Dolgoročno ovrednotenje intervencij farmacevta svetovalca v ZD Ljutomer pri starejših bolnikih s polifarmakoterapijo in srčno-žilnimi obolenji

Auguštin, Barbara (author), Štuhec, Matej (mentor)

Srčno-žilne bolezni predstavljajo pomembno skupino bolezni, ki so prisotne v največji meri pri starejši populaciji, kar je pogosto vzrok zdravljenja s številnimi zdravili (t.i polifarmakoterapija). Ena izmed možnih rešitev v zmanjševanju iracionalne polifarmakoterapije je vključevanje farmacevta svetovalca v proces zdravljenja bolnika. Glavni namen raziskave je bil raziskati dolgotrajni pomen vključitve farmacevta svetovalca v proces zdravljenja bolnikov, ki so imeli vsaj eno izmed srčno-žilnih bolezni. V retrospektivno, multicentrično, neintervencijsko in opazovalno raziskavo so bili vključeni bolniki iz področja oskrbe Zdravstvenega doma Ljutomer, ki so bili napoteni k farmacevtu svetovalcu na farmakoterapijski pregled v obdobju med januarjem 2015 in junijem 2017. Bolniki so bili na dan pregleda stari 65 ali več let in prejemali vsaj pet zdravil sočasno. Terapijo bolnikov smo pregledali dva in šest mesecev po obravnavi pri farmacevtu svetovalcu. Vpliv farmacevta svetovalca na skladnost zdravljenja s smernicami ter na število zdravil po obravnavi smo preverili z oblikovanjem dveh napovednih modelov. 46 vključenih bolnikov je skupno prejemalo 425 zdravil, od tega je bilo 232 predpisanih za zdravljenje srčno-žilnih bolezni, kar je predstavljalo 54,6 % vseh zdravil. Pred farmakoterapijskim pregledom je imel bolnik v povprečju predpisanih 9,2 (SD=3,65) zdravil. Po upoštevanih intervencijah s strani zdravnika se je povprečje predpisanih zdravil na bolnika po dveh mesecih znižalo na 8,5 (SD=3,04) oz. po šestih mesecih na 8,6 (SD=3,07). Farmacevt svetovalec je v terapiji srčno-žilnih bolezni predlagal 94 intervencij (49,7 % vseh intervencij), ki jih je zdravnik sprejel v 38,3 %. S statistično analizo smo dokazali, da je bilo zmanjšanje števila zdravil, potencialnih interakcij tipa X ter števila potencialno neprimernih zdravil za starostnike statistično značilno (p < 0,001). Po obravnavi pri farmacevtu svetovalcu se pri bolnikih statistično značilno (p < 0,001) poveča verjetnost skladnega zdravljenja s smernicami ter zmanjša število predpisanih zdravil vsaj za eno. Rezultati raziskave prikazujejo zmanjšanje celokupnega števila zdravil, potencialnih interakcij X in potencialno neprimernih zdravil ter povečanje deleža bolnikov, pri katerih je zdravljenje potekalo v skladu s smernicami.

• Language: Slovenian
• Keywords: polifarmakoterapija, farmacevt svetovalec, farmakoterapijski pregled, starostniki, srčno-žilne bolezni, dolgotrajne intervencije
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2019
• PID: 20.500.12556/RUL-111299
• Publication date in RUL: 27.09.2019

Secondary language

• Language: English
• Title: Long-term evaluation of the Community Health Centre Ljutomer consultant pharmacist's interventions

Abstract

Cardiovascular diseases are widely represented in the elderly and consequently these patients often receive multiple drugs simultaneously. A possible approach to reduce irrational polypharmacotherapy is the involvement of a clinical pharmacist in the patient’s treatment process. The main aim of the study was to investigate the long-term consequences a pharmacist consultant’s interventions in patients with cardiovascular diseases. The retrospective, multicentre, non-interventional, observational study included patients from the Ljutomer community health centre. Patients who were referred to a pharmacist consultant during the period from January 2015 to June 2017 were included. The patients included in the study were 65 years of age or older and were receiving at least five medications at the same time. Pharmacotherapy changes were checked after 2 and 6 months after interventions. The pharmacist consultant’s impact on the treatment guidelines adherence and on the number of medications were evaluated using two different statistical models. 46 patients were receiving 425 medications in total, of which 232 were prescribed for treatment of cardiovascular diseases (54,6% of all medications). Before the pharmacist consultant’s interventions, the patients had an average of 9,2 (SD=3,65) medications per patient, which decreased after interventions to 8,5 (SD=3,04) after two months and to 8,6 after six months (SD=3,07). In the pharmacotherapy of cardiovascular diseases, the pharmacist consultant suggested 94 (49,7% of all interventions) interventions and 38,3% were accepted by the physicians. The statistical analysis showed that the decrease both in the total number of medications and potential type X interactions, as well as the number of potentially inappropriate medications were statistically significant (p < 0,001). Both treatment guidelines adherence and fewer medications per patient were positively associated with the involvement of a pharmacist consultant (p < 0,001). The results of our study show a positive impact of pharmacist consultant’s interventions on the number of total prescribed medications to the patients, as well as the number of potential type X interactions and potentially inappropriate medications per patients and better treatment guidelines adherence.

• Keywords: polypharmacotherapy, pharmacist consultant, medical review, cardiovascular disease, elderly, long-term interventions