Odnos do zdravil pri bolnikih s hipertenzijo v Sloveniji

Petrovič, Timoteja (author), Kos, Mitja (mentor), Kodrič, Ana (comentor)

Uvod. Hipertenzija je srčno-žilna bolezen sodobnega časa, ki je v največjem deležu odgovorna za prezgodnjo smrt v svetu. Bolezen lahko obvladujemo z nefarmakološkimi ukrepi in zdravili za zniževanje krvnega tlaka, med katerimi so najpogostejši zaviralci angiotenzinske konvertaze ter antagonisti angiotenzina 2. Za uspešno zdravljenje je potrebno, da pacient aktivno sodeluje pri zdravljenju. Prav tako na potek zdravljenja vpliva pacientov odnos do zdravil, ki vključuje različna prepričanja glede zdravil in zdravljenja. Odnos do zdravil vrednotimo s pacientovo potrebo po zdravljenju, morebitnimi prisotnimi skrbmi, ki se nanašajo na jemanje zdravil, če je prisoten strah pred neželenim učinki zdravil ter mnenjem pacientov o potencialno prekomernem predpisovanju in rabi zdravil. Namen. Namen magistrske naloge je ugotoviti, kakšen je odnos pacientov s hipertenzijo do njihovih zdravil in zdravljenja. Metode. V sklop opazovalne raziskave smo vključili paciente s hipertenzijo, ki so kot antihipertenzivno terapijo prejemali zaviralce angiotenzinske konvertaze ter antagoniste angiotenzina 2 (kot monoterapijo ali v kombinaciji z drugimi antihipertenzivnimi zdravili). Zanimal nas je vpliv na novo uvedene terapevtske skupine antagonistov angiotenzina 2 v primerjavi z že obstoječo terapevtsko skupino zaviralcev angiotenzinske konvertaze. Paciente smo izbirali naključno, ko so obiskali lekarne. Z njimi smo študentje farmacije, ki smo bili takrat na praktičnem usposabljanju opravili intervju, pridobili informacije o njihovih demografskih značilnostih in terapiji. Pacienti so izpolnili vprašalnik BMQ, za ovrednotenje odnosa do zdravil ter vprašalnik MMAS-8, s katerim smo dobili vpogled v sodelovanje pri zdravljenju. Ob koncu intervjuja smo pacientom izmerili krvni tlak. Pri prvem obisku lekarne smo se s pacienti dogovorili še za drugo srečanje, na katerem smo jim izročili vprašalnik MMAS-8 ter jim izmerili krvni tlak. Vpliv dejavnikov na posamezne poddomene BMQ-ja smo analizirali z multiplo linearno regresijo. Povezavo med odnosom do zdravil in sodelovanjem pri zdravljenju smo ovrednotili s Spearmanovim koeficientom. Rezultati. V raziskavo je bilo vključenih 117 pacientov. 65 % je bilo žensk, povprečna starost vključenih pacientov znaša 66 let. 39 % pacientov se za hipertenzijo zdravi več kot 10 let, v 35 % traja zdravljenje 1-5 let. Nekaj več kot 10 % je pacientov, ki se zaradi hipertenzije zdravijo manj kot 1 leto. 64 % pacientov prejema eno, približno 27 % pacientov pa dve antihipertenzivni zdravili, . Majhen odstotek je tistih, ki prejemajo tri ali več zdravil za zniževanje krvnega tlaka. Povprečne meritve krvnega tlaka s prvega srečanja znašajo 142/86 mm Hg, z drugega srečanja pa 136/83 mm Hg. Pacienti, ki občutijo večjo potrebo po zdravljenju z zdravili za zniževanje krvnega tlaka, so starejši in pacienti s srednješolsko ter visokošolsko izobrazbo. Skrbi povezane z zdravili so pogostejše pri pacientih, ki so doživeli neželene učinke zdravil. Strah pred prekomerno rabo zdravil je pogostejši pri pacientih z zdravim življenjskim slogom, natančneje uživanjem sadja in zelenjave. Strah pred neželenimi učinki zdravil pa je pogostejši pri ženskah, mlajših pacientih, tistih, ki terapijo prejemajo med 5 in 10 let, in tistih, ki nimajo povsem urejenega krvnega tlaka. Pri zdravljenju dobro sodeluje 55 %, srednje 43 % in slabo 2 % pacientov s hipertenzijo. Odnos do zdravil med vključenimi pacienti nima značilnega vpliva na sodelovanje pri zdravljenju. Zaključki. Pacienti s hipertenzijo v Sloveniji imajo pozitiven odnos do svojih zdravil in aktivno sodelujejo pri svoji terapiji.

• Language: Slovenian
• Keywords: Hipertenzija, krvni tlak, odnos do zdravil in zdravljenja, vprašalnik BMQ, sodelovanje pri zdravljenju, Slovenija
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2020
• PID: 20.500.12556/RUL-114434
• Publication date in RUL: 28.02.2020

Secondary language

• Language: English
• Title: Beliefs of patients with hypertension about their medicines in Slovenia

Abstract

Introduction: Hypertension is a cardiovascular disease of the modern world that is largely responsible for premature death in the world today. The disease can be controlled with lifestyle choices and medicines. The most frequently used pharmaceutical drugs are angiotensin-converting enzyme inhibitors and angiotensin 2 receptor antagonists Active cooperation of patients is necessary for successful treatment of the disease. Patients` beliefs about medicines also influence the course of treatment. Patients` attitudes are assessed by their need for treatment, concerns about the potential adverse effects of taking medicines, possible harmful effects of medicines and the patients` opinion about overprescribing of medicines. Purpose: Purpose of master’s thesis is to find out beliefs of patients with hypertension about their medicines and treatment. Methods: Patients involved in observational research received angiotensin-converting enzyme inhibitors and angiotensin 2 receptor blockers (as monotherapy or in combination with others antihypertensive). We were interested in influence of new therapeutic group of angiotensin 2 receptor blockers in comparison to already existent therapeutically group of angiotensin-converting enzyme inhibitors. Patients were chosen randomly at their visit at the pharmacy. Information about their demographic characteristics and treatment was gained in interviews by students of pharmacy. BMQ questionnaires were used to assess patients` beliefs about their medicines and treatment, while MMAS-8 questionnaires measured their medication adherence in treatment. At the end of the interviews, patients` blood pressure was measured. At the first pharmacy visit the second meeting was arranged. We submitted MMAS-8 questionnaire to patients and measured their blood pressure. Multiple linear regression analysis was used to establish the correlation between the variables. The correlation between patients` beliefs about medicines and their medication adherence was measured with Spearman's coefficient. Results: There were 117 patients in our study. 65% of patients were women, the mean age was 66 years. 39% of patients receive their therapy for hypertension more than 10 years and in 35% therapy lasts 1-5 years. Something more than 10% of patients receive their therapy for less than 1 year. 64% if patients get one antihypertension medicine, approximately 27% of patients get two medicines. Small percent of patients have three or more antihypertension medicines. Average measurements of blood pressure in the first meeting were 142/86 mmHg, and 136/83 mmHg in the second meeting . Older patients, patients with secondary and higher education feel a greater need for treatment with medicines for hypertension. Patients who have already experienced adverse effects of drugs are more concerned about the use of medicines. Fear of overuse of medicines is more prevalent in patients with healthy lifestyle choices, notably fruit and vegetables consumption. Fear of harm of medicines is more prevalent in women, younger patients, patients who have undergone therapy for 5 to 10 years, and patients who do not have a normal blood pressure. Medication adherence is estimate as high in 55% of patients, 43% of patients have medium and 2% have low adherence rate in treatment of hypertension. The involved patients ‘ beliefs about medicines does not have a significant influence on their medication adherence. Conclusion: Patients with hypertension in Slovenia have positive beliefs about their medicines and take an active part in treatment.

• Keywords: Hypertension, blood pressure, patients` beliefs, BMQ questionnaire, medication adherence, Slovenia