社區健康促進：以老人正確用藥知能培力方案為例

Evaluation of community health promotion empowerment for the competence of correct medication among elderly

我國60歲以上老人醫療費用占健保支出近四成，且有逐年攀升趨勢。我國藥費支出占整體醫療費用的比重偏高，部分原因來自民眾的正確用藥知能不足與錯誤，導致珍貴的健保資源浪費。若能改善民眾正確用藥知能，除了將有效節約健保資源，更對個人健康有正面助益。本研究方案以台南市歸仁社區65歲以上（含）的長者為研究對象，使用美國健康國民2020指南的MAP-IT為實施架構，包括動員（Mobilize）、評估（Assess）、計畫（Plan）、實施（Implement）和追蹤（Track）等五個步驟，進行前測的需求評定、擬定與執行處遇策略，並進行後測的成效評估。研究成果發現，藉由引介藥師到宅用藥指導的處遇策略，確實明顯的改善與提升社區長者的正確用藥與健康知能。本方案研究結果發現，藉由引介藥師到宅用藥指導的處遇策略，確實明顯的改善與提升社區長者的正確用藥與健康知能。在媒合社區需求與專業資源的歷程中，若欲使藥師與長者建立有效溝通的長期關係，社會工作者在社區健康促進的可能角色與定位將能作為潤滑劑，扮演資源連結者、需求評估者、方案規劃者、中介協調者和權益倡導者等的角色，與社區共構健康促進的目標與成效。

The national medical expenditure of the elderly is 40% over than the national health insurance spending and has been gradually increasing in recent year. The percentage of medication expense in overall medical expenditure is high. Partly because the lack and errors of correct medication of the public lead the waste of national health insurance resource. To improve the medication knowledge of the public not only increase the effectiveness of national health insurance resource but also benefits the individual with good health outcome. The research studied the elderly in Gui-Ren District, Tainan City. The study design was referred to the MAP-IT framework that included mobilize, assess, plan, implement and track of Healthy People 2020 guideline. We assessed the needs and resources in the community, created and carried out the action plan, and evaluated the outcome. The result shows the in-home correct medication education does significantly improve the elderly’s competence of correct medication. Social workers may play an important role to facilitate the effective communication between the elderly and the pharmacists. Moreover, the social workers could be the bridge of participants to reach out for the applicable resources to receive its benefits, need assessment, coordinator, empowerment and help to achieve the goal of community health promotion.