某區域教學醫院藥物諮詢服務分析

Analysis of Drug Information Service of a Regional Teaching Hospital

研究醫院為提升臨床藥事服務品質，特設置藥物諮詢室、藥物諮詢服務 專線及電子郵件信箱，提供24 小時全天候藥物諮詢服務。本研究針對2004 年1 月至12 月之諮詢服務紀錄做分析研究，總計全年共有2，238 件， 其中一般病患 及家屬之諮詢服務有1 ，990 件（88.9%） ，醫療人員則有248 件（ 11.1 % ） 0 1,990 件一般病患及家屬之諮詢服務中問題分類及比例依序為詢問藥物之使用法 （703 件， 35.3%）、副作用（527 件， 26.5%）、注意事項（403 件， 20.3%）、飲 食禁忌（203 件， 10.2%） 、懷孕安全性（ 102 件， 5.1 %）及詢問內容屬於非西 藥類的其他（52 件， 2.6%） ； 248 件醫療人員之諮詢服務中問題分類及比例則 依序為詢問研究醫院未常備的商品名藥物之成份（ 112 件， 45.1 %） 、藥物交互 作用（ 72 件， 25 % ） 、藥物動力學（43 件，17 . 3 % ） 、針劑配伍（ 21 件， 12.6% ）。諮詢途徑以利用藥物諮詢室（2,008 件， 89.7%） 及藥物諮詢服務專 線（205 件， 9.1 %） 諮詢為主，電子郵件信箱（25 件， 1.2%） 最少。 從分析研究結果得知：雖然目前研究醫院藥袋已依規定標示病患應知事 項，但一般病患及家屬仍期望得到更深入的用藥資訊，其中依序以今併服用 多料看診藥物（尤其是在不同醫療院所）、藥物是否會傷胃、傷肝或傷腎、服 藥期間之飲食禁忌、對孕婦有何危險性等最常見；另外，老年病患則最在意 處方中是否有買藥。醫療人員則最常因病患從其他醫療院所帶來之非學名藥 物而需要諮詢，顯示藥物名稱有必要統一規範為以成份名為主，後再附加商 品名。電子郵件信箱之諮詢途徑雖然最少，但因較不受時間、空間之限制， 且為教育水準較高者使用，其諮詢內容一般最詳細深入。而從一般病患及家 屬之諮詢服務中，我們也及時發現18 件藥物不良反應之案例，並適時建議就 醫診治處理， 確實提升臨床藥事服務品質， 確保病患用藥安全。

In order to promote the quality of clinical pharmacy services of Dajia Lee's General Hospital (DLGH), we set up a drug consulting room and provide a special line telephone and e-mail mailbox, offer Drug Information Service (DIS) for 24- hour on-call service seven days a week. This research analyzed the DIS from January of 2004 to December. There was 2238 DIS in total in the year of 2004. Among them there were 1990 DIS consultations requested from the general patient and their relatives (88.9%), and 248 DIS consultations requested from medical staffs (11.1%). The 1990 DIS consultations requested from the general patient and their relatives were in the order of drug dosage and administration (703, 35.3%), side effects and adverse reactions (527, 26.5%), precautions (403, 20.3%), drugfood interactions (203, 10.2%), drug use in pregnancy (102, 5.1%), and other alternative medications and natural products (52, 2.6%). The 248 DIS consultations requested from medical staffs were drug availability and identification (112, 45.1%), drug interactions (72, 25%), pharmacokinetics (43, 17.3%), and IV compatibility and stability (21, 12.6%). The major consulting channels were on the site of drug consulting room (2008, 89.7%), telephone (205, 9.1%), and e-mail mailbox (25, 1.2%). Although the drug bag of DLGH has already labeled the item in accordance with the regulation at present, we found the patient and their relatives still expect to get more information of their taking drugs. The most common questions were: (1) how to take in combination with many departments' drugs (especially in different medical institutes), (2) whether drugs are hazardous to the stomach, liver or kidney, (3) diet taboo during taking drugs, and (4) whether drugs have any risk during pregnancy. However, the old patients most concerned themselves about whether there are antacids in their prescriptions. Medical staffs most needed to consult on the proprietary drug names that the patient brought from other medical institutes. Therefore, the drug name is necessary to unify on its active pharmaceutical ingredient, and then add its trade name. Although the e-mail mailbox consulting is not restricted by time and space, it is utilized the least and only for the high level education persons; their consulting content is generally more thorough. And from the consulting services of patient and their relatives, we found 18 cases of adverse drug reactions in time, advised them to seek medical treatment in proper time, and really promoted the quality of clinical pharmacy services and guaranteed the drug safety. The analysis of our study results can be regarded as the index of the quality of hospital clinical pharmacy services; it also provides a clinical pharmacy teaching note on 'Drug Safety' for the pharmacy school and young pharmacists. In addition, it also provides an important reference for the Department of Health, Executive Yuan and the Bureau of National Health Insurance to legislate and revise the relative laws of management and medical insurance payment.