Pružanje ljekarničke skrbi i utjecaj na kliničke ishode pacijenata s kroničnim bolestima u domu za starije osobe

master's thesis

• Title (english): The provision of pharmaceutical care and its impact on clinical outcomes in patients with chronic diseases in a nursing home
• Author: Petra Bogadi
• Mentor: Andrea Brajković (mentor)
• Committee member: Andrea Brajković (predsjednik povjerenstva)
• Committee member: Iva Mucalo (član povjerenstva)
• Committee member: Kristina Radić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Centre for applied pharmacy); Zagreb
• Defense date and country: 2024-09-30, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Cilj rada je procijeniti učinak usluge upravljanja farmakoterapijom (CMM) na kliničke ishode pacijenata s kroničnim
bolestima u domu za starije osobe te prikazati provedene intervencije za poboljšanje terapijskih ishoda i njihovu
prihvaćenosti od strane liječnika obiteljske medicine (LOM) i pacijenata. Prospektivno, intervencijsko istraživanje
provedeno je od listopada 2023. do srpnja 2024. u Domu za starije osobe Centar u koje su uključeni korisnici Doma koji
uzimaju barem jedan lijek ili dodatak prehrani i imaju barem jednu kroničnu bolest. CMM usluga pružana je od strane
farmaceuta koji su zajedno s LOM-om i pacijentom postavili specifične terapijske ciljeve (TC) za svakog korisnika.
Sudjelovalo je 56 pacijenata, (87,5 % žena), s medijanom od 11 (1-20) korištenih lijekova i 9 (1-24) komorbiditeta.
Identificirano je 289 terapijskih problema (TP), prosječno 5,5 po pacijentu. Najučestaliji TP bili su „Nepotrebna terapija“
(22,15 %) i „Preniska doza“ (19,72 %). Predloženo je 289 intervencija, od kojih su pacijenti prihvatili 90 %, a LOM 88,04
%. Najčešće intervencije bile su „Prekid terapije“ (27,68 %) i „Povećanje doze lijeka“ (13,49 %). Pokazana je statistički
značajna razlika u broju korištenih lijekova između prve i zadnje konzultacije; kod stacionarnih korisnika uočena je
povećana depreskripcija (p=0,0019), a kod stambenih povećanje broja lijekova (p=0,0014). Najčešći lijekovi koji su
isključeni iz terapije bili su tramadol/paracetamol, diazepam i pantoprazol. Kod pacijenata s dijagnozom primarne
hipertenzije uočen je trend povećanja broja onih koji su postigli terapijski cilj za arterijski krvni tlak na zadnjoj konzultaciji
(33,33 %) u odnosu na prvu konzultaciju (26,67 %). Rezultati ovog istraživanja pokazuju da pružanje usluge CMM i
uključivanje farmaceuta u multidisciplinarni tim s LOM-om i medicinskom sestrom u domu za starije osobe može imati
značajan utjecaj na poboljšanje kliničkih ishoda i optimizaciju terapije korisnika DZS što upućuje na potrebu za širenjem
CMM usluge i u druge domove za starije osobe s ciljem unaprjeđenja zdravstvene skrbi osoba starije životne dobi.

Abstract (english)

The aim of this study is to assess the impact of comprehensive medication management (CMM) services on clinical
outcomes in older patients with chronic conditions in a nursing home, and to present the interventions aimed at improving
therapeutic outcomes, as well as their acceptance by general practitioners (GPs) and patients. A prospective, interventional
study was conducted from October 2023 to July 2024 at the Nursing Home Center. Participants included residents taking
at least one medication or dietary supplement and having at least one chronic disease. The CMM services were provided
by pharmacists, who, together with the GP and patient, established specific goals of therapy for each resident. A total of
56 patients participated, 87.5% of whom were women, with a median of 11 (1–20) medications used and 9 (1–24)
comorbidities. 289 drug therapy problems (DTP) were identified, averaging 5.5 per patient. The most frequent DTPs were
"Unnecessary drug therapy" (22.15%) and "Dosage too low" (19.72%). Overall 289 interventions were proposed, of which
90% were accepted by patients and 88.04% by GPs. The most common interventions were "Discontinue drug therapy"
(27.68%) and "Increase dose" (13.49%). A statistically significant difference in the number of medications used between
the first and final consultations was observed, with increased deprescribing in inpatient care residents (p=0.0019) and
increased medication use in residential users (p=0.0014). The most frequently deprescribed drugs were
tramadol/paracetamol, diazepam, and pantoprazole. For patients diagnosed with primary hypertension, there was an
observed increase in the number of those who achieved the therapeutic goal for the blood pressure at the last consultation
(33.33%) compared to the first consultation (26.67%). The results of this study indicate that providing CMM services and
integrating a pharmacist into a multidisciplinary team with a general practitioner and a nurse in a nursing home can
significantly impact clinical outcomes improvement and optimization of therapy for nursing home residents. This suggests
the need to expand CMM services to other nursing homes to improve healthcare for the elderly.

• Keywords: osobe starije životne dobi; usluga upravljanja farmakoterapijom; ljekarnička skrb; klinički ishodi
• Keywords (english): elderly; comprehensive medication management services; pharmaceutical care; clinical outcomes
• Language: croatian
• URN:NBN: urn:nbn:hr:163:672693
• 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: 2024-10-15 12:50:34