國立中山大學學位論文典藏.PDF

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雨划讷殷富察
7 years ago
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1 A Study on Active Status about community pharmacist after the Separation of Prescribing and Dispensing

2 i

3 Abstract This research aims to study the current situation of the community pharmacists services, such as the collaboration mode with hospitals and medical institutes corresponding to the Separation of Prescribing and Dispensing (Separation of P&D) in Taiwan and prescription dispensing policies, the service orientation, and the operation results in Kaohsiung City, where the Separation of P&D was implemented as early as March Furthermore, this research also aims to understand the cognition of the community pharmacists upon Pharmaceutical Services and their service orientation. It was discovered from 67 effective samples that the amount of prescriptions dispensed to those registered National Health Insurance (NHI) pharmacies were still few, hence the current situation of Separation of P&D is not that satisfying. In addition, the amount of prescriptions dispensed to community pharmacies joining the NHI were significantly more than those who did not join. Moreover, as far as for those registered NHI pharmacies collaborating with hospitals and medical institutes are concerned, the opportunity for them to receive prescriptions is far from those registered NHI pharmacies that did not collaborate with hospitals and medical institutes. The amount of prescriptions dispensed has a significant and positive correlation to the increasing of pharmacy business. In light of this, it can be said that the collaboration mode between registered NHI pharmacies and hospitals and medical institutes helps with the implementation of the Separation of P&D. The cognition of pharmacist s practicing can be divided into five categories according to factor analysis, and they are; Health Maintaining, Health Enhancing, Pharmaceutical Professional Service, Pharmaceuticals Management, and Specialists Consultation. This research discovered that when the practicing credential is a pharmacist instead of pharmaceutical student, the service cognition on health maintaining, health enhancing, pharmaceutical professional service, and specialist s consultation were ii

4 significantly different. The cognition of a pharmacist upon health enhancing and pharmaceuticals control showed significant and positive correlation to his/her business volume. Although the Separation of P&D has been implemented for over six years, and most of the regions in this country have conformed to the P&D separation regulations and the business has been carried out, the outcomes have not met the expectation, and the medicine circle alone cannot solve such problem. It needs a comprehensive consideration and review to effectively implement the existing policies. Keywords: Separation of Prescribing and Dispensing, community pharmacy, dispensing prescription, pharmacist s cognition on practicing iii

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6 Barbara(1986) t v

7 102 ( ) ( 1997) ( 1998) 1

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14 (Sheryl L. Joseph L Johan. J 2000)) (Johan. 2000) ( ) (self-medication) (health-promotion programs) (WHO) ( 2000) 1. ( ) 2. 8

15 3. 4. ( ) 5. (pharmacy practice) 6. ( ) 7. ( (pharmacy practice) ) ( diabetes cholesterol) 11. ( AIDS )

16 (Barbara A,1986) 10

17 ( ) ( ) ( 1994) ) ( 11

18 (Galt, K.A.,1995 Marlene, Z.B.,1990) (Moss R.L.,1980 Earle KA.,2001 ) (Ruth,1994) (Gallagher,1983 Gilbert, 1998) 12

19 (1997) (1997) ( 1998) Jan D. H(1995) Jane P.G. Norman.V.C. (1982) 13

20 ( ) ( ) ( ) ( )

21 ( ) ( ) ( ) ( ) (Dennis,H. T.,1991) 15

22 (patient oriented) (one-stop-shopping) (1997) ( ) ( ) ( ) 16

23 (Ray, E.,1992 Christine, M.B.,1993) ( 1997) ( ) ( 1997 Marvin D.S.,1995) 17

24 (1995) Barbara (1986) 20 ( ) ( ) 7. ( )

25 ( ) (TPN) (IV) Barbara(1986)

26 2-4-1 Barbara(1986) (T E ) ( ) 11E (0.76) 17E (0.76) 18E (0.72) 10E (0.68) 20E (0.54) (0.46) 3E 7T 6T 4T 8T 9T 5T 2T 1T ( ) (0.59) ( ) (0.59) (0.48) (0.45) (0.36) (0.32) (0.32) 13T (0.71) 12T (0.60) 19E (0.58) 14E (TPN) (IV) (0.58) 15E (0.43) 16E (0.42) (0.62) L.Gilbert( 1998) ( )

27 ( ) Donald.(1973) ( ) ( ) ( ) ( ) ( ) ( ) 21

28 ( ) ( ) ( ) ( ) Donald(1973) Barbara(1986) Donald(1973) L.Gilbert(1998) (Richard,P.P.,1983) 22

29 ( ) Donald(1973) L.Gilbert(1998) Barbara(1986) (T)* (T) (T) (T) (T) (T) (T) (T) (T) (T) (T) (T) (T) (T) (T) (T) (T) (T) (T) (T) (T) (T) (T) (T) *(T)

30 (deprofessionalization) (1997) 0.09% ( ) (1997) (1997) (1997) ( 1997) 30 ( ) 24

31 ( ) ( 1997) ( 25

32 ( ) ( ) ( )

33 H1 H1-1 H1-2 H1-3 H1-4 H2 H2-1 H2-2 H2-3 H2-4 H2-5 H3 H3-1 H3-2 H3-3 H3-4 H3-5 H3-6 H3-7 27

34 H3-8 H3-9 H3-10 H3-11 H3-12 H4 H4-1 H4-2 H4-3 H4-4 H4-5 H4-6 H4-7 H4-8 H4-9 H4-10 H4-11 H4-12 H4-13 H4-14 H

35 H5 H5-1 H5-2 H5-3 H5-4 H5-5 H5-6 H5-7 H5-8 H5-9 H5-10 H6 H6-1 H6-2 H6-3 H6-4 H6-5 H6-6 29

36 (>25%) (<25%) (>25%) 30

37 ( ) 31

38 = 2= 3= 4= 5= 1= (>25%) 2= (<25%) 3= 4= (<25%) 5= (>25%) 1= 2= 3= 4= 5= 6= 7= 8= 9= 10= ( ) 1= 2= 3= 4= 5= ( ) 1= 2= 3= 4= 5=

39 ( 1) 1= 2= 1= 2= 3= 1= 2= 3= 4= 5= ( ) ( / ) 1=<5 2=6~10 3=11~15 4=16~20 5=21~25 6=>26 1= 2= 3= 4= 1= 2= 3= 4= ( ) 1= 2= ( ) 3= 1= 2= 3= 4= 5= ( )

40 ( 2) 1= 2= 3= 4= 5= 6= 7= 8= ( ) 1= 2= 3= 4= 5= ( ) 1= 2= 3= 1= 2= 3= 1= 2= 3= 4= 5= 6= 7= 8= 9= 10= 11= 1= 2=

41 3-4-1 ( 3) ( ) ( ) 1= 2= 1= 2= 3= 4= 1= 2= 3= 1= 2= 1= 2= 3= 4= ( ) 5= 6= 7= 20 Adamcik L.Gilbert Donald

42 ( 20%) 67 (15.2%) 36

43 SPSS For Windows 9.0 (Reliability Analysis) Cronbach Cronbach (Descriptives Statistic Analysis) ( ) ( ) ( ) (Factor Analysis) t (t-test) ( ) (Correlation Analysis) 37

44 ( ) (Spearman) (Logistic Regression) 38

45 t %(27 ) (10.5% 4 ) (5.3%2 ) %(27 ) 28 ( %) (9 25.0%) (6 16.7%) (4 12.9%) 28 (73.7%) 10 (26.3%) ( ) 10 5 ( ) 19 (42.2%) 18 (40.0%) 39

46 8 (17.8%) ( %) ( %) ( %) (79.0%) 13 (34.2%) ( ) 5 (13.2%) 18 (47.4%) ( %) ( %) (9 14.5%) (8 22.2%) 40

47 4-1-1 (n) % (38case) (38case) (38case) < ~ ~ ~ ~ > (38case) (38case) (n) % of response % of total case

48 4-1-3 (n) % (n) % of response % of total case (38case) (38case) (38case)

49 4-1-5 (38case) (n) % of response % of total case (73.1%) 6 (19.4%) 2 (3.0%) 11 (>11 57 ) ( %) ( %) ( %) ( %) 15 (22.7%) (47 ) (42 ) (40 ) (36 ) (53 ) (32 (25 ) 43

50 ( ) (n) % ( )

51 (67case) (n) % of response % of total case (67case) (67case) (46.2%) 14 (20.9%) 45

52 16 (23.9%) 25% 24 (35.8%) 11 (16.4%) 25% (n) % >25% <25% <25% >25%

53 79.1% 7 39 (58.2%) (n) % ( )

54 4-1-9 ( 1) (n) % ( ) %(48 ) 23.9%(16 ) ( %) 13 (19.4%) ~60 48

55 (n) % (67case) (n) % of response % of total case

56 (67case) (n) %

57 20 (Varimax) ( 1 ) Cronbach` Cronbach` ( ) Cronbach` Cronbach` ( ) Adamcik Barbara A Cronbach`

58 4-2-1 ( ) % ( ) ( )

59 r=0.845 P=0.000 (P<0.01) ( ) (Addo ratio =15.85) ( Spearman) 0.845* ** ** **P<0.01 *P<

60 4-3-2 t (n) t P ** **P< Model 1(B) Model 2(B) Exp( ) ( ) ( ) * * ( ) ( ) ( ) ( ) LL % 82.50% *p<0.05, **<0.01 t 54

61 4-3-4 t-test (n) t P ** **P< * 0.466** **p<0.01 *P<

62 ( ) * *P<

63 57

64 4-4-1 (t-test) (n) t P *

65 4-4-1 ( 1) (n) t P * ** * P<0.05, **P<

66 4-4-2 (t-test) (n) t P * ** *

67 4-4-2 ( 1) (n) t P **

68 4-4-2 ( 2) (n) t P * P<0.05, **P< (Spearman) 1 a a ** **.659** **.660**.452** **.677**.508**.554** b.449** *.528**.331**.555**.448**.483** **.522**.311*.302* ** **.527**.370*.747**.540**.383**.610**.468** * **.411**.539**.644**.311**.447** * * ** a * P<0.05, **P<0.01 b

69 4-4-4 (Spearman) 1 1 d * **.399** * d 1~

70 1/3~1/5 ( 410 ) 141 (34.4%) 660 ( ) ; 1/ % 64

71 30 ( ) 65

72 66

73 45 logo 67

74 68

75 5-1-1 > > 69

76 5-1-3 > >

80 74

81 . 82 ( 20%) 67 (15.2%)... 0~ Logistic regression >5 <5. 75

82 p p Vol17 No.1 p /03 p

83 p /99 p Sheryl, L. Joseph, L.(1984).Identifying the Pharmacist s Professional Status. American Pharmacy Vol.NS24,No9 September60-63 Barbara, A.A.(1986). New clinical roles for pharmacists A study of role expansion. Soi. Sci. Med.Vol.23, No11, p Dennis, H.T.(1991). Marketing to the mature population, part 2 :Developing marketing strategies. American Pharmacy Vol.NS31. No.2 February52-59 Donald, C.B.,James,E.K.& Albert,I.W.(1973). Expanded roles for pharmacists American. Journal of Pharmaceutical Education p KA. Earle. & P Taylor. & S Wyatt. & S Burnett. & J Ray. (2001). A physician-pharmacist model for the surveillance of blood pressure in the community a feasibility study. Journal of Human Hypertension 15, Galt, K.A.(1995).The key to pharmacist prescribing Collaboration American Journal of Health-System Pharmacy volume52(15) August ) 77

84 Jan D. H., Jean P.G. & Ruth C.( 1990 ). Value of Pharmacy Services Perception of Consumers Physicians and Third Party Prescription Plan Administrators American Pharmacy vol NS30 NO.3 March p20-25 Jane P. G. & Norman V.C.(1982). A strategy for marketing pharmacy services American Pharmacy Vol.1 January Johan J.G.( 2000).Clinical pharmacy in primary care and community pharmacy Pharmacotherapy.20(10 pt 2):278s-281s Christine M. B.(1993). The interface between the community pharmacist and patient. BMJ. Vol March K.F.Gallagher.(1983). General practitioner and the pharmacist British Medical Journal Volume Aaugust L.Gilbert.(1998).Pharmacy s attempts to extend its roles A case study in South Africa Soi. Sci. Med.Vol.47,No2 p L. Gilbert (1998). Dispensing doctors and prescribing pharmacists : A South African perspective Soi. Sci. Med.Vol.46,No1 p83-95 Marlene Z.B.(1990). Clinical pharmacy services improve patient care and reduce costs. American Pharmacy Vol.NS30. No 4 April Marvin D.S.( 1995). Defining and Marketing Value Added Services. American Pharmacy. vol NS35 NO.1 p46-53 Moss R.L.,Garnett W.R., Steiner K.C.( 1980). Physician attitudes toward pharmacists counseling patients on adverse drug reactions. American Journal of Hospital Pharmacy.37(2) 24-37, Feb. ) Richard P. P.(1983). Expanded roles for pharmacists Have we gone too far American Pharmacy Vol.NS23. No 12 December 78

85 Ruth D., Hodge M.M.& Murphy B.(1994). Patient drug education. Improving the working relationship between general practitioners and pharmacists. Australian Family Physician Vol. 23, No 8, August. 79

86 ( ) ( ) I

87 ( 1) (TPN) (IV) II

88 ` ( ) III

89 (TPN) (IV) IV

90 1. ( 10 ) 2. ( / ) <5 6~10 11~15 16~20 21~25 > ( ) ( ) 7. ( ) 8. ( ) (>25%) (<25%) (<25%) (>25%) 12. ( ) ( (5) 6 ) V

91 14. ( ) ( ) ( ) VI

92 VII

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