多重用藥評估與整合

10.6666/ClinMed.202003_85(3).0027

陳亮宇

多重用藥（polypharmacy） ； 過度用藥（excessive polypharmacy） ； 自備牛皮紙袋策略（brown bag method） ； 藥物整合（medication reconciliation）

臨床醫學月刊

85卷3期（2020 / 03 / 27）

143 - 148

繁體中文

多重用藥（polypharmacy）為常見老年症候群，意指平時使用處方藥物在5種以上，高齡族群盛行率約24-39%不等，並隨著多重共病與照護階段轉換情形逐年增加，導致整體醫療費用與服務成本逐年攀升。追藥反應（prescribing cascade）與醫療專業過度分工之穀倉效應（silo effect）被認為與多重用藥成形直接相關，常涉及潛在不適當用藥處方（potentially inappropriate medications），增加藥物不良反應與交互作用機會、錯誤處方、重複開立也不在少數，因而增加高齡族群死亡風險、失能與機構化、認知功能衰退、跌倒、與急性住院等不良健康預後。單一門診整合服務模式、定期藥物回顧整理、專業藥事服務、跨領域多專業團隊成員協助、搭配藥物資訊決策系統輔助，則是可能改善多重用藥的各個關鍵環節。如何於門診有限時間評估高齡族群多重用藥問題、提高病患遵囑性、改善個案生活品質、擬定照護服務計畫等，則需要評估用藥適應症、有效性、必要性等，並視實際狀態進行客製化調整，方能有效減輕多重用藥問題。

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