綜合評論 Commentary 6,7 (American college of 圖一 IDF 公布 2013 年全球 20~79 歲糖尿病輿圖 (IDF-ATLAS) Fisher 6 8, / % (< 7%) 34.5% ( ) ( ) ( ) (diabetes

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1 Commentary 綜合評論藥師加入糖尿病共同照護東安藥局藥師陳淑謐摘要 Fisher 6 8,754 95% (Diabetes Shared Care System) 1990 Hepler and Strand (patient-centered care model) highly accessible (Taiwan Association of Diabetes Educators; TADE) CDE (certified diabetes educator) shared care CDE 壹背景 (International Diabetes Federation, IDF) ( ) 1 46% 25% % ,373, % 藥學雜誌第 118 冊 15

2 綜合評論 Commentary 6,7 (American college of 圖一 IDF 公布 2013 年全球 20~79 歲糖尿病輿圖 (IDF-ATLAS) Fisher 6 8, / % (< 7%) 34.5% ( ) ( ) ( ) (diabetes shared care model) 1953 Walker (patient-centered care model) 1960 mini-clinic Hepler Strand (pharmaceutical care) clinical pharmacy) 1997 (collaborative drug therapy management, CDTM) (National certification board for diabetes educators) 2008 (CDE) 4.5% % A1C (< 7%) 1/3 / / / 4, (medication-therapy management) (pharmacist current procedural terminology codes) 3 APhA 16 THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.1

3 8 (Canadian pharmacists association, CPhA) - 9 貳我國糖尿病共同照護歷史沿革 1990 ( Banting ) 1991 () 1996 (shared care) 2001 () ( ) 附錄一國健署認證基準公告 ( ) ( ) ( ) ( ) 2.5 ( 5 ) 4 ( ) ( ) 2.5 ( 5 ) 4 ( ) ( ) 1.5 ( 3 ) 藥學雜誌第 118 冊 17

4 綜合評論 Commentary ( ) ( ) 3 6 ( ) 48 ( ) 72 ( ) 6 ( ) 參相關給付制度 P1407C 650 / 1 P1408C 200 / 3 P1409C 800 / 1 肆如何取得團隊衛教人員資格 ( 以藥師為例 ) ( TADE) ( ) 表一取得共照網醫事人員資格方式 () () CDE * * 32 伍藥師角色 APhA shared care model 7 (AADE 7 self-care behaviors ) 18 THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.1

5 藥師加入糖尿病共同照護附錄二共照網 CDE 健康促進機構-醫療給付人分為初診及複診藥師實際上可執行譚延局即可取得共照網證照但限於藥師一處輝執行長設計之醫藥間轉介及回覆單張而職業法規若為獨立藥局則目前尚無法成為予以靈活運用機構成員之一此難題我相信全聯會於陸我們的契機及未來規劃今年7月前將戮力解決未取得 CDE 證照之藥師可於修習32小時的學分後 (上課時間截至2013年7月全台已取得 CDE 證書表附錄四) 向該地衛生局報名參加電腦共有4,394人藥師132位 (3%) 對照國外藥筆試 (成績會當場得知一年二次) 並進一師占所有 CDE 4.5%的比例我們仍偏低步完成實習及修習4小時的照護管理課程藥師考照通過率和醫師相近我們可將目即可取得證照藥師專業是核心態度更是標人數放在和醫師占會員比例相同 (3% vs. 價值所在用心且謙卑地向其他專業學習 15%) 尚有3倍的成長空間領照人數 (132 鼓勵積極參加剩餘的3場藥師核心課程會是人 vs. 747人) 尚有5-6倍成長空間 (附錄三) 第一步驟若企業要10倍速成長關鍵絕對是我們鼓勵所有已取得 CDE 的藥師今年起在於開源藥界也是現在這個舞台需要藥可直接加入共照網無須再修習4小時的照師積極的投入護管理課程建議藥師儘速聯繫當地衛生基層院所不易同時聘僱營養師及護理第 30 卷第 1 期藥學雜誌第118冊 19

6 綜合評論 Commentary certificated credentialing 附錄三各專業人員取得 CDE 分布圖附錄四各地區藥師核心開辦課程時間 1. ( ) 誌謝 ( ) 參考資料 : 1. IDF-Atlas: tw/stat/month/list.htm 3. : gov.tw/cht/dos/statistic.aspx?f_list_no=312&fod_list_ no= Smith, M. Pharmacists' Role in Improving Diabetes Medication Management. Journal of Diabetes Science and Technology (2009) 3: tw/education/index.php?menu=weekly 6. Campbell, K. Focus on the front line: the role of pharmacists in diabetes care. Diabete voice 2005: 50(4): Palaian, S., Chhetri, A., Prabhu, M., Rajan, S. and Shankar, P. Role Of Pharmacist In Counseling Diabetes Patients. The Internet Journal of Pharmacology, 2004: 4: American Pharmacists Association. The Pharmacist & Patient-Centered Diabetes Care. Retrieved Dec 1, Canadian Pharmacists Association. Diabetes Strategy for Pharmacists Retrieved Dec 1, ; ; THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.1

7 藥師加入糖尿病共同照護 Pharmacist Joining in Diabetes Shared Care Shu-Mi Chen Dong-An Pharmacy Abstract NHI proclaimed that there are 160 million people taking DM medicines. Plus the undiagnosed, an estimated 200 million people suffered from diabetes. Fisher mentioned that even though DM patients meet their doctors up to 6 hours each year, an additional 8,754 hours are required by the patients themselves. Due to the complexity of this treatment for diabetics by themselves estimating as high as 95%, the situation was addressed. The Department of Health promoted by physicians, dietitians and nurses, led diabetes into a shared care system, however, pharmacists were not included. In 1990, Hepler and Strand created a "pharmaceutical care" term, emphasizing direct care (patient-centered care model) to the patient. This presented a landmark article being published. It also launched the concept of pharmacists in collaboration with other health care teams. Pharmacists in medication therapy, however, is highly accessible and professionally trained, to provide pharmaceutical care to patients. TPA and TADE cooperate closely to bring about the Department of Health enactment for the new system (diabetes shared care network medical personnel certiﬁcation criteria) on July 25, The pharmacists involved in diabetes care established a new milestone. The Pharmacists Association has actively pursued education and training. Also, encouraging pharmacists to join in the network and acquire CDE qualiﬁcation. They hope Taiwan pharmacists will be ready in June 2014! 第 30 卷第 1 期藥學雜誌第118冊 21

( s y s t e m ) ( s t r e s s ) (stress model) ( s y s t e m ) [ ] [ 5 ] C o x [ 3 ] 1 [ 1, 2 ] [ 6-8 ] [ 9 ] Tw Fam Med Res 2003 Vol.1 No.1 23

( s y s t e m ) ( s t r e s s ) (stress model) ( s y s t e m ) [ ] [ 5 ] C o x [ 3 ] 1 [ 1, 2 ] [ 6-8 ] [ 9 ] Tw Fam Med Res 2003 Vol.1 No.1 23 1, 4 1, 2 3 1 4 1, 2 1977 E n g e l 1999 5 1 ( 1 ) ( 2 ) ( 3 ) ( 4 ) ( 5 ) 2003 1 2 2-32 stress model, stress analysis [ 1 ] ( p s y c h o g e n e s i s ) (holism) (biomedical model) ( r e d u c t i o

綜合評論 Commentary 6,7 (American college of 圖一 IDF 公布 2013 年全球 20~79 歲糖尿病 輿圖 (IDF-ATLAS) Fisher 6 8, / % (< 7%) 34.5% ( ) ( ) ( ) (diabetes

綜合評論 Commentary 6,7 (American college of 圖一 IDF 公布 2013 年全球 20~79 歲糖尿病輿圖 (IDF-ATLAS) Fisher 6 8, / % (< 7%) 34.5% ( ) ( ) ( ) (diabetes