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系統識別號 U0026-0207202022460700
論文名稱(中文) 促進中高齡者與藥師溝通之教學實驗計畫及成效分析
論文名稱(英文) An Experimental Program for Effective Communication of Middle-Aged and Older Adults with Pharmacists
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 108
學期 2
出版年 109
研究生(中文) 孫意惟
研究生(英文) Yi-Wei Sun
學號 TC6061031
學位類別 碩士
語文別 中文
論文頁數 151頁
口試委員 指導教授-翁慧卿
口試委員-歐凰姿
口試委員-楊登棋
中文關鍵字 溝通  藥師  中高齡者  自我效能  用藥清單 
英文關鍵字 communication  pharmacist  middle-age  older adults  self-efficacy  medication list 
學科別分類
中文摘要 台灣的高齡人口比例已於2018年3月超過14%,正式邁入高齡社會,且中高齡及高齡者潛在許多用藥問題,除了可能對病患疾病控制狀況及健康造成影響,也導致健保資源的浪費。藥師在協助高齡者用藥方面扮演著重要的角色,而良好且有效的溝通能促使藥師與病患的意見協調一致,以提升藥物治療成效並減少用藥問題的發生。然而研究顯示藥師與病患的溝通仍有很大的進步空間,且過去研究大多重視醫療人員溝通能力的提升,但病人本身的溝通能力同樣會影響兩者之間溝通的成效,亦有研究指出訓練病患的溝通能力比訓練醫療人員更具成本效益。因此本研究目的為設計一項溝通訓練計畫,了解中高齡及高齡者藥事服務資源使用狀況,並增進中高齡及高齡者對於藥師的功能與角色的了解程度、提升藥物相關溝通之自我效能,且有能力完成最新的個人用藥清單。
本研究利用教學手冊、實體課程及角色扮演活動進行溝通教學課程。透過專業藥師教材內容效度訪談及ㄧ般民眾焦點團體訪談確保教學計畫內容的專業性與合適性,並以非隨機實驗控制組前後測設計招募55歲以上中高齡者及高齡者共178位,分為實驗組(n=100)與對照組(n=78)。實驗組在前測後進行兩階段共2.5小時之溝通教學計畫,內容包括藥物的好處與風險、認識你的藥師、我的用藥清單、與藥師溝通的重要性、何時需要及如何與藥師溝通等,而對照組則無訓練介入,以評估此計畫的有效性。評估內容包含藥師的角色與功能之知識、藥物相關溝通的自我效能評估、藥事服務資源的使用率以及個人用藥清單的完成度,並以人口學變項、健康識能、單項素養作為控制變項。評估問卷皆經專家效度檢定(CVI=1)及信度分析(Cronbach’s α> 0.7) 以確保問卷內容之信效度。
實驗組與對照組皆以女性為多數 (71.0%;66.7%),平均年齡70.81歲。透過此教學計畫顯著提升實驗組對於藥師的角色與功能之了解程度及藥物相關溝通之自我效能 (p<0.05),對照組之前後測則無顯著差異。實驗組個人用藥清單的完成度由39.52% 提升至78.09%,且顯著高於對照組。雖然參與者年齡越高,在前測三項主要評估問卷的表現皆越差,但實驗組在後測的表現則已無年齡上的差異,且年齡越高者進步幅度越大。
本研究透過專業藥師訪談及中高齡者焦點團體訪談設計出一項屬於中高齡及高齡者與藥師溝通的教學計畫。此溝通教學計畫有效地提升實驗組在藥師角色與功能的知識、藥物相關溝通自我效能及用藥清單完成度的表現。
英文摘要 Plenty of potential drug-related problems were noted in the middle-aged and older adults. Effective communication is essential for pharmacists to coordinate their opinions with patients to improve the effectiveness of drug treatment and reduce drug-related problems. However, few studies focused on patients’ abilities to communicate with pharmacists even though it was vital for the effectiveness of medical treatment. The purpose of this study was to design a communication training program for middle-age and older adults not only to enhance their understanding of pharmacists’ responsibilities and the importance to communicate with pharmacists, but also to improve their self-efficacy about drug-related communication and the ability to list their latest medication. A non-randomized control-group pretest-posttest design was conducted in Tainan City. Through individual interviews of five pharmacists and a focus group interview, we ensured the appropriateness and expertise of the training program. 178 adults over 55 years old were distributed into experimental group or control group. The experimental group underwent the training program after the pretest, while no intervention was provided to the control group. Face-to-face and role-play sessions were in process with a training booklet in the courses. Both groups completed the posttest four weeks after the pretest. This communication training program appeared to be effective since the knowledge about pharmacists’ responsibilities and self-efficacy of drug-related communication were significantly improved in the experimental group (p < .05) rather than the control group. Completion of the recent medication list was also improved from 39.52% to 78.09% and was significantly higher than the control group.
論文目次 中文摘要 I
Abstract III
誌謝 VII
目錄 VIII
表目錄 XI
圖目錄 XIII
第壹章 緒論 1
第一節 研究背景 1
第二節 研究重要性與研究缺口 2
第三節 研究目的 3
第四節 名詞解釋 3
第貳章 文獻回顧 5
第一節 高齡者用藥安全 5
第二節 資訊取得管道 6
第三節 健康識能不足 7
第四節 溝通的目的 8
第五節 藥師與病人溝通的現況 10
第六節 溝通訓練計畫的介入 12
第七節 文獻小結 21
第參章 研究方法 22
第一節 研究設計 22
第二節 專業藥師教材內容效度訪談 22
第三節 一般民眾焦點團體訪談 28
第四節 非隨機實驗控制組前後測設計 34
第五節 研究架構 37
第六節 研究假設 38
第七節 研究工具 40
第八節 變項說明 46
第九節 資料處理與統計分析 55
第十節 研究步驟 56
第十一節 研究倫理 59
第肆章 研究結果 60
第一節 人口學變項 60
第二節 健康狀況 62
第三節 健康識能 64
第四節 藥事服務資源使用狀況 65
第五節 藥師的功能與角色之知識 69
第六節 藥物相關溝通自我效能 73
第七節 目前用藥清單 75
第八節 研究對象背景資料與評估問卷結果之相關分析與比較 76
第九節 研究小結 80
第伍章 討論 81
第一節 研究摘述 81
第二節 研究對象 82
第三節 中高齡者健康狀況之調查比較 92
第四節 中高齡者藥事服務資源使用之調查 92
第五節 課程介入提升藥師角色與功能的認識 94
第六節 藥物相關溝通自我效能 95
第七節 建立用藥清單 96
第八節 相關分析之討論 98
第九節 研究限制 99
第陸章 結論與未來研究方向 101
第一節 結論 101
第二節 建議與未來研究方向 101
參考文獻 104
附錄 115
附錄一 研究問卷 115
附錄二 教學手冊 132
附錄三 角色扮演教案 137
附錄四 專家效度名單 143
附錄五 專家內容效度檢定函 144
附錄六 同意人體研究證明書及同意計畫修正證明書 150
附錄七 人體研究說明及同意書 152
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