| Abstract | Kako se u svijetu, ali i u Hrvatskoj, dobna starost sve više povećava, tako raste i incidencija Alzheimerove bolesti. Dio
bolesnika, osobito u zadnjim godinama života, smješten je u domovima za starije i nemoćne osobe zbog nemogućnosti
samostalne brige. Kako su u pitanju starije osobe s brojnim komorbiditetima, česta je i polipragmazija koja rezultira brojnim
terapijskim problemima. Uloga farmaceuta praktičara je da na stručan način detektira sve moguće terapijske probleme,
eventualno ih predvidi i na odgovoran i siguran način upravlja pacijentovom terapijom. Cilj ovog istraživanja bio je utvrditi
učestalost i vrstu terapijskih problema oboljelih od Alzheimerove demencije u domu za starije i nemoćne osobe. Provedeno
istraživanje bilo je dizajnirano kao presječno, a provedeno je u razdoblju od veljače do lipnja 2016. godine u Domu za starije i
nemoćne „Sv. Kamilo de Lellis", u Vrbovcu. Ukupno je bilo uključeno 27 pacijenata. Glavni kriterij za odabir uzorka bila je
indikacija Alzheimerove demencije. Podaci o terapiji, nuspojavama, životnim navikama, alergijama i komorbiditetima te
osnovni laboratorijski nalazi prikupljeni su uvidom u medicinsku dokumentaciju te kroz razgovor s medicinskim osobljem
Doma. Procjena moguće neprikladnosti propisane terapije provedena je primjenom kategorizacije terapijskih problema prema
Strand i sur. Interakcije lijekova definirane su u programu "Lexi-Comp Online", a u analizu terapijskih problema uključene su
klinički značajne interakcije stupnja X zbog kontraindicirane kombinacije lijekova i stupnja D za koje je potrebno razmotriti
promjenu terapije. Provedbu ovog istraživanja odobrilo je Etičko povjerenstvo Doma. U istraživanje je bilo uključeno 27
ispitanika prosječne životne dobi 79,66 ± 7,56 (raspon 65-91) s ukupno 97 komorbiditeta i 158 propisanih lijekova. Prosječan
broj postojećih komorbiditeta bio je 3,59 ± 1,47 (raspon 1-7), a korištenih lijekova 5,85 ± 2,46 (raspon 2-13). Najčešći
komorbiditeti bili su iz MKB skupine F (mentalni poremećaji i poremećaji ponašanja), potom I (bolesti cirkulacijskog sustava),
K (bolesti probavnog sustava), M (bolesti mišićno-koštanog sustava i vezivnog tkiva). Najčešće propisivani lijekovi u Domu
su iz ATK skupine N i njih je uzimalo 44,94% ispitanika. Utvrđeno je ukupno 141 terapijski problem s prosjekom 5,23 ± 3,48
terapijskih problema po ispitaniku. Najviše je terapijskih problema svrstano u kategoriju "neliječeno stanje" s udjelom od
20,08%, potom "predugo trajanje primjene lijeka" s učestalosti od 14,89% te "interakcija koja nije ovisna o dozi" s 12,77%.
Veliki broj utvrđenih terapijskih problema među starijim osobama oboljelima od Alzheimerove bolesti u Domu pokazuje kako
je potrebno implementirati farmaceuta u zdravstveni tim da bi pacijenti primali primjerenu terapiju i postigli maksimalni
klinički učinak. |
| Abstract (english) | There is a global tendency, present in Croatia as well, of an ever-growing older population which results in a higher incidence rate of Alzheimer's disease. Numerous Alzheimer's patients are settled in nursing homes due to lack of self-care, especially during their last years of life. As the patients are elderly people, they have other comorbidities that can potentially lead to polypragmasy and drug therapy problems. Pharmaceutical care practitioner's role is to efficiently detect all therapy problems, even predict them, and in a responsible and safe way - manage the patient's drug therapy. The aim of this research was to determine the prevalence of Alzheimer's disease, the type of residents' and drug therapy problems of those suffering from Alzheimer's disease. The conducted research was cross-sectional and it was carried between February and June 2016 in Caritas Nursing Home "Kamilo de Lellis" in Vrbovec, Croatia. The main inclusion criterium was being diagnosed with Alzheimer's disease. Patients’ data, including drug therapy, adverse drug reactions, standard demographic details, current and previous medical diagnoses, regular prescription medicines, social history, history of drug allergy, serum biochemistry and renal function, were retrieved by a review of patient’s medical records, admission documents, (when available and it was considered even if outdated) and through the interview with the medical staff. To this day, 6 out of 27 patients passed away but were included in final results. The identification of drug therapy problems was based on the categorization according to Cipolle, and the analysis included type X and D interactions searched for in Lexi-Interact program. Ethical Committee of the nursing home approved this research. This research included 27 participants whose average age was 79,66 ± 7,56 (range 65-91) with the total of 97 comorbidities and 108 prescribed medications. The average number of the existing comorbidities was 3,59 ± 1,47 (range 1-7), and the average number of the used medications was 5,85 ± 2,46 (range 2-13). The most common comorbidities were from the ICD group F (Mental and behavioural disorders, then I (Diseases of the circulatory system), K (Diseases of the digestive system) and M (Diseases of the musculoskeletal system and connective tissue). The most frequently prescribed medications were classified as ATC group N and were taken by 44,94% of residents. A total of 141 drug therapy problems were determined with the average occurrence of 5,3 ± 3,48. The majority of drug therapy problems were categorized as “untreated condition” (20,08%), then “duration too long – dosage too high” with the frequency of 14,89% and “drug interaction – adverse drug reaction” being 12,77%. A large number of drug therapy problems with elderly patients diagnosed with Alzheimer's disease in this nursing home demonstrate the need for the inclusion of a pharmacist in the healthcare team so that patients are able to receive optimal drug therapy and achieve the maximal clinical effect. |
