Language:
Serbian
Dissertation note:
Dissertation Универзитет у Крагујевцу, Факултет медицинских наука 2021
DDC:
306
Abstract:
Cilj: Istraživanje koje je vršeno imalo je za cilj da odredi prevalencu PIM-a u populaciji starih ispitanika koji su imali dijagnostikovano kardiovaskularno oboljenje i da kvantifikuje značaj određenih varijabli na prisustvo PIM-a. Metoda: Sprovedena je hibridna studija koja je u prvom delu, od početka 2016. godine do kraja 2017.godine izvedena kao studija preseka (periodična prevalencija), a u drugom delu, tokom 2018. godine, kao klinička studija sa intervencijom putem edukacije, sa poređenjem pre i posle intervencije. Studijski uzorak obuhvatao je 1500 pacijenata starijih od 65 godina sa kardiovaskularnim oboljenjima a da su bili korisnici zdravstvenih usluga i imali dostupnu medicinsku dokumentaciju u Zavodu za gerijatriju i palijativno zbrinjavanje u Beogradu. Intervencijski deo istraživanja vršen je sa lekarima koji sprovode zdravstvenu zaštitu starih osoba a samim tim i propisivanje medikamentozne terapije čija adekvatnost propisivanja je analizirana upotrebom standardnih međunarodnih kriterijumima, American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. Potrošnja lekova u navedenoj ustanovi za posmatrane periode je vršena prema utvrđenoj ATC/DDD metodologiji koja je definisana od strane ekperata SZO. Rezultati: Učestalost PIM-a u ispitivanoj populaciji iznosila je 70,3% za period 2016.-2017. godine i 71,3% u toku 2018. godine. Posmatrano u odnosu na pol, ispitanice ženskog pola su bile dominatnije u grupi sa PIM-om. Najviše ispitanika imalo je 4 komorbiditeta uz osnovnu dijagnozu. Komorbiditeti sa visokom frekvencom su bili u grupi bolesti I00-I99 (bolesti srca i krvnih sudova) (36.9%). Dijagnoze koje su najviše zabeležene su bile iz podgrupe I10- I15 (hipertenzivne bolesti) (48,83%), I20-I25 (ishemijske bolesti srca) (20,38%). Po pacijentu je u periodu 2016-2017 godine propisivano 7,2 leka dok je tokom 2018. godine iznosio 7,3. Lekovi koji su potencijalno neadekvatno propisivani sa najvećom frekvencom su: benzodiazepini srednjeg delovanja (79,03%), centralni α blokatori (23,57%), antipsihotici (tipični i atipični) (30,75%). Potencijalno klinički značajne neinfektivne interakcije lek-lek koje bi trebalo izbegavati kod starih osoba beleži pad sa (35,5% na 30,9%) u prospektivnom periodu. Potencijalno neadekvatno propisivanje lekova koji se moraju koristiti sa oprezom kod starih osoba beleži smanjenje za: antipsihotike (29,5% na 27,8%), diuretike (69,9% na 63,8%) i SSRI (22,7% na 19,7%). Potencijalno neadekvatno propisivanje lekova usled lek-bolest ili lek-sindrom interakcije koje mogu pogoršati bolest ili sindrom zabeleženo je u periodu 2016.-2017. u 105 slučajeva ili (8,6%) a nakon intervencije 2018.godine u 74 slučajeva odnosno (6,4%) Prediktori za PIM su brojni i to: polifarmacija, pol, upotreba nikotina, kognitivni status, uhranjenost i komorbiditet za period pre intervencije a nakon toga je pokazan i uticaj bračnog stanja i emocionalnog statusa. Zaključak: Kardiovaskularne bolesti u starijoj populaciji povezane su sa visokom prevalencijom potencijalno neadekvatnog propisivanja lekova. Iako je zabeleženo smanjenje potrošnje pojedinih kardiovaskualrnih lekova nakon održane edukacije, prevalenca PIM-a nije se smanjila. Kreiranje zdravstvenih preporuka za propisivanje lekova kod starijih osoba koje bi naglasile navedene faktore moglo bi uticati na smanjenje prevalencije PIM-a u navedenoj popilaciji. ; Aim: Study has purpose to show prevalence of PIM in the population of elderly person with the cardiovascular disease and to quantify influence of the specific variable on PIM presence. Methods: A hybrid study was performed, which in the first part, from the beginning of 2016 to the end of 2017, was performed as a cross-sectional study (periodic prevalence), and in the second part, during 2018, as a clinical study with interventions during education and after interventions. Sample of the study inluded 1500 partcipants older then 65 years with cardiovascular disease and who was used specific health services and had medical data at the Institute for Gerontology and Palliative Care, Belgrade. Interventional part of the study was done with medical doctor who presribed drugs at this institution. The adequacy of the prescribed therapy was assessed by American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. Drug consumption for the observed periods was determinated by established ATC/DDD methodology defined by WHO experts. Results: PIM frequency in the examined population was 70,3% during the period 2016-2017 and 71,3% during the 2018. Observed in relation to gender, female respondents were more dominant in the group with PIM. Most subjects had 4 comorbidities with a basic diagnosis. Comorbidities with high frequency were in the group of diseases I00-I99 (cardiovascular diseases) (36.9%). The most frequently diagnosed diagnoses were from subgroup I10-I15 (hypertensive diseases) (48.83%), I20-I25 (ischemic heart diseases) (20.38%). In the period 2016-2017, 7.2 drugs were prescribed per patient, while in 2018 it was 7.3. Drugs that are potentially inadequately prescribed with the highest frequency are: medium-acting benzodiazepines (79.03%), central α blockers (23.57%), antipsychotics (typical and atypical) (30.75%). Potentially clinically significant non-infectious drug-drug interactions that should be avoided in the elderly decreased from 35.5% to 30.9% in the prospective period. Potentially inadequate prescribing of drugs that must be used with caution in the elderly decreased for: antipsychotics (29.5% to 27.8%), diuretics (69.9% to 63.8%) and SSRIs (22.7% to 19.7%). Potentially inadequate drug prescribing due to drug-disease or drugsyndrome interactions that may exacerbate the disease or syndrome was noted in the period 2016-2017. in 105 cases or (8.6%) and after the intervention in 2018 in 74 cases or (6.4%) Predictors for PIM are numerous, as follows: polypharmacy, sex, nicotine use, cognitive status, nutrition and comorbidity for the period before interventions and after that the influence of marital status and emotional status is shown. Conclusion: Cardiovascular diseases in the elderly population are associated with a high prevalence of potentially inadequate drug prescribing. Although a decrease in the consumption of certain cardiovascular drugs was observed after the training, the prevalence of PIM did not decrease. Creating health recommendations for prescribing drugs in the elderly that would emphasize these factors could reduce the prevalence of PIM in this population.
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