運用多元策略提升精神科日照中心個案完全自主服藥率

Applying Multiple Strategies to Increase the Rate of Total Self-administration of Medication in a Psychiatric Daycare Center

10.6540/NTJN.202209_24(2).0008

吳皇進(Huang-Chin Wu)；張佩琳(Pei-Lin Chang)；蔡瑞貞(Jui-Chen Tsai)；林雨君(Yu-Chun Lin)；陳瑞(Ruey Chen)

自主服藥 ； 提醒機制 ； 創意性藥物團體 ； self-administration of medication ； reminder system ； creative group activities

新臺北護理期刊

24卷2期（2022 / 09 / 01）

83 - 95

繁體中文

精神科病人以藥物治療為主，不遵從醫囑服藥將導致疾病復發，反覆至精神科急性病房住院，增加醫療成本及家庭負擔。2020年1月本日間照護中心病人完全自主服藥率僅有30%，主要問題為缺乏服藥提醒機制及藥物訓練作業流程、病人不清楚藥物作用及病識感差、衛教內容及教材不符合病人需求、缺乏合適的藥典查詢設備，經本專案進行多元策略，發展提醒機制、創意性藥物團體、個別性藥物衛教及藥物訓練，進而改善病人藥物認知及服藥觀念，使完全自主服藥率大幅由30.0%提升至61.7%，遠超過專案目標值55.3%，目標達成率111.6%，顯示運用多元策略能有效改善病人自主服藥管理歷程，提升服藥遵從性，穩定病情，避免疾病復發，強化自我價值，促使病人及早回歸社會。

The pharmacological treatments offering to the psychiatric patients in the daycare unit are indispensable parts of therapeutic intervention. Poor compliance is linked to disease recurrence and repeated admission to the acute psychiatric ward, causing increased medical expenses and care burden. In 2020/1, the rate of total self-administration of medication in our daycare unit reached only 30%. The principal problems were the absence of a reminder system and compliance training, the lack of insight and understandings concerning drug effects, and the ineptitude of current psychoeducation materials and no available access to pharmacopoeia. Our project used multidisciplinary interventions such as a reminder system, creative group activities, individual psychoeducation, and drug compliance training to improve patients' understandings toward medication. The results show that the rate of total self-administration of medication augmented from 30.0% to 61.7% (which exceeded the target of 55.3%). These findings indicate that using multidisciplinary intervention strategies is related to improved drug compliance, stabilized disease condition, reinforcement of self-efficacy, and better social integration.

1. 林姵妘,林淑華,林筱芳(2017)。運用創意衛教模式提升血液透析病人對高磷飲食之認知。臺灣腎臟護理學會雜誌，16(2)，44-58。
   連結：
2. 陳倩妮,程碧君,羅麗華(2018)。急性病房思覺失調症病人藥物認知提升專案。若瑟醫護雜誌，12(1)，54-69。
   連結：
3. 黃雅惠,高薏茹,曾素美,黃慈心(2015)。提升慢性精神科住院病人服藥結盟行為之改善方案。長庚護理，26(3)，301-315。
   連結：
4. Semahegn, A.,Torpey, K.,Manu, A.,Assefa, N.,Tesfaye, G.,Ankomah, A.(2020).Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis.Systematic Reviews,9(1),1-18.
5. Teng, Y. C.(2019).Effect of board game activities on cognitive function improvement among older adults in adult day care centers.Social Work in Health Care,58(9),825-838.
6. Velligan, D. I.,Sajatovic, M.,Hatch, A,Kramata, P.,Docherty, J.P.(2017).Why do psychiatric patients stop antipsychotic medication? A systematic review of reasons for nonadherence to medication in patients with serious mental illness.Patient Prefer Adherence,11,449-468.
7. 洪采婕,李慧娟,汪麗真(2020)。幼兒園推動戶外翻轉課程之實踐與省思。長庚科技學刊，32，1-23。
8. 許斐筑,陳靜嫻,王譯鳳(2016)。運用賦權於一位慢性思覺失調症病人照護。秀傳醫學雜誌，15(3&4)，99-110。
9. 衛生福利部統計處（2020，8月31日）・身心障礙者人數按障礙成因及類別分。https://dep.mohw.gov.tw/DOS/cp-2976-61122-113.html