| Abstract | Lijekovi, iako korisni, ponekad mogu imati štetne i neželjene učinke koje nazivamo nuspojavama. One se dijele na nuspojave tipa A - predvidljive, o dozi ovisne i preventabilne i tipa B - o dozi neovisne i nepredvidive. Najčešće se javljaju nuspojave tipa A. Interakcije su promjene učinka lijeka u prisutnosti drugog lijeka, biljnog pripravka ili hrane i vrlo često su štetne. Nuspojave su uzrok hitne hospitalizacije u 0,2 - 41,3%, a oko 50% tih nuspojava moguće je spriječiti. Klinički važne interakcije javljaju se u 3-5% slučajeva. Većina je nuspojava i interakcija predvidiva i moguće ih je spriječiti dobrim poznavanjem racionalne farmakoterapije. LOM se nalazi u središtu zdravstvenoga sustava, a propisivanje lijekova i nadzor nad terapijom svakodnevne su aktivnosti u radu LOM-a. Osobit izazov predstavljaju propisivanje i nadzor lijekova posebnih skupina bolesnika kao što su osobe starije životne dobi, osobe s multimorbiditetima, trudnice, djeca i žene za vrijeme laktacije. Cilj ovoga istraživanja bio je utvrditi znanje, stavove i praksu provođenja kontrole terapije od strane LOM-a te čimbenike koji na to utječu. Materijali i metode: Presječna je studija provedena internetskim anonimnim anketnim ispitivanjem 195 LOM-a u Republici Hrvatskoj. Za istraživanje znanja, stavova i prakse upotrijebljen je upitnik s 46 pitanja sastavljenih po uzoru na slična istraživanja. Validacijom prvotne verzije upitnika na trideset LOM-a utvrđena je niska pouzdanost (Chronbach's alpha = 0.61) jedne skupine pitanja te su u skladu s time učinjene odgovarajuće izmjene. Podaci su analizirani prikladnim statističkim metodama uz razinu značajnosti P<0.05. Rezultati: U skupini od 195 ispitanika najviše ih je bilo iz Osječko-baranjske županije i Grada Zagreba. Medijan dobi ispitanika je 51 godina, a broja osiguranika 1700. Prema broju točnih odgovora nema značajnih razlika prema spolu, mjestu rada ili duljini radnoga staža, ali značajno su veći broj točnih odgovora dali specijalisti obiteljske medicine. U potpunosti se slaže s tvrdnjom da mogu samostalno propisivati lijekove samo na osnovu svoga znanja osobama s većim brojem kroničnih bolesti (komorbiditeta) 26,7 % ispitanika, osobama starije životne dobi njih 32,3 %, djeci 18,5 % ispitanika, a trudnicama i ženama za vrijeme laktacije 15,9 % ispitanika. Većina ispitanika se niti slaže niti ne slaže s tvrdnjama da pacijente treba uputiti kliničkome farmakologu pri propisivanju lijekova. Više od 80 % ispitanika potrebu za edukacijom o racionalnoj farmakoterapiji ocijenilo je nužnom. Upravo zbog važnosti educiranosti LOM-a o nuspojavama i interakcijama lijekova kroz deset pitanja utvrđivano je njihovo znanje o najčešće propisivanim lijekovima. Najviše ispitanika, njih 93,8%, točno je odgovorilo da nije opravdana kombinacija antihipertenziva valsartan + ramipril. 84,1 % ispitanika zna da Izotretinoin ubrajamo u kategoriju X po FDA klasifikaciji, 63,1 % ispitanika tvrdi da bi Klaritromicin bio lijek izbora za atipičnu pneumoniju uzrokovanu Mycoplasmom pneumoniae-om kod sedmogodišnjega djeteta. Znanje LOM-a o mirtazapinu, kao odabranom antidepresivu koji vrlo rijetko izaziva seksualnu disfunkciju kao nuspojavu, navodi 32,8 % ispitanika. Samo 35% ispitanika složilo se s tvrdnjom da im je fakultet medicine pružio dovoljno znanja o nuspojavama lijekova. Zaključak: Gotovo polovina LOM-a pokazala je dobro znanje iz područja nuspojava i interakcija, a većina je svjesna potrebe za dodatnom edukacijom iz toga područja. Nedostatak informacija o održavanju edukacija smatraju najvećom zaprekom za njihovo pohađanje, a na drugome mjestu je nedostatak vremena. Kao prediktor lošijega znanja pokazala se dob ispitanika, te se mlađi ispitanici osjećaju manje sposobno samostalno propisivati lijekove. |
| Abstract (english) | Objective: Although drugs are useful, sometimes harmful and unwanted effects can be induced, what is described as side effects. Side effects are divided into type A which are predictable, dose dependent and can be prevented, and type B which are dose independent and unpredictable. Type A side effects are the most common. Interactions are changes in the drug effect in the presence of another drug, herbal preparation or food and are very often harmful. Drug side effects participate in 0.2 - 41.3% of allemergency hospitalization, and about 50% of these side effects can be prevented. Clinically important interactions occur in 3-5% of cases. Most side effects and interactions are predictable and can be prevented by good knowledge of rational pharmacotherapy. Primary care providers (PCPs) is at the center of the healthcare system, and carefully prescribing medications and controlling the therapy are everyday activities in PCP's work. A rising challenge is prescribing and monitoring of medicines to particular groups of patients such as elderly people, people with multimorbidities, pregnant women, children and women during lactation. The aim of this study was to examine the knowledge, establish attitudes and practice of controlling the therapy by PCPs and the factors that influence it. Materials and Methods: An intermediate study conducted through anonymous survey of 195 PCPs in the Republic of Croatia. For the study of knowledge, attitudes and practices, a questionnaire was used with 46 questions based upon similar research. Validation of the initial version of the questionnaire on thirty PCPs revealed low reliability (Chronbach's alpha = 0.61) in one group of questions and corresponding changes were made accordingly. The data were analyzed and p <0.05 was considered as statistical significance difference. Results: In the group of 195 respondents, most are from the Osijek-Baranja County and the City of Zagreb. The median age of the respondentsis 51 and the number of insured persons per team of PCPs is 1700. According to the number of correct answers, there are no significant differences in gender, place of work or length of service, but a significant number of exact answers have been given by PCPs specialists. 26.7% of respondents fully agree with the claim that they can independently prescribe drugs only on the basis of their knowledge to people with a higher number of chronic diseases (comorbidity), 32.3% to the elderly, 18.5% tothe children and 15,9% of respondents to pregnant women and women during lactation. Mostrespondents nor agree nor disagree with the claims that patients should be referred to a clinical pharmacologist when prescribing medicines. More than 80% of respondents considered the need for rational pharmacotherapy education necessary. Just because of the importance of PCPs education on side effects and drug interactions, ten quick questions test reveal their knowledge of the most commonly prescribed drugs.93.8% questioners responded correctly that a combination of antihypertensive drug Valsartan and Ramipril is not justified, 84.1% of questioners know that Izotretinoin is included in category X by FDA (Food and Drug Administration) classification. 63.1% of questioners claim that Clarithromycin should be a medicine of choice for atypical pneumonia caused by Mycoplasma pneumoniae in a seven-year-old child. PCP’sdata of the mirtazapine, as the selected antidepressant, which very rarely causes sexual dysfunction as a side effect, suggests 32.8% of questioners. Only 35% of questioners agree with the statement that their faculty of medicine has provided enough knowledge about drug side effects. Conclusion: Almost half of PCPs has shown good knowledge of side effects and interactions, but most are aware that additional education is needed. Lack of information about education is considered the greatest barrier to not attending, and lack of time is a second greatest barrier. From the aspect of experience and age, beside inferior knowledge, younger questioners felt less able to independently prescribe drugs. |
