Aygin BAYRAKTAR-EKİNCİOĞLU, Kutay DEMİRKAN

Birinci Basamak Tedavi Hizmetlerinde Baş Ağrılarına Yaklaşım: Eczacının Rolü

Primer baş ağrıları, yaygın gözlenen kronik ağrı sendromlarından biri olup, toplumun her kesimini etkileyebilmektedir. Basit analjezik ve non-steroidal anti-inflamatuvar ilaçların kullanımı ile özellikle akut tedavilerde etkili ağrı kontrolü sağlanmakla birlikte, baş ağrısı tiplerinin arasındaki farkların toplum tarafından yeteri kadar bilinmemesi, yanlış ve gereksiz ilaç kullanımına yol açmakta ve baş ağrısının süresini uzatarak tedavinin etkinliğini azaltmaktadır. Atak döneminde veya episodik durumlarda kısa süreli olarak kullanılması öngörülen triptanların, önerilen doz ve sıklıktan daha fazla olarak hasta tarafından kullanılması yan etki gözlenme sıklığını arttırmakta ve ilaç aşırı kullanımına bağlı baş ağrısı gelişmesine sebep olmaktadır. Uzun dönem tedavide kullanılan adjuvan analjezikler ile uygulanan tedavi prensiplerinin hasta tarafından tam olarak anlaşılmaması ilaç tedavi sürelerinin optimize edilmesini zorlaştırmakta ve beklenen etkinin gözlenmemesine neden olmakta ve bunun sonucunda hastanın yaşam kalitesini azalmaktadır. İlaçla ilgili sorunların birinci basamakta hastanın ‘ilk başvuru noktası’ olarak gördükleri eczacılar tarafından önceden fark edilerek, gerekli danışmanlık hizmetinin verilmesi ve ikinci basamak tedaviye erken yönlendirilmesi; hem gereksiz ilaç tedavileri ve buna bağlı gelişen sosyo-ekonomik olumsuzlukları en aza indirecek, hem de birinci ve ikinci basamak sağlık personeli arasındaki koordinasyonu sağlayarak ağrı tedavisindeki başarıyı artıracaktır. Sağlık sistemindeki bu kesintisiz iletişimin ve multidisipliner çalışmanın sağlanabilmesi için eczacının sorumluluklarının ve danışmanlık hizmetinin hastalar ve diğer sağlık personeli tarafından benimsenmesi ve ekip içerisinde hizmet verebilmesi için gerekli altyapı ve uygulamaların sağlanması gerekmektedir.

Anahtar Kelimeler:

eczacı, baş ağrısı

An approach to headache in primary care settings: the pharmacist’s role

Primary headaches are among common causes of chronic pain which can affect great portions of the society regardless of age, gender, socioeconomic status and education. Although successful pain management can be achieved by the use of basic analgesic and nonsteroidal antiinfammatory drugs especially in the treatment of acute attacks, inadequate knowledge or misperceptions about the different types of headaches in the society may lead to inappropriate and unnecessary drug use which results in longer duration of pain and decreased effectiveness of therapy. The use of triptans beyond the recommended dose and frequency for attacks results in an increased frequency of side effects and may lead to medication overuse headache. Patients’ misunderstanding of treatment principles of adjuvant analgesics in long term use makes optimisation of drug therapy difficult and reduces quality of life. An identification of drug therapy problems, counseling and early referrals to the secondary care specialist by the pharmacist, whom are known as a ‘first call point’ by most patients, may minimise unnecessary drug use and related unwanted socio-economic problems. Therefore, maintaining the link between primary and secondary health care providers will enhance the success of pain management. In order to establish the communication pathways and multidisciplinary team work in a health system, the role and the responsibilities of the pharmacist should be acknowledged by other health care professionals and required infrastructures and practices should be provided.

Keywords:

pharmacist, headache,

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