Klinično ovrednotenje intervencij farmacevta svetovalca pri starejših bolnikih z duševnimi motnjami in polifarmakoterapijo v Zdravstvenem domu Ljutomer

Lah, Lea (author), Štuhec, Matej (mentor)

Duševne motnje predstavljajo pomembno klinično in ekonomsko breme v svetu, kar nakazuje tudi na pomembno vlogo farmacevta pri zdravljenju. Največji izziv v tej populaciji predstavlja zdravljenje starostnikov s komorbidnostjo in polifarmakoterapijo. Kljub splošno znani učinkovitosti intervencij farmacevta na tem področju nam primanjkuje raziskav dolgoročnih izidov. V Sloveniji uveljavitev zdravstvenega programa Farmacevtsko svetovanje pomeni priložnost za neposredno sodelovanje zdravnika in farmacevta v zdravstvenem domu, a učinki tovrstnega sodelovanja še niso bili podrobno raziskani. Namen raziskave je bil klinično ovrednotiti, ali lahko z neposrednim vključevanjem farmacevta svetovalca dosežemo dolgoročen vpliv na kakovost predpisovanja zdravil pri starostnikih z duševnimi motnjami in polifarmakoterapijo. Izvedli smo neintervencijsko, retrospektivno in opazovalno kohortno raziskavo, v katero smo vključili bolnike iz območja, ki ga pokriva zdravniška služba ZD Ljutomer, ki so bili v obdobju dveh let z delovnim nalogom napoteni v ambulanto farmacevta svetovalca. Bolniki so bili na dan pregleda stari najmanj 65 let in meli v terapiji sočasno pet ali več zdravil, od tega vsaj eno iz skupine psihofarmakov. Vpliv farmacevta svetovalca na zdravljenje v skladu s smernicami smo ovrednotili z oblikovanjem napovednega modela za zdravljenje s psihofarmaki. Na podlagi aktualnih smernic smo ovrednotili zdravljenje v skladu s smernicami in s pomočjo Priscus liste preverili prisotnost potencialno neprimernih zdravil (PIM) za starostnike. V raziskavo je bilo vključenih 48 bolnikov, ki so skupaj prejemali 558 zdravil, od tega 155 za zdravljenje duševnih motenj. Po farmacevtski obravnavi se je število zdravil zmanjšalo za 9,5 %. Farmacevt je podal 60 intervencij za terapijo zdravljenja s psihofarmaki, od katerih jih je zdravnik sprejel 32 (53,3 %). Intervencije farmacevta svetovalca so privedle do zmanjšanja števila zdravil, PIM in potencialnih X interakcij (p < 0,001). Večji delež upoštevanja intervencij farmacevta svetovalca napoveduje večjo verjetnost, da bo bolnik zdravljen v skladu s smernicami za zdravljenje s psihofarmaki (p < 0,001). Intervencije farmacevta svetovalca so privedle k boljšemu sledenju smernicam ter manjšega števila zdravil, potencialnih X interakcij in zdravil na sezamu Priscus. Sprejete intervencije so se v večini ohranile tudi po šestih mesecih, kar kaže na pomembno vlogo farmacevta svetovalca pri zdravljenju duševnih motenj.

• Language: Slovenian
• Keywords: starostniki, polifarmakoterapija, duševne motnje, farmacevtske intervencije, potencialno neprimerno zdravilo, farmakoterapijski pregled, farmacevt svetovalec, klinična raziskava.
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2019
• PID: 20.500.12556/RUL-112617
• Publication date in RUL: 26.10.2019

Secondary language

• Language: English
• Title: Clinical evaluation of pharmacist consultant interventions in elderly patients with mental disorders and polypharmacy at the Health Centre Ljutomer

Abstract

Mental disorders are a significant clinical and economic burden in the world, which means that the role of the pharmacist in the treatment process is very important. The greatest challenge within the elderly population is the treatment of patients with comorbidity and polypharmacotherapy. Despite the widely known efficacy of pharmacist interventions, there is a lack of long-term research in this field. In Slovenia, the adoption of the new healthcare service Pharmaceutical Counseling presents an opportunity for direct cooperation between a physician and a consultant pharmacist in a primary health center. However, long-term effects of such cooperation have not been well researched yet. The aim of the study was to clinically evaluate whether direct involvement of a consultant pharmacist in the treatment process can have a long-term impact on the quality of medication prescribing in elderly patients with mental disorders and polypharmacotherapy. We conducted a non-interventional, retrospective and observational cohort study that included patients from the area covered by the Ljutomer primary health center who were referred to a pharmacist consultant's setting during a two-year time period. Patients were at least 65 years old at the time of examination and were receiving five or more active substances at the same time, including at least one psychotropic. The impact of the consultant pharmacist on treatment guidelines adherence was evaluated with binary logistic regression. The pharmacotherapy was evaluated on the basis of current treatment guidelines, while potentially inappropriate medications (PIM) for the elderly were detected with the Priscus list. The study included 48 patients receiving a total of 558 medications, including 155 for the treatment of mental disorders. After pharmacist interventions the total number of medicines decreased by 9.5 %. The consultant pharmacist proposed 60 interventions including psychotropics, of which 32 (53.3 %) were accepted by the general practitioners. Consultant pharmacist interventions led to a decrease in the total number of medications, PIM, and potential X-type drug-drug interactions (p < 0.001). A higher proportion of accepted consultant pharmacist interventions predicts a greater probability for treatment guidelines adherence (p < 0.001). Clinical pharmacist interventions have increased treatment guideline adherence and reduced the number of prescribed medications, potential X-type interactions, and medications on the Priscus list. Most of the accepted interventions have been maintained after six months, which indicates the important role of the consultant pharmacist in the long-term treatment of mental disorders.

• Keywords: the elderly, polypharmacotherapy, mental disorders, pharmaceutical interventions, potentially inappropriate medication, medical review, consultant pharmacist, clinical trial.