It is extremely difficult to extrapolate results of recent studies to contemporary recommendations. It seems that there is a need for properly randomised studies on large groups, with good control of dietary and non-dietary parameters, which account for not only the sum of SFA and TFA, but also their source. Only such studies will allow for full evaluation of an effect of substituting SFA and TFA on cardiovascular risk.

Tom 74 · nr 3 · 2018 164 Nieprzestrzeganie zaleceń terapeutycznych (non-adherence) jest powszechnym problemem na całym świecie. Szacuje się, że nawet połowa pacjentów chorujących przewlekle nie stosuje swoich leków zgodnie z zaleceniami, co może mieć klinicznie istotne konsekwencje [4,5]. Przestrzeganie zaleceń terapeutycznych poprawia zarówno skuteczność, jak i bezpieczeństwo leczenia -wiąże się z mniejszym ryzykiem niepowodzenia terapii, powikłań i hospitalizacji, a także mniejszymi kosztami leczenia [5][6][7]. W międzynarodowym badaniu Morrisona i wsp. nieprzestrzeganie zaleceń terapeutycznych w odniesieniu do stosowania terapii hipotensyjnej zadeklarowało aż 57,6% respondentów z Polski [8]. Wyróżnia się trzy wymiary przestrzegania zaleceń terapeutycznych [3]: 1) rozpoczęcie leczenia (initiation) -pacjent może zaniechać przestrzegania zaleceń terapeutycznych już na etapie realizacji nowej recepty lub opóźnić w czasie decyzję o realizacji recepty; 2) realizacja terapii (implementation) -na tym etapie mogą wystąpić nieprawidłowości w przyjmowaniu leków (np. zapominanie o zażyciu leku, zmienianie dawek). Niestosowanie się do zalecanego dawkowania może być świadome i intencyjne albo nieświadome i przypadkowe, zwłaszcza jeżeli chodzi o pomijanie pojedynczych dawek [2]. Mogą występować zjawiska: "białego fartucha" (początkowe nieregularne przyjmowanie, z systematycznością pojawiającą się kilka dni przed wizytą lekarską), "parkingu" (pacjent, chcąc nadrobić wcześniejsze zaniedbania, przed wizytą u lekarza przyjmuje dawki większe lub WstępŚwiatowa Organizacja Zdrowia (World Health Organization, WHO) uznaje termin adherence za podstawowe pojęcie opisujące stosowanie się przez pacjenta do zaleceń terapeutycznych. W języku polskim pojęcie to tłumaczone jest jako adherencja lub przestrzeganie zaleceń terapeutycznych [1]. WHO definiuje adherence jako zakres, w jakim zachowanie pacjenta w odniesieniu do przyjmowania leków, przestrzegania zaleceń żywieniowych i/lub modyfikacji stylu życia, odpowiada uzgodnionym zaleceniom personelu medycznego [2]. Definicja przestrzegania zaleceń terapeutycznych uzgodniona w europejskim projekcie ABC (Ascertaining Barriers for Compliance) to zakres, w jakim pacjenci przyjmują swoje leki zgodnie z otrzymanymi zaleceniami [3].Pharmacist opportunities to support medication adherence · Pharmacists have at their disposal many practical opportunities to support patients in corresponding with recommendations from a health care provider. It is important that pharmacists verify whether a patient knows their medication and how to take it. If any difficulties arise, it is a good idea to talk to the patient about potential coping strategies with proper administration of medication and offer tools and accessories that are available in the pharmacy. This paper represents a brief examination of the phenomenon of non-adherence and a reminder of interventions that can improve adherence with recommendations from a health care provider. Many of these interventions can be used by patients in practice and promot...

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Summary What is known and objective Myocardial infarction (MI) in young adults accounts for up to 10% of all cases. Regarding life expectancy and professional activity, it is extremely important to restore and maintain young patients’ full performance. Therefore, secondary prevention is especially vital in this group of patients. The paper focuses on the analysis of pharmacotherapy in young MI patients in Poland, assessing disparities between the European Society of Cardiology guidelines and clinical practice, and regional differences among the provinces. Methods The analysis was conducted using the data from a nationwide, observational, multicentre, prospective study—the Polish Registry of Acute Coronary Syndromes (PL‐ACS). The data were collected from patients ≤45 years old with MI who were hospitalized in the period 2010‐2014. Results and discussion A retrospective study included 6367 MI patients. They constituted 3.9% of all the patients with MI in Poland. Despite the fact that during hospitalization regional differences were observed in case of acetylsalicylic acid (range 70.3%‐93.8%), β‐blockers (range 50.0%‐79.6%), statins (range 53.4%‐85.7%) and angiotensin‐converting enzyme inhibitors (range 46.9%‐75.0%), the majority of patients received the drugs according to the guidelines. Regional differences found at discharge also regarded those medications, but the range of observed variations was smaller. On average, three‐quarter of patients received guideline‐recommended medications. Still, in some provinces, almost a quarter of patients were administered those medications only at discharge. What is new and conclusion In the study population, there were significant differences between the provinces regarding pharmacotherapy during hospitalization, which concerned major groups of medications. However, pharmacotherapy indicated at discharge revealed fewer regional differences and adhered to guideline recommendations to a greater extent. Nevertheless, there is still some room for improvement, especially with regard to pharmacotherapy during hospitalization.

Potentially inappropriate prescribing (PIP) is one of the major risk factors of adverse drug events in elderly patients. Pharmacotherapy assessment criteria may help reduce the instances of PIP among geriatric patients. This study aimed to verify the applicability of selected tools designed to assess prescribing appropriateness in elderly and to identify PIP in the study population. Based on pharmacist-led medication reviews that were performed among patients attending senior day-care centers based in Poland, aged 65 years and over, the following tools were applied for assessing the appropriateness of pharmacotherapy: PILA (patient-in-focus listing approach): STOPP/START v.2 and Amsterdam tool, DOLA (drug-oriented listing approach): PRISCUS list, and DOLA+: Beers criteria v.2019 and the EU(7)-PIM list–the criteria oriented on medications requiring indications. Fifty patients participated in the study. The prevalence of prescribing issues in the study population was very high and ranged from 28% to 100%, depending on the criteria applied. The highest number of PIP cases was identified based on the PILA criteria: STOPP/START v.2 (171, a mean of 3.4 PIP cases per patient), and the Amsterdam criteria (124, a mean of 2.5 PIP cases per patient). The lack of protective vaccinations against pneumococci identified using the START criterion was found to be the most common PIP (identified in 96% of the patients). Proton-pump inhibitors (PPIs) were identified as the most problematic group of medications. The STOPP, EU(7)-PIM and Beers criteria revealed cases of inappropriate prolonged PPI use, whereas the Amsterdam tool identified cases where PPIs should have been prescribed but were not. The highest number of PIP cases in the study population were identified with the PILA tools, and on this basis the most comprehensive assessment of pharmacotherapy appropriateness in geriatric patients was conducted. Further studies should be designed, covering a larger group of patients across different healthcare settings (inpatient and outpatient), with access to comprehensive patient data.