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  • Parenteralna Uporaba Protib...
    Petek Ster, Marija; Svab, Igor; Kalan Zivcec, Gordana

    Zdravstveno varstvo, 09/2013, Letnik: 52, Številka: 3
    Journal Article

    Parenteralna uporaba zdravil za lajšanje bolečine v križu se zaradi odsotnosti dokazov o njihovi večji učinkovitosti in dodatnem tveganju za zaplete odsvetuje. Namen raziskave je bil ugotoviti, kolikšen delež in kateri bolniki z bolečino v križu so dobili zdravilo v injekciji. V presečni študiji smo med 12.596 zaporednimi obiski pri 42 naključno izbranih zdravnikih družinske medicine analizirali vse obiske zaradi bolečine v križu. Na vzorcu bolnikov v starosti med 18 in 65 let smo analizirali pogostnost in dejavnike, ki vplivajo na odločitev za uporabo protibolečinskih zdravil v injekciji. Zaradi bolečine v križu je zdravnika obiskalo 819 (6,5 %) vseh obiskovalcev ambulante, 300 (2,4 %) bolnikov z akutno in 519 (4,1 %) s kronično bolečino v križu. Injekcijo je prejelo 132 (20,7 %) obiskovalcev z bolečino v križu, starih med 18 in 65 let. Med dejavniki, ki so se v multivariatnem modelu izkazali kot pomembni pri odločitvi za injekcijo, so bili dejavniki bolnika (višja starost, nižja stopnja izobrazbe), vrsta bolečine v križu (akutna radikularna bolečina) in dejavniki zdravnika (zdravnik specialist, nižja starost). Razlike v odločitvi za injekcijo so bile med zdravniki zelo velike: 8 od 42 zdravnikov injekcije ni dalo niti enemu bolniku, medtem ko se je en zdravnik za injekcijo odločil pri 19 od 32 (59,4 %) bolnikih. Velike razlike med zdravniki v pogostnosti odločitve za uporabo protibolečinskih zdravil v injekciji pri bolečini v križu kažejo na potrebo po usmerjeni intervenciji, katere cilj bi bil poenotiti delo zdravnikov ter povečati kakovost in varnost obravnave bolnikov. Injections are not recommended due to the lack of evidence about their effectiveness and potential additional risks. We would like to know the proportion and characteristics of general practice attainders with low back pain who were treated with medications in injection. In a cross-sectional study including 12,596 consecutive attainders of general practice in 42 general practices, we analysed all the contacts due to low back pain. In a sample of attainders in the age group from 18 to 65, we analysed the proportion and factors influencing a decision for treatment with medications in injection. Low back pain was the reason for attendance in 819 (6.5%) patients; 300 (2.4%) with acute and 519 (4.1%) with chronic low back pain. 132 (20.7%) patients from 18 to 65 years were treated with medications in injection. In multivariate analysis, several factors were found to be important for the decision for injection of medications: patients’ characteristics (older age, lower level of education), type of pain (acute ishialgic pain) and physicians’ factors (specialisation in family medicine, younger age). Differences between physicians in using injections were significant: 8 out of 42 physicians did not use injections, but there was a physician who used injections in 19 out of 32 patients (59.4%). Huge differences in the use of medications in injection in patients with low back pain indicate a necessity for intervention whose aim would be to reduce the differences between physicians and improve the quality and safety of patient care.