Ovrednotenje izidov zdravljenja z zdravili po ambulantni ali bolnišnični napotitvi v obravnavo h kliničnemu farmacevtu v Univerzitetnem kliničnem centru Maribor

Osmanbegović, Sara (author), Kerec Kos, Mojca (mentor), Petre, Maja (comentor)

Klinična farmacija je področje farmacije, ki se osredotoča na optimizacijo in racionalizacijo uporabe zdravil z namenom izboljšanja izidov zdravljenja bolnikov ter kakovosti njihovega življenja. Namen naše raziskave je bil klasificirati težave povezane z zdravili (DRP), ki so jih klinični farmacevti zaznali tekom ambulantne in hospitalne obravnave bolnikov, v skladu s PCNE klasifikacijo V9.1. Predvsem nas je zanimalo, v kolikšni meri je lečeči zdravnik priporočila kliničnega farmacevta upošteval in implementiral ter kakšni so bili izidi intervencij. V raziskavo smo vključili 34 ambulantno in 72 bolnišnično obravnavanih bolnikov, za katere so klinični farmacevti v UKC Maribor med letoma 2020 in 2021 izvedli farmakoterapijski pregled. Pri ambulantno obravnavanih bolnikih je mediana starosti znašala 44 let (razpon: 16-88), več je bilo moških (53 %). Mediana prejetih zdravil v redni terapiji je znašala 7 (razpon: 3-14). Skupno smo pri ambulantno obravnavanih bolnikih zabeležili 75 DRP, največ pa jih je isti bolnik imel 8. Mediana DRP je na bolnika znašala 2 (razpon: 1-8). Najpogostejša vrsta DRP je bil verjeten neželeni učinek zdravila (41/75, 54 %), najpogostejši vzrok za DRP pa neprimerna kombinacija zdravil (23/75, 30 %). Intervencija je bila s strani kliničnega farmacevta predlagana v 75 % (56/75) in s strani zdravnika sprejeta v 46/56 primerov (82 %). Celokupno je bila intervencija sprejeta v 61 % DRP (46/75) in težava se je vsaj delno razrešila v 45 % (34/75). Pri bolnišnično obravnavanih bolnikih je mediana starosti znašala 64 let (15-94), tudi tukaj pa je več obravnavanih bilo moških (60 %). Mediana prejetih zdravil v redni terapiji je bila 12, največ pa jih je bolnik prejemal 24 (razpon: 4-24). Skupno smo pri bolnišnični obravnavi zabeležili 209 DRP, mediana na bolnika pa je znašala 3 (razpon: 1-10). Najpogostejša vrsta in vzrok za DRP sta tudi pri teh bolnikih bila verjeten neželeni učinek zdravila (101/209, 48 %) in neprimerna kombinacija zdravil (73/209, 35 %). Intervencija je pri bolnišnično obravnavanih bolnikih bila s strani kliničnega farmacevta predlagana v 90 % (189/209), s strani zdravnika pa sprejeta v 71 % (148/209). DRP se je (delno) razrešila v 61 % (129/209) . Z raziskavo smo pokazali pomembnost zagotavljanja farmakoterapijskega pregleda s strani kliničnega farmacevta za ambulantne in hospitalizirane bolnike.

• Language: Slovenian
• Keywords: farmakoterapija, DRP, PCNE, zdravljenje z zdravili, klinična farmacija
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2024
• PID: 20.500.12556/RUL-158942
• Publication date in RUL: 23.06.2024

Secondary language

• Language: English
• Title: Evaluation of treatment outcomes after outpatient or inpatient referral to a clinical pharmacist at the University Medical Center Maribor

Abstract

Clinical pharmacy is a component of pharmacy that focuses on optimizing and rationalizing the use of medications to improve patient treatment outcomes and quality of life. The aim of our research was to classify drug-related problems (DRPs) identified by clinical pharmacists during outpatient and inpatient care of patients according to the PCNE classification V9.1. We were particularly interested in assessing the extent to which the attending physician followed and implemented the recommendations of the clinical pharmacist and what the outcomes of these interventions were. The study included 34 outpatient and 72 hospitalized patients, for whom clinical pharmacists at the University Medical Centre Maribor conducted pharmacotherapy review between 2020 and 2021. For outpatient patients, the median age was 44 years (range: 16-88), with a majority being male (53 %). The median number of medications in regular therapy was 7 (range: 3-14). A total of 75 DRPs were recorded among outpatient patients, with the highest number observed in a single patient being 8. The median number of DRPs per patient was 2 (range: 1-8). The most common type of DRP was a suspected adverse drug reaction (41/75, 54 %), with the most common cause being inappropriate drug combination (23/75, 30 %). Intervention was proposed by the clinical pharmacist in 75 % (56/75) of cases and accepted by the physician in 46 out of 56 cases (82 %). Overall, intervention was accepted in 61 % of DRPs (46/75), and the DPR was at least partially resolved in 45 % (34/75) of cases. For hospitalized patients, the median age was 64 years (15-94), with a majority also being male (60 %). The median number of medications in regular therapy was 12, with one patient receiving up to 24 medications (range: 4-24). A total of 209 DRPs were recorded during hospitalization, with a median of 3 DRPs per patient (range: 1-10). The most common type and cause of DRPs in these patients were suspected adverse drug reactions (101/209, 48 %) and inappropriate drug combination (73/209, 35 %). Intervention was proposed by the clinical pharmacist in 90 % (189/209) of cases and accepted by the physician in 71 % (148/209). DRPs were (partially) resolved in 61 % (129/209) of cases. Through this research, we have demonstrated the importance of providing pharmacotherapy review by a clinical pharmacist for outpatient and hospitalized patients.

• Keywords: pharmacotherapy, DRP, PCNE, drug treatment, clinical pharmacy