在這篇論文中，我們研究兩個具有幫助決定醫療決策的問題。此兩個問題皆是由衛生福利部雙和醫院執行。首先，第一個問題是討論使用「藥來速」方法在慢性處方領藥時的方便性及病人遵從性比沒有使用「藥來速」方法的優缺點比較。據了解，這個決策在台灣沒有人研究過。也藉此機會了解全球之使用藥來速的方法決策，然後進一步擬定有益病人之醫療決策。我們使用「藥來速」方法進行慢性疾病處方。然後分析實施「藥來速」方法前6 個月及後6 個月之慢性患者對藥物處方遵從率及使用率之影響，以評估這個新方法的效果。
實施藥來速之後，整體慢性處方簽使用率，網路上預約的使用率以及返回來拿藥物的比例等均有增加的趨勢，並在實施「藥來速」方法後6 個月內有越來越多病人使用這個方法領慢性處方的情形。我們還發現，中年人群（40-65 歲）通過「藥來速」處方服務拿藥的多於其他年齡組。「藥來速」比一般領慢性處方可以讓病人或家屬在較短時間內拿到處方藥及接受處方諮詢說明，並免除停車之不方便性。我們的調查顯示，超過90%的被訪患者滿意「藥來速」的服務。網路資訊的運用，大幅度提升就醫的便利性及醫療服務品質。
第二個研究是討論整合雲端血壓計與門診醫令系統之結合，改善慢性腎病病人之血壓、腎功能及生活品質。於醫療決策之角度來分析國內血壓記錄提供，最理想的模式就是透過雲端血壓計的資料最終能與門診醫令系統做連結，醫師於病人就診時，可以隨時直接從門診醫令系統了解病人居家的血壓平均值與趨勢圖，完全不需要再另外登入其他系統或使用其他方式，必要時，並可以每週請病人提早回診調整降血壓藥物種類及劑量；對照組通常三個月後才回診。36 名參加我們計劃的慢性腎病患被隨機分配到使用整合雲端血壓計與門診醫令系統或平時手寫血壓記錄表來追蹤他們的血壓及腎功能。後續追蹤病人6 個月。兩組病人在使用整合雲端血壓計與門診醫令系統或平時手寫血壓記錄表後，在0、3 和6 個月完成收縮壓、舒張壓和腎功能進行評估及比較。
我們發現研究組的夜間收縮壓及舒張壓比對照組有顯著降低。6 個月的血清肌酸酐在研究組有顯著改善。但是，與6 個月結束後研究組的腎小球濾過率（eGFR）和蛋白尿雖有改善趨勢，但並沒有達到統計學上差異。在夜間收縮壓和舒張壓與基線相比，研究組顯著改善。從基線血清肌酸酐變化也發現，研究組呈現顯著下降趨勢。總之，藥來速及雲端血壓這兩個研究項目值得將來臨床上之使用及推廣，促進醫療服務品質之提升，藥來速提昇病人慢性處方取藥之方便性及縮短取藥之時間；雲端血壓並有助於改善患者的治療療效和預後。

In this dissertation, we address two health decision making projects, and both are implemented in TMU-SHH. In the first project, we implemented a drug refilling system, drive-through pharmacy service to the patients with a refilling prescription for chronic illnesses. The study is a hospital outpatient drug prescription level analysis that adopts a pretest-posttest control group experiment design. We analyze the changes in patient drug prescription behavior 6 months before and 6 months after the system was deployed to assess the efficacy of this new refilling system.
An increase in the overall refilling prescription rate, with an increased use of online reservations (7.9% vs. 4.9%, p < 0.001), an increased proportion of medications picked up (93.0% vs. 88.1%, p < 0.001) were noted. Furthermore, an elevation in the percentage of patients using drive-through pharmacy services (45.4% vs. 28.9%, p < 0.001; second vs. first quarter, respectively) during the 6 months after the implementation period was found. After age-group analysis, we noticed that the middle-aged population group (40-65 years of age) utilizes the drive-through prescription service more than other age groups. Generally, the prescription refilling rate for all population categories at Shuang-Ho Hospital increased significantly after the
drive-through service was provided (51.1% vs. 50.2%, p < 0.01).
The drive-through pharmacy provides patients with convenient access to pick up
refilling prescriptions within a shorter duration than ordinary pharmacy service. During a short-term follow-up, an overall increase in the prescription refilling rate was noted after the drive-through service was implemented. Our survey revealed that among the users, over 90% of the patients were satisfied with the drive-through service.
In the second project, we use cloud-based manometers integrated to physician
order entry systems to trace the patients’ blood pressure in assisting control renal function deterioration. Then, we investigated whether integrating cloud-based manometers and physician order entry systems benefit in our outpatient CKD patients compared with usual blood pressure tracing systems. A total of 36 participants with chronic kidney disease patients were randomly assigned to use cloud-based manometers integrate to physician order entry systems or usual blood pressure recording sheets to trace their blood pressure. The online blood pressure was seen weekly in the study group by physician and the antihypertensive medications will be adjusted in case of
values higher than optimized level that is around 130/80mmHg. The composite outcome was patient’s blood pressure improvement and assessment of renal function deterioration. The patients were followed for 6 months. The systolic and diastolic blood pressure and renal function assessment were done during 0, 3 and 6 months after using,the integrated cloud-based manometers and usual blood pressure monitoring sheets are compared.
Both the night time systolic and diastolic blood pressure were reduced
significantly in the study group compared with control group. Serum creatinine level reduced significantly at 6th month in the study group. Glomerular filtration rate (eGFR) and proteinuria after using the integrated cloud-based manometers is also improved but did not reach significance statistically compared with the control group. Both systolic and diastolic blood pressures during night time significantly improve in the study group compared with baseline. Serum creatinine change from baseline is also found to be
significantly reduced in the study group.
In our knowledge, the above two projects were not implemented in Taiwan before.
In conclusion, the first drive through prescription model improve the chronic
prescription rate, first drive through rate and shorten the time to obtain regular medications. Cloud-based manometers integrated to physician order entry systems improve the blood pressure control and renal function preservation in chronic kidney disease patients. Two projects deserve future use and promote in the health care services, and may help physicians to improve patients’ therapeutic management and prognosis.

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