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 160 200 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) 2013 7 25 CDE (certified diabetes educator) 2014 6 shared care CDE 壹 背景 (International Diabetes Federation, IDF) 2013 3 8 2 2035 5 9 2 3 40-59 ( ) 1 46% 25% 160 25% 200 2013 12 23,373,517 2 8.56% 11 1 10 5 3 4.3 4-7 30 1 藥學雜誌第 118 冊 15
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 8,754 4 36 / 3 5 54% (< 7%) 34.5% ( ) ( ) ( ) (diabetes shared care model) 1953 Walker (patient-centered care model) 1960 mini-clinic 1970 1990 Hepler Strand (pharmaceutical care) clinical pharmacy) 1997 (collaborative drug therapy management, CDTM) (National certification board for diabetes educators) 2008 (CDE) 4.5% 7 6 624% A1C (< 7%) 1/3 / / / 4,7 2008 (medication-therapy management) (pharmacist current procedural terminology codes) 3 APhA 16 THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.1
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 () 10-12 2006 2006 2013 201 13 2013 7 25 ( ) 附錄一國健署認證基準公告 92 1 23 95 7 1 102 7 25 ( ) 1. 4 2. ( ) 4 1 4 ( ) ( ) 2.5 ( 5 ) 4 ( ) ( ) 2.5 ( 5 ) 4 ( ) ( ) 1.5 ( 3 ) 4 30 1 藥學雜誌第 118 冊 17
綜合評論 Commentary ( ) ( ) 3 6 ( ) 48 ( ) 72 ( ) 6 ( ) 參 相關給付制度 13 500 1000 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 4 1 4 * 4 1.5 4 2.5 4 2.5 * 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
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
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. ( ) 102 12 8 15 22 29 2. 103 2 15 16 3 1 2 3. 103 3 23 30 4 6 13 4. 103 4 13 20 27 5 4 誌謝 ( ) 參考資料 : 1. IDF-Atlas: 2013-12-01 http://www.idf.org/diabetesatlas 2. 2013-12-01 http://sowf.moi.gov. tw/stat/month/list.htm 3. : 2013-12-01 http://www.mohw. gov.tw/cht/dos/statistic.aspx?f_list_no=312&fod_list_ no=2747 4. Smith, M. Pharmacists' Role in Improving Diabetes Medication Management. Journal of Diabetes Science and Technology (2009) 3: 175-179. 5. 1565 2013 12 1 http://www.taiwan-pharma.org. 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): 25-27. 7. 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: 1. 8. American Pharmacists Association. The Pharmacist & Patient-Centered Diabetes Care. Retrieved Dec 1, 2013 http://www.pharmacist.com/pharmacist-patient-centereddiabetes-care) 9. Canadian Pharmacists Association. Diabetes Strategy for Pharmacists Retrieved Dec 1, 2013 http://www.pharmacists.ca/index.cfm/education-practice-resources/professional-development/diabetes-strategy-for-pharmacists/ 10. 2 2002; 2-79 11. 2006; 16-19 12. 98 2010 13. 103 2012013 12 1 http://www.tade.org.tw/place/health.asp 20 THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.1
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, 2013. 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