Raziskava neprimernega predpisovanja zdravil ob sprejemu in odpustu pacientov na medicinsko-geriatrični kliniki v Frankfurtu na podlagi meril Priscus 2010 in Beers 2012 : diplomska naloga

Janžekovič, Aleksandra (author), Kos, Mitja (mentor), Keiner, Nils (comentor)

Pri geriatričnih bolnikih sta multimorbidnost in polifarmakoterapija zelo razširjeni, zaradi česar so podvrženi povečanemu tveganju za pojav neželenih učinkov zdravil. Uporaba neprimernih zdravil pri teh bolnikih lahko tveganje za pojav neželenih učinkov še dodatno poveča. Cilj raziskave je bil ugotoviti razširjenost in lastnosti neprimernega predpisovanja zdravil pri geriatričnih bolnikih ob sprejemu in odpustu na Medicinsko-geriatrični kliniki v Frankfurtu na Majni. Za analizo razširjenosti neprimernega predpisovanja smo izbrali merila Priscus 2010 in merila Beers 2012. Podatke za raziskavo smo pridobili iz odpustne dokumentacije, ki je bila zbrana v arhivu bolnikov. Pregledali smo terapijo le tistih bolnikov, ki so bili z druge bolnišnice premeščeni na geriatrično kliniko z namenom nadaljnje mobilizacije in okrevanja. Pri ugotavljanju razširjenosti neprimernega predpisovanja smo uporabili le tisti del meril Beers 2012, ki vsebuje učinkovine, neodvisne od spremljajočih bolezni. 145 v raziskavo vključenih bolnikov starih nad 65 let je ob sprejemu na geriatrično kliniko prejemalo v povprečju 9,70 učinkovin, ob odpustu pa 8,68 učinkovin. Po merilih Priscus 2010 je ob sprejemu na geriatrično kliniko 17,24 % starostnikov prejemalo vsaj eno neprimerno učinkovino, ob odpustu pa 9,66 %. Po merilih Beers 2012 je 40,00 % starostnikov prejemalo vsaj eno neprimerno učinkovino ob sprejemu na geriatrično kliniko in 21,38 % ob odpustu. Ugotovili smo, da so starostniki, ki so prejeli vsaj eno neprimerno učinkovino, bodisi po merilih Priscus 2010 bodisi po merilih Beers 2012, tako ob sprejemu kot ob odpustu z geriatrične klinike dobili predpisano statistično značilno več učinkovin kot starostniki, ki niso prejemali nobene neprimerne učinkovine. Po merilih Priscus 2010 sta bila najpogosteje predpisana amitriptilin in klozapin ob sprejemu ter zolpidem ob odpustu. Po merilih Beers 2012 je bil ob sprejemu najpogosteje predpisan ibuprofen, ob odpustu pa spironolakton. Nadalje smo ugotovili, da sta po merilih Priscus 2010 dva bolnika prejemala sočasno dve neprimerni učinkovini. Po merilih Beers 2012 je dve neprimerni učinkovini sočasno prejemalo deset starostnikov, trije starostniki pa so sočasno prejemali kar tri neprimerne učinkovine. Pomembno je poudariti, da merila neprimernega predpisovanja niso mišljena kot zapoved, temveč kot pomoč zdravnikom in farmacevtom pri izbiri ustrezne terapije.

• Language: Slovenian
• Keywords: geriatrični bolniki predpisovanje zdravil neprimerna zdravila neželeni učinki zdravil starostniki terapija bolnikov polifarmakoterapija
• Work type: Undergraduate thesis
• Typology: 2.11 - Undergraduate Thesis
• Organization: FFA - Faculty of Pharmacy
• Place of publishing: Ljubljana
• Publisher: [A. Janžekovič]
• Year: 2013
• Number of pages: XI, 71 f., 1 f. pril.
• PID: 20.500.12556/RUL-44306
• UDC: 615.03-053.9(043.2)
• COBISS.SI-ID: 3459185
• Publication date in RUL: 10.07.2015

Secondary language

• Language: English
• Title: Research of inapropriate prescribing at admission and discharge of patients at the Medico-geriatric clinic in Frankfurt based on the Priscus 2010 and Beers 2012 criteria

Abstract

Multimorbidity and polypharmacy are very common in geriatric patients, hence why they are subject to greater risks for adverse reactions of medications. The use of inappropriate medication with those patients can additionally increase the risk for adverse reactions. The purpose of the research was to establish the extent and characteristics of inappropriate prescriptions of medication for geriatric patients at the medico-geriatric clinic in Frankfurt on the Main at both the point of admission and discharge of patients. For the analysis of the prevalence of inappropriate prescriptions we chose the 2010 Priscus criteria and 2012 Beers criteria. The research data was obtained from admission letters, which were collected from the patients archive. Only therapies of patients, who were transferred from another hospital to the geriatric clinic for further mobilisation and recovery, were examined. While establishing the prevalence of inappropriate prescriptions we only used the part of the 2012 Beers criteria which includes substances, independent of the concomitant illnesses. 145 of the over 65 years old patients, included in the research, received at the admission into the geriatric clinic 9.70 medications, while at discharge they received 8.68 medications. According to the 2010 Priscus criteria 17.24 % of the elderly received at least one inappropriate substance at the admission into the geriatric clinic and 9.66 % at discharge. According to the 2012 Beers criteria 40.00 % of the elderly received at least one inappropriate substance at the admission into the geriatric clinic and 21.38 % at discharge. We discovered that the elderly, who received at least one inappropriate substance according to 2010 Priscus or 2012 Beers criteria, both at admission and discharge from the geriatric clinic, were prescribed statistically significantly more medications in comparison with elderly, who did not received any inappropriate substance. According to 2010 Priscus criteria amitriptyline and clozapine were the most often prescribed medications at admission while zolpidem was most often prescribed at discharge. According to the 2012 Beers criteria ibuprofen was most often prescribed at admission and spironolactone at discharge. Further we discovered that according to the 2010 Priscus criteria two patients were receiving two inappropriate substances simultaneously. According to the 2012 Beers criteria ten elderly were receiving two inappropriate substances simultaneously, while three elderly patients were receiving even three inappropriate substances simultaneously.