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系統識別號 U0026-0812200911513302
論文名稱(中文) 藥師對門診高血壓老年病患跌倒預防及用藥知識衛教介入研究
論文名稱(英文) An Intervention Study on Knowledge of Falls Prevention and Drug Use in the Elderly Hypertensive Outpatients by a Pharmacist
校院名稱 成功大學
系所名稱(中) 臨床藥學研究所
系所名稱(英) Institute of Clinical Pharmacy
學年度 94
學期 2
出版年 95
研究生(中文) 石明麗
研究生(英文) Ming-Li Shin
學號 s6692105
學位類別 碩士
語文別 中文
論文頁數 140頁
口試委員 指導教授-張慧真
指導教授-盧豐華
指導教授-高雅慧
口試委員-蔡瑞真
中文關鍵字 藥師  跌倒預防  用藥知識  門診老年病患  降血壓藥 
英文關鍵字 pharmacist  medication knowledge  antihypertensives  elderly outpatients  prevention of falls 
學科別分類
中文摘要 研究背景:預防老人跌倒為國際公共衛生重要議題之一。至2004年台灣地區65歲以上老年人口已佔總人口比例的9.36%,而跌倒是台灣地區老人事故傷害死因之第二大原因,國內社區老人跌倒發生率高達15%至32%。老人跌倒之危險因子可分為外因性和內因性,外因性因子與環境因素有關;內因性因子則與老人的個人特質、疾病及藥品的使用因素有關,服用降血壓藥、抗憂鬱劑、利尿劑、安眠劑、精神用藥為容易導致跌倒之內因性因子。高血壓疾病居國人十大死因第十位,盛行率以老年人最高。因此本研究以藥師來執行衛教介入,探討門診高血壓老年病患預防跌倒之相關用藥知識的成效。

研究目的:(1)評估藥師介入對門診高血壓老年病患用藥知識的成效。(2)評估藥師介入對門診高血壓老年病患跌倒預防知識的成效。(3)分析造成門診高血壓老年病患跌倒之相關因素。

研究方法:本研究為同一組研究對象之事前事後比較設計,研究期間為2005年9月至12月,於國立成功大學醫學院附設醫院家庭醫學部門診進行收案及衛教,研究對象為65歲以上有使用降血壓藥之門診老年病患,採立意取樣方式。藥師採系統式的高血壓用藥及跌倒預防知識衛教方式,且研究對象於衛教前及之後四週,以結構式問卷進行用藥知識、跌倒預防知識及人口學特徵之訪談。

研究結果:研究對象共110位完成第二次訪談,訪談完成率為84.6%。藥師衛教介入後,高血壓老年病患服藥自我報告簡易量表總分平均由3.3±0.8提升為3.9±0.3;用藥知識評估總分平均由8.8±1.1提升為9.8±0.4;跌倒預防知識評估總分平均由12.4±1.4提升為14.4±0.9(p<0.001)。這些門診高血壓老年病患過去一年跌倒發生率為31%。經逐步邏輯複迴歸分析,顯示視力不清楚、使用降血糖用藥及benzodiazepines用藥為顯著跌倒相關因素(p<0.05)。

結論:藥師衛教介入可以增進高血壓老年病患的用藥及跌倒預防知識,與改善服藥順從性。跌倒相關危險因子的衛教需著重於視力不清楚、使用降血糖用藥及benzodiazepines用藥方面。



英文摘要 Background:Preventing falls in the elderly is one of the most important public health issues in the world. In 2004, the population aged 65 and older had approached 9.36%, and falling is the second leading cause of injury-related death, ranked as the seventh leading cause of death, among elderly people in Taiwan. The incidence of falls in the community dwelling elderly is between 15% and 32%. The risk factors for falls in the elderly are classified as either extrinsic or intrinsic factors. Extrinsic factors are related to the environment, and intrinsic factors are related to the individual, diseases, and medication uses. Antihypertensives, antidepressants, diuretics, hypnotics, and psychotic drugs are the most frequently reported intrinsic risk factors for falls. Since hypertension is the tenth leading cause of death and has a higher prevalence in the elderly in Taiwan, we are interested to know the effect of the intervention on increasing the knowledge of fall related to drug use in the hypertensive elderly outpatients by a pharmacist
Objectives:(1) to assess the effect of the intervention about knowledge of drug use, (2) to assess the effect of the intervention about knowledge of falls prevention, and (3) to analyze risk factors for falls among the hypertensive elderly outpatients.

Methods:A one-group pretest-posttest design was used. This study was conducted in the outpatient clinics of the Department of Family Medicine, the National Cheng Kung University Hospital from September to December, 2005. Subjects were hypertensive outpatients aged 65 years and older and recruited by purposive sampling. A pharmacist provided a systematic education regarding the use of antihypertensives and knowledge of falls prevention. Subjects were interviewed before and 4 weeks after the intervention by using structured questionnaires which consists of knowledge of medication use, falls prevention, and demographic characteristics.

Results:One hundred and ten patients completed the second interview with a response rate of 84.6%. After intervention, the mean score of self-report medication compliance of subjects was increased from 3.30.8 to 3.90.3; the knowledge of antihypertensive drug use was increased from 8.81.1 to 9.80.4; and the knowledge of falls prevention was increased from 12.41.4 to 14.40.9 (p<0.001). The incidence of the elderly hypertensive outpatients is 31% in past year. Based on the analysis of stepwise multiple logistic regression, visual deficit, and using hypoglycemic agents and benzodiazepines are significant risk factors for falls (p<0.05).

Conclusions:The pharmacist intervention significantly increased knowledge of antihypertensive drug use and falls prevention, and improved medication compliance among the hypertensive elderly outpatients. Educations of risk factors for falls included visual deficit, using hypoglycemic agents and benzodiazepines were needed to emphasize.



論文目次 中文摘要 I
Abstract III
誌謝 V
目錄 VI
表目錄 IX
圖目錄 X
第一章 研究背景 1
第二章 文獻探討 3
第一節 老年人跌倒之相關研究 3
第一項、老年人跌倒之流行病學 3
第二項、跌倒對老年人所造成之影響 4
第三項、導致跌倒之相關危險因子 6
第四項、藥品使用與老年人跌倒的關係 10
第五項、預防老年人跌倒介入計劃 13
第二節 高血壓之重要性及治療 19
第一項、高血壓之流行病學 19
第二項、高血壓治療準則 20
2.1 高血壓之非藥物治療 24
2.2 高血壓之藥物治療 26
2.3 特殊病患族群之高血壓用藥考量 28
第三節 高血壓老年病患之用藥問題 32
第一項、高血壓老年病患服藥順從性 32
第二項、高血壓老年病患之用藥知識 34
第四節 藥師在預防老年病患跌倒之角色 37
第一項、檢視病患用藥方面 37
第二項、用藥衛教方面 38
第三章 研究目的 39
第四章 研究方法 40
第一節 研究設計 40
第二節 研究對象 40
第三節 研究架構與步驟 41
第一項、研究架構 41
第二項、研究步驟 42
第四節 研究工具 45
第一項、問卷內容 45
1.1問卷信效度 47
1.2問卷內部一致性 48
第二項、衛教內容 49
第五節 資料分析 50
第一項、統計模式設定 50
第二項、資料分析方法 50
第三項、統計軟體 51
第五章 研究結果 53
第一節 研究對象人口學特徵及臨床特徵分布與比較 53
第二節 研究對象用藥知識及跌倒預防知識的評量情形 57
第一項、高血壓病患服藥自我報告簡易量表 57
第二項、高血壓老年病患用藥知識評估 60
第三項、高血壓老年病患跌倒預防知識評估 64
第三節 研究對象跌倒之相關因素 69
第一項、高血壓老年病患過去一年有無發生跌倒者之人口學與臨床特徵比較 69
第二項、高血壓老年病患使用潛在性增加跌倒危險的藥品 73
第六章 討論 77
第一節 研究對象人口學特徵及臨床特徵分布與比較 77
第二節 研究對象用藥知識及跌倒預防知識的評量情形 78
第一項、高血壓病患服藥自我報告簡易量表 78
第二項、高血壓老年病患用藥知識評估 80
第三項、高血壓老年病患跌倒預防知識評估 83
第三節 研究對象跌倒之相關因素 86
第一項、高血壓老年病患過去一年有無發生跌倒者之人口學與臨床特徵比較 86
第二項、高血壓老年病患使用潛在性增加跌倒危險的藥品 87
第七章 研究優點與限制 88
第一節 研究的優點 88
第二節 研究的限制 89
第八章 結論與建議 91
第一節 結論 91
第二節 建議 92
第九章 臨床藥事服務 93
第一節 藥事服務的動機 93
第二節 藥事服務計劃 94
第一項、藥事服務對象 94
第二項、藥事服務進行方法 94
2.1用藥衛教 94
2.2 藥品認知評估 94
2.3 藥物諮詢 95
第三節 藥事服務成果 96
第一項、藥事服務對象的用藥特性 96
第二項、藥事服務對象的藥品認知情形 97
第三項、藥物諮詢情形 100
第四節 藥事服務討論 101
第一項、藥事服務對象的用藥特性 101
第二項、藥事服務對象的藥品認知情形 102
第三項、藥物諮詢情形 102
第五節 藥事服務結論與建議 104
第一項、結論 104
第二項、建議 104
參考文獻 107
附錄一:人體試驗委員會審核通過證明書 115
附錄二:參與研究同意書 116
附錄三:問卷內容 117
附錄四:藥品衛教單張 124
附錄五:老年人預防跌倒守則衛教簡報 134
附錄六:老年人預防跌倒衛教單張 138
附錄七:藥事服務記錄表 139
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