Istraživanje determinanti modela kolaborativne farmaceutske prakse u zdravstvenoj zaštiti starih osoba u Srbiji

Abstract

U prvoj fazi istraživanja je obavljena kritička analiza publikovanih modela kolaborativne farmaceutske prakse (KFP), kao i razvoj konceptualnog dinamičkog modela KFP u zdravstvenoj i socijalnoj zaštiti starije populacije. Desk analizom su pretraženi radovi iz elektronskih baza podataka i dobijen je alat u obliku vodiča i ček-liste za donosioce odluka i regulativa za postizanje preferiranih efekata prikupljenih kolaborativnih praksi, kroz označavanje modela i aktivnosti koje treba preduzeti za implementaciju najprimenjivije kolaborativne zdravstvene i socijalne zaštite starijih osoba. Pretraga je ponovljena u decembru 2021 godine i uočen je pad broja publikacija u 2020. i 2021. godini, uzrokovan svetskom COVID-19 pandemijom. Sprovodena je i studija preseka o stavovima starijih osoba (65+) prema interprofesionalnoj saradnji i KFP uz metodološki utemeljen (Delfi metod) i razvijen upitnik, adekvatnih psihometrijskih karakteristika. Istraživanje je sprovedeno u gerontološkim centrima u Srbiji, a ispitanici su kao najveće probleme sa kojima se suočavaju starije osobe u sistemu zdravstvene i socijalne zaštite naveli nedovoljnu vidljivost starije populacije i nedovoljnu informisanost. Na kraju, sprovedena je prospektivna sistemska analiza rizika u procesima propisivanja, izdavanja i načinu primene lekova za korisnike gerontoloških domova, radi identifikacije potencijalnih grešaka, kvantifikacije i rangiranja prioriteta pridruženih rizika, kao i definisanja korektivnih mera za smanjenje rizika za bezbednost pacijenata. Analiza načina i efekata otkaza (FMEA) pokazala je da su predložene korektivne mere postigle značajno unapređenje bezbednosti sistema u 36 od 38 slučaja potencijalnog otkaza sistema, uz smanjenje ukupne vrednosti kvantifikacije prioriteta rizika (RPN) za 45,08%.

In the first phase of the research, a critical analysis of published collaborative pharmaceutical practice (CPP) models was conducted, and conceptual dynamic model of CPP in health and social care of the elderly population was developed. Desk analysis was used to review the publications from electronic databases and provided a tool in the form of guides and checklists for decision makers and regulators to achieve the preferred effects of collected collaborative practices, through models` identifications and activities which needed to be conducted in order to implement the most applicable collaborative health and social care for the elderly. The search was repeated in December 2021 and a decrease in the number of publications in 2020 and 2021 was noticed, caused by the global COVID-19 pandemic. A cross-sectional study on the attitudes of older people (65+) towards interprofessional collaboration and CPP was conducted with a methodologically based (Delphi method) and developed questionnaire, with good psychometric characteristics. The research was conducted in nursing homes in Serbia, and the respondents mentioned the lack of visibility of the elderly population and insufficient information as the biggest problems faced by the elderly in the health and social care system. Finally, prospective systemic risk analysis was conducted in the processes of drug prescribing, dispensing and administering to nursing home users, in order to identify potential errors, quantify and rank the priorities of associated risks, and define corrective measures to reduce risks to patient safety. Failure Mode and Effects Analysis (FMEA) showed that the proposed corrective measures achieved a significant improvement in system security in 36 out of 38 cases of potential system failure, with a reduction in the total value of RPN (Risk Priority Number) by 45.08%.