| Abstract | Otpust iz bolnice kritična je točka u zdravstvenoj skrbi za bolesnika. Promjene u terapijskom režimu tijekom hospitalizacije su uobičajene i često praćene uvođenjem novih lijekova. Bolesnikovo nerazumijevanje promjena terapijskog režima može dovesti do slabe adherencije prema lijekovima, neučinkovitosti i nuspojava lijekova te rehospitalizacije. Ljekarničke usluge usklađivanja terapije, savjetovanja bolesnika o propisanoj terapiji te upravljanja farmakoterapijom mogu znatno unaprijediti ishode liječenja prilikom transfera skrbi. Cilj ovog rada bio je razviti protokol za savjetovanje kardiovaskularnih bolesnika o propisanoj terapiji prije otpusta iz bolnice te njegova pilot provedba i evaluacija u svrhu davanja preporuka za daljnja istraživanja. Studija je zamišljena kao prospektivno intervencijsko istraživanje s dvjema paralelnim skupinama te randomizacijom prilagođenom uvjetima istraživanja. Istraživanje je provedeno na Zavodu za bolesti srca i krvnih žila Kliničke bolnice „Sveti Duh“. Za razvoj protokola pretražena je relevantna literatura na temu savjetovanja pacijenata pri otpustu iz bolnice te su uzeti u obzir koncepti ljekarničke skrbi prema Cipolle i sur. Svi su ispitanici ispunili kratak upitnik o svom zdravstvenom stanju, medikacijskoj povijesti i poznavanju propisane terapije. Prilikom savjetovanja poseban se naglasak stavljao na prepoznate ispitanikove potrebe i nesigurnosti te se nastojao uspostaviti dobar terapijski odnos kao temelj kvalitetne ljekarničke skrbi, a u okviru savjetovanja ispitaniku je uručen pisani letak koji sadrži ključne informacije o svakom lijeku u terapiji. 30 dana nakon otpusta iz bolnice, svi su ispitanici telefonski kontaktirani radi telefonskog praćenja s ciljem procjenjivanja njihove adherencije, utilizacije zdravstvene skrbi i doživljaja vlastitog zdravlja. U istraživanje je uključeno 99 ispitanika medijalne dobi 70 godina i interkvartilnog raspona između 63 i 75 godina, s prosječno 10,91 ± 3,51 lijekova u terapiji pri otpustu iz bolnice. Nije pronađena statistički značajna razlika u adherenciji između intervencijske i kontrolne skupine niti u jednoj točki ispitivanja (p= 0,059 pri razgovoru u bolnici i p= 0,305 pri telefonskom praćenju). Za intervencijsku skupinu nije pronađena statistički značajna razlika između različitih točaka ispitivanja (p = 0,383), dok za kontrolnu skupinu jest (p =0,039). Statistički značajna razlika također nije pokazana za utilizaciju zdravstvene skrbi između intervencijske i kontrolne skupine (p = 0,568 za usluge hitne pomoći, p = 0,603 za broj dana provedenih u bolnici i p = 0,202 za posjete liječniku obiteljske medicine) te za ocjenu vlastitog zdravlja između intervencijske i kontrolne skupine (p = 0,266). Ispitanici u intervencijskoj skupini primjećuju veće poboljšanje vlastitog zdravlja sa statistički značajnom razlikom u odnosu na kontrolnu skupinu (p = 0,036) . Ispitanici u intervencijskoj skupini u najvećem broju smatraju da im je pružena usluga savjetovanja pomogla u razumijevanju njihove terapije, što pokazuje da razvijeni protokol može biti koristan u razvijanju kvalitetnog terapijskog odnosa i optimizaciji bolesnikovog terapijskog iskustva. Ovi rezultati, zajedno sa istraživačevim iskustvom prilikom pilot provedbe protokola, pokazuju da postoji potreba za edukacijom bolesnika o propisanoj terapiji, a posebice kod bolesnika s najvećim rizikom od neplanirane rehospitalizacije. Kako bi se ovaj protokol mogao implementirati u kliničku praksu, potrebna su daljnja istraživanja s većim brojem ispitanika, nasumičnom randomizacijom u intervencijsku i kontrolnu skupinu te dugoročnijim praćenjem ispitanika s više provedenih follow up savjetovanja. |
| Abstract (english) | Hospital discharge is a critical point in patient health care. Changes in the therapeutic regimen during hospitalization are common and often accompanied by the introduction of new drugs. The patient's lack of understanding of changes in the therapeutic regimen can lead to poor adherence, ineffectiveness and side effects of medications, and rehospitalization. Pharmacy services for medication reconciliation, educating patients on prescribed therapy, and medication management can significantly improve treatment outcomes during the transition of care. The aim of this research was to develop a protocol for counseling cardiovascular patients about the prescribed at hospital discharge and to pilot and evaluate it in order to make recommendations for further research. The study was designed as a prospective intervention study with two parallel groups and randomization adapted to the research conditions. The research was conducted at the Institute for Cardiovascular Diseases of the "Sveti Duh" Clinical Hospital. During the development of the protocol, the relevant literature was searched on the topic of counseling patients at discharge from the hospital, and the concepts of pharmaceutical care practice, according to Cipolle et al., were taken into account. All subjects filled out a short questionnaire about their health state, medication history and their understanding of the prescribed therapy. During counseling, special emphasis was placed on the individual’s identified needs and insecurities, and an effort was made to establish a good therapeutic relationship, as it is the foundation of pharmaceutical care, and as part of the counseling, each subject was given a written leaflet containing the most important information about each medication in the therapeutic regimen. 30 days after discharge from the hospital, all subjects were contacted by telephone for a follow-up questionnaire with the aim of assessing their adherence, utilization of health care and their self-rated health. The study included 99 subjects with a median age of 70 years and an interquartile range between 63 and 75 years, with an average of 10,91 ± 3,51 drugs prescribed at hospital discharge. No statistically significant difference in adherence was found between the intervention and control groups at any point of the study (p= 0,059 at the interview in the hospital and p= 0,305 at the telephone follow-up). For the intervention group, no statistically significant difference was found between the different points of examination (p = 0,383), while for the control group there was a statistically significant difference (p = 0.039). A statistically significant difference was also not shown for the utilization of health care between the intervention and control groups (p = 0,568 for emergency room admissions, p = 0,603 for the number of days spent in the hospital and p = 0,202 for visits to the family medicine physician) and for the assessment of self-reported health between the intervention and control group (p = 0,266). Respondents in the intervention group notice a bigger improvement in their own health with a statistically significant difference compared to the control group (p = 0.036). Most subjects in the intervention group stated that the provided counseling service helped them a lot in understanding their therapy, which shows that the developed protocol succeeds in establishing a good therapeutic relationship and in optimizing the patient's therapeutic experience. These results, together with the researcher's experience during piloting of the protocol, show that there is a need for educating patients about their therapy at hospital discharge, especially for patients with the highest risk of unplanned rehospitalization. In order to integrate this protocol into clinical practice, further research need to be conducted with a larger number of subjects, computer generated randomization and longer monitoring of subjects with more follow-up counsellings. |
