| Abstract | Cilj istraživanja: Utvrđivanje ustrajnosti prema farmakoterapiji kod kroničnih
bolesnika sa šećernom bolesti te utvrđivanje možebitne razlike u ustrajnosti bolesnika
s dijabetesom tip I koji primaju parenteralnu terapiju i dijabetesom tip II koji primaju
oralnu terapiju i možebitno postojanje razlike u ustrajnosti mjereno dvama različitim
skalama za mjerenje ustrajnosti (Čulig skala i Morisky-Green skala). Krajnji cilj je
davanje preporuka bolesnicima i ljekarnicima u svrhu povećanja stupnja ustrajnosti.
Na temelju tih rezultata ljekarnici će biti upoznati s problemom eventualne neustrajnosti
bolesnika te će se moći konkretno obraćati bolesnicima sa savjetima prilikom izdavanja
lijeka; poglavito vezano uz dozu lijeka, redovitost uzimanja, prijavljivanje nuspojava ili
štetnih učinaka te svih ostalih čimbenika vezanih uz medikaciju.
Ispitanici i metode: Istraživanje je neintervencijsko, osigurava se zaštita
podataka bolesnika te poštivanje bioetičkih standarda, odnosno četiriju temeljnih
bioetičkih principa. Odobreno je na sjednici Etičkog povjerenstva Nastavnog zavoda
za javno zdravstvo „Dr. Andrija Štampar“ dana 16.3.2015. te na sjednici Povjerenstva
za etičnost eksperimentalnog rada Farmaceutsko-biokemijskog fakulteta dana
11.2.2016..
Slučajnim odabirom anketirani su bolesnici oboljeli od šećerne bolesti u 11 ljekarni: na
području grada Zagreba (Martićeva, Vrbik, Gundulićeva i Rudeš) i u mjestima Ozalj,
Gvozd, Rugvica, Zadar, Slavonski Brod, Gornja Vrba i Donji Miholjac. Uspoređivani su
bolesnici koji se liječe oralnim antidijabeticima i oni koji se liječe parenteralno
inzulinom. Korištene su dvije skale: Čulig skala i Morisky-Green skala za mjerenje
ustrajnosti prema terapiji. Podatci su se obradili odgovarajućim statističkim metodama. Testiranja postavljenih
hipoteza provedena su uz pomoć statističkih metoda kojima se utvrđivala statistička
značajnost razlike.
Rezultati: Istraživanjem je bilo obuhvaćeno 448 bolesnika s ciljem utvrđivanja
njihove ustrajnosti prema antidijabetičkoj terapiji.
Broj ispitanika obuhvaćen i jednom i drugom skalom bio je gotovo identičan, Naime,
Morisky-Green skalom intervjuirano je 223 ispitanika, a Čulig skalom 225 ispitanika.
Međutim, razlika je u broju ispitanika obzirom na način primjene lijeka pa je 347 osoba
koristilo oralnu terapiju, a 101 parenteralnu inzulinsku terapiju.
Ukupna neustrajnost iznosi relativno visokih 40,8% i nešto je veća u slučaju oralnih
antidijabetika (42,4%) nego u slučaju parenteralne terapije (35,6%). Čulig skala koja
ima viši koeficijent unutarnje konzistentnosti (Cronbach alfa) pokazuje niži stupanj
neustrajnosti i u slučaju oralne (40,2% prema 44,5%), i u slučaju parenteralne terapije
(31,4% prema 40,0%).
Zaključak: Glavni problem dugotrajne terapije značajno je smanjenje ustrajnosti
prema lijekovima. Slaba ustrajnost je glavni razlog nedovoljne kliničke koristi terapije.
To uzrokuje medicinske i psihosocijalne komplikacije bolesti, smanjuje kvalitetu
bolesnikovog života te neracionalno troši resurse zdravstvenog sustava.
Bolesnike treba informirati o važnosti redovitog uzimanja propisane terapije te u
dogovoru s njima treba pronaći dobar način da ih se podsjeti na uzimanje propisane
terapije. |
| Abstract (english) | Objectives: Determining the adherence to drug therapy for chronic patients with
diabetes and determining possible differences in adherence between patients with
diabetes type I, who are treated with parenteral therapy, and those with diabetes type
II, who are treated with oral antidiabetic medications, and possible differences in
adherence measured by two different scales (the Čulig scale and the Morisky-Green
scale). The final objective is giving recommendations to patients and pharmacists in
order to increase the degree of adherence. Based on those results, pharmacists will
come to know the problem of possible non-adherence of patients and will be able to
directly talk to the patients with recommendations while issuing medications to
patients; especially regarding the medication dosage, regular intake, registering side
effects or adverse effects, and all other factors related to prescribed therapy.
Patients and Methods: The study is non-interventional, the protection of
personal data is provided, and bioethical standards, i. e. four fundamental bioethical
principles, are respected. The study was approved at the session of the Ethics
Committee of Andrija Stampar Teaching Institute of Public Health on March 16 2015,
and at the session of the Committee for Ethics of Experimental Research of the Faculty
of Pharmacy and Biochemistry on February 11 2016.
Patients with diabetes were randomly surveyed in 11 pharmacies: in the Zagreb area
(Martićeva, Vrbik, Gundulićeva, and Rudeš) and in Ozalj, Gvozd, Rugvica, Zadar,
Slavonski Brod, Gornja Vrba, and Donji Miholjac. The patients who are treated with
oral antidiabetic medications were compared to those who are treated with parenteral
insulin therapy. Two scales were used for the measurement of adherence to
medication therapy: the Čulig scale and the Morisky-Green scale.
The data were processed using appropriate statistical methods. The set hypotheses
were tested using the statistical methods in order to determine statistically significant
differences.
Results: The study was carried out on 448 patients in order to determine their
adherence to antidiabetic medication therapy.
The number of respondents included in both scales was almost identical. That is, 223
respondents were interviewed with the Morisky-Green scale, and 225 respondents with
the Čulig scale. However, there is a difference in number of respondents considering
the way medication was administered, thus 347 persons used oral medications, while
101 persons used parenteral insulin therapy.
The total non-adherence is relatively high (40.8%) and is somewhat higher with oral
antidiabetics (42.4%) than with parenteral therapy (35.6%). The Čulig scale, which has
a higher reliability coefficient (Cronbach alpha), shows lower degree of adherence with
both oral (40.2% to 44.5%) and parenteral therapy (31.4% to 40.0%).
Conclusion: The main problem with long-term therapy is significant reduction in
adherence to medication. The main reason for insuficient clinical benefit of therapy is
poor adherence. It causes medical and psychosocial complications of illness,
decreases the quality of patients' life, and wastes healthcare resources.
Patients need to be informed of the importance of regularly taking prescribed
medication therapy. Also, in agreement with the patients, one should find the right way
to remind them of taking the prescribed therapy. |
