Publication: Kalp yetersizliği hastalarında ilaç kullanımının klinik eczacılık yaklaşımıyla değerlendirilmesi
Abstract
Amaç: Kalp yetersizliği (KY) hastalarının tedavisi sırasında gelişen ilaçla ilişkili sorunların (İLİS'lerin) tespit edilmesi, çözümlenmesi ve 65 yaş ve üzeri geriatrik KY hastalarında tedavi uygunluğunun değerlendirilmesi oldukça önemlidir. Bu çalışma, KY hastalarının tedavisi sırasında gelişen İLİS'lerin klinik eczacılar tarafından tespit edilmesinde, bu İLİS'lerin çözümlenmesinde ve geriatrik KY hastalarının değerlendirilmesinde klinik eczacının rolünün belirlenmesini amaçlamaktadır. Gereç ve Yöntem: Bir Eğitim ve Araştırma Hastanesi kardiyoloji servisinde yatmakta olan 18 yaş ve üzeri KY hastalarının dahil edildiği bu prospektif çalışma gözlem dönemi (Eylül 2023- Aralık 2023) ve klinik eczacılar tarafından tespit edilen İLİS’lerin çözümüne yönelik önerilerin sunulduğu öneri/ müdahale dönemi (Aralık 2023-Mart 2024) olmak üzere iki dönemden oluşmaktadır. Tespit edilen İLİS’ler Hepler-Strand’ın İLİS sınıflandırma sistemi ile anımlanmıştır. Geriatrik KY hastalarında tedavi uygunluğunun değerlendirmesinde Beers kriterlerinden® yararlanılmıştır. Bulgular: Çalışmaya dahil edilen 90 hastada toplam 162 İLİS tespit edilmiştir. En sık tespit edilen İLİS, endikasyon olan bir durum için ilaç kullanılmıyor olması (%66.05) idi. Öneri/ müdahale döneminde hekimlere sunulan önerilerin %87,3’ü kabul edilmiş %63,3’ü uygulanmıştır. Öneri/ müdahale döneminde hasta başına düşen ve toplam İLİS sayısında anlamlı farklılıklar tespit edilmiştir (p<0.001). Öneri/ müdahale dönemi boyunca mineralokortikoid reseptör antagonistlerinin (p<0.05) ve sodyum glukoz kotransporter 2 inhibitörlerinin reçetelenme oranı (p<0.001) yükselmiştir. Geriatrik KY hastalarında Beers kriterlerine göre öneri/ müdahale döneminde potansiyel olarak kullanımı uygun olmayan ilaç sayısında anlamlı farklılık bulunmamıştır (p >0.05). Sonuç: Klinik eczacıların, kalp yetersizliği hastalarının tedavi sürecinde rol almaları ilaçla ilişkili sorunların ve potansiyel olarak uygun olmayan ilaç tedavilerinin önlenmesinde olumlu sonuçlar sağlayacaktır.
Objective: Detection and resolution of drug-related problems (DRPs) during the treatment of patients with heart failure (HF) and assessment of treatment appropriateness in geriatric patients with HF aged 65 years and older are very important. This study aims to determine the role of clinical pharmacists in the detection of DRPs during the treatment of patients with HF, the resolution of these DRPs, and the evaluation of geriatric patients with HF. Materials and Methods: This prospective study, which included patients with HF aged 18 years and older who were hospitalized in the cardiology service of a Training and Research Hospital, consisted of two periods: the observation period (September 2023-December 2023) and the suggestion/ intervention period (December 2023-March 2024) in which suggestions for the solution of DRPs identified by clinical pharmacists were presented. The identified DRPs were defined by Hepler-Strand's DRPs classification system. Beers Criteria® were used to assess treatment appropriateness in geriatric patients with HF. Results: A total of 162 DRPs were detected in 90 patients included in the study. The most frequently detected DRPs were not using medication for a condition for which there was an indication (66.05%). During the suggestion/ intervention period, 87.3% of the suggestions presented to physicians were accepted and 63.3% were implemented. Significant differences were found in the number of DRPs per patient and the total number of DRPs during thesuggestion/ intervention period (p<0.001). Theprescription rate of mineralocorticoid receptor antagonists (p<0.05) and sodium-glucose co-transporter 2 inhibitors (p<0.001) increased during the recommendation period. In geriatric patients with HF, no significant difference was found in the number of potentially inappropriate medications (PIMs) in the recommendation/ intervention period in the evaluation with Beers Criteria® (p >0.05). Conclusion: The involvement of clinical pharmacists in the treatment process of patients with heart failure will provide positive results in preventing DRPs and PIMs.
Objective: Detection and resolution of drug-related problems (DRPs) during the treatment of patients with heart failure (HF) and assessment of treatment appropriateness in geriatric patients with HF aged 65 years and older are very important. This study aims to determine the role of clinical pharmacists in the detection of DRPs during the treatment of patients with HF, the resolution of these DRPs, and the evaluation of geriatric patients with HF. Materials and Methods: This prospective study, which included patients with HF aged 18 years and older who were hospitalized in the cardiology service of a Training and Research Hospital, consisted of two periods: the observation period (September 2023-December 2023) and the suggestion/ intervention period (December 2023-March 2024) in which suggestions for the solution of DRPs identified by clinical pharmacists were presented. The identified DRPs were defined by Hepler-Strand's DRPs classification system. Beers Criteria® were used to assess treatment appropriateness in geriatric patients with HF. Results: A total of 162 DRPs were detected in 90 patients included in the study. The most frequently detected DRPs were not using medication for a condition for which there was an indication (66.05%). During the suggestion/ intervention period, 87.3% of the suggestions presented to physicians were accepted and 63.3% were implemented. Significant differences were found in the number of DRPs per patient and the total number of DRPs during thesuggestion/ intervention period (p<0.001). Theprescription rate of mineralocorticoid receptor antagonists (p<0.05) and sodium-glucose co-transporter 2 inhibitors (p<0.001) increased during the recommendation period. In geriatric patients with HF, no significant difference was found in the number of potentially inappropriate medications (PIMs) in the recommendation/ intervention period in the evaluation with Beers Criteria® (p >0.05). Conclusion: The involvement of clinical pharmacists in the treatment process of patients with heart failure will provide positive results in preventing DRPs and PIMs.
Description
Keywords
Beers Criteria®, Beers kriterleri®, Clinical pharmacist, Clinical pharmacy, Drug utilization, drug-related problems, Heart diseases, heart failure, İlaç kullanımı, ilaçla ilişkili sorunlar, Kalp hastalıkları, kalp yetersizliği, Klinik eczacı, Klinik eczacılık, potansiyel olarak uygun olmayan ilaçlar, potentially inappropriate medication