| Abstract | Cilj: Svrha ovog istraživanja bila je ispitati adherenciju pacijenata s kroničnim bolestima te njihovo iskustvo i stavove vezane uz utjecaj pandemije COVID-19 na dostupnost zdravstvenih radnika, straha od zaraze u zdravstvenim ustanovama i utjecaja na adherenciju.
Ispitanici i metode: Ispitivanje je bilo dizajnirano kao presječno, opservacijsko. U ispitivanju je sudjelovalo 200 nasumično odabranih pacijenata diljem Hrvatske. Uključne kriterije su činili dob veća od 18 godina, dijagnoza barem jedne kronične bolesti, najmanje dva propisana lijeka na recept i da pacijent sam podiže svoje lijekove u ljekarni. Kriterije isključivanja činila su stanja u kojima pacijent nije u mogućnosti dati točne informacije, primjerice dijagnoza demencije. Sudjelovanje u istraživanju je bilo dobrovoljno, a pacijenti koji su zadovoljili kriterije za uključivanje, sami su ispunjavali upitnik. Upitnik je razvijen za potrebe ovog istraživanja, a sadržavao je podatke o socio-demografskim karakteristikama ispitanika, zatim dvije skale za procjenu adherencije (MAQ - Medication Adherence Questionnaire i MARS - Medication Adherence Report Scale© Prof. Rob Horne) te dio o utjecaju COVID-19 pandemije na uzimanje lijekova. Svi su podaci obrađeni statistički.
Rezultati: U ispitivanje je bilo uključeno 200 pacijenata, prosječne dobi 64,32 ± 13,04 godina. 44,5% ispitanika su bile osobe muškog, a 55,5% osobe ženskog spola. Svi ispitanici su imali dijagnozu barem jedne kronične bolesti, najčešće hipertenzije (71%). Ispitanici su u prosjeku imali 3,98 ± 1,68 dijagnoza te 6,40 ± 2,87 lijekova propisanih na recept. 57% ispitanika koristilo je barem jedan pripravak za samoliječenje. Rezultati dobiveni na MAQ i MARS skalama upućuju na visok stupanj adherencije među pacijentima (MAQ 2,45 ± 2,05; MARS 22,38 ± 2,64). Nisu pronađene statistički značajne razlike s obzirom na spol, dob, obrazovanje i bračni status. Pronađena je statistički značajna razlika adherencije prema mjestu stanovanja pri čemu su ispitanici koji žive u ruralnim područjima bili manje adherentni no oni u urbanim sredinama. S obzirom na dijagnozu, pronađena je statistički značajna razlika za pacijente koji boluju od astme i reumatoidnog artritisa (RA), pri čemu su se astmatičari pokazali manje adherentnima no ostali, a pacijenti s RA adherentnijima. Manji dio pacijenata je prestao s uzimanjem lijekova tijekom pandemije uzrokovane COVID-19 virusom, što se uglavnom odnosilo na pacijente s RA. 39% ispitanika izbjegavalo je zdravstvene ustanove zbog straha od zaraze, a 34% je imalo problema stupiti u kontakt s liječnikom obiteljske medicine.
Zaključak: Većina se pacijenata prilagodila promjenama do kojih je uslijed pandemije COVID-19 došlo u zdravstvenom sustavu te novonastala situacija nije značajnije utjecala na njihovu adherenciju. Ipak, pokazalo se da je više od trećine pacijenata imalo otežan pristup zdravstvenim ustanovama i liječnicima obiteljske medicine te bi trebalo poduzeti mjere kako bi u okolnostima epidemije zdravstvena skrb ostala jednako dostupna svim potrebitim osobama. Istraživanje je također ukazalo na skupine pacijenata pod povećanim rizikom od neadherencije; osobe koje boluje od astme su imale najnižu adherenciju, dok su osobe koje boluju od RA bile adherentnije od ostalih, ali najčešće ukinuli pojedine lijekove zbog straha od utjecaja COVID-19 bolesti. |
| Abstract (english) | Objectives: The purpose of the study was to examine the adherence of patients with chronic diseases and their experience related to the impact of the COVID-19 pandemic on the availability of health workers, fear of infection in health facilities and the impact on adherence itself.
Patients and methods: The study was designed as a cross-sectional, observational study. The study involved 200 randomly selected patients throughout Croatia. Including criteria were age over 18, diagnosis of at least one chronic disease, at least two prescription drugs, and the patient picking up his or her own medication at the pharmacy. Exclusion criteria consisted of conditions in which the patient was unable to provide accurate information, such as a diagnosis of dementia. Participation in the study was voluntary, and patients who met the inclusion criteria completed the questionnaire themselves. The questionnaire was developed for the purposes of this research, and contained data on socio-demographic characteristics of respondents, then two scales for assessing adherence (MAQ - medication adherence questionnaire and MARS - Medication Adherence Report Scale © Prof. Rob Horne) and part on the impact of COVID- 19 pandemics on medication. All data were processed statistically.
Results: The study included 200 patients, mean age 64.32 ± 13.04 years. 44.5% of respondents were male and 55.5% female. All subjects were diagnosed with at least one chronic disease, most commonly hypertension (71%). Subjects had an average of 3.98 ± 1.68 diagnoses and 6,40 ± 2.87 prescription drugs. 57% of respondents used at least one self-medication drug. The results obtained on the MAQ and MARS scales indicate a high degree of adherence among patients (MAQ 2.45 ± 2.05; MARS 22.38 ± 2.64). No statistically significant differences were
found with respect to gender, age, education, and marital status. A statistically significant difference in adherence to place of residence was found, with respondents in rural areas being less adherent than those in urban areas. Based on the diagnosis, a statistically significant difference was found for patients with asthma and rheumatoid arthritis (RA), with asthmatics being less adherent and patients with RA being more adherent than others. A small proportion of patients stopped taking the medication during a pandemic caused by the COVID-19 virus, which mainly affected RA patients. 39% of respondents avoided health facilities for fear of infection, and 34% had trouble getting in touch with a physician.
Conclusion: Most patients have adapted to the changes that have taken place in the health care system as a result of the COVID-19 pandemic, and the new situation has not significantly affected their adherence. However, more than a third of patients have been shown to have difficulty accessing health facilities and family physicians, and measures should be taken to keep health care equally accessible to all those in need in the circumstances of the pandemic. The study also indicated groups of patients at increased risk of nonadherence; people with asthma had the lowest adherence, while people with RA were more adherent than others, but most often discontinued certain medications for fear of being affected by COVID-19 disease. |
