Vpliv intervencij kliničnega farmacevta na uporabo potencialno neprimernih zdravil pri starostnikih z duševnimi motnjami v Zdravstvenem domu Ljutomer: kohortna retrospektivna raziskava

Nemec, Alja (author), Štuhec, Matej (mentor)

Potencialno neprimerna zdravila (PIM), so tista zdravila, pri katerih tveganja ob uporabi presežejo želene koristi zdravljenja in se pogosto pojavljajo pri starejših odraslih. Med skupino zdravil, ki predstavljajo PIM, so psihofarmaki najbolj pogosto zastopana skupina, kar nakazuje na povečano potrebo za ukrepe in možnosti racionalizacije in optimizacije zdravljenja z zdravili na tem področju. Glede na dosegljive podatke raziskav, lahko uporaba PIM vodi v številne neželene učinke, nepotrebne hospitalizacije, vpliva na umrljivost in viša stroške zdravljenja. Vključevanje kliničnega farmacevta v zdravljenje z zdravili z uporabo storitve farmakoterapijskega pregleda, predstavlja enega izmed najpomembnejših načinov zmanjševanja PIM, kar je bilo dokazano v nekaterih raziskavah, a nam primanjkuje podatkov o vplivu kliničnega farmacevta na število PIM pri starejših bolnikih z duševnimi motnjami in polifarmakoterapijo. Glavni namen raziskave je določiti delež sprejetja farmacevtovih intervencij, raziskati razširjenost PIM ter ovrednotiti vpliv predlaganih intervencij kliničnega farmacevta na razširjenost PIM med starejšimi odraslimi z duševnimi motnjami. Izvedli smo retrospektivno, neintervencijsko, opazovalno kohortno raziskavo, v katero smo vključili bolnike ZD Ljutomer. Vključeni vzorec predstavljajo bolniki, starejši od 65 let, s polifarmakoterapijo in vsaj enim predpisanim zdravilom za zdravljenje duševnih motenj ter z vsaj eno diagnozo duševne motnje, ki so bili obravnavani pri kliničnem farmacevtu v obdobju raziskave. S pomočjo kliničnih izvidov in ostale medicinske dokumentacije smo si zabeležili podatke o terapiji in diagnozah bolnikov, ter intervencijah predlaganih s strani kliničnega farmacevta. S pomočjo Priscus liste in Beersovih kriterijev smo izračunali razširjenost in strukturo PIM med bolniki, ter izdelali napovedni model vpliva upoštevanja farmacevtovih intervencij na zmanjšanje števila PIM po farmakoterapijskem pregledu zdravil. Od 99 bolnikov, vključenih v raziskavo, jih je vsaj 1 PIM v terapiji prejemalo 69,7 % bolnikov glede na Priscus listo oz. 92,9 % bolnikov glede na Beersove kriterije. Najpogosteje razširjena skupina PIM je bila skupina benzodiazepinov in benzodiazepinom sorodna zdravila (t.i. »z«-zdravila). Zdravniki so skupno sprejeli 44,0 % vseh predlaganih intervencij. Intervencije kliničnega farmacevta so privedle do zmanjšanja števila PIM glede na Priscus listo za 21,1 % in glede na Beersove kriterije za 17,3 % (p < 0,05). Bolniki, pri katerih zdravniki predlogov kliničnega farmacevta niso upoštevali v celoti, so imeli v primerjavi z ostalimi bolniki, večje razmerje obetov za PIM glede na Beers kriterije (razmerje obetov = 3,8, interval zaupanja 1,4-10,1) in statistično neznačilno manjši obet za PIM glede na Priscus listo (razmerje obetov = 2,8, interval zaupanja 1,0-8,2). Rezultati raziskave dokazujejo pozitiven vpliv intervencij kliničnega farmacevta na kakovost zdravljenja z zdravili v smislu zmanjšanja števila zdravil, števila PIM glede na Beers in Priscus listo ter tako potrjujejo smotrnost navedenih intervencij v kliničnem okolju.

• Language: Slovenian
• Keywords: starejši odrasli, duševne motnje, potencialno neprimerna zdravila, klinični farmacevt, farmakoterapijski pregled
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2020
• PID: 20.500.12556/RUL-113692
• Publication date in RUL: 25.01.2020

Secondary language

• Language: English
• Title: Impact of clinical pharmacist interventions on the use of potentially inappropriate medications in the primary Health Centre Ljutomer in elderly patients with mental disorders: a cohort retrospective study

Abstract

Potentially inappropriate medications (PIMs) are medications where risks at use exceed the desired benefits of treatment, and their use is widespread among elderly patients. In the group of PIMs, the psychotropics are most often represented, what indicates the need of a rational pharmacotherapy with these medications. The results of several studies show that the use of PIM has many undesired effects, leads to unnecessary hospitalizations, higher mortality, and increases the costs of the medical treatment. An introduction of medical review provided by clinical pharmacist is one of the most important approach of PIM reduction, benefits have been shown in some studies although data about the influence of the clinical pharmacist on the number of PIMs in the elderly patients with mental disorders and polypharmacotherapy is missing. The main objective of the research is to determinate the interventions’ acceptance rate provided by clinical pharmacist, prevalence of PIM and the effect of clinical pharmacist’s interventions on the number of PIMs among elderly persons with mental disorders. A retrospective non-interventional observational cohort research, involving patients of the Community Health Centre was conducted. Only patients over 65 years with polypharmacotherapy and at least one psychotropic and one diagnosis of mental disorders who were screened by clinical pharmacist were included. Patients’ therapy and diagnosis and proposed clinical pharmacist’s interventions were collected from patients’ charts. Using the PRISCUS List and the Beers Criteria we have calculated the prevalence and structure of PIM among patients. Statistical models which evaluated the impact of clinical pharmacist’s interventions on the reduction of PIM number after the medical review were built. 99 patients were included in the research and at least one PIM was presented in 69.7 % (PRISCUS List) of patients and 92.9 % (Beers Criteria) of patients. Benzodiazepines and Z-drugs were the most common PIMs. Physicians accepted 44.0 % of all suggested interventions. The interventions led to 21.2 % decrease in the number of PIMs according to the PRISCUS List and 17.3 % decrease according to the Beers Criteria (p < 0.05). Patients where physicians did not fully accepted clinical pharmacist's interventions had higher odds ratios for PIM than those where interventions were fully accepted according to the Beers criteria (odds ratio for PIM = 3,8, confidence interval 1.4-10.1) and statistically insignificantly for PRISCUS list (odds ratio for PIM = 2,8, confidence interval 1.0-8.2). These results show positive effect of clinical pharmacist's interventions on the quality of the pharmacotherapy indicated by decrease in the number of medication and the number of PIMs according to the PRISCUS List and the Beers Criteria. These results confirm positive effects of clinical pharmacist’s interventions within this field in real clinical practice.

• Keywords: elderly persons, mental disorders, potentially inappropriate medication, clinical pharmacist, medical review