居家照護老年個案用藥安全與適當性之現況分析

A Survey Report on Medication Safety and Appropriateness for the Home Care Elderly

目的：本研究針對居家照護老年個案的處方用藥進行調查，分析其用藥安全的風險、藥品保存、及用藥遵從性的現況。方法：以桃園地區某護理之家附護居家護理所65歲以上107位老年個案，採結構式問卷進行調查。結果：居家照護老年個案平均患有4.13種疾病；同時服用四種或以上藥物者超過半數，潛在用藥危險因子評估以「每天服用九種以上的藥」的風險最高佔41.1％（44位），高危險用藥者的盛行率為0.93％，特殊處方藥品類別以服用Theophylline最多（16.8％），其他藥物以Anticonvulsants最多（27.1％）。以Beers criteria調查老人潛在不適當用藥盛行率達12.1％，以服用Dipyridamole（3.7％）；　Hydrochlorothiazide（2.8％）的問題為多數；34.9％的個案具有遵從性不佳的問題。結論：居家照護老年個案服用處方藥物存在潛在風險，包括：服用多種藥物、該藥勿不適合老年治療、服藥遵從性不佳等問題，未來長期照護政策應納人藥事照顧專業服務、整合照護個案的處方資訊、促進醫師與藥師間的溝通管道，以保障居家照護老年個案的用藥安全。

This study describes a survey report on the potential improper use of medication for the home care elderly. It analyzes the risk for medication safety, storage of medication, and medication compliance in the home care elderly. The surveyed subjects were the residents with the age of 65 and above in a nursing home at Taoyuan, Taiwan. 107 samples were collected. The survey form was a structured questionnaire, including assessment of the risk factors of medication, medication use, and medication storage. The study showed that the surveyed subjects suffered from various diseases with average of 4.13 different diagnosis per person. The top two listed diseases are stroke (21.8%) and diabetes (13.5%). More than half of the surveyed subjects took four or more different medications at scheduled medication time. 41.1% of the subjects took nine or more medicines daily. The prevalence of the subjects at high-risk for medications safety was 0.93%. The top two categories of medications the subjects ook is theophylline (16.8%), and anticonvulsants most (27.1%). According to the Beers criteria, the prevalence rate for potential improper use of medication was 12.1%. Dipyridamole (3.7%) and hydrochlorothiazide (2.8%) are major two medication problems. 34.9% of subjects have the problem of poor compliance. Conclusively, potential improper use of prescriptive medications for the elderly home care is a problem currently. To eliminate the risk, a long-term care policy should be established to facilitate the communications between physicians and pharmacists in the near future.