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Naslov:AMBULANTNO PREDPISOVANJE ANTIHIPERTENZIVOV IN KAKOVOST NADZORA ARTERIJSKE HIPERTENZIJE V SLOVENIJI
Avtorji:ID Pal, Marjetka (Avtor)
ID Ferk, Polonca (Mentor) Več o mentorju... Novo okno
ID Leskošek, Branimir (Komentor)
Datoteke:.pdf DR_Pal_Marjetka_2014.pdf (6,23 MB)
MD5: FC640A6932A9A6C8E35B4A05345114A5
 
Jezik:Slovenski jezik
Vrsta gradiva:Doktorska disertacija
Organizacija:MF - Medicinska fakulteta
Opis:Arterijska hipertenzija (AH) je v razvitih državah kljub številnim ukrepom že desetletja eden glavnih dejavnikov tveganja za razvoj bolezni srca in žilja. Število objavljenih epidemioloških raziskav o prevalenci in kakovosti nadzora AH in njenih posledic v svetu je veliko. V Sloveniji je tovrstnih obsežnih epidemioloških raziskav sorazmerno malo. Osrednjo vlogo pri nadzoru AH v Sloveniji imajo specialisti družinske (splošne) medicine, zato smo v naši študiji ocenjevali, kakšna je kakovost nadzora AH v ambulantah družinske medicine v Sloveniji. Pri tem smo uporabili podatke, pridobljene v okviru projekta Kakovost v zdravstvu Slovenije. Končni vzorec je vključeval 18.260 bolnikov, ki so obiskovali zdravnika družinske medicine. Kot merilo ustreznega nadzora smo uporabili v veljavnih smernicah določene vrednosti: sistolični krvni tlak (SKT) < 140 mmHg in diastolični krvni tlak (DKT) < 90 mmHg. Ugotovili smo, da je bil ustrezen nadzor AH na celotnem vzorcu v obdobju 2002–2008 zelo dober (55,8 %), tudi v primerjavi z drugimi evropskimi državami in prejšnjimi slovenskimi študijami, v katerih redko poročajo o več kot 50-% ustreznem nadzoru. Razlogov za tako uspešen nadzor AH v Sloveniji je lahko več, med drugimi: sledenje smernicam, pogosta izobraževanja zdravnikov in drugih zdravstvenih delavcev, ozaveščanje bolnikov, uvedba nadzora kakovosti v slovenskem zdravstvu. Pri interpretaciji našega rezultata je potrebno upoštevati, da je naš vzorec vključeval samo tiste bolnike z AH, ki so obiskovali specialista družinske medicine in da ga kot takega ne moremo opredeliti kot popolnoma reprezentativnega za slovenski prostor. Dober nadzor AH je med drugim povezan tudi z ustreznim farmakološkim zdravljenjem. Bolniki z AH imajo pogosto pridružene druge kronične bolezni. Običajno jemljejo več zdravil sočasno, kar lahko pogosteje vodi v težave, povezane z zdravili, med katere sodijo tudi neželene interakcije zdravil. V drugem delu disertacije smo zato proučevali število potencialno klinično pomembnih interakcij antihipertenzivov z drugimi zdravili na vzorcu 453.871 bolnikov, ki so v letu 2010 v Sloveniji vsaj enkrat prejeli antihipertenziv. Vir podatkov je bila podatkovna zbirka Zavoda za zdravstveno zavarovanje Slovenije (ZZZS) o ambulantno predpisanih zdravilih v letu 2010 za področje celotne Slovenije. Za izbiro parov zdravil, ki potencialno vstopajo v interakcije, smo uporabili dve podatkovni zbirki (plačljivo Lexi-Interact in prosto dostopno Drug Interactions Checker; DIC) ter knjižno obliko Stockley’s Drug Interactions (Stockley). Z izbranimi kriteriji smo identificirali 1.561 tovrstnih parov zdravil, katerih sočasna uporaba je kontraindicirana ali tvegana in je zato potrebna prilagoditev odmerjanja, sprememba terapije in spremljanje bolnika. Kontraindicirane interakcije tipa X po Lexi-Interact so bile v intervalu +/- 30 dni izdane v 16.315 primerih, kontraindicirane interakcije po Stockley pa v 1.010 primerih. Kombinacije zdravil, ki so najpogosteje vstopale v kontraindicirane interakcije po Lexi-Interact ali Stockley, so bile: (i) nespecifični antagonist na adrenergičnih receptorjih β in agonist na adrenergičnih receptorjih β2, (ii) dva antagonista na adrenergičnih receptorjih α, (iii) indapamid in kvetiapin, (iv) verapamil ali diltiazem in amjodaron, (v) nimodipin in karbamazepin, (vi) aliskiren in verapamil ter (vii) lerkanidipin in ciklosporin. Pogostnost ugotovljenih potencialnih interakcij glede na terapevtsko podskupino zdravil (po anatomsko-terapevtsko-kemični klasifikaciji-ATC) se pri izdaji v istem dnevu ali v intervalu +/- 30 dni ni bistveno razlikovala in se je zmanjševala v naslednjem vrstnem redu: diuretiki (C03), zdravila z delovanjem na renin-angiotenzinski sistem (C09), antagonisti na adrenergičnih receptorjih β (C07), zaviralci napetostno odvisnih kalcijevih kanalov (C08) in antihipertenzivi (C02). Rezultati naše študije so nekoliko osvetlili uspešnost nadzora AH v ambulantah družinske medicine in pojavnost potencialnih interakcij antihiperte
Ključne besede:arterijska hipertenzija, nadzor kakovosti v zdravstvu, antihipertenzivi, interakcije med zdravili, farmakoepidemiologija
Kraj izida:Maribor
Leto izida:2014
PID:20.500.12556/DKUM-43537 Novo okno
COBISS.SI-ID:31127001 Novo okno
NUK URN:URN:SI:UM:DK:XKD0US6V
Datum objave v DKUM:06.02.2014
Število ogledov:3355
Število prenosov:402
Metapodatki:XML DC-XML DC-RDF
Področja:MF
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Sekundarni jezik

Jezik:Angleški jezik
Naslov:Outpatient prescribing of antihypertensives and quality of arterial hypertension control in Slovenia
Opis:Despite numerous interventions, arterial hypertension (AH) remains one of the most important risk factors of cardiovascular diseases in developed countries. The number of published epidemiological studies on prevalence and quality of AH control and AH clinical consequences is large worldwide. However, in Slovenia there are only few such large epidemiological studies. Family medicine (general practice) physicians have the central role in AH management in Slovenia, therefore in our study we evaluated the quality of AH control in family practice. The data were gained from the “Quality of Healthcare in Slovenia” project. The final sample included 18,260 patients, visiting their family medicine physicians. According to the recommended guidelines the control blood pressure goals were < 140 mmHg for systolic blood pressure (SBP) and < 90 mmHg for diastolic blood pressure (DBP). We found out that the AH control was relatively high (55.8%) in the whole studied population in the period 2002-2008, also when compared to other European countries and to previous Slovene studies, in which more than 50% control was rarely reported. Various factors may contribute to high AH control in our study: guidelines’ implementation, frequent educational programs for physicians and other medical workers, greater patients’ awareness, introduction of quality control in Slovene healthcare system, and others. Among other factors, adequate AH control depends also on appropriate pharmacological treatment. Patients diagnosed with AH often have other chronic diseases and consume number of drugs, leading to drug related problems, including undesirable drug interactions. Therefore, in the second part of this dissertation, we evaluated the number of potential drug interactions with antihypertensives among 453,871 patients, who had received an antihypertensive drug at least once in year 2010. The data were obtained from the Health Insurance Institute of Slovenia from the database of drugs dispensed in 2010 by all Slovene community pharmacies. Potential drug interaction pairs were identified by three sources: Stockley’s Drug Interactions books and two on-line databases, Lexi-Interact (payable) and Drug Interaction Checker (DIC, free access). 1.561 drug interacting pairs were identified, which are contraindicated or potentially harmful and dosage adjustment or close patient's monitoring is needed, when concomitantly used. Contraindicated pairs of drugs were dispensed in 16,315 and in 1,010 cases in +/- 30 days interval according to Lexi-Interact (type X) and Stockley, respectively. The most widely dispensed contraindicated drug combinations were: (i) nonspecific β-adrenoceptor antagonist and β2 adrenoceptor agonist, (ii) two α-adrenoceptor antagonists, (iii) indapamide and quetiapine, (iv) verapamil or diltiazem with amiodarone, (v) nimodipine and carbamazepine, (vi) aliskiren and verapamil and (vii) lercanidipine and cyclosporine. The frequency of potential drug interactions according to the therapeutic subgroup (based on Anatomical-Therapeutic-Chemical Classification (ATC)) was similar for the same day and +/- 30 day dispension interval and declined as follows: diuretics (C03), drugs acting on renin-angiotensin system (C09), β-adrenoceptor antagonists (C07), voltage-dependent calcium channel blockers (C08) and antihypertensives (C02). Results of our study may contribute to the insight of AH control in family medicine practice and evaluation of potential drug interactions of antihypertensives with other concomitantly prescribed drugs in primary care in Slovenia. Despite some study limitations, we may conclude that AH control in Slovenia is high and comparable to other European countries. Identified potential drug interactions need to be carefully interpreted as the majority of these interactions is not clinically expressed. However, our results represent a valuable review of frequency of potential drug interactions with antihypertensives and as such a valuable basis for future improvements and studies, such as: examinations of medical rec
Ključne besede:arterial hypertension, health care quality control, antihypertensives, drug-drug interactions, pharmacoepidemiology


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