35

THE FUTURE OF PHARMACY

VOL 28, NO.1 - JUNE 2012

Among all of 5 79 p at i e nt s that we wer e able to coll e c t dat a fro m the pha r m a c is t s , 27 3 of the m wer e in Ta ip e i a re a and 3 0 6 wer e in K ao p ing a re a . T he a ge s of p at i e nt s r a nge fro m 4 to 95 ye a r s old wit h an ave r a ge of 6 4 . 1 ye a r s old (s e e Fig . 4 and t a b l e 1 ) . T hr e e hun dr e d ele v e n p at i e nt s a re mor e tha n 65 ye a r s old , wit h a high e r p o s sib ilit y of mult ip l e chro ni c dis e a s e s a nd mult ip l e me dic at i o n s .

Reasons for high use of outpatient services T h e a g gr e g at e d eight re a s o n s why the s e p at i e nt s b e c a m e high us e r s of out p at i e nt ser v i ce s a re a s foll o w s (s e e Fig . 5) :  VOSFTPMWFENFEJDBMQSPCMFNT O    NVMUJQMF EJTFBTFT O    HPJOHUPUIFEPDUPSBTTPPOBTUIFZ GFFMJMM O    IJHIOFFEGPSSFIBCJMJUBUJPO O     VOSFTPMWFEQTZDIJBUSJDQSPCMFNT O    ESVH BCVTF O    OPSFmMMBCMFQSFTDSJQUJPOTGPSDISPOJD EJTFBTFT O    OPDIBSHFPGDMJOJDWJTJUT O   5XPIVOESFEBOEmGUZUISFFQBUJFOUT  IBWFCFFOHPJOH t o dif fe r e nt he a lt h c a r e or g a ni z at i o n s for their illn e s s e s a nd coul d not find any phy si c i a n to int e gr at e a nd re s o l v e their pro b l e m s ; the r efo r e the y b e c a m e high us e r s of out p at i e nt ser v i c e s . For e x a mp l e , one p at i e nt went to ER ever y fe w day s for her sho r t n e s s of bre at h but the ho sp it a l coul d not find the c a us e of her bre at hing pro b l e m . At the s a m e tim e , she wa s going to ot h e r ho sp it a ls for her p a in and ga s t r i c ulce r. As a re sult , the numb e r of out p at i e nt ut ili z at i o n is ver y high . After the pha r m a c is t s sp e n d tim e to help the s e p at i e nt s to figur e out the c a us e s for their illn e s s or help the m find app r o p r i -

at e sp e c ia lis t s , the y usua ll y re du ce the fre qu e n c y of visit to out p at i e nt clini c s .

T h e se co n d mo s t comm o n re a s o n to c a us e fre qu e nt ut ili z a - UJPOPGPVUQBUJFOUTFSWJDFTJTNVMUJQMFEJTFBTFT O   T h e s e p at i e nt s hav e mult ip l e chro ni c dis e a s e s ; a nd ea ch dis e a s e is c a r e d by a dif fe r e nt sp e c ia lis t , re sult ing in high ut ili - z at i o n of out p at i e nt ser v i c e s . After pha r m a c is t s visit p at i e nt s a nd foll o w up dis e a s e s st at us , ma ke sur e p at i e nt s ’ chro ni c dis e a s e s a re und e r cont r o l , the y usua ll y conv in c e p at i e nt s to cho o s e one he a lt h c a r e or g a ni z at i o n that the y tr us t the mo s t for all their dis e a s e s . T his way the phy si c i a n s c a n ga in ove r a ll cont r o l of their dis e a s e s , at the s a m e tim e it de cr e a s e s the po s sib ilit y of dup li c at i o n the r a p y or any ot h e r dr ug the r a p y pro b l e m s .

Anot he r gro up of p at i e nt s wer e us e d to se e k me dic a l at t e nt i o n a s so o n a s the y hav e any min o r s y mpt o m s . T he s e 56 p at i e nt s  NBZIBWFEJNJOJTIFEJOUFSFTUJOMJGF PSUIFZNBZ w o r r y a b o ut the po s sib ilit y of hav ing undia gn o s e d dis e a s e s , the r efo r e the y are us e d to going to he a lt h c a r e or g a ni z at i o n s a ll the tim e . T he y may not e ve n t a ke the me dic at i o n s that the phy si c ia n s pre s c r ib e d . T he pha r m a c is t s e s t a b lish e d a mut ua l - t r us t relat i o n ship wit h the s e p at i e nt s af t e r fe w visit s . T he y t a ught the p at i e nt s cor r e c t know l e dge of dis e a s e s , whe n to se e k me dic a l at t e nt i o n , a nd the right te chni qu e s of self - c a r e . As a re sult , the p at i e nt s ha d b et t e r qua lit y - of - life a nd mo s t of the m st o p p e d going to the do c t o r for min o r illn e s s .

Fig. 4. Age distribution of the high users

Fig. 5. Reasons for becoming the high users of outpatient services.

Un de

r 1 0

10 - 2 0

21 - 30

31 - 40

41 - 50

51 6

0

61 - 70 71 - 8

0 81

- 9 0

Abo ve

90

PATIEN T N

U M

BER

AGE GROUP (YEAR-OLD)

180 160 140 120 100 80 60 40 20 0

Taipei area Kaoping area All patients

TA B L E 1: PROJEC T S O F PHARMAC Y SE R V I C E S GR ANTED BY NHSO SINCE 2004

RANGE OF AGE AGE MEDIUM AGE ( YEARS) MEAN ± SD ( YEARS) ( YEARS)

Ta i p e i D i v i s i o n (n = 35 1 ) 4 - 9 2 62 . 0 ± 1 8 . 4 67

K a o p i n g D i v i s i o n (n = 45 7 ) 7 - 9 5 6 5 .9 ± 15 . 2 6 9 Tot a l of 8 0 8 p a t i e nt s 4 - 9 5 6 4 . 1 ± 1 6 .9 6 8

260 240 220 200 180 160 140 120 100 80 60 40 20 0

253

111

56 48 41 22

9 5

Pa ti

en t n

um be

r

Un res

olv ed

m ed

ica l

pr ob

lem s

Mu lti

ple di

se as

es

Go ing

to th

e d oc

to r

as so

on as

fe el

ill

Hi gh

ne ed

fo r

reh ab

ilit ati

on

Un res

olv ed

ps yc

ho log

ic

pr ob

lem s

Dr ug

ab us

e

No re

fill ab

le pr

es cri

pt ion

s

for ch

ro nic

di se

as es

No pa

ym en

t f or

cli nic

vi sit

s