Efikasnost procjene adherence i komplijanse u hroničnih pacijenata
Sažetak
Kvalitet zdravstvene zaštite, propisivanje recepata i uzimanje lijekova na odgovarajući način može se donekle definisati terminima kao što su komplijansa, adherenca, perzistenca i konkordanca. Komplijansa je mijera do koje se ponašanje osobe koja uzima lijek, poklapa sa preporukom zdravstvenog radnika koji lijek izdaje/propisuje. Adherenca je pojam koji se često poistovjećuje s pojmom komplijansa, a podrazumijeva veće angažovanje pacijenta pri donošenju odluka vezanih za njegovu terapiju. Neadherenca se može razvrstati u dvije kategorije: primarnu i sekundarnu; namjernu i nenamjernu. Postoji niz načina kojima se utvrđuje ustrajnost pacijenata prema terapiji. Naročito su pogodna ispitivanja koja se svode na iskazivanje samih pacijenata s obzirom da su jeftina i neposredna, a ujedno dolazimo do stavova pacijenata o uzimanju lijekova. Ograničenja takvih istraživanja su moguća nedovoljna razumljivost pitanja od strane pacijenata te nepovjerenje i strah pacijenata vezanih uz objavljivanja podataka o uzimanju lijekova. Pretraživanjem PubMeda uz ključne riječi adherence, compliance i persistence (ustrajnost) te self-report questionnaire došlo se do svih do sada poznatih skala za mjerenje ustrajnosti. Večina skala je dizajnirana u zadnjih nekoliko godina (2005–2012). Pregledano je oko stotinjak članaka i 20 je uključeno u ovaj prikaz. Iako postoji niz različitih skala, još uvijek se ne može govoriti o zlatnom standardu, iako je tome najbliža medication Adherence Questionnaire (MAQ) skala nazvana još i, prema svom autoru, Morisky skala. Ova sinteza literature je izvedena sa željom da približi farmakoekonomsku dimenziju problema komplijanse i utiče na intenziviranje napora na njenom unapređenju u lokalnim uslovima.
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