ПОЛИПРАГМАЗИЯ У ЛИЦ ПОЖИЛОГО И СТАРЧЕСКОГО ВОЗРАСТА

УДК 615.01

POLYPHARMACY IN THE ELDERLY

Kosykh Alexander Vyacheslavovich

Teacher, pharmacist-organizer

clinical pharmacologist

FSBEI of HE «Stavropol State Medical University»Essentuksky branch

(Russia, Essentuki)

The article studies the issue of unreasonable simultaneous administration of several drugs, the principles of rational pharmacotherapy.

In the modern world, rapid progress has been noted in the creation and implementation of a huge number of drugs in practical healthcare, which, on the one hand, can cure or improve the condition of the patient, and on the other hand, cause significant harm to health. The desire to increase the effectiveness of treatment, to help the patient recover from all the diseases that developed in him, inevitably leads to polypharmacy, that is, the simultaneous unreasonable prescription of a large number of drugs, since only a reasonable prescription of drugs can increase the effectiveness of treatment and reduce the frequency of undesirable side reactions.

In connection with the increasing global statistical indicators of the aging of the population and an increase in the number of patients with multiple concomitant pathologies, polypharmacy (simultaneous, often unreasonable prescribing of many drugs or medical procedures), respectively, is also becoming more common. The correct therapeutic approach in patients with complex medical problems can improve clinical outcomes, quality and life expectancy, polypharmacy is also associated with an increased risk of adverse events that can lead to hospitalization of the patient or even death.

Key words: polypharmacy, polymorbidity, iatrogeny, polytherapy.

ПОЛИПРАГМАЗИЯ У ЛИЦ ПОЖИЛОГО И СТАРЧЕСКОГО ВОЗРАСТА

Косых Александр Вячеславович

Педагог, провизор-организатор

клинический фармаколог

ФГБОУ ВО «Ставропольский государственный медицинский университет» Ессентукский филиал

(Россия, Ессентуки)

В статье изучается вопрос необоснованного одновременного назначения нескольких лекарственных препаратов, принципы рациональной фармакотерапии.

В современном мире отмечается стремительный прогресс в создании и внедрении в практическое здравоохранение огромного количества лекарственных препаратов, которые, с одной стороны, способны излечить или улучшить состояние пациента, с другой стороны нанести значительный вред здоровью. Стремление повысить эффективность лечения, помочь пациенту излечиться от всех развившихся у него заболеваний неизбежно приводит к полипрагмазии, то есть одновременному необоснованному назначению большого количества лекарственных средств, так как только обоснованное назначение лекарственных средств может повысить эффективность лечения и снизить частоту нежелательных побочных реакций.

В связи с возрастающими всемирными статистическими показателями старения населения и увеличением количества пациентов со множественной сопутствующей патологией полипрагмазия (одновременное, нередко необоснованное, назначение множества лекарственных средств или лечебных процедур), соответственно, также становится все более распространенным явлением.

Ключевые слова: полипрагмазия, полиморбидность, ятрогения, политерапия.

The development and implementation of effective mechanisms to ensure the correct prescription of drugs only with appropriate indications, patient awareness of the benefits of the chosen therapeutic approach and its possible complications that may arise as a result of treatment, as well as regular monitoring of patients' compliance with the established treatment regimen is an extremely important task of medicine . In modern conditions, healthcare providers follow evidence-based guidelines for managing chronic diseases. The relative lack of guidelines that address the variability and versatility of concomitant pathology is one of the key limiting factors in the management of polymorbidity and associated polypharmacy. The development of new recommendations and the assessment of their impact on clinical outcomes in patients will take an indefinitely long time before becoming effective guidelines, due to the lack of the latest clinical studies involving this category of people. This is due to the fact that randomized clinical trials in the past carried out basically quite strict selection procedures, as a result of which patients with multiple concomitant pathologies, i.e. polymorbidity, were often excluded. However, it is precisely such patients that are increasingly found in the clinical practice of doctors and become the main risk group for polypharmacy. Based on this, in the absence of data on these patients from clinical trials, an alternative method of obtaining evidence of the benefits and risks of polypharmacy is to use information from large clinical databases or patient registers. Currently, active work is underway in the Russian healthcare sector to reduce the incidence of polypharmacy in medical practice. In the order of the Ministry of Health of the Russian Federation No. 575n of November 2, 2012 “On approval of the procedure for the provision of medical care in the“ Clinical Pharmacology ”profile, clause 6 stipulates that the decision to refer a patient to a doctor-clinical pharmacologist is made by the attending physician-physician- specialist, general practitioner, local pediatrician, general practitioner (family doctor) in case of simultaneous prescribing to the patient 5 or more names of drugs or more than 10 names for course treatment.

In the order of the Ministry of Health of the Russian Federation dated December 20, 2012 No. 1175n “On approving the procedure for prescribing and prescribing drugs, as well as forms of prescription forms for drugs, the procedure for filling out these forms, their accounting and storage” ”, coordination of prescribing drugs with the head of the department or by the responsible doctor on duty or by another person authorized by order of the chief physician of the medical organization, as well as with the doctor - clinical pharmacologist, it is necessary in cases of simultaneous Achen 5 or more drugs to a single patient. The prescription and prescription of drugs by decision of the medical commission in the provision of primary health care, palliative care on an outpatient basis is carried out in cases of simultaneous administration of 5 drugs or more to one patient for one day or more than 10 items within 1 month. In some cases, the appointment of many drugs is necessary, but in some situations it is impractical and even contraindicated. In this regard, two so-called categories of polypharmacy are identified: potentially relevant and potentially problematic. Potentially appropriate is defined as prescribing a variety of drugs to a patient when their use has been optimized or when they are prescribed based on the best available evidence.

Potentially problematic - the administration of several drugs inappropriately or the lack of perceived benefits for the patient. The main goal of this division is to identify the potentially inappropriate prescription of many drugs, especially in patients of the older age group. In this perspective, the results of the PRACtICe study demonstrated that 30 and 47% of patients who received 5 or more and 10 or more drugs, respectively, had errors in prescribing during the 12-month study period. After correction, taking into account other risk factors, each additional drug increased the likelihood of errors by 16%. A Scottish study of patients requiring primary health care who have the highest risk of adverse events with polypharmacy, reports that about 14% of patients have misspelled prescribing errors. Moreover, the highest risk is precisely the number of prescribed drugs: in patients who were prescribed 10 drugs, there is an almost three-fold increase in the risk of adverse effects compared with those who received 1 or 2 drugs.

The highest corresponding risk is observed in patients with concomitant diseases such as diabetes mellitus and rheumatological pathology, and an increase in the trend is directly proportional to the patient's age. The risk of hospitalization with the adverse effects of taking multiple drugs was higher in patients taking glucocorticosteroid drugs. The most common drugs associated with the development of adverse effects and leading to more frequent cases of hospitalization of patients are non-steroidal anti-inflammatory drugs, diuretics and warfarin (an antithrombotic agent of the vitamin K antagonist group). Given the rapid development, implementation and use of electronic medical records of patients as part of primary health care, the process of identifying patients with polypharmacy can be greatly simplified and accelerated. In addition to identifying patients based on the amount of drugs they take, the search can also include variables such as age, group of drugs taken, and laboratory test results. The key to controlling the risks associated with polypharmacy is to ensure that patients fully participate in the decision of the attending physician to start taking the drug, as well as to monitor the use of drugs to monitor compliance with the proper regimen of drugs. This set of measures should include, first of all, informing patients about the potential risks associated with the use of drugs, as well as its benefits, familiarizing medical personnel with regular drug reviews, and timely reporting by patients of any adverse events to their attending physician. The use of polypills, which allow patients to take one tablet instead of several, can also improve patient adherence to treatment and adherence to medication. The most effective approach to improve the use of medicines at the primary health care level in developing countries is through a combination of measures such as training specialists and monitoring the quality of medical services, educating consumers and ensuring the proper supply of medicines. According to WHO, it is effective to implement a set of measures to improve the rational use of medicines. Each of these measures individually has a limited impact on the decision to misuse medicines.

The above determines the relevance of studying the aspects of rational use, as well as the development of measures and approaches to rationalizing the use of medicines at all stages of circulation and the provision of medical care, taking into account factors such as the development of the pharmaceutical market, actions and decisions of government structures (features of state regulation of the scope of drug circulation funds), financial opportunities and the level of development of the health system, the level of education and awareness of doctors, pharmacists and consumers, especially the needs of the population.

LITERATURE

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© Kosykh A.V., 2020