精神科復健病房病人藥物治療品質改善方案

Quality Improvement of Pharmacotherapy among Patients in Psychiatric Rehabilitation Ward

精神藥物治療及配合度對嚴重精神疾病病人的預後及復健有重要的影響力。藥物種類過多常導致病人較差的服藥配合度，也有較高的藥物交互作用風險。本品質改善計畫的目標是透過藥師參與精神復健病房團隊會議及討論嚴重精神疾病病人治療計畫，以達到簡化該精神復健病房病人治療藥物與使藥物治療品質改善。透過藥師在精神復健病房團隊會議中選取品質改善計畫的關鍵成效指標；然後，藥師在2017年4到10月每個月第一週的病房團隊會議中討論病人臨床症狀、副作用與本品質改善計畫的關鍵成效指標。在本品質改善計畫介入前到介入後第六個月該精神復健病房使用2種(含)以上抗精神病用藥病人的比率由33%下降至24.3%；同時，2種(含)以上鎮靜安眠藥者由16.7%下降至0%；此外，2種(含)以上抗憂鬱藥、降血壓及降血脂藥物者都維持0%。在六個月品質改善計畫病房中，5種(含)以上治療藥物者由28.6%降至8.1%、用長效針劑病人比率由16.7%上升至32.4%，且該精神復健病房包含長效針劑的每人日平均藥費由65元降至63元，低於該醫院同時期所有精神復健病房的平均值。藥師參與精神復健病房團隊的6個月品質改善計畫可簡化藥物及提升藥物治療品質。

Psychopharmacotherapy and adherence play important roles in outcome and psychiatric rehabilitation among persons with severe mental illnesses (SMI). Many drugs have been associated with worse adherence and more drug interactions in this population. The aims of this quality improvement (QI) project were to simplify regimen of drugs and to improve the quality of pharmacotherapy by inviting pharmacists to attend the psychiatric rehabilitation team meeting and discuss the psychiatric rehabilitation plan that the team had for patients with SMI. The QI project was implemented by choosing the key performance indicators (KPIs) by pharmacists in the psychiatric rehabilitation team meeting. Afterwards, pharmacists discussed patients’clinical symptoms, side effects and KPIs of the QI project during the psychiatric rehabilitation team meeting the first week each month during Apr. 2017 and Oct. 2017. The rate of patients prescribed two or more kinds of antipsychotics among patients we studied in our psychiatric rehabilitation ward was lowered from 33% to 24.3% during the month before and six months after the QI project. Simultaneously, the rate of patients who was prescribed two or more kinds of benzodiazepine or hypnotics reduced from 16.7% to 0%. In addition, no patient was prescribed two or more kinds of antidepressants, anti-hypertensive or lipid-altering agents during the QI project period. The rate of patients prescribed more than five kinds of drugs decreased from 28.6% to 8.1%, the rate of patients with long-acting injectable (LAI) antipsychotics rose from 16.7% to 32.4%, and the average daily expenditure of total drugs including LAI antipsychotics per patient in the 6-month QI project ward was lowered from 65 to 63 NT dollars, lower than those of the whole psychiatric rehabilitation ward in general during the same period. The 6-month QI project with pharmacist’s participation in psychiatric rehabilitation ward team simplified the prescribed drug regimens and improved the quality of pharmacotherapy.