進階搜尋


下載電子全文  
系統識別號 U0026-1008201001532600
論文名稱(中文) 國人服藥順從性與醫療人員互動影響因素之探討
論文名稱(英文) Assessment of Medication Adherence Focused on Patient-Professional Interaction
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 98
學期 2
出版年 99
研究生(中文) 詹季蓁
研究生(英文) Chi-Chen Chan
學號 s6697103
學位類別 碩士
語文別 中文
論文頁數 105頁
口試委員 口試委員-盧豐華
口試委員-林香汶
指導教授-高雅慧
指導教授-張慧真
中文關鍵字 服藥順從性  醫療人員  溝通  藥物資訊 
英文關鍵字 medication adherence  professional  communication  information 
學科別分類
中文摘要 研究背景
病人順從性不佳會導致藥物資源的浪費,除了經濟的影響外,病人未按時服藥,亦會使本身疾病惡化,進而增加罹病率(morbidity)、致死率(mortality)以及住院率,因此病人依照醫囑服藥是很重要的議題,需要醫療人員介入關心。
專業醫療人員和病人互動的結果會影響病人對醫療照護的滿意度,病人的需求及滿意度和服藥順從行為有關係。在過去,我國關於醫療服務滿意度研究結果中發現,令病人最不滿意的的前三項是:未清楚回答問題、診斷處理不夠用心、決策時不尊重病人意見。另研究指出基層醫師與民眾在服務品質重要性認知上與品質滿意度認知上皆有落差,基層醫師對於「用藥解說」之重要性低估許多,且對「用藥解說」滿意度高估較多,需「迫切改善」之品質項目中,以「護士與藥師之服務態度」與「用藥解說」為民眾認為基層醫師應優先改善的項目。

研究目的
本研究著重於了解在藥物治療過程中:
1. 國人服藥順從性的情形
2. 在藥物相關問題上,病人與醫療人員互動的需求及滿意程度
3. 評估與醫療人員互動對服藥順從性影響之探討

研究方法
本研究為橫斷式研究,利用問卷進行調查。
藥師為訪談員,2010年3月至5月至兩家醫院(成功大學附設醫院和衛生署台南醫院)及協助研究的十家社區藥局為主要取樣地點,受訪者可選擇訪談後回答或自行填寫問卷。
研究對象
收錄對象需包含以下兩種條件:兩週內服用醫師所開立的西藥和大於二十歲以上且可自行服藥的成年人。

研究結果
在台南市共收集347份有效問卷,長期慢性疾病者未依照醫囑服藥的最常見原因為「忘記服用」,急性病痛者則為「服藥後不舒服」。
溝通方面,21.9%沒有醫療人員「主動詢問服藥後狀況」的經驗;高達四成(42.4%)沒有醫療人員「主動詢問是否有其他用藥問題」的經驗;27.7%受訪者表示不曾主動詢問用藥問題。
藥物資訊提供方面,通常由「醫師」說明(74.6%),由「藥師」提供佔56.8%,由「護理人員」提供佔20.5%;希望醫療人員主動說明的前三項依序為「治療效果」、「副作用」和「使用方式」;多數受訪者(76.1%)由「藥袋或包裝」得到藥品資訊;藥物資訊衝突而感到困擾者佔31.4%。
多變項分析後,「年輕族群」(20-30歲)和併服「中草藥」者順從性較差,「醫院」就醫者順從性較好,會由「藥袋或包裝」取得資訊者和醫療人員有主動說明「交互作用」者皆可使順從性增加,其中「幫助減低藥物治療上的疑慮或不安」為影響順從性重要因素,且有正向滿意度者順從性越好。

結論
由何種醫療人員提供藥物資訊與服藥順從性無顯著相關,在互動過程中,提供藥袋標示的資訊,並讓民眾感受到幫助減低用藥治療上的疑慮或不安,為增加服藥順從性重要關鍵。
英文摘要 Background
Medication nonadherence was contributing to substantial worsening of disease, death, and increased health care costs. Patient-professional interaction is an important variable associated with satisfaction and adherence. A previous study which analyzed communication on medical service in Taiwan revealed that lack of explicitness and respectiveness while answering questions by healthcare professionals had lead to the unsatisfaction of patients. Addistionally, a study found that the gaps of perceptions of quality importance and of quality satisfaction existed between primary care physicians and patients. Physicians often underestimated the importance of "medication explanation". Patients thought "nurses' and pharmacists' service attitudes" and "medication explanation" were the concentrated items for improvement.

Objectives
To examine patient’s medication adherence in Taiwan, this study aims to:
1. Investigate the needs and satisfaction about patient-professional interaction.
2. Assess the correlations between interaction with professional and medication adherence.

Methods
This was a cross-sectional study. The data were collected by questionnaire and conducted by pharmacists from March to May in 2010 in National Cheng Kung University Hospital, Tainan State Hospital and community pharmacies in Tainan. Patients were asked whether he or she was willing to participate in the study, and they should meet the following inclusion criteria: taking prescribed medication within two weeks and older than 20 years of age.

Results
A total of 347 questionnaires were collected in Tainan. The results showed that 21.9% patients responded that the health professionals didn’t inquire their condition after taking medication. 42.4% patients indicated that professional didn’t confirm whether he or she had more questions. Besides, some patients(27.7%)had never required information about medication.
In the aspect of medication information-providing, most patients (74.6%)were informed by physicians. Some(56.8%)were informed by pharmacists and the three most important informed-items were therapeutic effect, adverse effect and administration. Most patients(76.1%)got information from the drug labeling. We also found that 31.4% patients had the experience about conflicting information.
After statistical analysis, the main findings were as following:
1. The younger(age 20 to 30)had significantly poor adherence.
2. Patients used Chinese herbal medicine had lower adherence.
3. Patients who acquired information from drug bag (or containers)had significantly higher adherence.
4. Informing drug interaction could improve adherence.
5. Helping to reduce the fear or confusion of medication therapy was the determinant of adherence. The higher positive levels of satisfaction were significantly associated with greater reported adherence.

Conclusion
Regarding the process of information providing, professional experstise is irrelevant to medication adherence. In clinical scenario, providing the labeled information on drug bag(or containers)and reducing the fear or confusion through counseling will improve patients medication adherence.
論文目次 目錄
中文摘要 I
Abstract III
誌謝 V
目錄 VI
表目錄 IX
圖目錄 X
第一篇 國人服藥順從性與醫療人員互動影響因素之探討 1
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 2
第二章 文獻回顧 3
第一節 服藥順從性 3
2.1.1 定義 3
2.1.2 測量方法 3
2.1.3 影響服藥順從性的因素 5
2.1.4 服藥順從性不佳的結果 8
第二節 國人服藥順從行為 9
第三節 與醫療人員互動和服藥順從性之關係 11
2.3.1 與醫療人員互動和健康結果模式 11
2.3.2 與醫療人員溝通和服藥順從性之關係 12
2.3.3 醫療人員藥物資訊提供和服藥順從性之關係 13
第四節 國人與醫療人員互動之情形 15
2.4.1 國人與醫療人員溝通之情形 15
2.4.2 我國醫療人員藥物資訊提供之情形 15
第三章 研究材料與方法 17
第一節 研究設計 17
3.1.1 研究類型 17
3.1.2 研究時間 17
3.1.3 研究地點 17
3.1.4 研究對象 17
3.1.5 收樣方法 18
第二節 研究架構 19
第三節 研究工具及設計流程 20
3.3.1 問卷效度評估 20
3.3.2 問卷信度評估 22
第四節 研究變項與問卷指標之定義 23
第五節 資料彙整與分析 29
3.5.1 統計分析軟體 29
3.5.2 統計分析方法 29
第四章 研究結果 30
第一節 描述性統計 30
4.1.1 取樣分析及受訪者基本資料 30
4.1.2 兩週內服用藥物之基本資料 30
4.1.3 服藥順從情形 36
4.1.4 與醫療人員溝通 37
4.1.5 藥物資訊提供 39
第二節 各因素影響服藥順從性之分析 43
4.2.1 單一變項分析 43
4.2.2 多變項分析 52
第五章 研究討論 56
第一節 研究結果之分布與比較 56
5.1.1 服藥順從性研究方式與結果之探討 56
5.1.2 兩週內服藥基本資料之分布 56
5.1.3 與醫療人員溝通 57
5.1.4 藥物資訊提供 58
第二節 影響服藥順從性之因素探討 63
5.2.1 年齡對與醫療人員互動和服藥順從性之影響 63
5.2.2 兩週內服用藥物之基本資料對服藥順從性之影響 64
5.2.3 就醫場所和領藥場所對服藥順從性之影響 64
5.2.4 與醫療人員互動對服藥順從性之影響 65
5.2.5 藥袋或包裝對服藥順從性之影響 66
第六章 研究限制與未來研究方向 67
第一節 研究限制 67
第二節 未來研究方向 67
第七章 結論與建議 69
第一節 結論 69
第二節 建議 69
第二篇 臨床藥事服務 70
第一章 服務背景 70
第二章 管灌藥品考量之因素 71
第三章 服務結果 72
參考文獻 91
附錄一 96
附錄二 99
附錄三 104

表目錄
第一篇 國人服藥順從性與醫療人員互動影響因素之探討
表2-1 Morisky Medication Adherence Scale 4
表2-2 影響服藥順從性相關的參數 7
表2-3 藥師家訪記錄受訪者之服藥順從性 9
表2-4 藥師家訪記錄受訪者之服藥順從性不佳原因 10
表3-1 問卷調查變項暨操作定義 23
表4-2 受訪者基本資料分布 32
表4-3 不同年齡層之教育程度分布 33
表4-4 不同年齡層之疾病分類分布 33
表4-5 兩週內服用藥物之基本資料 34
表4-6 過去兩週內服藥順從情形 35
表4-7 兩週內未依照醫囑服藥原因之疾病分類分布 36
表4-8 與醫療人員溝通情形 38
表4-9 與醫療人員藥物諮詢時間 39
表4-10 藥物資訊提供 40
表4-11 藥物資訊衝突來源 42
表4-12 藥物資訊項目 42
表4-13 取樣分析對服藥順從性【佳/不理想】分布之影響 44
表4-14 基本資料對服藥順從性【佳/不理想】分布之影響 45
表4-15 兩週內服藥基本資料對服藥順從性【佳/不理想】分布之影響 46
表4-16 與醫療人員溝通對服藥順從性【佳/不理想】分布之影響 48
表4-17 藥物資訊提供對服藥順從性【佳/不理想】分布之影響 49
表4-18 藥物資訊衝突對服藥順從性【佳/不理想】分布之影響 50
表4-19 藥物資訊項目對服藥順從性【佳/不理想】分布之影響 51
表4-19 服藥順從性與多變項分析 52
表4-20 就醫場所分層分析與服藥順從性分組之探討 55
表5-1 年輕族群和老年族群與醫療人員互動之比較 64
第二篇 臨床藥事服務
表3-1 管灌藥品注意事項 74


圖目錄
第一篇 國人服藥順從性與醫療人員互動影響因素之探討
圖2-1 健康信念模式(Health Decision Model) 6
圖2-2. Interaction Model of Client Health Behavior (IMCHB) 11
圖4-1 不同年齡層之服藥順從性分組分布 45
圖5-1 不同年齡層之藥物資訊衝突來源分布 60
圖5-2 重要性前三項與常說明的藥物資訊項目之分布 62
第二篇 臨床藥事服務
圖2-1 腸胃道餵食管投藥流程 73

參考文獻 1. Lars Osterberg MD, and Terrence Blaschke, M.D. Adherence to medication. N Engl J Med 2005 Aug 4;:. 2005;4(353(5)):487-97.
2. Ngoh LN. Health literacy: a barrier to pharmacist-patient communication and medication adherence. J Am Pharm Assoc (2003). 2009 Sep-Oct;49(5):e132-46; quiz e47-9.
3. American Pharmacists Association. Enhancing patient adherence: proceedings of the Pinnacle Roundtable Discussion. Highlights News Letter. 2004`;Oct:7.
4. Wagner D, Bear M. Patient satisfaction with nursing care: a concept analysis within a nursing framework. J Adv Nurs. 2009 Mar;65(3):692-701.
5. 吳孟芬. 服務情境中之溝通問題分析:以醫療服務為例. 國立中正大學企業管理學系論文 1996.
6. Shih 蔡W-CT龔P-TK翁R-HW石H-Y. 基層醫師與民眾之服務品質認知落差分析. 醫務管理期刊.5卷4期(2004/12):385-402.
7. 李炳鈺. 醫院門診病患用藥行為之相關因素探討. 2002
8. MacLaughlin EJ, Raehl CL, Treadway AK, Sterling TL, Zoller DP, Bond CA. Assessing medication adherence in the elderly: which tools to use in clinical practice? Drugs Aging. 2005;22(3):231-55.
9. Burkhart PV, Sabate E. Adherence to long-term therapies: evidence for action. J Nurs Scholarsh. 2003;35(3):207.
10. Boudes P. Drug compliance in therapeutic trials: a review. Control Clin Trials. 1998 Jun;19(3):257-68.
11. Svarstad BL. Measuring adherence in community pharmacies: opportunities and challenges. J Am Pharm Assoc (2003). 2005 Mar-Apr;45(2):127-9.
12. Svarstad BL, Chewning BA, Sleath BL, Claesson C. The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999 Jun;37(2):113-24.
13. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008 May;10(5):348-54.
14. Gatti ME, Jacobson KL, Gazmararian JA, Schmotzer B, Kripalani S. Relationships between beliefs about medications and adherence. Am J Health Syst Pharm. 2009 2009 Apr 1;66(7):657-64.
15. 馬先芝. 冠心症老年患者服藥遵從行為及其相關因素之探討. 成功大學護理學系碩博士班論文 2004
16. Gonzalez J, Williams JW, Jr., Noel PH, Lee S. Adherence to mental health treatment in a primary care clinic. J Am Board Fam Pract. 2005 Mar-Apr;18(2):87-96.
17. Veazie PJ, Cai S. A connection between medication adherence, patient sense of uniqueness, and the personalization of information. Med Hypotheses. 2007;68(2):335-42.
18. Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med. 1984 Feb;100(2):258-68.
19. Gwadry-Sridhar FH, Manias E, Zhang Y, Roy A, Yu-Isenberg K, Hughes DA, et al. A framework for planning and critiquing medication compliance and persistence research using prospective study designs. Clin Ther. 2009 2009 Feb;31(2):421-35.
20. 郭素青. 某區域教學醫院門診高血壓病患服藥遵從行為及其相關因素之探討 1998
21. 廖建彰等人 台灣地區民眾抗生素認知與用藥行為 . Accessed April10 2010, at http://www.publichealth.org.tw/paper/paper.php?pid=231
22. Mahone IH. Medication decision-making by persons with serious mental illness. Arch Psychiatr Nurs. 2004 Aug;18(4):126-34.
23. Kiesler DJ, Auerbach SM. Optimal matches of patient preferences for information, decision-making and interpersonal behavior: evidence, models and interventions. Patient Educ Couns. 2006 Jun;61(3):319-41.
24. Cox CL. The interaction model of client health behavior: application to the study of community-based elders. ANS Adv Nurs Sci. 1986 Oct;9(1):40-57.
25. Mathews SK, Secrest J, Muirhead L. The Interaction Model of Client Health Behavior: a model for advanced practice nurses. J Am Acad Nurse Pract. 2008 Aug;20(8):415-22.
26. Fuertes JN, Mislowack A, Bennett J, Paul L, Gilbert TC, Fontan G, et al. The physician-patient working alliance. Patient Educ Couns. 2007 Apr;66(1):29-36.
27. Ford S`, Schofield T`, Hope T. Are patients’ decision-making preferences being met? Health Expect 2003`;6:72–80.
28. Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009 Aug;47(8):826-34.
29. Lodwick AD, Sajbel TA. Patient and physician satisfaction with a pharmacist-managed anticoagulation clinic: implications for managed care organizations. Manag Care. 2000 Feb;9(2):47-50.
30. Murray MD, Young J, Hoke S, Tu W, Weiner M, Morrow D, et al. Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med. 2007 May 15;146(10):714-25.
31. Gu NY, Gai Y, Hay JW. The effect of patient satisfaction with pharmacist consultation on medication adherence: an instrumental variable approach. Pharmacy Practice (Internet). 2008 Oct-Dec;6(4):201-210.
32. Shah B, Chewning B. Conceptualizing and measuring pharmacist-patient communication: a review of published studies. Res Social Adm Pharm. 2006 Jun;2(2):153-85.
33. Maclean N, Pound P. A critical review of the concept of patient motivation in the literature on physical rehabilitation. Soc Sci Med. 2000 Feb;50(4):495-506.
34. Mercer LM, Tanabe P, Pang PS, Gisondi MA, Courtney DM, Engel KG, et al. Patient perspectives on communication with the medical team: Pilot study using the communication assessment tool-team (CAT-T). Patient Education and Counseling. 2008;73(2):220-3.
35. Shikiar R, Rentz AM. Satisfaction with medication: an overview of conceptual, methodologic, and regulatory issues. Value Health. 2004 Mar-Apr;7(2):204-15.
36. Horne R`, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999`;47(6):555–67.
37. Knobel H`, Carmona A`, Lopez LJ`, et al. Adherence to very active antiretroviral treatment: impact of individualized assessment [in Spanish]. Enferm Infecc Microbiol Clin. 1999`;17:78-81.
38. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA. 2002 Dec 11;288(22):2868-79.
39. Henry A, Batey RG. Enhancing compliance not a prerequisite for effective eradication of Helicobacter pylori: the HelP Study. Am J Gastroenterol. 1999 Mar;94(3):811-5.
40. Gibson PG, Powell H, Coughlan J, Wilson AJ, Hensley MJ, Abramson M, et al. Limited (information only) patient education programs for adults with asthma. Cochrane Database Syst Rev. 2002(2):CD001005.
41. Verdu F, Castello A. Non-compliance: a side effect of drug information leaflets. J Med Ethics. 2004 Dec;30(6):608-9.
42. Ownby RL. Development of an interactive tailored information application to improve patient medication adherence. AMIA Annu Symp Proc. 2005:1069.
43. 台灣醫療改革基金會 台灣醫療品質民意調查(Ⅱ)http://www.thrf.org.tw/uploads/%7B18A2EE22-148A-4898-ACC6-9EA4EE97C003%7D_醫療品質民調Ⅱ結果摘要.pdf.
44. 台灣醫療改革基金會籌備處醫療品質民意調查. http://www.thrf.org.tw/uploads/7BF86F3C53-00E1-4D7A-968F-2DF531FFA1C5%7D_891217醫療民調Ⅰ結果分析.pdf.
45. 陳育傑 林育貞 謝右文 提升門診藥局藥物諮詢服務之滿意度. The Journal of pharmacy 第20卷 第4期
46. 張家嫻 合理調劑量與藥事服務品質之探討. 國立成功大學臨床藥學所碩班論文 2006
47. 賴東(有邑) 社區藥局標準調劑作業模式與藥事照護之探討 國立成功大學臨床藥學所 2007.
48. Journal article by Doris Mcgartland Rubio MB-W, Susan S. Tebb, E. Suzanne Lee, Shannon Rauch; Social Work Research, Vol. 27, 2003.
49. 吳明隆 SPSS操作與應用問卷統計分析實務 2007.
50. 93年 中華景康基金會 社區用藥安全健康營造-社區藥事服務認養計畫.
51. 廖恩宜 探討中草藥之使用與健康及慢性疾病之關聯性 亞洲大學長期照護研究所論文 2009.
52. 94年 中華景康基金會 社區用藥安全健康營造-社區藥事服務認養計畫.
53. 陳育平 臺北地區民眾對藥師形象之認知及其影響因素 臺北醫學大學醫學人文研究所論文2006.
54. 董C-YT林F-LLW林C-CL林S-JL何Y-F. 民眾對醫院與社區藥局慢性病連續處方調劑服務的觀感. 臺灣醫學. 2008.
55. 行政院衛生署 藥物資訊網 Accessed June 8, 2010 at http://drug.doh.gov.tw/medication/index.html.
56. 台灣醫療改革基金會 Accessed June 8,2010 at http://www.thrf.org.tw/Page_Show.asp?Page_ID=902.
57. 台灣醫療改革基金會 Accessed June 10, 2010 at http://www.thrf.org.tw/Page_Show.asp?Page_ID=902.
58. 台灣醫療改革基金會 Accessed June 14, 2010 at http://www.thrf.org.tw/Page_Show.asp?Page_ID=1096.
59. 電子新聞 Accessed June 20, 2010 at http://www.epochtimes.com.au/b5/8/6/17/n2157743.htm.
60. Carpenter DM, Devellis RF, Fisher EB, Devellis BM, Hogan SL, Jordan JM. The effect of conflicting medication information and physician support on medication adherence for chronically ill patients. Patient Educ Couns. 2009 Dec 29.
61. 洪增陽 藥袋副作用標示-民眾需求之探討 臺灣大學衛生政策與管理研究所碩士論文 2007.
62. Horne R, Hankins M, Jenkins R. The Satisfaction with Information about Medicines Scale (SIMS): a new measurement tool for audit and research. Qual Health Care. 2001 Sep;10(3):135-40.
63. Newby DA, Hill SR, Barker BJ, Drew AK, Henry DA. Drug information for consumers: should it be disease or medication specific? Results of a community survey. Aust N Z J Public Health. 2001 Dec;25(6):564-70.
64. 王詩盈 老人的醫療自主性意願及其相關影響因素探討 臺灣大學護理學研究所論文 2009.
65. 吳佳蓉﹒陳清忠﹒葉忍莉. 老年患者服藥行為影響因素的探討 長庚護理雜誌 13(2) 166-174. 2002.
66. 台灣醫療改革基金會 Accessed June 13, 2010 at http://www.thrf.org.tw/elder/c_1.htm.
67. Trevena LJ DH, Barratt A, Butow P, Caldwell P. J Eval Clin Pract. Feb;12(1):13-23. A systematic review on communicating with patients about evidence.
68. Nicolson D, Knapp P, Raynor DK, Spoor P. Written information about individual medicines for consumers. Cochrane Database Syst Rev. 2009(2):CD002104.
69. Raynor DK, Blenkinsopp A, Knapp P, Grime J, Nicolson DJ, Pollock K, et al. A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines. Health Technol Assess. 2007 Feb;11(5):iii, 1-160.
70. Visschers VH, Meertens RM, Passchier WW, de Vries NN. Probability information in risk communication: a review of the research literature. Risk Anal. 2009 Feb;29(2):267-87.
71. Accessed June 13, 2010 at http://www.medscape.com/viewarticle/585397 .
72. Chou 張Y-WC高T-WK高S-YK羅C-HL周C-C. 居家照護之老年管灌病人不適合磨碎藥物的處方分析. 臺灣家庭醫學雜誌. (2009/03);Vol.19 No.1 (2009/03).
73. M. Christina Beckwith P. A Guide to Drug Therapy in Patients with Enteral Feeding Tubes: Dosage Form Selectionand Administration Methods. Hospital Pharmacy. 2004; 39(Number 3):225-37.
74. Williams NT. Medication administration through enteral feeding tubes. Am J Health-Syst Ph. 2008 Dec 15;65(24):2347-57.
75. National Health Service doncaster community healthcare Policy for the Management of Patients with an Enteral Tube Insitu 2010.

第二章臨床藥事服務參考資料
1. 藥品仿單
2. Handbook of Drug Administration via Enteral Feeding Tubes 2007
3. The electronic Medicines Compendium (eMC) contains information about UK licensed medicines.
4. 行政院衛生署西藥查詢系統
5. 藥師電子週刊 Accessed June 14, 2010 at http://ys34485257.ncc.to/1566/1566-5-2.htm
6. Micromedex
7. Williams NT. Medication administration through enteral feeding tubes. Am J Health Syst Pharm. 2008 Dec 15;65(24):2347-57.
8. National Health Service primary care trust. Administration of Medicines to Patients Who Have Difficulty Swallowing or Have A Percutaneous Endoscopic Gastrostomy (PEG) Or Naso-Gastric (NG)Tube Guidelines For Primary Care Health Professionals. 2008
9. 藥師電子週刊 Accessed June 14, 2010 at http://ys34485257.ncc.to/1565/1565-5-2.htm
10. National Health Service Colchester hospital university. NEEMMC Guidelines For Tablet Crushing And Administration Via Enteral Feeding Tubes Key To Drug Administration Guidelines. 2009
11. DailyMed
12. Medscape Accessed June 12, 2010. At http://www.medscape.com/viewarticle/585397_appendix3
13. National Health Service. Doncaster community healthcare. Management Of Patients With An Enteral Tube Insitu Policy 2010
14. 成大藥劑部網站



論文全文使用權限
  • 同意授權校內瀏覽/列印電子全文服務,於2015-08-23起公開。
  • 同意授權校外瀏覽/列印電子全文服務,於2015-08-23起公開。


  • 如您有疑問,請聯絡圖書館
    聯絡電話:(06)2757575#65773
    聯絡E-mail:etds@email.ncku.edu.tw