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全都不是問題 全力支持的史部長柏定你好 做民意代表同樣聽到 行政官員 應職顧委 職不是問題 專業職持這屆委差不多要顧兩百三十幾億 麻煩柏定"},{"start":30.257,"end":35.368,"text":"也希望補充給我回答一下 質疑不是問題專業支持 我要聽這位阿表要不要再問下去"},{"start":38.854,"end":53.297,"text":"被申訴我知道行情啦 但是委員沒說我不知道這事情以前是衛生署 現在是衛生福利部 那幾屆 官方都說不公平了尤其你是對衛生署的歷史 只是這樣不簡單 背景比較補充所以你的歷練啦 跟你的經驗 跟這幾年多餘 要怎麼支持 要怎麼協調應該都是 大家可以信賴的啦"},{"start":63.228,"end":79.715,"text":"所以不一定算運氣你給他感情高高,感情崩潰就好好,這點我給你記起來錄影給他加起來,對照剛才徐副國跟他的對話好啦,我先感謝我們昨天安排這個專案報告我們要整整這個平衡醫療跟當教的阻礙落差嘛我想我們在這裡,因為我可能把很多"},{"start":91.877,"end":108.155,"text":"這個長者比他還要高其實真的是在衛生署的時代那時候是楊志良署長然後蕭美齡副署長我曾經還把蕭美齡副署長邀集到台中去去看這個在宅醫療當時是針對牙醫的部分"},{"start":109.036,"end":129.973,"text":"然後在林前部長 林卓人部長的時候是在2016我要特別召集到這個諾氏醫院去召開我們改善雲林的可靜性的這樣的一個醫療的可靜性我也要感謝委員會這幾天的努力所以保證化學對照病我們這幾天居家醫療的經費跟使用人數 人數都終於在增加"},{"start":130.533,"end":137.44,"text":"如果從居家醫療及照護的經費10946.54億每年出現增加一直到113.4億、43.09億然後輔助人次居家醫療18萬119然後到113是23萬多重度居家醫療29萬多一直到113是37萬8左右"},{"start":154.295,"end":177.843,"text":"居家中醫這個成長速度更快2523一直到1134 1萬5千多但是不小心再看最後一個居家藥師照護一百九年43一百十年一百四十一百一年一百七十四一百十幾年到三百以內一百十三八十七"},{"start":181.567,"end":195.66,"text":"部長也注意到了部長也有特別去在週六好像週六的時候有受訪未來在長沙3.0在宅醫療及急性後期照護等政策中中醫都將有更要參與的角色"},{"start":198.5,"end":224.017,"text":"這個我們當然全力支持也在關西省過去一直希望中醫可以再跟長照連結更加的內取啦2019年的時候6月健保署公告居家醫療整個計畫將藥師納入居家醫療的一份子針對末期病人的管制藥品以及特殊劑型的用藥指導來提供服務"},{"start":224.998,"end":232.588,"text":"但是我們我們看到現在這樣的一個數據不曉得有掌握嗎為什麼在居家要事的招呼是"},{"start":234.016,"end":261.222,"text":"是這麼低的人次在使用原因出在什麼地方謝謝委員提醒這些健保的服務的服務數據啦我真的是忽略掉那個藥事服務我沒注意到謝謝你給我提醒我還要了解為什麼會掉下來因為健警的穩定在成長每一項的服務我們的居家整合每一項服務其實都是穩定在成長怎麼會藥事服務突然間掉下來我會來了解一下副署長也在這裡"},{"start":263.402,"end":269.65,"text":"我們再分析一下這樣分析一下好嗎?這應該是經紀人嘛,一個禮拜應該怎麼做一些應變跟調整也好,好謝謝因為我們對日本的長照,居家的醫療服務,日本的藥師能夠執行的服務這麼多"},{"start":281.601,"end":295.612,"text":"對不對 送藥到宅 緊急送藥到宅產藥計算 藥力管理用藥的整合評估 用藥執行指導分裝 特殊製劑調製與管理大大大一堆啦那事實上如果你根據食藥署在"},{"start":297.574,"end":319.72,"text":"113年度的國內上市後藥品不良的反應通報案例的分析全國藥物不良反應通報中心共接獲到一萬三千多件然後集中在40-79歲的壯年及老年的病患共佔整體通報案件的54%也就是說長者同時在使用過五種藥物我們媽媽就要抽過五款藥物她會疼疼的"},{"start":323.982,"end":342.289,"text":"有一些狀況會發生他也會忽略國際上對多重用藥的定義醫師、藥師就會去提醒用藥不了環境可能就因為多重用藥還是藥物的交互作用而發生或是加重所以"},{"start":343.69,"end":356.656,"text":"所以這其實有時候我覺得是而且還有針對長者如果是家長記憶的衰退失智、獨居、老老照顧等等除了多重用藥也容易出現吃錯藥的這些狀況重用藥狀況還是服務劑量錯誤等等"},{"start":363.004,"end":386.876,"text":"所以藥師在這個居家醫療照護他扮演的角色絕對是用藥的一個守門人所以特別拜託部長來重視這件事情因為部長有特別提到我去看這個居家醫療照護其實藥師扮演的角色很好他會幫那個病人整理藥還會幫他分隔分天分類"},{"start":388.157,"end":416.497,"text":"我覺得這個藥師服務是在社區藥局可以扮演很重的角色我會來瞭解為什麼這個服務量會下降就一個禮拜嘛我們也可以就是說參照日本的一些藥師的功能的提升加強他的一些資物讓藥師可以扮演的更在3.0裡面可以協助病人提高他的自我照顧能力然後這個跟健保署有關還是請教部長"},{"start":418.158,"end":438.957,"text":"除了居家的藥事照顧之外在者醫療還有很多問題嘛健康署宣稱目前有數千家院所參與居家醫療整合計畫那過去一年這個出診次數為零或僅出診個位數的診所比例有多少能說明嗎出診"},{"start":441.339,"end":466.832,"text":"因為我們這個它是有這個叫做合作關係合作關係的意思是說它有的是診所跟居護所去合作提供居家醫療啦然後我們那個居護所去提供照顧那醫師有的時候是靠遠距居家住院嘛在宅住院那個界位是可以遠距但是至少他要去看一次啦"},{"start":467.812,"end":475.379,"text":"所以不應該有出證為零的這應該是不可能才對這應該是嘛所以你又說應該就代表不可能喔"},{"start":478.967,"end":503.203,"text":"所以你是不是要把這個阻撓我們再整理一下然後第二個是這個例外使用居家醫療的民眾最終還是在醫院死亡的狀況這是不是跟我們叫做醫療不需要離開所居的社區對我們居家醫療有另一個目標就希望他能夠在家往生能夠在居家我們現在還是將近差不多"},{"start":504.204,"end":533.364,"text":"八成的會在醫院不過如果是進入安寧的計畫的就比較多進入安寧的就會比較多在居家安寧計畫的就會比較多在宅往生這個還有一個數據因為時間關係請部長看第三點因為印尼週日對外的一個說法裡面長照三點來我們就是要做各方面的一個強化但是你看到居家"},{"start":534.645,"end":539.178,"text":"醫療的醫師常在反映不知道病人的常常需求常在端也不知道這個居家醫療醫師的意囑"},{"start":541.248,"end":565.159,"text":"所以這兩者應該是相互相整啊怎麼會變成兩邊各做各的對對對 這個委員點出我們之前的問題就是那個兩個資料沒有互接啦所以我們現在正在做資料的互接已經在進行中了嘛就是健保的資料先整合然後長照也有一個長照系統那現在長照跟健保兩邊的資料在就對接了"},{"start":566.059,"end":577.482,"text":"不然你回想一下,這其實喔,日記點說開始要實施其實我們也去參謀日本很多案,很多他們這個對折要經營,我們有理由讓你們看但是我們到現在,2.0變3.0了還有這種問題,就是不應該發生的啦阿現在這個3.0的重點就是要讓它這邊兩邊可以對接應該已經在進行嘗試了嘛,已經在嘗試了好一定要試辦啦,不用對接要試辦多久?"},{"start":595.325,"end":619.51,"text":"今天已經跟差不多現在開始沒有啦我們看今年可以開始那個今年內就開始今年內對不起今年還有8個多月你是要在這一季應該上半年就可以了吧上半年上半年就可以了啦好 上半年啦準備要差不多啦OK啦 好 謝謝謝謝部長 謝謝主席 謝謝謝謝中國委員"}]}},"supported_relations":[],"relations":[]}