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Identifier 000441447
Title Ο αντίκτυπος της πανδημίας Κορωνοϊού (COVID-19) στην προσβασιμότητα για συνταγογράφηση φαρμάκων από την πρωτοβάθμια φροντίδα υγείας στην Κρήτη, και στη συμμόρφωση των ασθενών στην φαρμακευτική αγωγή για χρόνια νοσήματα
Alternative Title Impact of Coronavirus disease (COVID-19) pandemic on access to prescription refill and medication adherence of patients with non-communicable diseases in Crete
Author Βολτυράκη, Φιλοθέη
Thesis advisor Τσιλιγιάννη, Ιωάννα
Reviewer Λιονής, Χρήστος
Ιεροδιακόνου, Δέσπω
Abstract Introduction - Purpose: Compliance with medication is the extension of the patient's behavior, which is related to taking medication, adapting his lifestyle to new conditions, in order to improve his health. It is now estimated by the World Health Organization that improving compliance can have a greater positive effect on health as a whole than improving various medicines. Each medical recommendation aims at achieving specific desired results for the mental and physical health of patients with the ultimate goal of optimal management of various pathological conditions. Proper management of patients with chronic diseases such as asthma and COPD by the P. H.C, through the continuation of health care and treatment of comorbidity can lead to the avoidance of emergency admissions to the hospital. As the COVID-19 pandemic has shown us, it is quite important that the tertiary health care not to be burdened and therefore that the hospital’s beds not to be charged with incidents that would have been treated in the P.H.C. through the good regulation of the chronically ill. As it has been proven so far, the P.H.C. due to the continuity of care, it acted protectively in people with chronic diseases such as COPD and asthma, as their hospitalization rate was low, despite the increased risk of disease by COVID-19. The aim of this dissertation was to describe the possible effects of the coronavirus pandemic (COVID-19) on drug accessibility and medication compliance in patients with selected chronic diseases such as hypertension, dyslipidemia, asthma and chronic obstructive pulmonary disease (COPD ) in P.H.C. in Crete. An additional goal was to investigate the application of intangible prescription in Greece. Population and Methodology: The study was a contemporary study, which was carried out in a structure of Primary Health Care (4th Local Health Unit) Heraklion, Crete. The period that took place was from October to November 2020. The target population of the study was patients who had visited the PHC structure for regular monitoring of chronic diseases and for prescribing drugs while belonging to the age group over 18 years. The initial invitation was made to 121 people, of which 17 refused (final participation of 104 people). Prerequisite for participation was that the participants had one or a combination of the following diseases: hypertension and / or dyslipidemia, and / or asthma and / or chronic obstructive pulmonary disease (COPD) and were residents of Heraklion. The information was extracted from the patients' medical records as well as from the completion of the questionnaire that we created and which is divided into 5 parts by collecting the following data: demographics, compliance and accessibility to medication during the pandemic restrictive measures and the use of new health services such as intangible prescription. In addition, medication compliance was assessed in general (use of a specific compliance assessment tool [Morisky Medication Adherence Scale (MMAS-8)]). Results: Of the total patients who participated, 64.4% were men, 45.2% were 61-75 years old, while 69.2% of the individuals were unemployed, retired or had a domestic job. Four diseases were selected, two of the respiratory system (asthma / COPD) and two of the cardiovascular (H / Dyslipidemia) in which the following were observed per category: From the distribution of the responses, in medication adherence, 72.1% reported receiving antihypertensive therapy (p <0.05) or 69.2% for dyslipidemia (p <0.05) or 76.9% inhaled asthma treatment COPD (p <0.05) and significantly less or 5.8% cortisone for asthma (p <0.05). The 93.3% continued their treatment normally (p <0.05), during quarantine and distancing measures. The three decimal questions from 0 to 10 (10: very much) concern the self-esteem of the anxiety and fear they feel "If the interruption or modification of the treatment may have deranged any of their chronic diseases". Although patients - visitors differ in these diseases, it seems that 86.4% express the highest anxiety-fear (8 to 10 on the scale) for the deregulation of the respiratory problem. At the same level of concern - fear for blood pressure is 72.9% and only 48.8% for dyslipidemia. The distributions of the study participants' responses to medication questions related to discontinuation or modification showed that due to the deregulation of their blood pressure 16.5% had to contact by phone or visit their doctor (p <0.05) while only 3.5% to visit the ER. 80.2% (n = 69) (p <0.05) felt that the interruption or modification of the inhaled treatment worsened their respiratory problem with the main outcome being the appearance of various symptoms (n = 48) while in the cessation or modification of oral cortisone as the most common reported sputum production (n = 13), 24.7% forced them to visit a doctor or the ER or 6.7% to be hospitalized. The questions regarding the application and use of intangible prescription showed that only 39.4% (p <0.05) stated that they use intangible prescription while the main reason for non-use by those who do not use it (n = 60) stated that “no I didn’t need it because I had access to a regular prescription from my doctor "(54.2%) and it follows" that I could not activate the intangible prescription. " (30.5%). The majority received their treatment themselves (66.7%) while all of them were 100% satisfied and will continue to use it. The Morisky Medication Adherence Scale (MMAS-8) showed a significant differentiation of responses which was observed in all discrete responses but also in the last one concerning a graded scale (p <0.001). Specifically, 83.7% of the patients-visitors stated that they do not forget to take their medicines sometimes, 93.3% that when they travel or leave the house, they sometimes do not forget to take their medicines. Also, the majority or 57.7% said "never or rarely" to the question "How often do you find it difficult to remember to take all your medicines?". The Medication Compliance Scale identifies a total average score of 8 questions of 6.55 (± 1.90) with a possible value range of 0-8, with a higher score determining better or excellent compliance. The consistency of responses yielded to a coefficient of K-R = 0.793 (good reliability). However, the categorical gradiation of the Scale showed high compliance in 49.0% of patients (p <0.01) versus 24.0% in moderate or 26.9% in low. The low score of the Medication Compliance Scale in medication and therefore lower adherence seems to be significantly related to receiving treatment for Hypertension (rho = -0.235, p <0.05) or for dyslipidemia (rho = -0.224, p <0.05) against respiratory COPD / Asthma diseases where a high rate of adherence was found (rho = 0.155, p <0.05). Respectively, the Anxiety and Fear of stopping or modifying the treatment seems to be significantly correlated with the continuation of receiving treatment at a normal rate (rho = 0.259, p = 0.05). Multiple accounting regression was performed to correlate high compliance with medication versus moderate / low and in terms of the characteristics of the study participants or the levels of the Anxiety & Fear Scale, from stopping or modifying the treatment. Taking treatment for Hypertension determines a low probability of high compliance (OR = 0.25, p = 0.011) or generally confirms the negative relationship of high compliance / adherence to receiving treatment for Hypertension. However, there were no other factors that were significantly associated with high adherence to treatment including the factor of Anxiety & Fear of discontinuation or modification (p> 0.05). Conclusions: In the present study it was shown that the selection of the four diseases, two of the respiratory system (asthma / COPD) and two of the cardiovascular (Hypertension / Dyslipidemia) was catalytic as in the cardiovascular diseases there was a low score of the Compliance Scale and therefore lower adherence (Ηypertension / dyslipidemia) against respiratory diseases (COPD / Asthma) where a high rate of adherence-compliance was found, a fact that is verified by the literature. In these cardiovascular diseases, if the medication is stopped or modified by the patient without the informed knowledge of the therapist, immediate symptoms will rarely appear against the respiratory diseases, which will be aggravated. The doctor-patient relationship, especially in P.H.C., is essential and is one of the main connecting links of education, empowerment and finally compliance even in stressful conditions of global health crisis, as evidenced by the high rate of 73% high to moderate levels of compliance at present study. While despite the educational and technological peculiarity of the 3rd age (45.2% were 61-75 years old) that constituted the majority of the individuals of the sample, a high percentage of acceptance of the Intangible Prescription was recorded (39.4%) of which all in 100% said they were satisfied and will continue to use it. A fact that proves based on literature the value of the technological contribution to the compliance of patients and their dedication to their medication, especially during the period of quarantine distancing measures. Patients through Intangible Prescription take medication consciously and more degrees of freedom and self-management are given to them enhancing their self-confidence. These findings are worth studying in further research to capture compliance behaviors and after the pandemic crisis.
Language Greek
Issue date 2021-07-29
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work
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