藥師參與「末期腎臟病前期之病人照護與衛教計畫」的影響

The Impact of Pharmacist Involvement in Care and Education Programs for Pre-End-Stage Renal Disease Patients

本研究分析藥師加入「末期腎臟病前期（pre-ESRD）之病人照護與衛教計畫」，提供以病人為中心的藥事照護，對門診病人的成效與影響。回溯性收集2022年1月至2023年12月，經腎臟內科醫師轉介照護至少3次，且符合慢性腎臟病（CKD）3b、4或5期之pre-ESRD病人。分析藥師在提供藥事服務後病人的用藥配合度丶非類固醇抗發炎藥（NSAIDs）使用情況，及腎功能相關的變化，並記錄醫師對於用藥建議的接受率。共有57位病人，藥師介入後，用藥配合度不佳的比率，從26.3%降至10.5%（=0.004），NSAIDs使用率，由22.8%減少至8.8%（=0.008），尿蛋白與肌酸酐比值（UPCR）從2009.7mg/g降至1743.2mg/g（<0.001）。藥師提出15項用藥建議，醫師接受率為86.7%。藥師參與pre-ESRD計畫後，讓病人能更安全且有效地使用藥品，改善了病人的CKD嚴重程度。

Integrating pharmacists into the care and education program for pre-end-stage renal disease (pre-ESRD) patients can provide patient-centered pharmaceutical care. This study evaluates the effectiveness and impact of this intervention on outpatient care. Retrospectively collect data from January 2022 to December 2023 on pre- ESRD patients with chronic kidney disease (CKD) stages 3b, 4, or 5 who were referred by nephrologists and received care at least three times. Analyze patients' medication adherence, non-steroidal anti-inflammatory drugs(NSAIDs) usage, and renal function-related changes following pharmacists' provision of pharmaceutical care services, and document the acceptance rate of pharmacists' medication recommendations by physicians. A total of 57 patients were included. Following pharmacist intervention, the proportion of patients with poor medication adherence decreased from 26.3% to 10.5% (p=0.004), and NSAIDs usage decreased from 22.8% to 8.8% (p=0.008). The urine protein-to-creatinine ratio (UPCR) was reduced from 2009.7 mg/g to 1743.2 mg/g (p<0.001). Pharmacists provided 15 therapeutic recommendations, with an acceptance rate of 86.7% by physicians. The involvement of pharmacists in the pre-ESRD program enhanced the safety and efficacy of medication use, leading to an improvement in the severity of CKD among the patients.