國人對用藥安全之認知、行為及態度之探討 — 以懷疑中藥摻西藥送驗之民眾為例

1. 國人對用藥安全之認知、行為及態度之探討—以懷疑中藥摻西藥送驗之民眾為例國人對用藥安全之認知、行為及態度之探討—以懷疑中藥摻西藥送驗之民眾為例 • 所謂中藥摻西藥係指以中藥製劑擅自摻加西藥成分欺騙消費者之行為。台灣地區自1983～2002年中藥摻西藥送檢案件檢出率平均在13.0﹪左右，其中若依檢體來源屬別區分第一類合法廠商、醫療機構業者中藥摻西藥檢出率平均8.4﹪；第二類不列入醫療管理行為場所卻提供藥品者中藥摻西藥檢出率平均25.2﹪。若以檢出西藥檢體別區分依送驗指定主治效能排名，依序為風濕鎮痛類、類固醇類、感冒鎮咳類、止痛類、精神安定類為主，若依經常檢出之成分別則有caffeine、acetaminophen、hydrochlorothiazide、indomethacin、及diazepam等。 • 相較於2002年「臺北市政府衛生局黑藥丸檢驗專案」中藥摻西藥之檢出率平均為14.2﹪，檢體來源屬第一類之合法廠商、醫療機構者其檢出率為7.8﹪；第二類不列入醫療管理行為場所者檢出率為18.9﹪。檢出率及檢出西藥檢體購買用途與檢出西藥成分與台灣地區類似。但統計結果顯示，檢體來源屬於第一類合法場所與第二類不列入醫療管理行為場所其檢出西藥有顯著差異（p<0.001）。不同性別、年齡層、產品之購買誘因與其產品購買地點有顯著相關（p<0.05）；而使用送驗產品後覺得有效者其產品則絕大多數檢出含有西藥（p<0.001）。 • 在針對2002年「臺北市政府衛生局黑藥丸檢驗專案」送驗民眾進行問卷調查後發現，民眾用藥資訊來源以報紙、醫院診所所佔的比例最多；統計結果顯示不同人口學變項其“認知得分”並無顯著差異（p>0.05），“態度得分”則與「年齡」、「收入」變項呈現相關（p<0.05）。“行為得分”僅與「性別」變項呈現相關（p<0.05）。另外，送驗民眾其藥品購買誘因，與人口學變項無關聯，而受樣本每月補養藥之花費影響（p<0.05）。 • 整體而言，本研究問卷調查有效樣本其認知與態度呈現顯著相關（Pearson相關數值= 0.521，p<0.001），但是認知與行為、或態度與行為卻無統計上顯著相關。而自覺健康狀況與有無使用保健藥品習慣有顯著關聯（p<0.05），但是覺得健康狀況因為使用中藥而改善者其“認知得分”、“態度得分”及“行為得分”與未覺得健康狀況因為使用中藥而改善者比較，並無顯著差異（p>0.05）。

2. The study of knowledge, attitude and behavior of medicine use among applicants associated with Chinese herbal medicine adulteration • The term “Chinese herbal medicines adulteration” refers to traditional Chinese herbal medicines that are tested and found to contain chemical substances not prescribed or labeled as part of the intended use. In Taiwan between 1983 and 2002 the adulterated rate of Chinese herbal medicines adulteration in received sample average around 13.0%. On average 8.4% of sample from category I registered medicine or healthcare provider is adulterated. In sample from category II unsupervised medicine-providing sources the rate averages 25.2%. The major indication of added chemical substances in order is rheumatism, steroid, respiratory tract infection/coughing, anesthesia, and tranquilizer. Most frequently seen ingredients include caffeine, acetaminophen, hydrochlorothiazide, indomethacin and diazepam. • In “Project 2002 black-pills examination by Department of health, Taipei City Government”, the rate of identifying Chinese herbal medicines adulteration is 14.2%. 7.8% of sample from category I registered medicine or healthcare provider was identified as adulterated. 18.9% of sample from category II unsupervised medicine-providing sources was identified as adulterated. The indication and ingredient of identified chemical substances from the sample are similar to what formerly found throughout Taiwan. Statistical analysis shows a significant difference in the probability of identifying western medicine ingredient between category I registered medicine or healthcare provider and category II unsupervised medicine-providing sources (p < 0.001). Sex 、age and Male and elder mostly purchased have significant impacts on places of purchasing (p < 0.05). In most cases when the buyer/user claims the medicine to be effective, it is adulterated. • After a questionnaire study of sample provider in “Project 2002 black-pills examination by Department of Health, Taipei Ccity Government”, we learned that citizen’s information sources of medicine usage in most percentage are news paper and hospital/clinics. Statistical analysis shows no significant difference in demographic variables “knowledge score” (p > 0.05). “Attitude score” is related to age and income variables (p < 0.05). Behavior score is only related to sex variable (p <0.05). Besides, the incentive of medicine-purchasing among sample-providing citizen is related only to the monthly cost of the health-maintaining medicine (p <0.05) ), but not related to demographic variable. • In summary, this study of questionnaire investigation demonstrated that attitude is related to knowledge（Pearson correlation = 0.521, p < 0.001）. However, behavior is not significantly related to knowledge or attitude, statistically. The self-recognized health condition is significantly related to the habit of health-maintaining medicine (p <0.05). Compare one who considered his/her health condition improved by using Chinese herbal medicine with one who didn’t feel the improvement, there is no significant difference in terms of “knowledge score”, “attitude score” and “behavior score” (p > 0.05).