Zavzetost bolnic za zdravljenje osteoporoze: Patient adherence to osteoporosis therapy

Background: Studies have shown that the level of patient adherence to osteoporosis treatment is similar to that for other chronic diseases, i.e. approx. 50%. The observed constant decrease in adherence is due to a lack of motivation for long-term treatment. The purpose of our study was to determine the level of patient adherence to once-weekly bisphosphonate, the most commonmedication prescribed for osteoporosis treatment. Methods: A retrospective cohort study was conducted among female patients with primary osteoporosis, who were included in the study by 14 randomly selected Slovene family physicians on the basis of diagnosis classification in a computer-based patient list. For the adherence analysis, the patients were followed for 13 months after the initiation of treatment with once-weekly bisphosphonate. Results: Among the 334 questionnaires returned, 124 met the criteria for the analyisis of patient adherence to once-weekly bisphosphonate therapy. Over the studied 13-month period, the percentage of patients adheringto therapy dropped to 62.9 %. The observed patient compliance was not related to age, level of education, marital status or household size. Thegreatest decrease in adherence was noticed in the first month after treatment initiation due to perceived side effects. Later on, the most common reason for abandoning treatment was failure to ask for a new prescription. Theadherence level of approx. 80 %, reported by the participating doctors, was overestimated. Conclusions: Adherence of patients to osteoporosis therapy tends to be overestimated. The adherence level decreases over time and the proportion of patients abandoning treatment increases, mostly because of side effects and failure of patients to have their prescription refilled. Patients should therefore be monitored for medication adherence and motivated for treatment. Izhodišča: Zavzetost bolnikov za zdravljenje osteoporoze je po študijah podobna kot pri drugih kroničnih boleznih in se giblje okoli 50 %. Za dolgotrajno zdravljenje je značilno stalno padanje zavzetosti zaradi zmanjšanemotiviranosti za zdravljenje. Zanimalo nas je, kakšna je zavzetost zazdravljenje osteoporoze z najpogosteje predpisovanimi zdravili - enotedenskim bisfosfonatom. Metode: Izvedli smo retrospektivno kohortno raziskavo med bolnicami s primarno osteoporozo, ki jih je na osnovi šifriranihdiagnoz v računalniškem izpisu opredeljenih bolnikov vključilo 14 naključno izbranih zdravnikov družinske medicine v Sloveniji. V analizi smo spremljali 13-mesečno obdobje po uvedbi enotedenskega bisfosfonata. Rezultati:Ustrezno izpolnjenih je bilo 334 vprašalnikov, med njimi jih je 124 ustrezalo merilom za analizo zavzetosti. V 13-mesečnem obdobju se je zavzetostzmanjševala do končne vrednosti 62,9 %. Zavzetost ni bila odvisna odstarosti, izobrazbe ali zakonskega stanu bolnic, niti od števila ljudi v skupnem gospodinjstvu. Največji padec je bil prvi mesec po uvedbi zdravila zaradi stranskih učinkov. Kasneje je bil najpogostejši razlog za opustitev zdravljenja to, da bolnica ni prišla po recept. Sodelujoči zdravniki so ocenili, da 80 % njihovih bolnic vztraja pri zdravljenju. Zaključki: Pri zdravljenju osteoporoze precenjujemo bolnikovo zavzetost za zdravljenje, ki počasi upada, delež bolnikov, ki opustijo zdravljenje, pa se sčasoma povečuje,predvsem na račun stranskih učinkov in dejstva, da preprosto ne pridejo po zdravilo. Bolnike je potrebno spremljati in motivirati za zdravljenje.