Vpliv usklajevanja zdravljenja z zdravili na primarno sodelovanje internističnih bolnikov pri zdravljenju z zdravili po odpustu s Klinike Golnik

Breznik, Luka (avtor), Knez, Lea (mentor), Jošt, Maja (komentor)

Hospitalizacija je pogosto povezana s spremembami v terapiji bolnikov. Da bi bili bolniki bolje seznanjeni s spremembami in posledično bolje opolnomočeni pri svojem sodelovanju pri zdravljenju z zdravili, se v klinično prakso uvaja storitev usklajevanja zdravljenja z zdravili. Glavni namen magistrske naloge je bil raziskati, ali storitev usklajevanje zdravljenja z zdravili izboljša bolnikovo primarno sodelovanje, to je sodelovanje pri zdravljenju z zdravili, ki so bila uvedena ob odpustu iz Klinike Golnik. V našo raziskavo je bilo vključenih 414 internističnih bolnikov, hospitaliziranih v Kliniki Golnik, ki so bili razdeljeni v intervencijsko skupino (225/414; 54,3 %) in primerjalno skupino (189/414; 45,7 %). Bolniki v intervencijski skupini so bili s strani kliničnega farmacevta deležni storitve usklajevanja zdravljenja z zdravili ob sprejemu in odpustu iz bolnišnice s svetovanjem, bolniki v primerjalni skupini pa so bili deležni standardne klinične prakse. Vse podatke smo prejeli iz zdravstvene dokumentacije bolnikov, evidence prevzemov zdravil ter prek telefonskega pogovora z bolnikom 30 dni po odpustu. Bolnik je primarno sodeloval pri zdravljenju s posameznim zdravilom, če ga je bodisi prejel že ob odpustu iz bolnišnice ali če ga je prevzel v lekarni najkasneje dan po odpustu iz bolnišnice. Bolnikom je bilo po odpustu iz Klinike Golnik uvedenih 787 zdravil na recept, z mediano 2 zdravili na bolnika. Bolniki so bili primarno sodelujoči pri 71,0 % uvedenih zdravil na recept (559/787). Bolniki v intervencijski skupini so primarno sodelovali pri zdravljenju z več zdravili (316/391; 80,8 %) kot bolniki v primerjalni skupini (243/396; 61,4 %). Bolniki v intervencijski skupini so bili že na dan odpusta preskrbljeni z več (270/391; 69,0 %) uvedenimi zdravili kot bolniki v primerjalni skupini (189/396; 47,0 %). Prav tako je bilo v intervencijski skupini statistično značilno več bolnikov primarno sodelujočih (178/225; 79,1 %) kot v primerjalni (100/189; 52,9 %; p < 0,001). Bolniki v intervencijski skupini so imeli več kot 3-krat večjo verjetnost za primarno sodelovanje pri zdravljenju z zdravili kot tisti v primerjalni skupini (OR = 3,428; 95% CI 2,156–5,450; p < 0.001). Verjetnost za primarno sodelovanje je bila večja pri mlajših bolnikih in bolnikih z manjšim številom uvedenih zdravil. Pri zdravilih, namerno uvedenih ob odpustu, je bila verjetnost za primarno sodelovanje večja kot pri nenamerno uvedenih zdravilih, in sicer 33-krat večja za namerne, dokumentirane (OR = 33,776; 95% CI 9,709–117,506; p < 0,001) in 15-krat večja za namerne, nedokumentirane uvedbe (OR = 14,886; 95% CI 4,201–52,755; p < 0,001). Verjetnost za primarno sodelovanje je bila skoraj 4-krat večja, kadar je bilo zdravilo uvedeno za časovno omejeno zdravljenje (OR = 3,780; 95% CI 1,362–10,488; p = 0,011). Razlike v primarnem sodelovanju opazimo tudi med različnimi ATC skupinami uvedenih zdravil (p = 0,005), kjer je verjetnost za primarno sodelovanje najslabša ob uvedbi zdravil za pljučne bolezni in zdravil iz skupine antidepresivov, sedativov in antipsihotikov, najboljša pa ob uvedbi antidiabetikov, antitrombotikov, zdravil za sistemsko zdravljenje infekcij ter analgetikov. V raziskavi smo potrdili pozitiven vpliv svetovanja ter usklajevanja zdravljenja z zdravili ob sprejemu in odpustu na primarno sodelovanje bolnikov pri zdravljenju z zdravili, uvedenimi ob odpustu iz bolnišnice, kar dodatno potrjuje potrebo po redni vključitvi le-tega v klinično prakso.

• Jezik: Slovenski jezik
• Ključne besede: Usklajevanje zdravljenja z zdravili, primarno sodelovanje pri zdravljenju z zdravili, Klinika Golnik, napake pri zdravljenju z zdravili, brezšivna skrb.
• Vrsta gradiva: Magistrsko delo/naloga
• Tipologija: 2.09 - Magistrsko delo
• Organizacija: FFA - Fakulteta za farmacijo
• Leto izida: 2025
• PID: 20.500.12556/RUL-175956
• COBISS.SI-ID: 258192387
• Datum objave v RUL: 14.11.2025

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Effect of medication reconciliation on primary medication adherence of medical patients following discharge from University Clinic Golnik

Izvleček

Hospitalization is often associated with changes in patients’ pharmacotherapy. Medication reconciliation aims, among other, to inform patients about these changes and consequently empower them to participate actively in their pharmacotherapy. The main aim of this Master’s thesis was to investigate whether medication reconciliation improves patients’ primary adherence to medications initiated upon discharge from the University Clinic Golnik. A total of 414 medical patients, hospitalized at the University Clinic Golnik, were included either in the intervention (225/414; 54,3%) or control group (189/414; 45,7%). Patients in the intervention group received medication reconciliation at hospital admission and discharge, including pharmacist-led counseling, while patients in the control group received standard clinical care. All data were obtained from medical records, pharmacy dispensing records, and follow-up telephone interviews with patients, conducted 30 days after discharge. Patients were judged to be primary adherent with a medication, if this was either provided upon hospital discharge or dispensed by the pharmacy not later than the day following hospital discharge. Upon discharge, a total of 787 newly initiated medications were issued, with a median of two per patient. Patients were primarily adherent with 71,0% of all newly initiated medications (559/787). Patients in the intervention group were primarily adherent to a higher proportion of medications (316/391; 80,8%) compared to those in the control group (243/396; 61,4%). Patients in the intervention group also obtained a higher proportion of newly initiated medications on the day of discharge (270/391; 69,0%) than patients in the control group (189/396; 47,0%). Furthermore, a significantly higher proportion of patients in the intervention group were fully primarily adherent (178/225; 79,1%) compared with those in the control group (100/189; 52,9%; p < 0,001). Patients in the intervention group were over three times more likely to be primarily adherent to newly initiated medications than those in the control group (OR = 3,428; 95% CI 2,156–5,450; p < 0,001). Primary adherence was also associated with younger age and a smaller number of newly initiated medications. Medications whose initiation was intentional and documented were 33 times more likely to be dispensed on the day of discharge or the following day (OR = 33,776; 95% CI 9,709–117,506; p < 0,001), while those with intentional but undocumented initiation were 15 times more likely (OR = 14,886; 95% CI 4,201–52,755; p < 0,001) compared with medications whose initiation was unintentional. Primary medication adherence was nearly four times higher when medications were initiated for a short-term treatment period (OR = 3,780; 95% CI 1,362–10,488; p = 0,011). Differences in primary medication adherence were also observed among different ATC groups of newly initiated medications (p = 0,005). The lowest adherence rates were observed for medications for respiratory diseases and for antidepressants, sedatives, and antipsychotics, while the highest adherence was found for antidiabetic agents, antithrombotic agents, anti-infectives for systemic use, and analgesics. This study confirmed the positive impact of medication reconciliation at hospital admission and discharge, coupled with patient's counseling, on patients’ primary adherence to newly initiated medications upon discharge, further supporting the need for the routine implementation of this service in clinical practice.

• Ključne besede: Medication reconciliation, primary medication adherence, University Clinic Golnik, medication errors, seamless care.