ANALIZA FAKTORA POVEZANIH SA PROPISIVANJEM POTENCIJALNO NEODGOVARAJUĆIH LEKOVA KOD PACIJENATA STARIJE ŽIVOTNE DOBI

Ksenija Z Kojičić

doi:10.5937/racter9-11643

Ksenija Z Kojičić Univerzitet u Kragujevcu Fakultet medicinskih nauka Integrisane akademske studije farmacije

DOI: https://doi.org/10.5937/racter9-11643

Ključne reči: inappropriate prescribing||, ||neodgovarajuće propisivanje, risk factors||, ||faktori rizika, elderly||, ||stari, grounded theory||, ||utemeljena teorija,

Sažetak

Pod neodgovarajućim propisivanjem lekova se smatra odabir leka ili načina primene koji bi mogao imati više štete nego koristi za pacijenta (PIR - Potentially Inappropriate Prescribing), kao i nepropisivanje leka koji bi znatno mogao da doprinese sprečavanju nastanka bolesti, ublažavanju tegoba ili izlečenju (PPO - Potential Prescribing Omissions). Ovakvo propisivanje predstavlja veliki javno-zdravstveni problem, obzirom da sa sobom nosi rizik po pacijenta od neželjenih efekata lekova, interakcija ili komplikacija, ali i predstavlja veliki ekonomski teret, kako za pacijenta, tako i za zdravstveni sistem.Studija je dizajnirana kao kvalitativna istraživačka metoda zasnovana na principima utemeljene teorije (grounded theory). U cilju dobijanja podataka sprovođeni su intervjui sa ispitanicima. Glavni faktori koji predisponiraju neodgovarajuće propisivanje u starijoj populaciji su: loša komunikacija (lekar-pacijent; lekar – lekar; lekar - farmaceut), navike lekara i pacijenata, polifarmacija, demotivisanost lekara, nedostatak vremena i nekorišćenje stručne literature.Visoka prevalencija nepravilnog propisivanja je neprihvatljiva i neopravdana. Neophodno je koristiti smernice, utvrđene kriterijume, relevantne i zvanične medicinske publikacije prilikom ordiniranja terapije, koje bi trebalo da budu dopuna kliničkom iskustvu.

Reference

Reich O, Roseman T, Rapold R, Blozik E, Senn O. Potentially Inappropriate Medication Use in Older Pa-tient In Swiss Managed Care Plan: Prevalence, Deter-minants and Association with Hospitalization. Public Library of Science2014; 9(8): e105425

Pretorius R, Gataric G, Swedlung S, Miller J. Reducing the Risk of Adverse Drug Events in Older Adults. American Family Physician 2013; 87(5): 331-6.

Cullinan S, O’Mahony D, Fleming A, Byrne S. A Meta-Synthesis of Potentially Inappropriate Prescribing in Older Patients. Drugs Aging 2014; 31(8):631-8.

Yayla М, Bilge У, Binen Е, Keskin А. The Use of START/STOPP Criteria for Elderly Patients in Primary Care. The Scientific World Journal 2013; (10):165873.

O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially anappropriate prescribing in older people: version 2. Age and aging. 2014; 0: 1-6.

O’Connor M, Gallagher P, O’ Mahony D. Inappropri-ate prescribing. Criteria, Detection and Prevention. Drugs Aging 2012; 29(6): 437-52.

Gallagher P, O'Mahony D.STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria. Age and Ageing 2008; 37: 673–9.

San-Jose A, Agusti A, Vidal X. et all. Innapropriate prescribing to the oldest old patients admitted to hos-pital: prevalence, most frequently used medicines, and associated factors. BioMed Central Geriatrics 2015; 15:42.

Galvin R, Moriarty F, Cousins G. et all. Prevalence of potentially inappropriate prescribing and prescribing omissions in older Irish adults: findings from The Irish LongituDinal Study on Ageing study (TILDA). Euro-pean Journal of Clinical Pharmacology2014; 70: 599-606.

HolmesH, Luo R, Kuo Y-F, Baillargeon J, Goodwin J. Association of Potentially Inappropriate Medicine Use with Patient and Prescriber Characteristics in Medicare Part D.Pharmacoepidemiology and Drug Safety 2013; 22 (7): 728–34.

Projovic I, Vukadinovic D, Milovanovic O. et all.Risk factors for potentially inappropriate prescribing to older patients in primary care. European Journal of Clinical Pharmacology 2016; 72(1): 93-107.

Vlahovic-Palcevski V, Bergman U. Quality of prescri-bing for the elderly in Crotia – computeriyed pharmacy data can be used to screen for potentially inappropriate prescribing. European Journal of Clinical Pharmaco-logy 2004; 60: 217-20.

Hamilton H, Gallagher P, O’Mahony D. Inappropriate prescribing and adverse drug events in older people. BioMed Central Geriatrics 2009, 9:5

Cullinan S, Fleming A, O’Mahony D.et all. Doctors’ perspectives on the barriers ti appropriate prescribing in older hospitalized patients:a qualitative study. British Journal of General Practice2014; 79(5): 860-9.

Cook J, Marshall R, Masci C, Coyne J. Physicians’ perspectives on prescribing benzodiazepines for older adults: a qualitative study. Society of General Internal Medicine. 2007; 303-7.

Spitz A, Moore A, Papalentiou M, Granieri E, Turner B, Reid C. Primary care providers’ perspective on pre-scribing opioids to older adults with chronic non-cancer pain: A qualitative study. BioMed Central Geriatrics 2011; 11:35.