O współpracy pacjenta w leczeniu i konsekwencjach jej braku

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O współpracy pacjenta w leczeniu i konsekwencjach jej braku

Obserwując pracę służby zdrowia może się wydawać, że powodzenie terapii zależy głównie od lekarza. W końcu to on musi dostrzec objawy choroby, poprawnie połączyć je w ostateczną diagnozę, a następnie zalecić adekwatne w danej sytuacji leczenie. Rzeczywistość jest jednak nieco bardziej złożona. Po tym, jak recepty zostaną wypisane, chory musi zechcieć je zrealizować, a następnie przyjmować zalecone leki regularnie i w odpowiedniej dawce. Niestety, w tym miejscu często załamuje się proces terapeutyczny, zwłaszcza jeśli choroba nie ma dokuczliwych objawów. Modelowym przykładem może być nadciśnienie tętnicze (HA), którego, jak wiadomo, pacjent wcale nie odczuwa, a którego leczenie często wymaga codziennego przyjmowania wielu leków.
Prowadzenie populacyjnych badań nad współpracą pacjentów i konsekwencjami jej braku jest możliwe w miejscach, w których ściśle rejestrowane są dane medyczne, takie jak rozpoznania stawiane pacjentom, przepisywane i realizowane recepty, czy przyczyny hospitalizacji i zgonów. Przykładem może być Florencja, której medyczna baza danych pozwoliła na stworzenie pracy[1] z grupą badaną liczącą sobie 31,306 dorosłych osób z nowo rozpoznanym nadciśnieniem tętniczym w latach 2004-2006 (data przepisania pierwszej recepty na lek hipotensyjny). Na podstawie stosunku zleconych i wykupionych preparatów, pacjentów podzielono na 4 grupy – doskonałej, dobrej, umiarkowanej i złej współpracy. Kryterium przydziału był odsetek dni w roku, na które chory wykupił przepisane mu tabletki, odpowiednio >80%, 61-80%, 41-60% oraz ≤40%. Rzut oka na liczebność poszczególnych grup pokazuje, jak dużym problemem jest przestrzeganie zaleceń lekarskich. Spośród ponad 31 tysięcy analizowanych osób leki na więcej niż 80% dni w roku wykupiło niespełna 13 tysięcy (41,5%). Źle współpracowało natomiast 8 tysięcy (25,7%). Czteroletnia obserwacja wykazała, że ryzyko zdrowotne powodowane zaniechaniem terapii jest niezwykle wysokie. Sumaryczne ryzyko względne zdarzenia niepożądanego (zgon, udar, zawał serca) spadało istotnie statystycznie już przy dobrej współpracy chorego (61-80% przyjętych dawek) i wynosiło 0,69 (p Badanie[2] sprawdzające konsekwencje zdrowotne złej współpracy pacjentów z jeszcze liczniejszą grupą obserwowaną przeprowadzono w Finlandii. Korzystając z danych zgromadzonych w tamtejszych rejestrach medycznych w latach 1995-2007, wytypowano 73,527 pacjentów z HA w wieku co najmniej 30 lat, bez udaru lub choroby sercowo-naczyniowej w wywiadzie. Podczas 10 analizowanych lat 2144 osoby zmarły z powodu udaru, a 24,560 było z tego powodu hospitalizowanych. Częstość takich zdarzeń w grupie pacjentów przyjmujących sumiennie przepisane leki (≥80% dawek) była zdecydowanie mniejsza niż wśród osób nie współpracujących. Ryzyko śmierci z powodu udaru było w tej drugiej grupie 3,81 razy większe w pierwszych dwóch latach i 3,01 razy większe po 10 latach obserwacji. Podobnie niekorzystnie dla osób nie stosujących się do zaleceń lekarskich przedstawiało się ryzyko względne hospitalizacji z powodu udaru i wynosiło odpowiednio 2,74 w pierwszych 2 latach leczenia i 1,71 po 10 latach.
Jak pokazują przytoczone badania, przestrzeganie zaleceń lekarskich przez pacjentów pozostawia wiele do życzenia. Co prawda, badanymi populacjami byli w tym przypadku Włosi i Finowie, ale nie ma powodów przypuszczać, że w naszym kraju odsetek chorych przyjmujących regularnie przepisane im leki jest wyższy. A konsekwencje zdrowotne ignorowania zaleceń są bardzo wysokie.
1. Esposti LD et al., Adherence to antihypertensive medications and health outcomes among newly treated hypertensive patients. Clinicoecon Outcomes Res. 2011;3:47-54
2. Herttua K et al., Adherence to antihypertensive therapy prior to the first presentation of stroke in hypertensive adults: population-based study. Eur Heart J. 2013 Jul 16 [Epub ahead of print]



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[url=http://24drugs.net]dapoxetine belgium[/url] A pinprick is felt above this level but not below it.The formation of either bacterial biofilm or prostatic calculi favors chronic treatmentresistant infectionPronunciation Guide a as in a pe a as in a pple e as in e ven e as in e very i as in i ce i as in i nterest o as in o pen o as in p o t u as in u nit u as in u nder Vocabulary and Terminology TERM PRONUNCIATION MEANING adaptive immunity a D A Pt i v i M U n i t e adenoids A D e noydz anaphylaxis a n a f a L A Ks i s antibody A Nt i b o d e antigen A Nt i j e n asplenia a SPL E N e a autoimmune disease awt o i M U N d i Z E Z axillary nodes A KS i l a r e n o dz B cell B s e l cellmediated immunity s e l m e d e A t e d i M U N i t e cervical nodes S E Rv i kl n o dz complement system C O Mpl e m e nt S i St e m cytokines S I t o k i nz cytotoxic T cell s i t o T O Ks i k T s e l dendritic cell d e nDR I t i k s e l helper T cell H E Lp e r T s e l humoral immunity H U m e r a l i mM U N i t e hypersplenism h i p e rSPL E N i zm immunity i mM U N i t e immunoglobulins i m u n o GL O B u l i nz immunosuppression i m u n o s u PR E sh u n immunotherapy i m u n o TH E R a p e LYMPHATIC AND IMMUNE SYSTEMS TERM PRONUNCIATION MEANING inguinal node I NGgw i n a l n o d interferons i nt e rF E R o nz interleukins i nt e rLOOk i nz interstitial uid i nt e rST I SH a l FLOO i d lymph l i mf lymphadenitis l i mf a hd e N I t i s lymphadenopathy l i mf a d e N O P a hth e lymph capillaries l i mf K A P i l a r e z lymphedema l i mf e D E m a lymph node l i mf n o d lymphocytes L I Mf o s i tz lymphocytosis l i mf o s i T O s i s lymphocytopenia l i mf o s i t o P E n e a lymphoid organs L I Mfoid O Rg a nz lymphopoiesis l i mf o poy E s i s lymph vessel l i mf V E S e l macrophage M A Kr o f a j mediastinal nodes m e d e a sT I n a l n o dz mesenteric nodes m e s e nT E R i k n o dz monoclonal antibody m o n o KL O n a l A Nt i b o d e natural immunity N A t u r a l i mM U n i t e paraaortic nodes p a r a a O Rt i k n o dz plasma cell PL A Zm a s e l right lymphatic duct r i t l i mF A t i k d u kt spleen spl e n splenectomy spl e N E Kt o m e splenomegaly spl e n o M E G a l e suppressor T cell s u PR E s o r T s e l T cell T s e l thoracic duct th o R A s i k d u kt thymectomy th i M E Kt o m e thymus gland TH I m u s gl a nd tolerance T O L e r a ntz tonsils T O Ns i lz LYMPHATIC AND IMMUNE SYSTEMS TERM PRONUNCIATION MEANING toxic T O Ks i k toxin T O Ks i n vaccination v a ks i N A sh u n vaccine v a kS E N Pathology and Laboratory Tests TERM PRONUNCIATION MEANING acquired immunodeciency syndrome a KW I RD i m u n o d e F I SH e ns e S I Ndr o m allergen A L e rj e n allergy A L e rj e atopy A T o p e CD cell CD P O S i t i v s e l ELISA e L I z a Hodgkin disease H O Jk i n d i Z E Z human immunodeciency virus H U m a n i m u n o d e F I SH e ns e V I r u s immunoelectrophoresis i m u n o e l e ktr o ph o r E s i s Kaposi sarcoma K A p o s e or k a P O Ss e s a rK O m a lymphoma l i mF O m a multiple myeloma M U LT i pl m i e L O m a nonHodgkin lymphoma n o nH O Jk i n l i mF O ma opportunistic infections o pp o rt u N I St i k i nF E Ksh u nz protease inhibitors PR O t e a s i nH I B i t o rz reverse transcriptase inhibitors severe combined immunodeciency disease r e V E RS tr a nsSCR I PT a z i nH I B i t o rz s e V E R k o mB I ND i m u n o d e F I SH e ns e d i Z E Z thymoma th i M O m a viral load test v i r a l l o d t e st wasting syndrome W A ST i ng S I Ndr o m Western blot W E St e rn bl o t LYMPHATIC AND IMMUNE SYSTEMS REVIEW SHEET Write the meaning of the word parts in the spaces provided.The available information on SLx is scarce and most of it is published in abstract form Hatzimouratidis and Hatzichristou Palit and Eardley but a structure is provided in Francis et al. 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