整合型高齡友善藥局公共衛生服務導入研究－－以桃園市藥局為例

Research on the Introduction of the Integration Age-Friendly Pharmacy Public Health Services - Take Taoyuan City Pharmacy as an Example

依據世界衛生組織的定義，65歲以上老年人口比率超過總人口數7%的國家，稱之為高齡化社會；超過14%者稱為高齡社會。依此界定，2018年台灣地區的老年人口，已到達高齡社會標準，而人口老化將嚴重衝擊著醫療照護體系。在台灣，許多老年人因罹患多種慢性病，需長期使用多種藥物，而有多重用藥及服藥配合度不佳的現象，包括自行買藥、用藥時間或劑量錯誤、隨便停藥、忘記服藥、西藥併用中草藥療法、與他人分享藥物及使用過期藥品等問題。這些問題可能導致病人疾病惡化、藥品副作用而需不預期門診、急診或住院，嚴重者更可能導致死亡。本研究主要目的在探討社區中建立高齡友善社區藥局導入公共衛生服務模式，以提供社區居民多項藥事服務專業服務，對於年長者的用藥配合度與藥物治療問題，達到有效之改善。高齡友善社區藥師所提供之服務項目可包括：(1)藥局內調劑藥品、測量血壓、藥物諮詢服務、用藥安全或健康促進等宣導、提供糖尿病照護、二代戒菸、長期照護或其他健康需求等照護轉介服務、具備座椅供等候時使用、設置老花眼鏡或放大鏡供高齡者使用、指導民眾如何清除廢棄過期藥品等。(2)居家式及機構式藥事照護服務。桃園市政府與桃園市藥師公會合作，積極說明及宣導並請健保特約藥局加入此計畫，然後協助與教育訓練藥師提供多項專業服務。結果在563家藥局中共輔導設立181家(32%)高齡友善藥局。本計畫執行11個月後，許多項目藥師提供上萬人次的服務。針對提供用藥配合度諮詢服務的585人次之統計，民眾平均年齡為64.9歲，使用1-4種藥品者佔38.5%，5-9種藥者有45.9%，而大於10種用藥者有15.6%，顯示有多種疾病並有多重用藥的人數很多。屬於低服藥配合度者由42.4%降為2.5%，同時高服藥配合度者由3.8%上升為58.3%，有明顯增加。藥師發現藥物治療問題以重複用藥最多有26.8%，有不良反應24.4%，劑量過高9.8%。歷經高齡友善藥局之藥事服務後，九成以上民眾皆認為服務對其用藥認知提升、用藥行為改善都有幫助。社區藥師對民眾尤其是高齡者提供多項專業服務，可確實保護其用藥安全並提升用藥配合度。 According to the World Health Organization, countries with the elderly population over 65 years old exceeding 7% of the total population are called the aging society; more than 14% are called the aged society. Accordingly, the elderly population in Taiwan in 2018 has reached the level of aged society, and the elderly population will impact the healthcare system significantly. In Taiwan, many elderly people suffer from multiple chronic diseases, require long-term use of multiple drugs, thus, they have polypharmacy and poor adherence issues, which include self-medication, errors in time and dosage of administration, stop or forgot of taking medication, combine herbal medications and share medications with others. These problems may result in poor control of their diseases, having adverse drug reactions, that need unexpected clinic visits, emergency service or hospitalization, or even resulting in death. The establishment of public service modules, which is incorporated by Age Friendly Pharmacy within residential communities is the main purpose of this research. By providing the residents with professional pharmacists' services, it is expected to encourage attitude of cooperation and responsible use of medicine and improve treatment difficulties among elderly people with tangible efficiency. Age Friendly Pharmacy should provide the following services: (1) prescription dispensing, blood pressure measurement, medication adherence counseling service, medication safety or health promotion and other advocacy, provide diabetes education, smoking cessation advice, long-term care or referral service. In the pharmacy, they should have semi-private counseling space and chairs, eye glass or magnifying glass for the elderly, and instruct how to dispose obsolete drugs. (2) home and institutional medications review services. There were a total of 563 community pharmacies contracted with NHIA in Taoyuan City, however, 233 of them (41.4%) established the Age Friendly Pharmacies. After implementation of the project the data showed the average age of subjects participated in this project was 64.9 years old. Around 76.6% of these people took 1-4 drugs and 20.1% took 5-9 drugs, indicating many of them had multiple diseases and polypharmacy problems. After being consulted in the Age Friendly Pharmacy, more than 90% of the subjects thought that the service was helpful in improving their awareness of drug use and improved their drug taking behavior. Duplication of drug (26.8%) was the highest drug therapy problems found. There was a significant improvement in people with low adherence of medications (from 21.2% to 1.8%) and people with high adherence (from 3.8% to 58.3%). These results showed the important roles of community pharmacists in taking care of senior citizens.