Vrednotenje intervencij kliničnega farmacevta pri starostnikih s polifarmakoterapijo v Psihiatrični bolnišnici Ormož

Stolnik, Eva (avtor), Vovk, Tomaž (mentor), Štuhec, Matej (komentor)

Polimorbidnost, ki je značilna za starostnike, pogosto vodi v zdravljenje z več zdravili hkra-ti, kar je lahko zelo učinkovito in v nekaterih primerih nujno potrebno, posebej pri bolnikih z duševnimi motnjami. Z višanjem števila zdravil v terapiji se veča verjetnost nastanka mož-nih neželenih učinkov in medsebojnega delovanja zdravil, zato imajo pri optimizaciji poli-farmakoterapije, ter izbiri varnega ter učinkovitega zdravljenja z zdravili, klinični farmacevti čedalje bolj pomembno vlogo. Pozitivni vplivi vključevanja farmacevta v obravnavo pacien-tov so bili v Sloveniji dokazani predvsem na ambulantnem nivoju (farmacevt svetovalec), medtem ko je podatkov za psihiatrične bolnišnice malo. Namen raziskave je oceniti vpliv kliničnega farmacevta na kakovost zdravljenja z zdravili z optimizacijo farmakoterapije pri starostnikih (klinični vidik) ter na zmanjševanje stroškov povezanih s farmakoterapijo (ekonomski vidik). Izvedli smo neintervencijsko retrospektivno raziskavo primerov v Psihiatrični bolnišnici Ormož, v katero smo vključili paciente, ki so bili med letoma 2013 in 2018 napoteni na farmakoterapijski pregled (FTP) h kliničnemu farmacevtu. Na dan pregleda so bili stari vsaj 65 let in so prejemali vsaj pet različnih zdravil. S pomočjo analize FTP in odpustnih pisem smo vrednotili število in vrste nasvetov farmacevta (primarni izidi spremljanja kvalitete zdravljenja) ter finančno vrednost sprejetih nasvetov (sekundarni oziroma ekonomski izidi). V raziskavo je bilo vključenih 106 pacientov (povprečna starost 78,4 leta), ki so imeli v povprečju predpisanih 11,4 zdravil. Po obravnavi pri farmacevtu je vsak pacient v povpre-čju prejemal 1,1 zdravila manj, torej 10,3 zdravil. Celokupno je bilo predpisanih 9,6 % manj zdravil kot pred FTP (1089 v primerjavi z 1204). Pojavnost potencialno neprimernih zdravil za starostnike (PIM) se je zmanjšala za 53,1 % glede na Priscus listo (iz 96 na 45 PIM), ter za 37,3 % (iz 166 na 104 PIM) glede na Beersove kriterije. Število potencialnih X interakcij se je z značilno razliko zmanjšalo iz 24 na 4 (83,3 % delež zmanjšanja) (p = 0,050), število potencialnih D interakcij pa za 65,9 % (iz 129 na 44 zdravil) (p < 0,001). Število zdravil, predpisanih brez jasne indikacije, se je po FTP skoraj prepolovilo v primerjavi s številom pred FTP (42,7 % delež zmanjšanja; N = 75) (p < 0,001). Z upoštevanimi intervencijami farmacevta je bilo prihranjenih 177.758,5 € stroškov, razmerje med vloženimi in pridoblje-nimi sredstvi za en FTP je v tem primeru (16,0–22,6) € : 1 €. Visok delež upoštevanih inter-vencij (63,8 %; N = 570) nakazuje na dobro sodelovanje med farmacevtom in zdravniki v bolnišnici, visoka donosnost storitve FTP pa potrebo po sistemskem financiranju in s tem omogočanje večje dostopnosti storitev za bolnike in finančna sredstva bolnišnicam za zapo-slovanje kliničnih farmacevtov z namenom izvajanja storitev FTP. Rezultati raziskave pri-kazujejo, da vključevanje kliničnega farmacevta izboljšuje kvaliteto zdravljenja z zdravili pri starostnikih.

• Jezik: Slovenski jezik
• Ključne besede: starostniki, farmakoterapijski pregled, klinični farmacevt, optimizacija zdravljenja z zdravili, duševne motnje, zdravstveni program, sistemsko financiranje storitve
• Vrsta gradiva: Magistrsko delo/naloga
• Organizacija: FFA - Fakulteta za farmacijo
• Leto izida: 2023
• PID: 20.500.12556/RUL-145698
• Datum objave v RUL: 10.05.2023

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Evaluation of clinical pharmacist interventions in elderly patients treated with polypharmacy at the Psychiatric hospital Ormož

Izvleček

Multimorbidity is more common in advanced age and often leads to polypharmacy, which can be effective and sometimes even necessary, especially in patients with mental disor-ders. However, the more medications a patient takes, the greater the risk of drug interac-tions and adverse effects. Clinical pharmacists are gaining recognition for optimizing drug therapy and selecting the safest and most effective medications for patients. Studies in have shown that the involvement of clinical pharmacists is effective, especially in primary care, while data for psychiatric units are limited. We aimed to investigate the impact of clinical pharmacists' interventions on the quality of medication prescribing by optimizing drug therapy in the elderly (clinical aspect) and on reducing the cost of pharmacotherapy (economic aspect). We conducted a non-interventional, retrospective case study that included patients hospi-talized in the Ormož Psychiatric Unit who were referred to a clinical pharmacist for a med-ication review between the years 2013 and 2018. On the day of the consultation, patients were at least 65 years old and had prescribed at least five different medications. Using ret-rospective analysis of medical records, we collected information on the number and type of interventions made by the clinical pharmacist (primary outcomes of therapy optimization monitoring) and the financial value the suggestions adopted (secondary or economic out-comes). The study included 106 patients (mean age 78.4 years) who had been prescribed an average of 11.4 drugs before the medication review. Medication reviews conducted by clinical pharmacists reduced the number of medications prescribed in the patients' drug regiments by an average of 1.1 and 10.3, respectively. Overall, patients received 9.6 % fewer medica-tions (from 1204 to 1089) after the medication review. The number of prescribed PIMs decreased by 53.1 % according to the Priscus list (from 96 to 45 PIM) and by 37.3 % ac-cording to the Beers criteria (from 166 to 104). A statistically significant difference was observed in reducing potential drug-drug interactions of type X from 24 to 4 (83.3 % re-duction rate) (p = 0,050), and of type D from 129 to 44, corresponding to a reduction rate of 65.9 % (p < 0,001). The number of medications prescribed without a clear indication (p < 0,001) was reduced by almost half after medication review (42.7 % reduction rate; N = 75). 177,758.5 € in unnecessary costs were saved by the considered interventions, and the ratio between invested and acquired funds for medication review was (16.0–22.6) €: 1 €. The high acceptance of the proposed interventions (63.8 %; N = 570) indicates that the collaboration between clinical pharmacists and physicians works well. The high profitability of the medication review service indicates the need for sytematic financing of the service, allowing better accessibility for patients and financial resources for hospitals employing clinical pharmacists to perform medication review services. The results of the study show that the involvement of a clinical pharmacist positively affects the quality of drug therapy in the elderly.

• Ključne besede: elderly, medication review, clinical pharmacist, medication therapy optimization, mental disorders, healthcare program, financial implementation of clinical pharmacy services.