires were administered to IT software providers (16 brands known by primary-care professionals) and Taipei County primary-care pharmacist practitioners (480 community pharmacies, 480 clinics). The response rates were 62.5%, 48.1%, and 57.1%, respectively. Data revealed that the pharmacy IT functions could be categorized as dispensing, point-of-sales, accounting, inventory, statistics, and others, with dispensing being the mostly installed amongst the six categories. The IT has been extensively (93.1%) adapted by these primary care sites. Yet, pharmacists practicing at clinics had restricted access to IT, demonstrated by merely 35.8% using computers to facilitate dispensing; 34.4% having printers solely for prescription print-outs; and significantly less frequent use of assorted IT function than community pharmacy practitioners (p < 0.0001). Among various dispensing sub-functions, prescription key-in and insurance reimbursement were the most commonly installed (> 90%) and utilized (for each prescription, > 87%) functions. On the other hand, only 52.0% community pharmacies installed check-up sub-functions for evaluating prescription appropriateness. Nonetheless, the utilization rate for this advanced sub-function reached 85.9%, indicating remarkable needs for development. Prescriptions encountered and dispensed by these primary care practitioners were mostly computer print-outs, with 193 community pharmacies (97.0%, accounting for 92.2 ± 13.7% prescriptions) and 206 clinics (76.3%). Most prescriptions were processed by pharmacist manual key-in (82.7%) and computerized physician order entry (74.4%) at community pharmacies and clinics, respectively (p < 0.0001). The community pharmacy practitioners’ appreciation of newer technology, i.e., IC cards (6.3 ± 3.0) and 2D barcodes (6.5 ± 2.9) in pharmaceutical practices was moderate. However, they still regard IT highly in the quality assurance of dispensing by a score of 8.2 ± 2.1 which was significantly greater than those by clinic practitioners (7.8 ± 2.1; p = 0.0292). Overall, pharmacists practicing at community pharmacies had higher expectations for IT than those at clinics. The study might provide professionals, engineers, and relevant fields with current status of IT applications and needs in primary care. We would anticipate more innovative systems available to promote quality pharmaceutical practice and service in the years to come.