Terapijski problemi u liječenju astme: opservacijsko istraživanje na uzorku pacijenata iz Doma zdravlja "Solin"

professional thesis

• Author: Marina Cokarić
• Mentor: Vesna Bačić Vrca (mentor)
• Committee member: Vesna Bačić Vrca (predsjednik povjerenstva)
• Committee member: Ivana Čepelak (član povjerenstva)
• Committee member: Sanja Popović-Grle (član povjerenstva); MBZ: 153353
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; Zagreb
• Defense date and country: 2016, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Cilj istraživanja: Cilj je ovog istraživanja utvrditi najčešće terapijske probleme u liječenju astme, u suradnji s liječnicima obiteljske medicine.
Ispitanici i metode: Ovo opservacijsko istraživanje provedeno je u Ljekarni SDŽ „Solin” u sklopu Doma zdravlja „Solin”. U istraživanje su uključeni bolesnici s dijagnozom J45 (astma) prema Međunarodnoj klasifikaciji bolesti (MKB) koji su pristali sudjelovati prilikom redovnog preuzimanja antiastmatika propisanih na recept u ljekarni. Isključeni su oni bolesnici kojima je dijagnoza astme tek postavljena i došli su u ljekarnu prvi put preuzeti antiastmatik te bolesnici mlađi od 18 godina. Prvi dio potrebnih podaka prema obrascu za analizu terapije preuzet je iz zdravstvenog kartona bolesnika od suradnog liječnika, dok su ostali potrebni podatci prikupljeni od strane ljekarnika u razgovoru s bolesnikom.
Rezultati: Rezultati Asthma Control Test-a (ACT) pokazuju da 54% ispitanika nema adekvatno kontroliranu astmu (ACT < 20). 36% ispitanika ima dobro (ACT = 20 – 24), a 10% potpuno kontroliranu astmu (ACT = 25). Srednja vrijednost ACT-a svih ispitanika uključenih u istraživanje iznosi 17,26 ± 5,39. U 32% slučajeva propisana terapija za astmu prati GINA smjernice.
Kod 34% ispitanika pronađene su moguće klinički značajne interakcije antiastmatika s ostalim lijekovima u terapiji. Kod ovih ispitanika utvrđena je ukupno 31 interakcija stupnja značajnosti C i D. Od ukupnog broja interakcija 87% je kategorije značajnosti C, a 13% D. U 48% ispitanika propisani su lijekovi koji su kontraindicirani za primjenu kod osoba koje boluju od astme. Moguće interakcije antiastmatika s OTC lijekovima, biljnim lijekovima i dodatcima prehrani nisu uočene. Kontraindikacije za primjenu u astmi uočene su kod njih 32%. 40% ispitanika prijavljuje da su uočili neku od nuspojava antiastmatika koje primjenjuju. 3 ispitanika su zbog nuspojava počela neredovito uzimati lijek, a jednak broj je naveo nuspojave kao razlog prestanka uzimanja terapije. 20% bolesnika je izjavilo da neredovito koristi propisanu terapiju za astmu, a 66% njih se izjasnilo da u nekom trenutku liječenja nisu redoviti u korištenju lijekova. Kod 42% ispitanika utvrđeno je nepravilno korištenje inhalera.
Zaključci: Rezultati ovog istraživanja ukazuju na prisutnost značajnih terapijskih problema u liječenju bolesnika s astmom u primarnoj zdravstvenoj zaštiti. Tako više od polovice ispitanika nema adekvatno kontroliranu astmu, dvije trećine ispitanika nemaju propisanu terapiju u skladu s GINA smjernicama, potencijalne klinički značajne interakcije lijekova prisutne su u terapiji više od jedne trećine ispitanih, a nuspojave kod njih 40 %, dok je jedna trećina ispitanih koristila OTC lijekove s kontraindikacijom za primjenu u astmi, njih 66% pokazuje određeni stupanj neadherencije i veliki broj ispitanika nepravilno koristi inhalere. Utvrđeni brojni i značajni terapijski problemi u liječenju astme ukazuju na nužnost aktivnog uključivanja ljekarnika u praćenje i nadzor terapije oboljelih od ove bolesti te na potrebu edukacije bolesnika o važnosti redovitog uzimanja lijekova, pravilnoj inhalacijskoj tehnici i izbjegavanju korištenja bezreceptnih lijekova bez konzultacija s ljekarnikom.

Abstract (english)

Objectives: The aim of this study is to determine asthma treatment related problems, in cooperation with primary care physician.
Patients and methods: This observational study was conducted on patient sample from Health Centre “Solin”. The study included the patients who had medical diagnosis J45 (asthma) according to International Classification of Disease (ICD) and who agreed to participate while taking antiasthmatic drugs in pharmacy on a regular basis. Excluded were those patients who had just been diagnosed with asthma and patients who were less than 18 years old. First set of data for the questionnaire was collected from their primary care physicians as medical data, while other necessary data was collected by the pharmacist through conversation with the patients.
Results: Asthma Control Test (ACT) score identifies 54% of the patients with uncontrolled asthma (ACT < 20), 36% of the patients with well control (ACT = 20 – 24) and 10% with complete control of asthma (ACT = 25). Mean ACT score of all the patients in this study was 17,26 ± 5,39. Adherence to GINA guidelines was identified in 32% of the patients.
Potential interactions between antiasthmatic drugs and other drugs in therapy were identified in 34% of the patients. Total number of potential interactions marked as level of significance C or D was 31. Out of that number, 87% of interactions is marked as level of significance C and 13% as D. 48% of the patients are using drugs contraindicated in asthma.
Potential interactions of antiasthmatic drugs and OTC drugs, herbal drugs and food supplements were not found. Contraindicated drugs were found in 32% of the patients. 40% of the patients experienced side effects from antiasthmatic drugs. Out of 20 patients, three patients started to use their therapy irregular and the same number of patients stopped using their drugs. 20% of the patients are declared as nonadherent to their asthma therapy at present time. 66% of the patients were nonadherent to their therapy at some time in the past. 42% of the patients demonstrated incorrect use of inhalers.
Conclusions: Results of this study indicate the presence of significant asthma treatment-related problems in primary health care. More than half of the patients in this study have uncontrolled asthma, two-thirds do not have antiasthmatic drugs prescribed in adherence to GINA guidelines, potential interactions with clinical significance are present in therapies of more than one-third of examinees, adverse drug reactions in 40%, one-third of the patients have used OTC drugs contraindicated in asthma, 66% are nonadherent in some level and a large number of them demonstrated inadequate inhaler technique. Significant therapy-related problems in asthma and their number indicate the need for active integration of pharmacists into the process of monitoring and supervision of patients with asthma. It is imperative to educate the patients about the need for adherence, correct inhaler technique and to avoid OTC drugs without consultations with pharmacist.

• Keywords: astma; inhalator; antiastmatik
• Keywords (english): asthma; antiasthmatic drug; inhaler
• Language: croatian
• URN:NBN: urn:nbn:hr:163:092123
• Study programme: Title: Clinical pharmacy; Study programme type: university; Study level: postgraduate specialist; Academic / professional title: sveučilišni/a magistar/sveučilišna magistra kliničke farmacije (sveučilišni/a magistar/sveučilišna magistra kliničke farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Access restricted to students and staff of home institution
• Created on: 2016-03-03 16:34:52