Propisivanje diklofenaka bolesnicima sa kardiovaskularnim bolestima ili visokim rizikom od razvoja kardiovaskularnih bolesti na nivou primarne zdravstvene zaštite u Crnoj Gori: retrospektivna, nacionalna, studija upotrebe leka
Sažetak
Uvod/Cilj. Diklofenak, neselektivni inhibitor ciklooksigenaze sa analgetskim, protivupalnim i antipiretičkim dejstvima, jedan je od nesteroidnih protivupalnih lekova (NSPUL) koji se najčešće propisuje. Cilj rada bio je da se istraže propisivanje i potrošnja sistemskih formulacija diklofenaka na nivou primarne zdravstvene zaštite (PZZ) u Crnoj Gori (CG), kod bolesnika sa kardiovaskularnim (KV) bolestima (KVB) i bolesnika sa faktorima rizika od KVB, u periodu od 2016. do 2020. godine. Metode. Sprovedena je retrospektivna, nacionalna studija upotrebe leka, koja je uključivala bolesnike sa KVB kojima je bilo kontraindikovano propisivanje diklofenaka, kao i bolesnike sa faktorima rizika od KVB, kojima se diklofenak mogao propisati uz pojačane mere opreza. Kao izvor podataka o bolesnicima korišćeni su podaci iz informacionog sistema PZZ. Rezultati. U posmatranom periodu, propisivanje sistemskih formulacija diklofenaka, dominatno oralnih, u jačini od 75 mg, povećana je za 36,9% [sa 4,6 definisanih dnevnih doza (DDD)/1 000 stanovnika/dan u 2016., na 6,3 DDD/1 000 stanovnika/dan u 2020. godini]. Zabeležen je trend rasta propisivanja diklofenaka bolesnicima sa KVB, ili onim sa faktorima rizika od KVB, kojima je propisivanje diklofenaka kontraindikovano. Od ukupnog broja bolesnika kojima je tokom 2016, 2017, 2018, 2019. i 2020. godine bio propisan diklofenak, njih 16%, 18%, 24%, 15% i 20%, redom, već je imalo KVB ili neki faktor rizika od KVB. Najviše (39,7%) KV bolesnika, kojima je bila kontraindikovana primena diklofenaka, imalo je ishemijsku bolest srca i njima je bilo propisano 40,7% od ukupno propisane količine diklofenaka za grupu KV bolesnika (izraženo u DDD/1 000 stanovnika/dan za dati lek). Najviše (77,4%) KV bolesnika kojima se lek mogao propisati, ali uz pojačane mere opreza, imalo je hipertenziju i njima je bilo propisano 77,2% ukupno propisane količine diklofenaka za grupu KV bolesnika (izraženo u DDD/1 000 stanovnika/dan za dati lek). Zaključak. Uprkos preduzetim regulatornim merama, čiji je cilj bezbednija primena sistemskih formulacija diklofenaka, bolesnicima sa KVB ili visokim rizikom od razvoja KVB se i dalje široko propisuje ovaj lek na nivou PZZ u CG, čak i u slučajevima koji predstavljaju kontraindikaciju za njegovu primenu.
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