Učinak implementacije integriranog modela usklađivanja farmakoterapije na učestalost nenamjernih odstupanja i sigurnost bolesnika

doctoral thesis

• Title (english): Implementation of un integrated model of medication reconciliation: effect on unintentional discrepancies and patient safety
• Author: Ivana Marinović
• Mentor: Vesna Bačić Vrca (mentor)
• Committee member: Srećko Marušić (predsjednik povjerenstva)
• Committee member: Maja Ortner Hadžiabdić (član povjerenstva)
• Committee member: Robert Likić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Centre for applied pharmacy); Zagreb
• Defense date and country: 2021-10-07, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE
• Universal decimal classification (UDC): 615 - Pharmacology. Therapeutics. Toxicology

Abstract

Uvod: Transfer skrbi je kritična točka za nastanak nenamjernih odstupanja koja mogu ugroziti ishode
farmakoterapije. Do sada nije utvrđen optimalan i standardizirani model u rješavanju problematike transfera skrbi
između bolnica i ustanova primarne zdravstvene zaštite.
Svrha rada: Cilj ovog istraživanja bio je ispitati učinak integriranog modela usklađivanja farmakoterapije na
učestalost nenamjernih odstupanja i sigurnost bolesnika.
Metode i ispitanici: Provedeno je randomizirano kontrolirano istraživanje. U istraživanje je bilo uključeno 353
pacijenata u dobi od 65 i više godina kojima je propisana terapija s dva ili više lijekova. Ispitanici su randomizirani
u kontrolnu i intervencijsku skupinu (182 ispitanika u intervencijskoj skupini i 171 ispitanik u kontrolnoj skupini).
U intervencijskoj skupini proveden je integrirani model usklađivanja farmakoterapije, kojeg je u potpunosti vodio
bolnički klinički farmaceut (usklađivanje farmakoterapije prilikom prijema, pregled i optimizacija farmakoterapije
tijekom hospitalizacije, edukacija i savjetovanje pacijenta, usklađivanje farmakoterapije pri otpustu, usklađivanje
farmakoterapije kao dio primarne zdravstvene zaštite u suradnji s liječnikom primarne zdravstvene zaštite i javnim
ljekarnikom, praćenje pacijentove adherencije i stupnja razumijevanja farmakoterapije nakon otpusta).
Rezultati: Integrirani model usklađivanja terapije značajno je smanjio broj bolesnika s nenamjernim odstupanjima
za 57,1% (p<0,001). Intervencija je smanjila broj pacijenata s nenamjernim odstupanjima koja mogu izazvati
umjereno kliničko pogoršanje za 58,6% (p<0,001) i ona koja mogu izazvati ozbiljno kliničko pogoršanje za 68,6%
(p=0,039). Najčešća odstupanja bila su netočna doza, izostavljanje lijeka i dodavanje lijeka. Kardiovaskularni
lijekovi najčešće su bili uključeni u nenamjerna odstupanja. Nije pronađena statistički značajna razlika između
intervencijske i kontrolne skupine u stupnju adherencije i broju potencijalno neprikladnih lijekova niti u jednoj
vremenskoj točki.
Zaključak: Integrirani model usklađivanja farmakoterapije kojeg vodi bolnički klinički farmaceut, a uključuje sve
zdravstvene profesionalce i samog pacijenta, smanjuje broj nenamjernih odstupanja. Zbog njihovog specifičnog
položaja i znanja o farmakoterapiji, bolnički klinički farmaceut treba koordinirati prijenos skrbi između bolnice i
primarne zdravstvene zaštite kako bi se osigurala ispravna, potpuna i sigurna farmakoterapija. Rezultati
istraživanja ukazuju na specifične segmente ovog modela u koje se aktivnije trebaju uključiti javni ljekarnici.

Abstract (english)

Background: Transfer of care is a critical point during which unintentional discrepancies, that can
jeopardize pharmacotherapy outcomes, can occur. There is no optimal standardized model in the transfer of care
between hospitals and primary healthcare facilities.
Aim of the study: The aim of this study was to evaluate effect of un integrated medication reconciliation
model on unintentional discrepancies and patient safety.
Methods and patients: A randomized controlled study was conducted on an elderly patient population.
A total of 353 patients were analysed (182 in the intervention and 171 in the control group). The intervention group
of patients received a medication reconciliation model, led entirely by a hospital clinical pharmacist (medication
reconciliation at admission, review and optimization of pharmacotherapy during hospitalization, patient education
and counselling, medication reconciliation at discharge, medication reconciliation as part of primary health care
in collaboration with a primary care physician and a community pharmacist).
Results: The medication reconciliation model, led by a hospital clinical pharmacist, significantly reduced
the number of patients with unintentional discrepancies by 57,1% (p<0,001). The intervention reduced the number
of patients with unintentional discrepancies associated with a potential moderate harm by 58,6% (p<0,001) and
those associated with a potential severe harm by 68,6% (p=0,039). The most common discrepancies were incorrect
dosage, drug omission and drug commission. Cardiovascular medications were most commonly involved in
unintentional discrepancies. No statistically significant difference in adherence and number of potentially
inappropriate medications was found at any measuring time point between the intervention and control groups.
Conclusion: The integrated medication reconciliation model, led by a hospital clinical pharmacist in
collaboration with all health professionals involved in the patient's pharmacotherapy, significantly reduced the
number of patients with unintentional discrepancies in the transfer of care. Due to their specific position and
pharmacotherapy knowledge, the hospital clinical pharmacists should coordinate the transfer of care between the
hospital and the primary care to ensure correct, complete and safe pharmacotherapy. The results of the study
indicate the need for active involvement of community pharmacists in certain segments of the care transfer as they
are an essential link in optimizing pharmacotherapy after discharge of elderly patients from the hospital.

• Keywords: klinički farmaceut; pacijenti starije životne dobi; usklađivanje farmakoterapije; nenamjerna odstupanja
• Keywords (english): clinical pharmacist; elderly; medication reconciliation; unintentional discrepancies
• Language: croatian
• URN:NBN: urn:nbn:hr:163:938444
• Promotion: 2022
• Study programme: Title: Pharmacy and biochemistry; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor znanosti (doktor znanosti)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-11-08 16:11:38