Utjecaj usluge upravljanja farmakoterapijom na proces deeskalacije benzodiazepina i Z-lijekova kod pacijenata na primarnoj razini zdravstvene zaštite

master's thesis

• Title (english): The impact of comprehensive medication management service on the process of de-escalation of benzodiazepines and Z-drugs in patients at the primary level of health care
• Author: Ivona Kolarević
• Mentor: Iva Mucalo (mentor)
• Committee member: Iva Mucalo (predsjednik povjerenstva)
• Committee member: Andrea Brajković (član povjerenstva)
• Committee member: Lidija Bach-Rojecky (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Centre for applied pharmacy); Zagreb
• Defense date and country: 2024-08-26, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Cilj istraživanja: Prikazati učinak usluge upravljanja farmakoterapijom na uspješnost deeskalacije benzodiazepina i
Z-lijekova kod pacijenata na primarnoj razini zdravstvene skrbi.
Materijali i metode: Provedeno je prospektivno, intervencijsko istraživanje u FTS unutar DZZC gdje se provodila
usluga upravljanja farmakoterapijom u razdoblju od siječnja 2018. do travnja 2024. Kroz proces pružanja skrbi
prikupljeni su relevantni podatci o pacijentu, njegovim bolestima i lijekovima koje uzima. Na temelju prikupljenih
informacija identificirani su terapijski problemi te je izrađen plan skrbi s predloženim intervencijama. Kriterij za izbor
sudionika za ovo istraživanje je ustanovljen terapijski problem vezan uz primjenu benzodiazepina ili Z-lijeka na jednoj
od konzultacija. Kod tih ispitanika predložen je postupak deeskalacije i praćeni su ishodi. Prikupljene informacije
obrađene su metodom deskriptivne statistike pomoću Microsoft Excel programa.
Rezultati: U ispitivanju je sudjelovalo ukupno 118 pacijenata, od čega su 77,1% činile žene. Pacijenti su bili prosječne
dobi od 71,2±11,1 godina. Identificirano je ukupno 1201 komorbiditeta (prosječno po pacijentu 10,2±6,0) i 1192 lijekova
(prosječno po pacijentu 11,2±5,1). Ukupno je zabilježeno 115 lijekova iz skupine benzodiazepina i 24 iz skupine Zlijekova
, među kojima je najviše bio zastupljen diazepam (35,3%). Evidentirana su ukupno 1142 terapijska problema
od kojih je 151 povezan s primjenom benzodiazepina/Z-lijekova. Predložena je 151 intervencija za spomenute lijekove
od kojih je njih 140 predloženo s ciljem deeskalacije istih. Predloženo je 125 protokola deeskalacije te je kod 7 pacijenata
proveden protokol za više od 1 lijeka. Za 57 predloženih protokola (45,6%) nije dobivena povratna informacija. Kod
ostalih 68 protokola uspješan ishod postignut je za 51 ispitanika (75%), među kojima je 23 (33,8%) ispitanika u
potpunosti prestalo s primjenom lijeka. Najveća uspješnosti deeskalacije zabilježena je za diazepam (45,0%).
Zaključak: Farmaceut kroz uslugu upravljanja farmakoterapijom i suradnjom s liječnicima opće medicine može
značajno doprinijeti uspjehu u protokolu deeskalacije benzodiazepina i Z-lijekova te poboljšanju kliničkih ishoda
povezanih s neopravdanom primjenom ovih lijekova.

Abstract (english)

Objective: To evaluate the efficacy of comprehensive medication management service in facilitating the de-escalation
of benzodiazepine and Z-drug use among primary care patients.
Materials and Methods: A prospective, interventional study was undertaken within the FTS of the DZZC to evaluate
the impact of comprehensive medication management service. The study period spanned from January 2018 to April
2024. Patient data, including comorbidities and medications, were collected during routine care. Therapeutic problems
were identified based on these data, and individualized care plans were developed. Inclusion criteria for the study were
the presence of established therapeutic problems related to benzodiazepine or Z-drug use, as identified during a
consultation. For these participants, de-escalation protocols were proposed, and outcomes were monitored. Descriptive
statistics were employed to analyze the collected data using Microsoft Excel.
Results: A prospective study involving 118 patients was conducted to evaluate the efficacy of a pharmaceutical care
management intervention. Participants were predominantly female (77.1%) with a mean age of 71.2 ± 11.1 years. A
comprehensive medication review identified a mean of 10.2 ± 6.0 comorbidities and 11.2 ± 5.1 medications per patient,
including 115 benzodiazepines and 24 Z-drugs. Of the 1142 therapeutic problems identified, 151 were directly related
to benzodiazepine/Z-drug use. De-escalation interventions were proposed for these problems, with 125 distinct deescalation
protocols implemented. While feedback was not available for all proposed protocols, a successful outcome
was achieved for 75% of the remaining protocols, with 33.8% of participants completely discontinuing the target
medications. Diazepam demonstrated the highest de-escalation success rate (45.0%).
Conclusion: Pharmacists, through comprehensive medication management service and collaborative efforts with
general practitioners, can substantially enhance the success of benzodiazepine and Z-drug de-escalation protocols and
improve clinical outcomes associated with the suboptimal use of these medications.

• Keywords: benzodiazepini; Z-lijekovi; deeskalacija; usluga upravljanja farmakoterapijom; ljekarnička skrb
• Keywords (english): benzodiazepines; Z-drugs; de-escalation; comprehensive medication management; pharmacy care
• Language: croatian
• URN:NBN: urn:nbn:hr:163:002106
• Study programme: Title: Pharmacy - integrated undergraduate and graduate - university study; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: sveučilišni magistar farmacije (sveučilišni magistar farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-10-11 12:00:30