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Medikamentenadhärenz bei chronischen Erkrankungen

Bedeutung und neue Ansätze

Medication adherence in patients with chronic diseases

Significance and new approaches

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Zusammenfassung

Ein signifikanter Anteil (etwa 20–50%) der Patienten nach Schlaganfall und mit anderen chronischen Erkrankungen nimmt die zur Sekundärprävention verordneten Medikamente mit nachgewiesener Wirksamkeit nicht dauerhaft ein. Patienten mit reduzierter Einnahmetreue sind durch ein hohes Risiko für kardiovaskuläre Ereignisse gekennzeichnet. Die Anzahl älterer Patienten mit chronischen Erkrankungen und Polypharmakotherapie wird in der Zukunft aufgrund der demographischen Entwicklung weiter ansteigen. Folgende Strategien werden derzeit zur Unterstützung der Einnahmetreue diskutiert: individuelle Beratung des Patienten und der versorgenden Personen, individualisierte Therapie, Medikamentenmanagement auf Ebene der Verordnung und durch die Apotheken einschließlich dem Einsatz von Hilfsmitteln wie dem individuellen Stellen der Medikamente oder der Verwendung von Wochenblistern.

Die Verbesserung der Einnahmetreue ist ein neues Forschungsgebiet mit möglicherweise hohem Nutzen sowohl in Hinblick auf den klinischen Bereich als auch hinsichtlich der Behandlungskosten. Umfangreiche Maßnahmen zur Verbesserung der Adhärenz wie individuelle Patientenberatung oder Medikationsmanagement sind möglicherweise ähnlich wichtig einzustufen wie die Erforschung neuer Wirkstoffe. Dennoch fehlen bislang praktische Richtlinien und prospektive Studien zur Durchführbarkeit und mit klinischen Endpunkten zur Beurteilung von Maßnahmen zur Steigerung der Einnahmetreue.

Summary

Many patients post stroke or with other chronic diseases do not continue to take their evidence-based medication. Patients with reduced medication adherence are characterized by increased cardiovascular morbidity and mortality. The number of elderly individuals with chronic conditions requiring polypharmacy will continue to increase. The following strategies are discussed to enhance adherence: individual advice and continuous counselling of the patients and the caregivers, individualized pharmacotherapy, and medication management including combination pills and unit doses. Medication adherence represents a field of research with increasing importance for patient outcomes and healthcare costs. Measures to improve adherence may be equally important to the development of novel drugs. However, prospective clinical studies evaluating the effects of the proposed interventions on clinical endpoints are rare and therefore evidence-based recommendations are missing.

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  1. Klinik für Innere Medizin III; Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland

    U. Laufs

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Laufs, U. Medikamentenadhärenz bei chronischen Erkrankungen. Nervenarzt 82, 153–158 (2011). https://doi.org/10.1007/s00115-010-3115-4

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