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研究生： 游佩雯
Yu, Pei-wen
論文名稱： 藥師對繼續教育課程需求之探討
Assessment of Pharmacists’ Needs about the Subjects of Continuing Pharmacy Education
指導教授： 高雅慧
Yang, Yea-Huei Kao
學位類別： 碩士
Master
系所名稱： 醫學院 - 臨床藥學研究所
Institute of Clinical Pharmacy
論文出版年： 2009
畢業學年度： 97
語文別： 中文
論文頁數： 114
中文關鍵詞： 藥師 、繼續教育 、藥師繼續教育
外文關鍵詞： Continuing education, pharmacists, CPE
相關次數： 點閱：159  下載：5 
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    • 【研究背景】
    由於醫學及藥物發展之日新月異，因此，欲成為一位專業藥師，除了經過國家考試的認定，在之後的職業生涯仍需不斷地增進自己的專業知識，因此，繼續教育是不可或缺的機制。在我國，民國九十六年新修訂的《藥師法》規定︰「每六年提出完成繼續教育證明文件，辦理執業執照更新。」衛生署繼而於民國九十七年十二月底，依據藥師法公告《藥師執業登記及繼續教育辦法》草案，對於藥師繼續教育之法定要求開啟新的發展，原先施行數年的《全民健康保險特約醫事服務機構藥事人員繼續教育認定要點》所規範之「健保特約藥事人員」轉變為所有的「執業藥師」，除了範圍的擴大之外，同時也形成了強制性。因此，可以想見我國藥師對於繼續教育之需求將大為增加。
    根據過去我國相關藥師繼續教育的研究中，顯示了不同執業領域的藥師對繼續教育課程確有「量身訂做」的需求；但是，針對課程內容需求之研究則屬闕如。因此，藥師之執業環境類型與繼續教育課程內容之相關性是亟待探討的議題。
    【研究目的】
    探討藥師之執業環境類型與繼續教育課程內容需求之相關性，並比較在藥師需求面與制度面的差異。
    【研究方法】
    本研究為橫斷式研究，以網路問卷進行調查。
    以執業藥師為研究對象，採公開徵求受訪者的方式來進行收樣，過程中利用藥師週刊的廣告與藉由台灣藥學相關網站來宣傳，以邀請藥師前往問卷網站進行問卷之填寫，隨後再由回傳的資料庫來進行分析。
    【研究結果】
    排除重複與無效資料後，共有 486位藥師完成問卷。共 197位男性與 289位女性藥師，而在執業類型的分布，共有醫院藥師 257位、社區藥局藥師114位、診所藥師 53位、藥業藥師 25位、其餘執業類型藥師 37位。而在年齡層以50歲以下佔 89.9%，學士學歷藥師佔 63.6%。
    經過分析後，執業類型在藥師對繼續教育課程需求之影響最廣，調查的 41項課程中有21項會因藥師執業類型的不同而有差異。而性別、年齡、職業年資、最高學歷則僅在部份的課程有影響。此外，有 91.2%藥師認同應依不同執業類型而有不同必修課程要求，結果間具一致性。而藥師對非講授式課程的時數限制則有較低同意度。
    藥師認為最理想的繼續教育形式為講授式課程，其次為網路繼續教育。而整體影響藥師選擇繼續教育最大的因素為繼續教育費用；而在社區藥局與藥業藥師影響選擇繼續教育最大的因素則為執業必需。
    【結論】
    在本研究中，藥師對課程之需求強烈反應了其在執業上的需要，而藥師亦認同應對不同的執業類型有不同必修課程要求，顯示針對藥師的執業需求來設計繼續教育的課程是合理且必要的，尤其在社區藥局與藥業藥師。繼續教育提供者應依不同的聽眾來設計課程，繼續教育審查單位也應針對此把關，而在我國藥政也應審視法規面與藥師需求的不一致處並考慮調整。

    [Background]
    Maintaining competence throughout their careers is a lifelong challenge for all health care professionals, including pharmacists. To maintain up-to-date professional competency, continuing education is indispensable.
    Not until 2007, the mandatory CPE (Continuing Pharmacy Education) was limited to the NHI contracted pharmacy-practitioners in Taiwan. Because, the Pharmacists’ Act was amended in March 2007, which had expanded mandatory CPE from pharmacy-practitioners in the NHI contracted medical care services to every practicing pharmacist. Therefore, increasing needs for CPE can be expected under the rule in Pharmacists’ Act. Recently, draft regulations governing the registration of practice and continuing education for pharmacists was announced in December 2008. Besides, the studies related to CPE in Taiwan revealed that pharmacists had the customization need to subjects of the continuing education for different practice settings. However, the needs are unclear.
    [Objectives]
    To investigate pharmacists’ needs related to CPE in Taiwan, this study aimed to:
    1. Compare the regulations of CPE with the pharmacists’ needs for CPE; and
    2. Assess the needs about the subjects of CPE for different practice practices.
    [Methods]
    This was a cross-sectional study. The pharmacists in Taiwan were surveyed by a Web questionnaire during March 31 and May 15 in 2009. We advertised the study on pharmacy-related websites and the "Pharmacist Weekly" in order to invite volunteer pharmacists to the homepage of the Web questionnaire.
    [Results]
    After excluded duplicated and invalid data, 486 pharmacists filled the Web questionnaire. There were 197 male and 289 female pharmacists. The number of the pharmacists from hospital, community, clinic, industry, and other settings were 257, 114, 53, 25, and 37, respectively. Furthermore, most of the participants were graduated with bachelor degree and younger than 51 years old.
    The practice setting was found to be the most significant factor to the needs about the subjects of CPE. Among the 41 CPE subjects, 21 were found to be significantly associated with the practice setting as examined by multivariate analysis. The other variables including, gender, age, literature, or period of practice only had partial correlation with the needs. Additionally, 91.2% pharmacists agreed with "Mandatory CPE should be designated based on various practice settings". The results were consistent.
    In the methods of delivery, pharmacists were most preferred to the live lecture. The most effective determinant for CPE is cost. Other determinants had various effects in different practice settings. By the way, the practice related need had the highest correlation in community and industrial pharmacists.
    [Conclusion]
    Pharmacists do have various needs about the subjects of CPE in different practice settings. CPE providers should design the subjects of continuing education for the audience from different practice settings, and the pharmacy associations for the accreditation of CPE should also pay attention to the design of each CPE program. Finally, the national organization should consider if any inappropriateness in the regulation of CPE.

    【目錄】 中文摘要................................................................................................. i 英文摘要............................................................................................... iii 誌謝......................................................................................................... v 目錄........................................................................................................ vi 表目錄................................................................................................... ix 圖目錄.................................................................................................... x 第一篇 藥師對繼續教育課程需求之探討 第一章 緒論.......................................................................................... 1 第一節 研究背景............................................................................... 1 第二節 研究目的............................................................................... 2 第二章 文獻回顧.................................................................................. 3 第一節 藥學繼續教育的定義......................................................... 3 第二節 藥學繼續教育的發展......................................................... 3 2.2.1 藥學繼續教育的歷史........................................................... 3 2.2.2 「持續專業發展」與「繼續教育」................................. 5 2.2.3 未來發展的目標.................................................................... 7 第三節 各國藥師繼續教育的執行現況........................................ 9 2.3.1 英國....................................................................................... 10 2.3.2 美國....................................................................................... 12 2.3.3 加拿大................................................................................... 13 2.3.4 澳洲....................................................................................... 15 2.3.5 日本....................................................................................... 16 2.3.6 其他....................................................................................... 17 第四節 我國藥師繼續教育的演進與執行現況......................... 19 2.4.1 法源依據............................................................................... 19 2.4.2 執行現況............................................................................... 23 第五節 相關藥師繼續教育研究及意涵...................................... 26 2.5.1 影響藥師對繼續教育看法的因素.................................... 26 2.5.2 藥師對繼續教育的偏好或需要 ....................................... 29 2.5.3 我國相關藥師繼續教育之研究........................................ 32 第六節 發展網路問卷之可行性................................................... 34 2.6.1 我國網路利用率.................................................................. 34 第三章 研究材料與方法................................................................... 36 第一節 研究設計............................................................................. 36 3.1.1 研究類型............................................................................... 36 3.1.2 研究時間............................................................................... 36 3.1.3 研究對象............................................................................... 36 3.1.4 收樣方法............................................................................... 36 第二節 研究架構與流程................................................................ 38 第三節 研究工具............................................................................. 38 3.3.1 問卷效度評估...................................................................... 40 3.3.2 網路問卷設定...................................................................... 41 3.3.3 問卷信度評估...................................................................... 44 第四節 研究變相與問卷評估指標之定義.................................. 46 3.4.1 網路問卷調查變項暨資料庫操作定義........................... 46 3.4.2 無效資料之判定.................................................................. 53 3.4.3 樣本品質指標...................................................................... 54 第五節 資料彙整與分析................................................................ 55 3.5.1 統計分析軟體...................................................................... 55 3.5.2 統計分析方法...................................................................... 55 第四章 結果........................................................................................ 56 第一節 描述性統計........................................................................ 56 4.1.1 受訪藥師之特質.................................................................. 56 4.1.2 藥師對繼續教育課程之需求............................................ 58 4.1.3 藥師對繼續教育規定之看法............................................ 58 4.1.4 藥師參與繼續教育之活動................................................. 60 4.1.5 藥師選擇繼續教育之因素................................................. 63 第二節 統計檢定............................................................................. 63 4.2.1 繼續教育課程需求............................................................. 63 4.2.2 藥師執業類型與繼續教育規定之看法........................... 79 4.2.3 藥師執業類型與選擇繼續教育課程之因素.................. 81 第三節 藥師對繼續教育相關意見記錄...................................... 81 4.3.1 藥師對繼續教育課程內容之建議.................................... 81 4.3.2 藥師對繼續教育其他建議................................................. 82 第五章 討論........................................................................................ 84 第一節 藥師對繼續教育課程需求之探討.................................. 84 5.1.1 基本特質對繼續教育課程需求之影響........................... 84 5.1.2 各執業類型對繼續教育課程之需求............................... 85 第二節 藥師對繼續教育形式的偏好.......................................... 87 第三節 研究結果對繼續教育課程規定之意涵......................... 89 5.3.1 繼續教育課程設計............................................................. 89 5.3.2 繼續教育積分要求及課程認定範疇............................... 90 5.3.3 繼續教育進行形式與網路繼續教育的發展.................. 92 第六章 研究限制與未來研究方向................................................. 94 第一節 研究限制因素.................................................................... 94 6.1.1 樣本代表性 ......................................................................... 94 6.1.2 網路問卷的限制.................................................................. 94 第二節 未來研究方向.................................................................... 95 第七章 結論與建議........................................................................... 96 第一節 結論..................................................................................... 96 第二節 建議..................................................................................... 96 第二篇 臨床藥事服務－門診病患諮詢服務分析 第一章 臨床藥事服務緣起.............................................................. 98 第一節 服務背景............................................................................. 98 第二節 研究材料與方法................................................................ 98 第二章 結果與討論........................................................................... 99 第一節 結果與討論........................................................................ 99 2.1.1 描述性資料.......................................................................... 99 2.1.2 諮詢問題記錄.................................................................... 103 第二節 改善提案........................................................................... 106 2.2.1 衛教單張設計.................................................................... 107 第三節 感想與建議...................................................................... 108 參考文獻............................................................................................ 109 【表目錄】 第一篇 藥師對繼續教育課程需求之探討 表 2-1、澳洲藥學繼續教育活動分級 ........................................... 16 表 2-2、全民健康保險特約醫事服務機構藥事人員繼續教育認 定要點與藥師執業登記及繼續教育辦法草案比較..................... 21 表 2-3、各國藥師繼續教育執行現況比較.................................... 24 表 3-1、台灣藥學相關網站............................................................. 37 表 3-2、網路問卷調查變項暨操作定義........................................ 46 表 4-1、受訪藥師之人口資料描述................................................. 56 表 4-2、受訪藥師執業相關人口資料描述.................................... 57 表 4-3、藥師對繼續教育規定之看法............................................ 59 表 4-4、受訪藥師參與繼續教育的時間........................................ 62 表 4-5、性別、年齡、最高學歷與繼續教育課程之需求.......... 66 表 4-6、執業年資、執業類型與繼續教育課程之需求.............. 70 表 4-7、繼續教育課程之需求與多變項分析............................... 74 表 4-8、藥師執業類型與臨床藥學服務相關課程需求.............. 77 表 4-9、藥師執業類型與繼續教育規定之看法........................... 80 表 5-1、選修課程與藥師正向需求比例........................................ 91 表 6-1、樣本與母群體之比較......................................................... 94 第二篇 臨床藥事服務－門診病患諮詢服務分析 表一、諮詢者之年齡分層.............................................................. 100 表二、不良反應諮詢問題分類..................................................... 102 表三、藥物交互作用諮詢問題分類............................................. 103 【圖目錄】 第一篇 藥師對繼續教育課程需求之探討 圖 2-1、 FIP所定義之 CPD的步驟...................................................... 5 圖 2-2、英國藥師執行 CPD的步驟.................................................. 11 圖 2-3、過去必修課程開課狀況..................................................... 33 圖 2-4、過去選修課程開課狀況..................................................... 34 圖 2-5、台灣個人曾經上網比例趨勢圖........................................ 34 圖 3-1、收樣方法暨流程示意圖..................................................... 36 圖 3-2、研究架構與流程.................................................................. 38 圖 3-3、問卷發展過程與步驟......................................................... 39 圖 3-4、網路問卷架構之內涵......................................................... 42 圖 3-5、ASP.NET運作示意圖.............................................................. 43 圖 4-1、得知繼續教育開課資訊的管道........................................ 60 圖 4-2、網路搜尋所使用的網站..................................................... 61 圖 4-3、選擇繼續教育的開課單位................................................. 61 圖 4-4、藥師對繼續教育進行形式之偏好.................................... 62 圖 4-5、影響藥師選擇繼續教育之因素........................................ 63 圖 6-1、問卷回收檢量線.................................................................. 95 第二篇 臨床藥事服務－門診病患諮詢服務分析 圖一、用藥相關問題分類.............................................................. 100 圖二、用法細項分類...................................................................... 101 圖三、非口服藥品分類.................................................................. 101 圖四、Proposed model for acetazolamide's reduction of AMS............ 105 圖五、 Forteo® (Teriparatide) 骨穩® 注射液衛教單張................ 107

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