提升慢性精神科住院病人服藥結盟行為之改善方案

Strategies to Enhance Alliance of Drug Alliance Behaviors in Chronic Psychiatric Inpatients

藥物治療是慢性精神病人主要的治療方式，未規則持續服藥，易導致疾病症狀復發，如此會導致醫療成本增加及社會的負擔。護理人員應著力於和病人分享服藥過程中的主觀感受與困擾，藉以提高服藥意願，協助病人主動正確服藥。本專案於2011年1月3日至3月1日調查得知主動配合服藥者僅24％；而在藥物認知上完全無法說出個人用藥種類、時間、劑量、作用、副作用達70.7％。因此專案小組制訂服藥訓練計劃、舉辦藥物團體衛教、製作個別性服藥訓練卡、建立獎勵制度作為解決方案。結果：1.病人主動按時服藥由24％提升至65％。2.病人藥物認知，完全無法正確說出由70.7％下降至35％。顯示此專案推行確實提升病人服藥結盟行為，控制病情避免復發及功能退化，進而提升照護品質。

Psychotropic medications play a major role in treating psychiatric patients and poor drug adherence results in frequent relapses, which raised the cost and burden both on medical care and society. Psychiatric nursing staff should be able to identify the subjective feelings and difficulties in patients taking these medications in order to enhance their willingness to comply actively with the prescriptions. Eighty chronic psychiatric inpatients were assessed for their medication adherence behavior by two self-developed questionnaires—the "Drug Adherence Training Observations" and the "Questionnaire on Factors Affecting Active Adherence" from January 2011 to March 2011. Results revealed that only 24% of participants were compliant actively and many patients (70.7%) were not fully aware of their own medications, time to take, dosage, indications, and possible adverse effects. We have thus developed an intervention program based on what we found above and the related literature. The program includes: (1) an individual drug adherence education (2) a group psycho-education for psychopharmacology (3) a customized individual drug adherence training card, and (4) a reward system.
Three months after implementing the intervention program, we found that the active adherence rate rose from 24% to 65% and inadequate knowledge of psychotropic medication dropped from 70.7% to 35%. The intervention program can enhance active drug adherence and promote the psychotropic knowledge in chronic psychiatric inpatients. The results suggest that such intervention program is effective.