| Abstract | Cilj istraživanja bio je utvrditi učestalost i vrstu terapijskih problema pri otpustu hospitaliziranih bolesnika koji boluju od astme i kronične opstruktivne plućne bolesti (KOPB-a). Retrospektivno opservacijsko istraživanje provedeno je na Klinici za unutarnje bolesti Kliničke bolnice Dubrava u razdoblju od listopada 2014. do travnja 2016. godine. Uključni kriteriji bili su 1) postavljena dijagnoza astme, KOPB-a ili sindroma preklapanja astme i KOPB-a (ACOS-a), 2) najmanje jedan lijek u terapiji pri otpustu te 3) potpisan Informirani pristanak. Za svakog bolesnika prikupljeni su podaci o terapiji, komorbiditetima, nuspojavama, alergijama, adherenciji i životnim navikama te laboratorijski nalazi. Podaci su se prikupljali kroz razgovor s ispitanicima te uvidom u njihovu medicinsku dokumentaciju. Kategorizacija prema Cipolleu i suradnicima bila je temelj identifikacije terapijskih problema, a u analizu su bile uključene X i D interakcije pretraživane u programu Lexi-Interact. Etičko povjerenstvo Kliničke bolnice Dubrava odobrilo je provedbu ovog istraživanja. U istraživanje je bilo uključeno 55 ispitanika prosječne životne dobi 66 godina (raspon 30-82 godine) koji su u prosjeku koristili 10,6 lijekova (raspon 4 do 19) i bolovali od 8,2 komorbiditeta (raspon 3-20). Ukupan broj propisanih lijekova iznosio je 580, a komorbiditeta 450. Najviše je ispitanika imalo KOPB (n=42), nakon čega su uslijedili astma i ACOS (redom n=10 i n=3 ispitanika). Utvrđeno je ukupno 238 terapijskih problema u 94,5% ispitanika, s prosjekom od 4,3 ± 3,0 terapijska problema po osobi. Najviše je terapijskih problema svrstano u kategoriju „potreba za uvođenjem dodatne terapije“ (24,4%) te „preniska doza“ (19,8%). S astmom i KOPB-om bilo je povezano 45,0% terapijskih problema, najčešće u kategoriji "potreba za uvođenjem dodatne terapije" te "nuspojave", a na drugom su mjestu uslijedili kardiovaskularni komorbiditeti odgovorni za 26,1% ukupnog broja terapijskih problema. Dodatno, tek polovina identificiranih X i D interakcija definirana je kao terapijski problem, i to najčešće u kategoriji nuspojava. Može se zaključiti da izrazito visoka učestalost terapijskih problema identificiranih kategorizacijom Cipollea i suradnika upućuje na potrebu za poboljšanjem skrbi pacijenata koji boluju od astme i KOPB-a, a u kojoj bi ljekarnici mogli ponuditi jedinstveni doprinos. |
| Abstract (english) | The aim of this study was to determine the frequency and types of drug therapy problems experienced by hospitalized patients with asthma and chronic obstructive pulmonary disease (COPD) at discharge. An observational retrospective study was conducted at the Clinical Department of Internal Medicine, University Hospital Dubrava from October 2014 to April 2016. Inclusion criteria were as follows: 1) diagnosis of asthma, COPD or asthma-COPD overlap syndrome (ACOS), 2) at least one medication prescribed at discharge and 3) signed Informed consent. For each patient we collected data on drug therapy, comorbidities, side-effects, allergies, adherence and life habits as well as laboratory results. The data were collected by interviewing participants and accessing their medical records. Drug therapy problems were identified using the categorization presented by Cipolle et al. Moreover, the analysis included X and D interactions identified by Lexi-Interact tool. Ethical approval for the conduct of this study was granted from Hospital Ethics Committee. There were 55 patients included in the study with an average age of 66 (range 30 to 82 years). On average, the participants used 10,6 drugs (range 4 to 19) and suffered from 8,2 comorbidities (range 3-20). There were 450 comorbidities and 580 drugs prescribed altogether. Most of the participants were diagnosed with COPD (n=42) followed by asthma and ACOS (n=10 and n=3 participants, respectively). Overall, there were 238 drug therapy problems identified in 94,5% of participants, that is, 4,3 ± 3,0 on average. Most of the drug therapy problems were seen in category „needs additional therapy“ (24,4%) and „dosage too low“ (19,8%). There were 45,0% drug therapy problems relating to asthma and COPD, most commonly in categories „needs additional therapy“ and "adverse drug reaction". Cardiovascular comorbidities took the second place accounting for 26,1% of total drug therapy problems. In addition, only half of the identified interactions were defined as drug therapy problems, most frequently ascribed to the category "adverse drug reaction". It can be concluded that markedly high frequency of drug therapy problems identified by categorisation according to Cipolle et al. indicates that there is a need for improvement in asthma and COPD patient care, where pharmacists could contribute in a unique way. |
