Evaluation of Multiple Drug Using Status by Sociodemographic Characteristics of Individuals with Chronic Disease

Öz

Introduction: The most common belief in traditional medicine is necessarily needed to prescribe a drug.  Studies show two-thirds of medical examinations are ended up with the prescription.  In this study, our aim is showing the effects and features of polypharmacy on chronic disease patients and assess the sociodemographic properties, create awareness about them. Method: This descriptive cross-sectional study is done with 340 patients who admit Inonu Unıversity Turgut Ozal Medicine Centre cardiology, pulmonary disease, neurology, family medicine and psychiatry policlinics. Statistical analysis is done with SPSS ver. 22.0 and in all tests p<0.05 level is accepted as statistically meaningful. Results: In our study, there are 333 participants and 154 of them are female (46.2%) 179 of them are male (53.8%) and mean age is 52.37.  Eighty participants are 65 years old or over. When we evaluate the chronic disease patients, the most common diagnoses are heart disease which is seen in 177 (52.1%) of participants and hypertension which is seen in 176 of participants (51.8%).  184 of participants (54.1%) are using less than 5 drugs and 149 of participants (43.8 %) are using more than 5 drugs. In the comparison of multi-drug using and suffer from side effects, 50 of less than 5 drugs using participants (27.2%) and 29 of more than 5 drugs using participants (19.5%) had adverse effects, this difference is not statistically meaningful (p=0.100). Conclusion: We are in thought of family physicians can lower multi-drug using rates collaborating with patients for managing both acute and chronic diseases in our country where the cost of drugs are rising day by day. Because of that sociodemographic properties and drugs should be questioned for all the policlinics appeal of chronic disease patients and the cessation of drugs should be done according to the proper guidelines, they should be warned about drug interaction and how to use it.

Giriş: Geleneksel tıpta en yaygın inanış bir hekim muayenesine gidildikten sonra mutlaka ilaç yazılması gerektiğidir. Yapılan çalışmalarda hekim muayenelerinin yaklaşık üçte ikisi reçete yazılması ile sonuçlanmaktadır. Bu çalışmada amacımız kronik hastalığı olan bireylerde çoklu ilaç kullanımının özelliklerini, bireyin sosyodemografik özelliklerine göre değerlendirmek ve bu konuda farkındalık yaratmaktır. Yöntem: Kesitsel tanımlayıcı olan çalışma, İnönü Üniversitesi Turgut Özal Tıp Merkezi Hastanesi’nin Aile hekimliği, Kardiyoloji, Göğüs hastalıkları, Nöroloji ve Psikiyatri polikliniklerine müracaat eden 340 hastada yapılmıştır. Verilerin istatistiksel değerlendirilmesi SPSS ver. 22.0 yazılımı ile yapılmış ve tüm testlerde p˂0.05 istatistiksel olarak anlamlı kabul edilmiştir. Bulgular: Çalışmada toplam 333 katılımcı mevcut olup, 154’i kadın (%46,2), 179’i erkek (%53,8) ve yaş ortalaması 52.37 yıl idi.80 kişi (%23.5) 65 yaş ve üzerindeydi. Kronik hastalığı olan bireylerin hastalıkları sorgulandığında en çok 177 kişi (%52,1) kalp hastalığı ve 176 (%51,8) inde hipertansiyon tanısı mevcuttu. Katılımcıların 184’ü (%54,1) 5’den az ilaç kullanırken, 149’u (%43,8) 5 ve üzeri ilaç kullanmaktaydı. Çoklu ilaç kullanım durumlarıyla yan etki görülme durumları kıyaslandığında 5 ten az ilaç kullananların 50’ si (%27,2), 5 ve üzeri ilaç kullananların 29’ u (%19,5) yan etki gördüğünü ifade etmiş bu fark istatistiksel olarak anlamsız bulunmuştur (p=0.100). Sonuç: İlaç maliyetinin her geçen gün arttığı ülkemizde aile hekimlerinin hastasıyla iş birliği yaparak hastasının hem akut hem kronik hastalıklarını aynı anda yöneterek çoklu ilaç kullanım oranlarını düşürebileceği kanaatindeyiz. Bu nedenle kronik hastalığı olan bireylerin polikliniğe her müracaatında sosyodemografik özellikleriyle kullandıkları ilaçlar sorgulanmalı, kılavuzlar eşliğinde gereksiz kullandığı ilaçlar kesilmeli ve etkileşime girebilecek ilaçlar konusunda hasta uyarılarak, ilaçları nasıl kullanacağı hakkında gerekli bilgilendirme yapılmalıdır.

Anahtar Kelimeler

• Chronic disease,polypharmacy,patient education

Kaynakça

1. 1. Viktil KK, Blix SS, Moger TA, Reikvam A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. BJC Pharmacology2007;63:187-95.
2. 2. Moriarty F, Hardy C, Bennett K, Smith S, Fahey T. Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study. BMJ Open 2015;5(9):e008656.
3. 3. Gokce Kutsal Y, Barak A, Atalay A, Baydar T, Kucukoglu S, Tuncer T, et al. Polypharmacy in the elderly: a multicenterstudy. J Am Med Dir Assoc 2009;10(7):486-90.
4. 4. Wettermark B, Godman B, Neovius M, Hedberg N, Mellgren TO, Kahan T. Initial effects of a reimbursement restriction to improve the cost-effectiveness of antihypertensive treatment. Health Policy 2010;94(3):221-9. doi: 10.1016/j.healthpol.2009.09.014. Epub 2009 Oct 29.
5. 5. Taskın SC, Aslan Karaoglu S,Evcil Toprak D. Evaluation of polypharmacy and complementary therapy use in patients ≥65 years, attending to Family Medicine Outpatient Clinic of Sisli Etfal Training and Research Hospital.Turk Aile Hek Derg 2014;18(1):35-41.
6. 6. Venturini CD, Engroff P, Ely LS, Zago LF, Schroeter G, Gomes I, et al. Gender differences, polypharmacy, and potential pharmacological interactions in the elderly. Clinics (Sao Paulo) 2011;66(11):1867-72.
7. 7. Hofer-Dückelmann C. Gender and polypharmacotherapy in the elderly: a clinical challenge. Handb Exp Pharmacol 2012;(214):169-82.
8. 8. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother2007 Dec;5(4):345-51.

9. 9. Çakmur H. Factors affecting polypharmacy in elderly in two different (Kars-Izmir) cities of turkey. Turkiye Klinikleri J Med Sci 2014;34(1):71-80. doi: 10.5336/medsci.2013-36059.
10. 10. Dedeli O, Karadakovan A. Investigation of complementary and alternative medicine practice and drug use in the elderly. Spatula DD 2011;1:23-32.
11. 11. Solmaz T, Akın B. Medication use and ability of selfmedication use ın elderly living at home. TurkishJournal of Geriatrics 2009;12:72-81.
12. 12. Loyola Filho AI, Uchoa E, Firmo JO, Lima- Costa MF. [Influence of income on the association between cognitive impairment and polypharmacy: Bambuí Project]. Rev Saude Publica 2008;42(1):89-99.
13. 13. Odubanjo E, Bennett K, Feely J. Influence of socioeconomic status on the quality of prescribing in the elderly a population based study. Br J Clin Pharmacol 2004;58(5):496-502.
14. 14. Haider SI, Johnell K, Weitoft GR, Thorslund M, Fastbom J. The influence of educational level on polypharmacy and inappropriate drug use: a register-based study of more than 600,000 older people. J Am Geriatr Soc 2009;57(1):62-9. doi: 10.1111/j.15325415.2008.02040.x. Epub 2008 Nov 14.
15. 15. Patterson SM, Hughes C, Kerse N, Cardwell CR, Bradley MC. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 2012 May 16;(5):CD008165.
16. 16. Esengen S, Seckin U, Borman P, Bodur H, Gokce Kutsal Y, Yucel M. The assessment of functional cognitive impairment and drug consumption in a group of elderly residents of a nursing home. Turkish Journal of Geriatrics 2000;3:6-10.
17. 17. Diker J. Chronıc diseases and drug use in elderly over 65 years in the körfez health center 6 as well as in the one at Yüzbasılar in the province of Kocaeli.Turkish J Geriatrics 2000;3:91-7.
18. 18. Ozbek S, Kaya E, Tekin A, Doğan S. Medication compliance in elderly. Turkish J Geriatrics 2006;9:177-81.
19. 19. Akın B, Emiroglu N. Mobility related disability and associated factors in the elderly living at home. Turkish J Geriatrics2003;6(2): 59-67.
20. 20. Yesilbalkan OU, Karadakovan A. The frequency of falls in elderly individuals living in Narlidere rest home and the evaluation of the affecting factors. Turkish J Geriatrics 2005;8:72-7.
21. 21. Peterson C,Gustafsson M. Characterisation of drug-related problems and associated factors at a clinical pharmacist service-Naive Hospital in Northern Sweden. Drugs Real World Outcomes 2017;4(2):97-107.
22. 22. Yesil Y, Cankurtaran M, Kuyumcu ME. Polypharmacy. Klinik Gelişim 2012;3:18-23.
23. 23. Hajjar ER, Hanlon JT, Sloane RJ, Lindblad CI, Pieper CF, Ruby CM, et al. Unnecessary drug use in frail older people at hospital discharge. J Am Geriatr Soc. 2005; 53: 1518–1523.