2017-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/648331摘要：潛在不適當用藥(potentially inappropriate medications, PIM)在所有臨床場所皆會發生，改善用藥安全已成為重要的議題，資訊科技產品可協助醫療專業人員預防病人潛在不適當用藥及藥物不良事件。本研究為3 年期研究計畫分三階段進行。第一階段為質性研究設計，採用焦點團體訪談法，以半結構式訪談指引居家護理師對於老人用藥護理指導的現況與困境、使用科技資訊之經驗、以及期望用藥安全科技輔助工具之內容與功能需求，所得結果以內容分析法分析及歸類資料。第一階段的結果合併PIM-Taiwan Criteria 和相關網路資源做為設計開發「雲端藥你安心E 點通」應用程式(application, APP)之基礎。第二階段為設計開發、測試與驗證APP 之穩定性，以科技接受模式測試此APP 之穩定性，採描述性及相關性研究設計，透過自擬結構性問卷，包括基本特性、認知有用性、認知易用性、使用態度、使用行為意圖等，驗證其相關性，預計收集52 位居家護理師使用APP 執行藥物審查，預計收集156 筆藥物審查資料，瞭解居家護理師對此APP 使用之正確性及看法。第三階段為實驗性研究設計，以此APP 作為護理師藥物審查、PIM 辨認及護理指導之輔助工具，採機構群集選樣法，隨機指派實驗組與控制組，透過結構性問卷收集前測、後測及追蹤後測資料，包括基本特性、疾病特性、PIM-TaiwanCriteria、健康相關生活品質、以及護理人員用藥審查及護理指導自信度問卷等，預計收案及追蹤兩組各95 位老年病人用藥狀況。所得資料以SPSS 20.0 套裝軟體編碼和輸入資料，以描述性統計及推論性統計，如獨立t 檢定、單因子變異數分析、皮爾森積差相關、和一般線性模式之廣義估計方程式等進行分析。預期本研究結果可了解居家護理師用藥護理指導科技輔助工具的需求，完成APP 開發、測試及驗證，並用以協助護理師進行老人用藥審查、PIM 辨認和提供相關護理指導，藉此瞭解及改善老人PIM 與其不良的健康結果，並作為延伸運用至其他醫療場所及設計介入研究之依據。<br> Abstract: Potentially inappropriate medications (PIM) prescription is common and improving medication safetyhas become one of the major issues in all clinical settings. Information technology (IT) plays an importantrole to prevent adverse drug events (ADEs) and PIM. This 3-year research proposal will be conducted inthree phases. In the first phase, qualitative research design will be used. Focus group interviews bysemi-structured interview guide will be used to understand home care nurses’ opinion regarding medicationreview, medication education, experiences in information technology, needs and expectations for IT productsin assisting medication safety in older adults. All the interview data will be transcribed verbatim. Contentanalysis will be used to categorize the information. In the second phase, based on Taiwan PIM criteria,related internet resources, and research findings from the first phase will be used for design and develop themedication safety application (APP). Testing the stability and validation of APP will be conducted bydescriptive and correlational study through Technology Acceptance Model (TAM). Based on TAM,structured questionnaires, including Perceived Usefulness, Perceived Ease of Use, Attitude toward Using andBehavioral Intention to Use, will be used for data collection after home care nurses have used the APP formedication review. Fifty-two home care nurses will be recruited with 156 medication reviews by APP will becollected. In the third phase, experimental design with cluster randomization of home care facilities intoexperimental and comparison groups will be used. Home care nurses use the new developed APP as assistedtool to provide medication review, recognition of PIM and providing medication education. Structuredquestionnaires, including demographic and disease-related information, PIM-Taiwan Criteria, Health-relatedQuality of Life (SF-12) and Efficacy of Medication Review and Education will be used for data collection inthree time points: baseline, 3-month post intervention, and 6-month post intervention, to understand theeffectiveness of the APP-assisted intervention in decreasing PIM. In each group, 95 elderly patients and theirmedication reviews will be collected. All the quantitative data will be coded and entered to the computersystem. Statistical analysis will be carried out with SPSS 20.0 software package. Both descriptive andinferential, such as independent t test, one-way ANOVA, Pearson product moment correlation and GEE willbe used to analyze data. The results will help to understand the nurses’ needs of IT. The newly developed andvalidated APP will be used as a useful tool in assisting nurses for medication review, early recognition ofPIM and prevention of adverse health outcome. Furthermore, the results of the study would be used in othercare settings or to set up intervention program for PIM.潛在不適當用藥應用程式科技接受模式健康相關生活品質老年病人potentially inappropriate medicationsapplicationtechnology acceptance modelhealth-related quality of lifeelderly patient