EVALUATION OF MEDICATION ADHERENCE IN PATIENTS OVER 65 YEARS OF AGE REGISTERED IN FAMILY HEALTH CENTER ACCORDING TO TIME CRITERIA

Yıl 2024, Cilt: 4 Sayı: 3, 101 - 108, 20.12.2024

Cemil Ulusan , Ayça Gültekin Ulusan , Melike Mercan Başpınar , Okcan Basat

https://doi.org/10.58961/hmj.1530118

Öz

Objective: Our aim is to compare the medications used by patients aged 65 and over who applied to our outpatient clinic with the TIME criteria, which measure drug use criteria in the elderly specific to Turkey.
Method In this study, a survey including sociodemographic characteristics and medical history was applied to 129 patients aged 65 and over, registered to Istanbul Gaziosmanpaşa Duygu Özyurt Family Health Center unit No. 34.21.068, by face-to-face interview method. While evaluating the study data, in addition to descriptive statistical methods, Mann Whitney U test was used to compare quantitative data, and Chi-Square test, Fisher's Exact Chi-Square test, Fisher Freeman Halton Test and Continuity (Yates) Correction were used to compare qualitative data.
Results: Of the 129 registered patients aged between 65 and 89, 41.1% were men and 58.9% were women. The average age was 71.89±5.22, 75.2% were married. 55.8% are retired and only 0.8% are college/university graduates. The average chronic disease rate was 4.11±2.10. The average number of medications was 7.67±3.16. Polypharmacy was present in 89.9% of the cases, and multiple polypharmacy was present in 31.8%. According to the Time to Stop criteria, the total incidence of inappropriate drug use in any system is 84.5%. According to the Time to Start criteria, the total incidence of inappropriate drug use in any system was The total incidence of inappropriate drug use is 100%.
Conclusion: : Due to the differences in drug prescribing practices in our country and the differences in our country's pharmaceutical market, the TIME criteria adapted to Turkey have been created and started to be implemented by taking into account the latest data and local practices. It will provide great convenience to our patients in evaluating the suitability of their drugs.

Anahtar Kelimeler

polypharmacy, improper drug use, TIME Criteria, START, STOP, elderly patient

AİLE SAĞLIĞI MERKEZİNE KAYITLI 65 YAŞ ÜSTÜ HASTALARDA İLAÇ UYUMUNUN TİME KRİTERLERİNE GÖRE DEĞERLENDİRİLMESİ

Öz

AMAÇ: Amacımız polikliniğinimize başvuran 65 yaş ve üstü hastaların başvuru sırasında kullanmakta oldukları ilaçları Türkiye’ye özgü yaşlıda ilaç kullanım kriterlerini ölçen TİME kriterleri ile karşılaştırmaktır.
GEREÇ ve YÖNTEM: Bu çalışmada İstanbul Gaziosmanpaşa Duygu Özyurt Aile Sağlığı Merkezi 34.21.068 No'lu ' birime kayıtlı 65 yaş ve üzeri 129 hastaya yüz yüze görüşme methodu ile sosyodemografik özellikleri ve tıbbi öyküyü içeren anket uygulandı . Çalışma verileri değerlendirilirken tanımlayıcı istatistiksel metodların yanısıra niceliksel verilerin karşılaştırılmasında Mann Whitney U testi, niteliksel verilerin karşılaştırılmasında ise Ki-Kare testi, Fisher’s Exact Ki-Kare testi, Fisher Freeman Halton Testi ve Continuity (Yates) Düzeltmesi kullanıldı.
BULGULAR: Yaşları 65 ile 89 arasında değişmekte olan Kayıtlı 129 hastanın %41,1 i erkek ;%58,9 u kadındı.Yaş ortalaması 71.89±5.22, %75.2’si evli, . %55.8’i emekli ve sadece , %0.8’i yüksekokul/üniversite mezunudur.Kronik hastalık ortalaması 4.11±2.10 du.Kullanılan ilaç sayısı ortalaması 7.67±3.16 idi.Olguların %89.9’unda polifarmasi, %31.8’inde çoklu polifarmasi mevcuttu.Time to Stop kriterlerine göre herhangi bir sistemde toplam uygunsuz ilaç kullanımı görülme oranı %84.5’tir.Time to Start kriterlerine göre herhangi bir sistemde toplam uygunsuz ilaç kullanımı görülme oranı %100’dür.
SONUÇ: Ülkemizdeki ilaç reçeteleme pratiği farklılıkları ve ülkemiz ilaç pazarındaki farklılıklar nedeniyle Türkiye’ye uygun hale getirilmiş TİME kriterleri, en son veriler ve yerel uygulamalar dikkate alınarak oluşturulmuş ve uygulanmaya başlanmıştır.Hastalarımızın ilaçlarının uygunluğunu değerlendirme konusunda büyük kolaylık sağlayacaktır

Anahtar Kelimeler

polifarmasi, uygunsuz ilaç kullanımı, TİME Kriterleri, START, STOP, yaşlı hastalar

Kaynakça

• KÜÇÜK U, Karadeniz H. Yaşlanmaya bağlı bireylerde görülen fizyolojik, ruhsal, sosyal değişiklikler ve korunmaya yönelik önlemler. Yaşlı Sorunları Araştırma Dergisi. 2021;14(2):96-103.
• Erenmemişoğlu A. Yaşlılarda ilaç kullanımını etkileyen farmakokinetik değişiklikler. Turk J Geriatrics. 2006;29-32.
• Erdoğan B. Bölüm 15. Sağlık Bilimlerinde Yenilikçi Yaklaşımlar. 299.-315
• Alshanberi AM. Recent updates on risk and management plans associated with polypharmacy in older population. Geriatrics. 2022;7(5):97.
• Bahat G, et al. Presenting Turkish inappropriate medication use in the elderly (TIME) criteria set in Turkish. Eur J Geriatr Gerontol (Online). 2021.
• Lesage J. Polypharmacy in the geriatric patient. Nurs Clin North Am. 1991;26:273-90.
• Qato DM, Alexander GC, Conti RM, et al. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300:2867-78.
• Cankurtaran M, Yavuz BB, Halil M, et al. Polypharmacy in elderly: does evidence based medicine brings more drug usage? 3rd European Geriatrics Congress. J Nutr Health Aging. 2004;8:280.
• Rochon PA. Drug prescribing for older adults. Section Editor: Schmader KE, Deputy Editor: Sokol HN. UpToDate. Last updated November 2012. Available from: http://www.uptodate.com
• Bahat G, et al. Assessments of functional status, comorbidities, polypharmacy, nutritional status and sarcopenia in Turkish community-dwelling male elderly. Aging Male. 2013;16(2):67-72.
• Erdil AÖ, Güney HZ. The evaluation of the prevalence of improper medication use in patients age of 65 and over in internal diseases and neurology intensive care units in terms of STOPP-START criteria. Gazi Med J. 2023;34(3).
• Acosta D, Rottbeck R, Rodriguez JG, et al. The prevalence and social patterning of chronic diseases among older people in a population undergoing health transition. A 10/66 Group cross-sectional population-based survey in the Dominican Republic. BMC Public Health. 2010;10:344.
• Bahat G, et al. Comorbidities, polypharmacy, functionality and nutritional status in Turkish community-dwelling female elderly. Aging Clin Exp Res. 2014;26:255-9.
• Ryan C, O'Mahony D, Kennedy J, Weedle P, Byrne S. Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol. 2009;68:936-47.
• San-Jose A, Agusti A, Vidal X, et al. Inappropriate prescribing to the oldest old patients admitted to hospital: prevalence, most frequently used medicines, and associated factors. BMC Geriatr. 2015;15:42.
• 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 Ageing. 2008;37(6):673-9.
• Kara O, Arik G, Kizilarslanoglu MC, Kilic MK, Varan HD, Sumer F, et al. Potentially inappropriate prescribing according to the STOPP/START criteria for older adults. Aging Clin Exp Res. 2016;4:761-8.
• Yayla ME, Bilge U, Binen E, Keskin A. The use of START/STOPP criteria for elderly patients in primary care. Sci World J. 2013;2013:165873.
• Borges EP, Morgado M, Macedo AF. Prescribing omissions in elderly patients admitted to a stroke unit: descriptive study using START criteria. Int J Clin Pharmacol. 2012;34:481-9.
• Gallagher P, Lang PO, Cherubini A, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol. 2011;67:1175-88.
• Zano-Montoya I, Velez-Diaz-Pallares M, DelgadoSilveira E, Montero-Errasquin B, Cruz Jentoft AJ. Potentially inappropriate prescribing detected by STOPP-START criteria: are they really inappropriate?Age Ageing. 2015;44:861-6.
• Luz AC, Oliveira MG, Noblat L. Potential prescribing omissions according to START criteria at the time of hospital discharge. Braz J Pharm Sci. 2021;57:e181060.
• Çavuşoğlu Ç. TIME kriterleri ile belirlenen uygunsuz ilaç kullanımı ve kırılganlık arasındaki ilişki. Cukurova Med J. 2022;47(3):1281-9.
• Frankenthal D, Lerman Y, Kalendaryev E, Lerman Y. Potentially inappropriate prescribing among older residents in a geriatric hospital in Israel. Int J Clin Pharm. 2013;35(5):677-82.
• Yılmaz T, et al. Geriatric patients’ influenza and pneumococcal vaccination status registered at home care services and the effect of physician’s advice. Ankara Med J. 2018;18:391-401.