| 摘要: | 背景與目的：近年來用藥安全漸受重視，及健保局為抑制費用，亦對異常處方藥費進行核刪，藥物警示功能是目前被視為最佳改善異常處方開立的工具之一，但國內中小型醫院在此警示系統建置上仍未見完備，警示也經常被醫師所忽略，故本研究期望瞭解藥物警示系統的成效及其醫師忽略警示之影響因素。
方法：本研究資料來源，首先針對 2008年7月至9月三家個案醫院之門診處方資料作異常處方比率分析，用以代表忽略警示程度。再以個案醫院研究期間有開立處方之醫師為樣本，進行影響因素探討。資料分析則分別作描述性分析，以及推論性的t檢定、ANOVA檢定、複迴歸分析等。
結果：藥物警示系統整體重要性平均為3.93分，使用滿意度平均為3.40分，其中醫師認為最重要的為操作便利構面，訊息回饋、程序簡潔構面則為滿意度最差者。研究發現忽略警示系統的影響因素為「醫師教育程度」與「對藥物特性影響程度之認知」。
結論與建議：整體而言醫師肯定藥物警示系統的重要性，但系統滿意上仍待進步。建議警示系統未來加入病人因素之考量，且警示系統設定異常處方的指標能取得共識，使其醫師願意服從。研究方面未來可以嘗試將樣本數擴大至醫學中心及區域級以上的醫院。
Objective：In recent years, drug safety has emerged to become one of the mainstream topics in the field of drug usages and medical practices. To maintain tight budget control, the Bureau of National Health Insurance (BNHI) started to eliminate bill coverage for controlled drugs. The Drug Alerting System, or DAS, then becomes one of the most effective tools to verify prescriptions for controlled drugs.
However, the DAS is not fully deployed in many small to mid-size hospitals in Taiwan, and many physicians also do not pay attention to the alerts provided by the DAS. Thus, the purposes of this research include 1) understanding the effectiveness of the DAS; and 2) researching factors that lead physicians to ignore alerts.
Method：This study first conducted a magnitude assessment on the level of warning message ignorance by physicians. Prescriptions from three local hospitals were collected as data for the assessment, and the collection period is from July 2008 to September 2008. Then, a factorial analysis was conducted with that sample population including only physicians whose prescriptions were collected for the assessment. Data analysis methods include descriptive analysis, t test, ANOVA test, and regression analysis.
Result：The analysis revealed that the overall significance for the DAS, on average, is 3.93, and satisfaction of usability, on average, is 3.40. Among all constructs, physicians perceive that easy to operate and message feedback are two of the most important dimensions, while simplified operating procedures is the worst dimension. The analysis further indicated that the factors leading physicians to ignore alerts include the educational level of physicians and the level of understanding that physicians have for prescribed drugs.
Conclusion and suggestion：Overall, respondents, or physicians surveyed in this study, approve the importance of the DAS, but they still perceive room for improvements for the DAS. Suggestions for the DAS deployments include 1) the DAS can incorporate patient health assessments in its decision algorithms; and 2) consensus about the measuring indexes should be established among physicians, and hence, physicians will be more willing to utilize the DAS. In the future, the study can be extended to include physicians from medical centers or regional hospitals as the sample population.
Keywords： drug alert system、effectiveness、influence factors、incorrect prescriptions、medication errors |
