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系統識別號 U0007-2007201118001100
論文名稱(中文) 藥師介入對於愛滋病感染者服藥順服性及用藥安全的影響
論文名稱(英文) The Impact of Pharmacist’s Interventions on Human Immunodeficiency Virus Infected Patients’ Adherence and Drug Safety
校院名稱 臺北醫學大學
系所名稱(中) 藥學研究所
系所名稱(英) Graduate Institute of Pharmacy
學年度 99
學期 2
出版年 100
研究生(中文) 楊欣瑜
研究生(英文) Yang-Hsin Yu
電子信箱 greendream129@gmail.com
學號 M301098003
學位類別 碩士
語文別 中文
口試日期 2011-07-05
論文頁數 89頁
口試委員 委員-河蘊芳
委員-陳世銘
指導教授-簡淑真
中文關鍵字 藥師  人類免疫缺乏病毒  高效能抗愛滋病毒治療  藥品持有率 
英文關鍵字 pharmacists  human immunodeficiency virus(HIV)  highly active antiretroviral therapy(HAART)  medication possession ratio(MPR) 
學科別分類
中文摘要 國內外文獻皆證實高效能抗愛滋病毒治療(highly active antiretroviral therapy, HAART)降低了愛滋病感染者的死亡率,使愛滋病轉變為一種慢性疾病。高效能抗愛滋病毒治療需達到95%以上的服藥順服性以減少病毒學失敗率,然而不同文獻卻指出愛滋病發病者的實際服藥順服性只有40-93%。本研究旨在評估藥師介入對愛滋病感染者服藥順服性及用藥安全的影響
研究醫院從2009年2月5日開始提供愛滋病感染者醫療服務,目前門診愛滋病感染者已達235位,其中83位正在接受高效能抗愛滋病毒治療。本研究從2010年9月15日至2011年5月31日,在研究醫院納入年滿十八歲且初次或正在接受HAART之愛滋病感染者。研究期間共29位個案納入研究分析,藥師主動提供藥事服務後,依藥品持有率(medication possession ratio, MPR)評估愛滋病感染者服藥順服性、同時評估用藥正確知識,並記錄潛在藥物交互作用及藥物不良反應。
本研究顯示藥師介入後,愛滋病感染者服藥順服性、用藥正確知識程度皆有顯著改善,且降低潛在藥物交互作用、副作用的發生率。
英文摘要 Many studies revealed that highly active antiretroviral therapies(HARRT) decrease mortality of HIV-infected patients and make the infection becoming a chronic condition. HAART requires 95% or greater adherence to minimize the risk of virologic failure. However the adherence varies between 40% to 93% in the literature. This study is aimed to assess the impact of pharmacist’s interventions on HIV-infected patients’ adherence and drug safety.
The hospital where this study conducted started medical care for AIDS patients since February 5, 2009. Now the number of patients cared has increased to 235, 83 of which are under HAART. Patients were eligible for study participation if they were 18 years of age or older and under HAART between September 15, 2010, and May 31, 2011. During the study period, 29 patients signed informed consents and were included for analysis. After pharmacist’s intervention, we assessed adherence by medication possession ratio(MPR)and comprehension of their medication regimen. Potential drug interactions and adverse effects were also assessed in these patients.
The results demonstrated that pharmacist’s interventions did improve adherence and comprehension of medication regimen in AIDS patients. The occurrence of drug interactions and adverse effects were also decreased.
論文目次 誌謝 …………………………………………………………………V
中文摘要 ………………………………………………………… VI
英文摘要…………………………………………………………… VII
縮寫表……………………………………………………………… IX
目次………………………………………………………………… X
表目錄……………………………………………………………… XIII
圖目錄……………………………………………………………… XIV
附錄目錄…………………………………………………………… XV
第一章 緒論…………………………………………………………1
第二章 文獻探討……………………………………………………3
2.1 愛滋病毒感染總論…………………………………………… 3
2.2 高效能抗愛滋病毒治療……………………………………… 7
2.2.1核苷酸反轉錄酶抑制劑………………………………… 8
2.2.2非核苷酸反轉錄酶抑制劑……………………………… 10
2.2.3蛋白酶抑制劑…………………………………………… 11
2.3 愛滋病感染者的服藥順服性及影響因素…………………… 13
2.4藥師對於愛滋病感染者照護的角色及目前成效…………… 16
第三章 研究目的……………………………………………………24
第四章 研究方法……………………………………………………25
4.1 研究資料收集………………………………………………… 25
4.2 研究設計……………………………………………………… 26
4.2.1 藥事服務內容與步驟…………………………………… 27
4.2.2 資料收集與分析………………………………………… 30
4.2.3 研究問卷信度與效度…………………………………… 32
4.2.4 研究分析方法…………………………………………… 33
第五章 研究結果……………………………………………………34
5.1 研究收案條件及個案基本資料……………………………… 34
5.1.1 收案對象條件…………………………………………… 34
5.1.2 排除個案………………………………………………… 34
5.1.3 個案基本資料及特性…………………………………… 34
5.2 藥師介入後臨床成效………………………………………… 39
5.2.1 愛滋病感染者用藥基本特性…………………………… 39
5.2.2 影響愛滋病感染者順服性的原因……………………… 42
5.2.3 愛滋病感染者服藥順服性……………………………… 43
5.2.4 愛滋病感染者對疾病及藥品正確知識測驗結果……… 44
5.2.5 愛滋病感染者服藥期間CD4及愛滋病毒量變化……… 46
5.2.6 愛滋病感染者服藥期間常見不良反應及嚴重度……… 49
5.2.7 潛在不同藥物或食物之間的交互作用………………… 52
第六章 討論…………………………………………………………55
6.1 研究對象差異………………………………………………… 55
6.2 藥師介入後臨床成效討論…………………………………… 56
6.2.1 愛滋病感染者服藥行為特性及順服性探討…………… 56
6.2.2 藥師介入對於藥物正確知識得分影響………………… 60
6.2.3服藥期間個案的CD4數值及愛滋病毒量變化………… 62
6.2.4 個案服藥期間常見不良反應型態及嚴重度…………… 64
6.2.5潛在藥物或食物間交互作用…………………………… 65
6.3 研究限制……………………………………………………… 67
第七章 結論…………………………………………………………68
第八章 未來展望……………………………………………………70
參考文獻…………………………………………………………… 71
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