Klinično ovrednotenje psihofarmakoterapevtskih intervencij farmacevta svetovalca pri starejših bolnikih s polifarmakoterapijo v Pomurju

Zorjan, Kaja (author), Štuhec, Matej (mentor)

Zdravljenje z zdravili pri starostnikih s polifarmakoterapijo in duševnimi motnjami predstavlja velik izziv. Kljub jasnim smernicam za zdravljenje bolniki prejemajo številna zdravila in kombinacije, ki so pogosto tvegana, kar lahko vodi v številne zaplete pri zdravljenju z zdravili. Vključevanje farmacevta svetovalca v zdravstveni tim, in njegovo svetovanje glede terapije v obliki farmakoterapijskega pregleda, je eden izmed možnih načinov optimizacije zdravljenja z zdravili, zdravljenja bolnikov v skladu s smernicami in zmanjševanja pojava težav, povezanih z zdravili. V raziskavi smo želeli klinično ovrednotiti, ali neposredna vključitev kliničnega farmacevta (farmacevta svetovalca) v zdravljenje, predvsem s psihofarmaki, vpliva na kakovost zdravljenja bolnikov. Izvedli smo neintervencijsko, retrospektivno, multicentrično raziskavo, v katero smo vključili bolnike iz pomurskih zdravstvenih domov, ki so bili v obdobju treh let napoteni k farmacevtu svetovalcu, na dan pregleda stari 65 let ali več, in so prejemali najmanj 10 zdravilnih učinkovin, od tega vsaj eno iz skupine N po ATC klasifikaciji. Vse podatke o terapiji bolnikov, njihovih diagnozah in nasvetih, podanih s strani farmacevta, smo pridobili iz medicinske dokumentacije. Za vrednotenje zdravljenja v skladu s smernicami smo uporabili aktualne smernice za posamezne diagnoze in Priscus listo za vrednotenje potencialno neprimernih zdravil za starostnike. Za vrednotenje vpliva kliničnega farmacevta na zdravljenje v skladu s smernicami smo oblikovali napovedna modela za zdravljenje depresije in zdravljenje z antipsihotiki. 246 bolnikov, vključenih v raziskavo, je skupaj prejemalo 3294 zdravil, od tega 14,6 % zdravil za zdravljenje duševnih bolezni. Na področju zdravljenja s psihofarmaki je bilo podanih 374 intervencij, 169 (45,2 %) teh je bilo sprejetih s strani zdravnika in implementiranih v terapijo bolnikov. Povprečno je imel bolnik po opravljenem farmakoterapijskem pregledu predpisanih manj zdravil, saj je bilo pred farmakoterapijskim pregledom povprečno število zdravil na enega bolnika 13,4, po pregledu pa 12,4. Zmanjšanje števila zdravil je bilo statistično značilno (p<0,001), prav tako se je statistično značilno zmanjšalo število potencialnih X interakcij, in sicer iz 71 na 32 (p<0,001). Po intervenciji kliničnega farmacevta se je delež potencialno neprimerih zdravil za starostnike bolnikom statistično značilno zmanjšal za 21,8 % (iz 312 na 244, p<0,001). Upoštevanje intervencij kliničnega farmacevta statistično značilno poveča verjetnost za zdravljenje bolnikov v skladu s smernicami, tako pri terapiji z antidepresivi (p<0,001), kot pri terapiji z antipsihotiki (p=0,003). Kljub spodbudnim rezultatom ima raziskava nekatere omejitve, vključno z nerandomizacijo udeležencev in pristranostjo pri izbiri bolnikov. Vendarle pa rezultati raziskave prikazujejo pozitiven vpliv intervencij kliničnih farmacevtov na zmanjšanje celokupnega števila zdravil, pomembnih interakcij med zdravili, potencialno neprimernih zdravil pri starostnikih in večje sledenje smernicam zdravljenja pri tej populaciji.

• Language: Slovenian
• Keywords: farmakoterapijski pregled, farmacevt svetovalec, starostniki, duševne motnje, klinična raziskava, polifarmakoterapija.
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2019
• PID: 20.500.12556/RUL-108320
• Publication date in RUL: 28.06.2019

Secondary language

• Language: English
• Title: Clinical evaluation of a pharmacist consultant`s psychopharmacological interventions in elderly patients treated with polypharmacotherapy in Pomurje region

Abstract

In elderly patients with mental disorders and polypharmacy, treatment is a challenge. Despite clear treatment guidelines, a large proportion of patients are receiving numerous medications, including combinations that often represent a risk, which can lead to a number of complications in drug treatment. A collaborative care approach including a medication review by a clinical pharmacist is a possible way of reducing drug-related problems, drug-drug interactions and irrational polypharmacy within this population. The aim of the research was to clinically evaluate whether the direct involvement of the clinical pharmacist (pharmacist consultant) in the treatment with mainly psychotropic medications can have an impact on the quality of pharmacotherapy. We conducted a non-interventional, retrospective, multicenter study that included patients from primary care community environment in Pomurje who were sent to a pharmacist consultant in a time period of three years, were 65 or older and were receiving 10 or more active substances at the same time, at least one of which was from the N group according to the ATC classification. All information on patient therapy, diagnosis and clinical pharmacists’ recommendations were obtained from the medical records. To evaluate whether patients were treated in line with the treatment guidelines, we used current treatment guidelines for individual diagnoses and the Priscus list for the evaluation of potentially inappropriate medications for the elderly. To evaluate the influence of the clinical pharmacist on the treatment according to guidelines for depression and treatment with antipsychotics, we used binary logistic regression to create statistical models. 246 patients were included in the study. Between them, they were receiving 3294 medications (14,6% were psychotropics). The pharmacists proposed 374 different interventions within psychopharmacotherapy. General practitioners accepted 169 interventions (45,2%). After the pharmacists’ interventions, the number of total medications decreased (from 13,4 to 12,4; p<0,001). The number of potential X-type drug-drug interactions decreased significantly (from 71 to 32, p<0,001), as did the number of potentially inappropriate medications in the elderly (from 312 to 244 or by 21,8%; p<0,001). The clinical pharmacists’ interventions have led to better adherence to current treatment guidelines in the treatment with antidepressants (p<0,001) and in antipsychotic therapy (p=0,003). Despite encouraging results, the study had its limitations, including non-randomized controlled design and selection bias. Nonetheless, the results show a positive impact of clinical pharmacists’ interventions which led to reducing the number of total prescribed drugs, potential X-type interactions, the number of potentially inappropriate medications and better adherence to treatment guidelines within this population.

• Keywords: medical review, clinical pharmacist, elderly, mental disorders, clinical study, polypharmacotherapy.