Die Auswirkungen eines vom Apotheker durchgeführten Medikationsassessments und der anschließenden Einleitung daraus resultierender Maßnahmen auf die Versorgungssituation von Typ-2-Diabetikern

Diabetes mellitus Typ 2 ist eine chronische Erkrankung, die in den meisten Fällen mit patientenbezogenen Störfaktoren, zahlreichen Co-Diagnosen und schwerwiegenden Folgeerkrankungen in Verbindung steht. Aufgrund der hohen und weiter steigenden Anzahl Betroffener ist diese Erkrankung von enormer gese...

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Bibliographic Details
Main Author: Treutle, Anne-Kathrin
Contributors: Morck, Hartmut (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2015
Online Access:PDF Full Text
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Type 2 diabetes mellitus is a chronic disease that is in most cases with patient-related confounders, numerous co-diagnoses and serious sequelae in conjunction. Due to the high and rising number of those affected is the disease of enormous social and health policy significance. The care of these patients can be very complex and represents a major challenge for everyone involved. In addition, the metabolic disease causes high costs, with a high percentage is caused by the complications of diabetes. Against this background, this work is examined in the context of whether and to what extent the pharmacist with the implementation of a comprehensive medication assessment and the subsequent monitoring of relevant treatment parameters and initiating any required appropriate actions impact on the supply situation of type 2 diabetes may have. The evaluation completed in the community pharmacy medication Assessment shows that the everyday care at a certain percentage of the studied diabetic patients actually does not meet the requirements that are placed on a cardiometabolic therapeutic conception. As before, the data evaluation in 2013 more than half are (53.66%) of the total of 382 type 2 diabetics analyzed insulinotropic antidiabetics such as insulin, sulfonylureas or glinides at least temporarily employed at the time. These substances are associated with an increased risk of hypoglycaemia and should, according to findings from the companies included in this work cardiovascular outcome trials, are discussed critically. Hypoglycemia increase according to current data, the cardiovascular risk significantly and therefore should, in particular among young (by WHO <65 years) newly diagnosed type 2 diabetic patients without vascular preliminary damage and even higher life expectancy, not or only after extensive risk-benefit assessment are used. Only a total of 77 (20%) and thus a small percentage of the 382 studied type 2 Diabeteiker are younger than 65 years. These patients should be the focus in the implementation of an assessment with regard to the prevention of cardiovascular complications. Because of diabetes mellitus type 2 is associated in most cases with comorbidities such as hypertension, dyslipidemia and obesity, as part of the medication assessments also the prescription co-medication is analyzed. Here the pharmacist should take particular account of the medicines that increase the risk of hypoglycemia in addition due to pharmacodynamic interactions. In addition, the pharmacist (cardio-) derive vascular risk factors, which make it possible to identify cardiovascular risk diabetic patients. With this approach has succeeded in ten type 2 diabetics who are younger than 65 years, already at the present time, however, already have five cardiovascular risk factors, identify. Especially for this vessel vulnerable patient group contributes to the medication a patient-specific assessment subsequent intervention within the meaning of "case management" to improve the supply situation. Basically, a "Case Management" at a target population that meets the following criteria, meaningful: Type 2 diabetics younger than 65 years, hypoglycemia Vascular by antidiabetic agents and co-medication (cardiovascular) risk, derived on the basis of medication and by patient survey detectable. To improve the supply situation of type 2 diabetes, a patient-specific "case management" is particularly useful for younger, cardiovascular risk type 2 diabetes as well as the abandonment of pure blood sugar centered therapies with insulinotropic substances in specifically these patients. The individual "manage" and to suffer the proper medical treatment of the small percentage of those with diabetes, their risk over the next ten to twenty years a series of complications, is large and multimodal therapeutic approaches and the use of newer innovative antidiabetics are necessary. As the complication rate would develop in specifically these patients for several years under a new therapeutic approach without risk of hypoglycaemia compared to standard care itself, the pharmacist could verify by Diabetes Register. This procedure allows the pharmacist to interpret its supply contract re-make an important contribution to health services research and thus improve the quality of care of type 2 diabetic patients and prove the condition laid down at the beginning of this working hypothesis definitively.