建構藥師參與心臟衰竭病人整合照護模式之成果初探

The Preliminary Results of Establishing a Pharmacist-Involved Integrated Care Model for Heart Failure Patients

目的：本院藥劑部於2022年開始加入心臟衰竭照護團隊，針對心臟衰竭住院病人發展完善的心衰藥事照護模式，希望能夠加強心臟衰竭病人藥物整合與衛教，降低潛在的藥物問題。方法：自2022年6月開始於本院心臟血管內科收案住院病人，其心臟衰竭左心室射出分率在40%以下且能配合接受衛教與評估追蹤。藥師在病人住院48小時內建置用藥清單與執行藥物整合，在病人出院前，藥師對病人進行心衰用藥衛教，提醒服藥重要性、藥物副作用，並於病人每次門診回診後一周內追蹤是否有服藥問題及異常狀況。主要以6個月內再住院率、不良反應通報率與2次服藥配合度的進步率（第一次在出院前完成，第二次需間隔三周以上）做為成效評估指標。
結果：至2023年5月共收案18位病人，每位病人出院後至少追蹤6個月。出院後6個月內再住院率為16.7%。服藥配合度以ARMS（Adherence to Refills and Medications Scale）評量。18位病人前後兩次ARMS平均分數為16.8與12分，後測進步率達100%（18/18）。出院後共回診80次，每人回診3~6次（中位數為5次），回診後病人的不良反應通報率達77.8%（14/18）。
結論：本研究病人再住院率較過去低，藉由介入藥師進行用藥狀況的追蹤關懷，並協助處理副作用症狀，可能因此防止了症狀變嚴重而需要再住院的發生。

Our hospital implemented a pharmacist-involved integrated care model for heart failure patients to assess the impact of enhanced medication reconciliation and patient education on medication safety. Starting from June 2022, hospitalized patients in our Cardiology Department with a left ventricular ejection fraction (LVEF) below 40% who were able to participate in education and follow-up assessments were enrolled.Pharmacists made personal medication lists and provided patient education during the first 48 hours of hospitalization. Before discharge, pharmacists educated patients on heart failure medication, emphasizing the importance of adherence and side effects. Patients were followed up within one week after each outpatient visit. By May 2023, 18 patients were enrolled, each followed for at least six months post-discharge. The readmission rate within six months was 16.7%. Medication adherence was assessed using ARMS(Adherence to refills and medications scale), showing a 100% improvement rate. After discharge, through follow-up interventions during 80 outpatient visits or regular communication via instant messaging platforms, 14 out of 18 patients reported experiencing adverse symptoms. This resulted in an adverse reaction reporting rate of 77.8% (14/18). This study demonstrated a lower readmission rate compared to historical data. The pharmacist intervention in monitoring medication usage and providing follow-up care, including addressing adverse effects, likely prevented symptom exacerbation and the need for readmission.