EVALUATION OF PHARMACEUTICAL CARE SERVICES FOR ANTITHROMBOTIC THERAPY PROVIDED IN COMMUNITY PHARMACIES IN TURKEY

Yıl 2019, Cilt: 33 Sayı: 1, 19 - 32, 26.04.2019

Elif Ertuna Mehmet Zuhuri Arun

https://doi.org/10.5505/deutfd.2019.81994

Öz

Objective:
 Antithrombotic drugs are high risk drugs used in treatment
of various conditions. The purpose of this study was to determine the nature of
pharmaceutical care activities related to antithrombotic therapy management and
the attitudes of community pharmacists in this area.

Material
and Method: 321 pharmacists from 53 provinces of Turkey completed
this cross-sectional self-administered web-based survey. The questionnaire
consisted of yes/no, closed-ended multiple choice, semi-closed multiple choice,
0-100 rating and 5-point Likert scale questions.

Results:  21.84 ± 1.05% of the pharmaceutical care
services provided by pharmacists were directed toward patients using
antithrombotic drugs. 99.1% of pharmacists provided information on more than
one antithrombotic drug. Only 33.0% of the pharmacists reported that their
knowledge on antithrombotic drugs was adequate. There was a weak positive
correlation between the pharmacists’ level of knowledge and various
pharmaceutical care services provided. Although pharmacists don’t think that
82.2% of patients have enough knowledge about treatments, 85.7% don’t hand out
written information to patients. Other drugs (88.8%), age (78.8%), health
literacy (72.9%) and education status (71.7%) were the most frequently
considered factors while providing pharmaceutical care services. There was a
weak positive correlation between pharmacist's perceived value for pharmacy
services by other healthcare professionals and frequency of communication with
physicians for possible treatment problems.

Conclusion: The results
of this study provide a framework for pharmaceutical care services provided by
community pharmacists in the management of antithrombotic therapy in Turkey.
The improvement of community pharmacy services may contribute to the increase
of safe and effective antithrombotic drug use in our country.

Anahtar Kelimeler

antithrombotic therapy, pharmaceutical care, community pharmacy services

Türkiye’de serbest eczanelerde antitrombotik tedavi ile ilgili sunulan farmasötik bakım hizmetlerinin değerlendirilmesi

Öz

Amaç: Antitrombotik ilaçlar birçok farklı
hastalığın tedavisinde kullanılan yüksek riskli ilaçlardır. Bu çalışmanın
amacı, Türkiye’deki serbest eczacıların antitrombotik tedavi ile ilişkili
faaliyetlerinin nitelik ve içeriğinin belirlenmesi ve serbest eczacıların
antitrombotik tedavi yönetimine katkıda bulunabilecek farmasötik bakım
aktivitelerine yaklaşımlarının belirlenmesidir.

Gereç ve Yöntem: Web ortamında
hazırlanan kesitsel anket çalışmasına Türkiye’de 53 ilden 321 eczacı kendi
kendine uygulama yöntemiyle katılmıştır. Ankette evet/hayır soruları, kapalı
uçlu çoktan seçmeli sorular, yarı kapalı uçlu çoktan seçmeli sorular, 0-100
arası derecelendirme ve 5 noktalı Likert ölçeği kullanılmıştır.

Bulgular: Eczacılar verdikleri
farmasötik bakım hizmetlerinin %21,84 ± 1,05’inin antitrombotik tedavi görmekte
olan hastalara yönelik olduğunu bildirmiştir. Eczacıların %99,1’inin birden
fazla antitrombotik ilaç hakkında bilgi verdiği belirlenmiştir. Eczacıların
sadece %33,0’ü antitrombotik ilaçların kullanıldıkları tıbbi durumlar ve ilgili
tedavi protokolleri ile ilgili bilgi düzeylerinin yeterli olduğunu düşündüğünü
bildirmiştir. Verilen çeşitli farmasötik bakım hizmetleri ile eczacıların bilgi
düzeyi arasında zayıf pozitif korelasyon bulunmaktadır. Eczacılar hastaların
%82,2’sinin ilaçları/tedavileri konusunda bilgisinin yeterli olmadığını
düşünmesine rağmen %85,7’si hastalara yazılı bilgilendirme materyali
vermemektedir. Eczacıların farmasötik bakım hizmeti sağlarken hastalar ile
ilgili faktörlerden en çok kullandığı diğer ilaçlar (%88,8), yaş (%78,8),
sağlık okuryazarlığı (%72,9) ve eğitim durumunu (%71,7) dikkate aldığı
belirlenmiştir. Eczacıların diğer sağlık profesyonellerinin eczacı hizmetlerine
verdikleri öneme ilişkin öz değerlendirme sonucu ile olası tedavi sorunları
için hekimle iletişime geçme sıklığı arasında istatistiksel olarak anlamlı
zayıf pozitif korelasyon bulunmuştur.

Sonuç: Bu çalışmanın sonuçları Türkiye’de
antitrombotik tedavi yönetiminde serbest eczacıların sundukları farmasötik
bakım hizmetleri ile ilgili bir çerçeve sunmaktadır. Sonuçlar doğrultusunda
serbest eczacılık hizmetlerin geliştirilmesi ülkemizde güvenli ve etkin
antitrombotik ilaç kullanımının artışına katkı sağlayabilir.

Anahtar Kelimeler

antitrombotik tedavi, farmasötik bakım, serbest eczacılık hizmetleri

Kaynakça

• Oktay E. Will NOACs become the newstandard of care in anticoagulation therapy? International Journal of the Cardiovascular Academy 2015; 1: 1-4.
• Papastergiou J, Kheir N, Ladova K ve ark. Pharmacists' confidence when providing pharmaceutical care on anticoagulants, a multinational survey. Int J Clin Pharm 2017; 39(6): 1282-1290.
• Hou K, Yang H, Ye Z ve ark. Effectiveness of Pharmacist-led Anticoagulation Management on Clinical Outcomes: A Systematic Review and Meta-Analysis. J Pharm Pharm Sci 2017; 20(1): 378-396.
• Saokaew S, Permsuwan U, Chaiyakunapruk N, Nathisuwan S ve Sukonthasarn A. Effectiveness of pharmacist-participated warfarin therapy management: a systematic review and meta-analysis. J Thromb Haemost 2010; 8(11): 2418-27.
• Locke C, Ravnan SL, Patel R ve Uchizono JA. Reduction in warfarin adverse events requiring patient hospitalization after implementation of a pharmacist-managed anticoagulation service. Pharmacotherapy 2005; 25(5): 685-9.
• Kearon C, Akl EA, Comerota AJ ve ark. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl): e419S-e496S.
• Desmaele S, De Wulf I, Dupont AG ve Steurbaut S. Pharmacists' role in handling problems with prescriptions for antithrombotic medication in Belgian community pharmacies. Int J Clin Pharm 2015; 37(4): 656-68.
• Holbrook A, Schulman S, Witt DM ve ark. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl): e152S-e184S.
• Wofford JL, Wells MD ve Singh S. Best strategies for patient education about anticoagulation with warfarin: a systematic review. BMC Health Serv Res 2008; 8: 40.
• Manzoor BS, Cheng WH, Lee JC, Uppuluri EM ve Nutescu EA. Quality of Pharmacist-Managed Anticoagulation Therapy in Long-Term Ambulatory Settings: A Systematic Review. Ann Pharmacother 2017; 51(12): 1122-1137.
• DiRenzo BM, Beam DM, Kline JA ve ark. Implementation and Preliminary Clinical Outcomes of a Pharmacist-managed Venous Thromboembolism Clinic for Patients Treated With Rivaroxaban Post Emergency Department Discharge. Acad Emerg Med 2017.
• Sevilla-Cazes J, Finkleman BS, Chen J ve ark. Association Between Patient-Reported Medication Adherence and Anticoagulation Control. Am J Med 2017; 130(9): 1092-1098 e2.
• Eroglu SE, Altinok Denizbasi A, Ozpolat C ve ark. Varfarin Kullanım Öyküsü Olan Hastalarda, INR Değerleriyle Komplikasyon Gelişim Risk İlişkisinin Ortaya Konması/The Investigation of the Relation Between INR Levels and Risk of Complication in Patients with a History of Warfarin use. Marmara Medical Journal 2012; 25: 138-142.
• Turnacilar M, Sancar M, Apikoglu-Rabus S, Hursitoglu M ve Izzettin FV. Improvement of diabetes indices of care by a short pharmaceutical care program. Pharm World Sci 2009; 31(6): 689-95.
• Toklu HZ, Akici A, Oktay Ş ve ark. The pharmacy practice of community pharmacists in Turkey. Marmara Pharmaceutical Journal 2010; 14: 53-60.
• Ryan R, Santesso N, Lowe D ve ark. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev 2014(4): CD007768.
• Horning KK, Hoehns JD ve Doucette WR. Adherence to clinical practice guidelines for 7 chronic conditions in long-term-care patients who received pharmacist disease management services versus traditional drug regimen review. J Manag Care Pharm 2007; 13(1): 28-36.
• Calvert SB, Kramer JM, Anstrom KJ ve ark. Patient-focused intervention to improve long-term adherence to evidence-based medications: a randomized trial. Am Heart J 2012; 163(4): 657-65 e1.
• Zhou S, Sheng XY, Xiang Q ve ark. Comparing the effectiveness of pharmacist-managed warfarin anticoagulation with other models: a systematic review and meta-analysis. J Clin Pharm Ther 2016; 41(6): 602-611.
• Ingram SJ, Kirkdale CL, Williams S ve ark. Moving anticoagulation initiation and monitoring services into the community: evaluation of the Brighton and hove community pharmacy service. BMC Health Serv Res 2018; 18(1): 91.
• Harrison J, Shaw JP ve Harrison JE. Anticoagulation management by community pharmacists in New Zealand: an evaluation of a collaborative model in primary care. Int J Pharm Pract 2015; 23(3): 173-81.
• Tig EO, Ayanoglu Dulger G, Hidiroglu S ve Toklu HZ. Serbest eczacıların elektronik bilgi kaynağı kullanımı. Marmara Pharmaceutical Journal 2012; 16(1): 29-35.
• Budnitz DS ve Layde PM. Outpatient drug safety: new steps in an old direction. Pharmacoepidemiol Drug Saf 2007; 16(2): 160-5.
• Metlay JP, Hennessy S, Localio AR ve ark. Patient reported receipt of medication instructions for warfarin is associated with reduced risk of serious bleeding events. J Gen Intern Med 2008; 23(10): 1589-94.
• Zdyb EG, Courtney DM, Malik S, Schmidt MJ ve Lyden AE. Impact of Discharge Anticoagulation Education by Emergency Department Pharmacists at a Tertiary Academic Medical Center. J Emerg Med 2017; 53(6): 896-903.
• Wysowski DK, Nourjah P ve Swartz L. Bleeding complications with warfarin use: a prevalent adverse effect resulting in regulatory action. Arch Intern Med 2007; 167(13): 1414-9.
• ISMP List of High-Alert Medications in Acute Care Settings. 2018, Institute for Safe Medication Practices (ISMP). Erişim adresi: https://www.ismp.org/recommendations/high-alert-medications-acute-list, Son erişim tarihi: 16.08.2018.
• Gladstone DJ, Geerts WH, Douketis J ve ark. How to Monitor Patients Receiving Direct Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation: A Practice Tool Endorsed by Thrombosis Canada, the Canadian Stroke Consortium, the Canadian Cardiovascular Pharmacists Network, and the Canadian Cardiovascular Society. Ann Intern Med 2015; 163(5): 382-5.
• Alhawassi TM, Krass I, Bajorek BV ve Pont LG. A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting. Clin Interv Aging 2014; 9: 2079-86.
• Demir Ö, Arıcı MA, Demiral Y ve Tunçok Y. Evaluation of Drugs Exposure in Pregnancy According to Different Risk Categories: Do FDA-Based Decisions Lead to More Curettage? Farklı Risk Kategorilerine Göre Gebelikte İlaca Maruz Kalımın Değerlendirilmesi: FDA Esaslı Kararlar Daha Fazla Küretaja Neden mi Oluyor? Turkiye Klinikleri J Med Sci 2012; 32(4): 901-9.
• Bishop L, Young S, Twells L, Dillon C ve Hawboldt J. Patients' and physicians' satisfaction with a pharmacist managed anticoagulation program in a family medicine clinic. BMC Res Notes 2015; 8: 233.
• Shaw J, Harrison J ve Harrison J. A community pharmacist-led anticoagulation management service: attitudes towards a new collaborative model of care in New Zealand. Int J Pharm Pract 2014; 22(6): 397-406.