Arteriālās hipertensijas ārstēšanas problēmas senioriem primārajā veselības aprūpē
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Date
2023
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Arteriālās hipertensijas ārstēšanas problēmas senioriem ir saistītas ar lielām izmaksām, iespējamām blakusparādībām, nepieciešamību lietot vairākus nozīmētos medikamentus vienlaikus. Nepietiekama līdzestība rekomendētajām dzīvesveida izmaiņām un nozīmētajai antihipertensīvajai farmakoloģiskajai terapijai senioru vidū rezultējas ar slikti kontrolētu AH šajā vecuma grupā. Ir atklāti vairāki faktori, kas var pasliktināt līdzestību, kā nepietiekamas zināšanas par šo hronisko saslimšanu vai nezināšana par tās esamību, jo tā var būt asimptomātiska. Polimorbīdi pacienti var saskarties ar finansiālām grūtībām iegādāties visus nepieciešamos medikamentus, kādēļ var būt spiesti ārstēt citas hroniskās saslimšanas, kas izpaužas simptomātiski.
Liela loma ir primārā veselības aprūpes sniedzēja komunikācijai ar pacientu un slimnieka izglītošana par uzstādītās diagnozes nopietnību, terapijas mērķiem, kā arī potenciālām negatīvām sekām, ja netiek sekots līdzi sniegtajām rekomendācijām. Līdzestības veicināšanai tiek rekomendēts izmantot tam speciāli paredzētas vadlīnijas, kurās tiek ierosināts izglītot pacientu un komunicēt gan ar pacientu, gan ar seniora piederīgajiem par ārstēšanu. Svarīgi ir iesaistīt pacientu lēmumu pieņemšanā par terapijas taktiku, lai pacients apzinātos, ka viņa viedoklis tiek respektēts. Pacientu jāmudina ieviest asinsspiediena dienasgrāmatu un veikt tā mērījumus mājas apstākļos, pirms tam iemācot pareizu asinsspiediena mērīšanas tehniku un izglītojot par atbilstošas asinsspiediena mērīšanas ierīces iegādi. Ja pacientam ir atmiņas traucējumi, tad ir jārekomendē izmantot tablešu penāļus, speciālas mobilās aplikācijas, kas ļauj veidot atgādinājumu paziņojumus noteiktā laikā par asinsspiediena mērīšanu un medikamentu lietošanu. Ja pacients nespēj nodrošināt patstāvīgu pašaprūpi, ir nepieciešams piesaistīt sociālo dienestu. Polimorbīdiem pacientiem nepieciešams izvērtēt visu speciālistu nozīmētos medikamentus, izvērtējot polifarmācijas riskus un ieguvumus, un nozīmēt pacientam skaidru un saprotamu medikamentu lietošanas kārtību.
In senior patients with hypertension, there are many factors that have been found to cause treatment problems of Arterial hypertension such as high costs, fear of possible side effects, and use of multiple medications. It is a challenge for both - the patient and the primary healthcare provider. The role of the primary healthcare physician is to ensure the effectiveness of antihypertensive therapy and prevent the development of its complications. Poor adherence to prescribed antihypertensive medication and recommended lifestyle changes contribute to the development of uncontrolled hypertension. A lack of awareness of hypertension because it can be asymptomatic, patient incomprehension of this disease, and the burden of comorbid conditions are some examples known to reduce adherence. Communication between patient and physician is the key to improve adherence, but sadly it is found often to be suboptimal. This article reviews reasons for nonadherence to antihypertensive therapy. There are guidelines to increase patient adherence to treatment with useful tips for primary care clinicians like educating senior patients and their family members about the chronic disease and engaging them in selecting their treatment plan. Demonstration of the correct technique of blood pressure measurement, a recommendation to monitor blood pressure at home, and to register results in a blood pressure diary after is a vital part of hypertension treatment. There are pill organizers, pill dispensers, and even smartphone apps to help remind patients with memory problems to measure blood pressure and take their antihypertensive medication. It is necessary to evaluate older adult self-care capacity in each visit to establish that the patient is capable to follow treatment recommendations and doesn’t need a caregiver. Patients with polymorbidity may be prescribed various medications by different medical specialists and primary healthcare physicians must assess the risk of polypharmacy, adjust the pharmacological therapy if needed and give clear instructions to the patients about the correct use of prescribed medications.
In senior patients with hypertension, there are many factors that have been found to cause treatment problems of Arterial hypertension such as high costs, fear of possible side effects, and use of multiple medications. It is a challenge for both - the patient and the primary healthcare provider. The role of the primary healthcare physician is to ensure the effectiveness of antihypertensive therapy and prevent the development of its complications. Poor adherence to prescribed antihypertensive medication and recommended lifestyle changes contribute to the development of uncontrolled hypertension. A lack of awareness of hypertension because it can be asymptomatic, patient incomprehension of this disease, and the burden of comorbid conditions are some examples known to reduce adherence. Communication between patient and physician is the key to improve adherence, but sadly it is found often to be suboptimal. This article reviews reasons for nonadherence to antihypertensive therapy. There are guidelines to increase patient adherence to treatment with useful tips for primary care clinicians like educating senior patients and their family members about the chronic disease and engaging them in selecting their treatment plan. Demonstration of the correct technique of blood pressure measurement, a recommendation to monitor blood pressure at home, and to register results in a blood pressure diary after is a vital part of hypertension treatment. There are pill organizers, pill dispensers, and even smartphone apps to help remind patients with memory problems to measure blood pressure and take their antihypertensive medication. It is necessary to evaluate older adult self-care capacity in each visit to establish that the patient is capable to follow treatment recommendations and doesn’t need a caregiver. Patients with polymorbidity may be prescribed various medications by different medical specialists and primary healthcare physicians must assess the risk of polypharmacy, adjust the pharmacological therapy if needed and give clear instructions to the patients about the correct use of prescribed medications.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Arteriālā hipertensija; ārstēšanas problēmas; seniori; līdzestība; līdzestības veicināšana; primārā veselības aprūpe, Arterial hypertension; treatment problems; senior citizens; adherence; adherence-improving interventions; primary health care