Ovrednotenje težav, povezanih z zdravili, pri izvajanju storitve pregled uporabe zdravil v Sloveniji

Petek, Marko (author), Kos, Mitja (mentor), Nabergoj Makovec, Urška (co-mentor)

Uvod: Pri predpisovanju, izdajanju in uporabi zdravil nastopajo različni dejavniki tveganja, ki lahko privedejo do težav, povezanih z zdravili (DRP) in posledično predstavljajo pacientom resne zdravstvene težave in zaplete. Storitev pregled uporabe zdravil (PUZ) predstavlja orodje za prepoznavo in razreševanje DRP. Namen: Namen magistrske naloge je bil ovrednotiti DRP pri izvajanju PUZ v Sloveniji. Metode: Podatke smo pridobili v okviru randomizirane kontrolirane klinične raziskave Ovrednotenje koristi storitve pregled uporabe zdravil, v kateri je bil pacientom v testni skupini izveden PUZ skladno z izvajanjem storitve v praksi. Podatke smo pridobili iz izpolnjenih delovnih listov izvajalcev PUZ in pogovora s pacienti. Izvedli smo opisno analizo DRP na nivoju pacienta in na nivoju posameznih DRP po konceptu »prej-potem«. V programu IBM SPSS smo z uporabo binomskega testa ovrednotili tudi vpliv PUZ na reševanje DRP. Rezultati: V testno skupino je bilo vključenih 77 pacientov s povprečno starostjo 68,7 let, 7,2 zdravili za redno uporabo in 2,2 zdravili po potrebi. Razlog za PUZ jim je v 56 % predstavljala polifarmakoterapija. Petdeset pacientov je imelo vsaj eno dejansko DRP, 27 pacientov pa zgolj potencialne težave. Med 221 identificiranimi DRP je bilo 90 dejanskih in sicer 60 % neželenih dogodkov (pri 39 pacientih), 18,9 % težav povezanih z učinkovitostjo zdravljenja (pri 16 pacientih), 12,2 % težav povezanih s stroški zdravljenja (pri 9 pacientih) in 8,9 % drugih težav (pri 7 pacientih). Pri dejanskih DRP smo med dejavniki tveganja klasificirali največ drugih vzrokov (pri 33 pacientih), samostojnih intervencij (pri 39 pacientih) in v celoti razrešenih težav (pri 21 pacientih). Zdravila za bolezni srca in ožilja so najpogosteje povzročala dejanske DRP (pri 26 pacientih). PUZ je značilno zmanjšal delež pacientov z vsaj 1 dejanskim DRP (p<0,001), delež vseh dejanskih DRP (p=0,001) in stopnjo ogroženosti z dejanskimi DRP (p<0,001). Zaključek: PUZ omogoča dobro prepoznavo dejanskih DRP in kaže velik potencial za njihovo razreševanje.

• Language: Slovenian
• Keywords: težave, povezane z zdravili, storitev pregled uporabe zdravil, dejavniki tveganja, intervencije, izidi
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2020
• PID: 20.500.12556/RUL-121469
• Publication date in RUL: 11.10.2020

Secondary language

• Language: English
• Title: Evaluation of drug-related problems identified during medicines use review service in Slovenia

Abstract

Introduction: When prescribing, dispensing and using drugs, various risk factors occur, which can lead to drug-related problems (DRP) and consequently present serious health problems and complications to patients. The Medicines Use Review service (MUR) is a tool to identify and resolve DRP. Aim: The aim of the master's thesis was to evaluate the DRP in the implementation of the MUR in Slovenia. Methods: The data were obtained as part of a randomized controlled clinical trial Evaluation of the benefits of the Medicines Use Review service, in which patients in the test group were performed MUR in accordance with the implementation of the service in practice. Data were obtained from completed worksheets of MUR providers and interviews with patients. We performed a descriptive analysis of DRP at the patient level and at the level of individual DRP according to the “before-after” concept. In the IBM SPSS program, we also evaluated the impact of MUR on DRP resolution using the binomial test. Results: The test group included 77 patients with a mean age of 68,7 years, 7,2 drugs for regular use, and 2,2 drugs as needed. The reason for MUR was polypharmacotherapy in 56% of them. Fifty patients had at least 1 manifested DRP, and 27 patients had only potential problems. Among the 221 identified DRP, 90 were manifested, namely 60% of adverse events (in 39 patients), 18.9% of treatment-related problems (in 16 patients), 12.2% of treatment-related problems (in 9 patients), and 8.9% of other problems (in 7 patients). In manifested DRP, the risk factors were classified as most other causes (in 33 patients), stand-alone interventions (in 39 patients) and fully resolved problems (in 21 patients). Cardiovascular drugs most commonly caused manifested DRP (in 26 patients). MUR significantly reduced the proportion of patients with at least 1 manifested DRP (p <0.001), the proportion of all manifested DRP (p = 0.001) and the level of risk with manifested DRP (p <0.001). Conclusion: MUR enables good identification of manifested DRP and shows great potential for their resolution

• Keywords: drug-related problems, Medicines Use Review service, risk factors, interventions, outcomes