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題 名 | 是看診輔助還是干擾?--門診使用藥品交互作用提示系統之成效探討=The Efficacy of the Warning System of Drug-Drug Interaction in Out-Patients Clinics |
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作 者 | 陳智芳; 丁賢偉; 詹前隆; 湯進聖; 蔡麗芬; 劉惠文; | 書刊名 | 臺灣臨床藥學雜誌 |
卷 期 | 13:2 民94.12 |
頁 次 | 頁15-30 |
分類號 | 418.11 |
關鍵詞 | 藥品交互作用; 醫療資訊; 門診處方; 病患安全; Drug-drug interaction; Medical informatics; Out-patients orders; Patients' safety; |
語 文 | 中文(Chinese) |
中文摘要 | 利用醫療資訊技術建立醫囑藥品交互作用提示系統之價值,已廣受各醫療院所肯定。藥品交互作用提示系統不僅具專業知識教育功能外,亦對病患用藥安全提供多一層保障。本研究之目的在了解某醫學中心門診醫囑藥品交互作用系統之成效,並探討醫師行為之改變,做為系統提昇之參考。 本研究利用交互作用提示系統之回饋管理輔助功能,收集某醫學中心2002年1月至2004年3月,門診處方筆數及醫囑萍品交互作用提示系統所得之資料,進行系統提示率及使用者接受率之分析。分析系統提示率及使用者接受各月之間的差異,以及系統提示率與醫師接受率之間的關聯性。並進一步分析使用者不接受之藥品交互作用提示項目分佈情形,並以問卷調查使用者的意見。 醫囑藥品交互作用提示系統平均提示率為0.228%±0.117%,使用者平均接受率為4.737%±0.542%,各月之間無明顯差異(p<0.01)。系統提示率愈高使用者接受率愈低,相關係數為-0.518(p<0.01)。醫師不接受之藥品交互作用提示項目中,毛地黃配醣體(digitalis glycoside)與thiazide類利尿劑之交互作用提示項目發生比例佔46.54%。醫師接受之藥品交互作用提示項目中,quinolnes與制酸劑(antacids)佔30.87%,tetracyclines與制酸劑(antacids)佔11.84%。問卷調查結果,認為不需再提示為3.43%,繼續提示為68.83%,由系統強制不可併用為8.92%,沒有意見為16.98%。 雖然藥品交互作用即時提示系統使用者之接受率低,但多數使用者仍希望系統繼續提供藥品交互作用訊息。然而系統的精確度與互動性會影響醫師接受率,因此,系統之互動式應更高:如加入疾病診斷碼、臨床檢驗數值等作為判斷之依據,並且加入視覺化系統模式以免因提示疲乏而造成接受度之降低。而針對含有潛在性交互作用之處方,藥師應加強監控病人臨床反應,並給予病患適當的藥物用藥指導,以確保病人用藥安全。 |
英文摘要 | It has been wildly approved by hospitals to build the drug-drug interaction warning systems with medical informatics. The systems provide not only professional education, but also more safety for patient’s drug use. This research aims the efficacy of the drug-drug interaction warning systems, as well as the users’ behavior change in out-patients clinics at a general teaching hospital. The results of this research will help to upgrade the systems. By using part of feedback management support in the drug-drug interaction warning system, this research collected a number of out-patients orders and data from a general teaching hospital from January 2002 to April 2004. We tried to analyze the system-warning rates, the user-accepted rates, the monthly correlations between the system-warning rates and the physician-accepted rates. Furthermore, we analyzed the items rejected by the users, and required their opinions by questionnaires. The mean warning rate is 0.228%±0.117% and the mean acceptation rate is 4.737%±0.542%. There is not significant difference between each month (p<0.01). The system-warning rate is negative correlation with the user-accepted rate. The coefficient score is -0.518 (p<0.01). Based on the rejected items, the rate to digitalis glycoside-thiazide is 46.54%, the quinolone-antacids is 30.87%, and the tetracyclines-antacids is 11.84%. As the result of the questionnaires, 3.43% users think the systems are useful, nearly 9% users suppose the orders will be rejected as soon as the drug-drug interaction warning systems are launched, and 16.98% users have no comments. Although the acceptation rate of the warning systems is low, most of the users still hope the systems can continuously provide the information of drug-drug interaction. However, the accuracy of the systems and the interactivity affect the preference of the users, so the systems need further improvements, such as making decisions with ICD 9 code or the laboratory data, and adding the visualization technologies to avoid the exhaustion arisen by over-warming. As far as the orders with potential interactions, pharmacists should closely monitor the patients’ clinical reactions, and offer them proper medical directions in order to secure the correct drug usages. |
本系統中英文摘要資訊取自各篇刊載內容。