Publication: Estudio de calidad de vida en pacientes con endometriosis
Authors
Martínez Gómez, Ana
item.page.secondaryauthor
Escuela Internacional de Doctorado
item.page.director
Marín Sánchez, Pilar ; Nieto Díaz, Anibal
Publisher
Universidad de Murcia
publication.page.editor
publication.page.department
DOI
item.page.type
info:eu-repo/semantics/doctoralThesis
Description
Abstract
Las benzodiacepinas son tratamientos farmacológicos que cuentan con un amplio abanico terapéutico al actuar como ansiolíticos, hipnóticos, sedantes, anticonvulsivantes y relajantes musculares, así como en el tratamiento del síndrome de abstinencia a diferentes sustancias de abuso. Sin embargo, su uso continuado puede tener efectos adversos como alteraciones cognitivas, caídas, abuso y dependencia. A pesar de que son fármacos cuyas recomendaciones exigen su uso a corto plazo (máximo tres meses), es muy común observar tratamientos crónicos y prolongados que pueden exponer al paciente al abuso y dependencia. Estudios previos sugieren un reciente incremento de su dispensación. Por ello, el objetivo general de este trabajo ha sido estudiar la evolución del consumo de benzodiacepinas entre 2014 y 2017 en la Comunidad Autónoma de la Región de Murcia (CARM) incluyendo áreas y zonas básicas de salud y relacionar las mismas con diferentes variables sociodemográficas como sexo, edad y TSI. Para ello se han recopilado los datos individuales anónimos de dispensación de estos subgrupos farmacológicos a través de la Dirección General de Planificación, Investigación, Farmacia y Atención al Ciudadano en formato de Dosis Diaria Definida (DDD), transformados en nuestro estudio en DHD (DDD cada 1000 habitantes y día). Nuestros resultados muestran que el consumo de benzodiacepinas en la Región de Murcia se incrementó desde 2014 con 81 DHD hasta 83 DHD en 2017, alcanzando las cifras más elevadas en las áreas del Noroeste (área 4; 97-103 DHD), Cartagena (área 2; 95-100 DHD) y Vega Alta del Segura (área 9; 93-99 DHD), mientras que las cifras menores en las áreas del Mar Menor (área 8; 67-62 DHD) y Altiplano (área 5; 69-68 DHD). Las Zonas Básicas de Salud en las que más consumo hubo son: Cartagena/Casco Antiguo (área 2; 133-132 DHD); Cartagena Este (área 2; 122-130 DHD); Calasparra (área 4; 118-122 DHD); Cartagena/Los Barreros (área 2; 111-112); Cehegín (área 4; 109-115); Archena (área 6; 112-110 DHD); Cartagena Oeste (área 2; 109-112 DHD); y Abarán (área 9; 104-108 DHD). Algunas de estas ZBS tienen una renta económica menor, así como la mayoría de la población tiene edad muy avanzada. Por otra parte, los principios activos más utilizados fueron: lorazepam (26-27 DHD), lormetazepam (15-16 DHD), alprazolam (13 DHD), zolpidem (8 DHD) diazepam (7 DHD) y bromazepam (3 DHD). Este patrón es prácticamente idéntico en todas las áreas y ZBS, demostrando que los protocolos de prescripción según indicación farmacéutica son similares. Además, principalmente se trata de benzodiacepinas de acción corta, inicio de acción rápido, alta biodisponibilidad y una semivida similar (10-20 horas), no produciendo metabolitos activos. Se prescriben para muchas patologías, como ansiedad, insomnio o deshabituación del consumo de tóxicos. Los meses con mayor retirada de benzodiacepinas en las farmacias comunitarias son febrero, junio, septiembre y octubre, con diferencias estadísticamente significativas respecto al mes de agosto. Al comparar por sexo biológico, obtuvimos 104-107 DHD en sexo femenino y 57-59 DHD en sexo masculino. El diagnóstico de problemas de ansiedad es mayor en mujeres, por lo que se esperaban resultados superiores, pero no tan significativos. En cuanto a la clasificación por tipo de aportación económica, nuestros resultados muestran que existe un consumo de benzodiacepinas estadísticamente significativo en los pacientes con TSI 001 y TSI 002 (>200 DHD), quiénes muestran un consumo hasta 6 veces mayor en comparación con TSI 003 y TSI 004 (31-36 DHD, aproximadamente). Y en cuánto a la edad, se incrementa a partir del grupo de 45 a 49 años hasta los 64 años, superando valores de 200 DHD a partir de los 65 años, edad de jubilación para muchas personas.
Benzodiazepines are pharmacological treatments that have a wide therapeutic range, acting as anxiolytics, hypnotics, sedatives, anticonvulsants and muscle relaxants, as well as in the treatment of withdrawal syndrome from various substances of abuse. However, their continued use can have adverse effects such as cognitive impairment, falls, abuse and dependence. Although these drugs are recommended for short-term use (maximum three months), chronic and prolonged treatment is very common, which can expose patients to abuse and dependence. Previous studies suggest a recent increase in their dispensing. Therefore, the overall objective of this study was to examine the evolution of benzodiazepine consumption between 2014 and 2017 in the Autonomous Community of the Region of Murcia (CARM), including basic health areas and zones, and to relate this to different sociodemographic variables such as gender, age and TSI. For this purpose, anonymous individual data on the dispensing of these pharmacological subgroups has been compiled by the Directorate-General for Planning, Research, Pharmacy and Citizen Services in Defined Daily Dose (DDD) format, which has been converted in our study to DHD (DDD per 1,000 inhabitants per day). Our results show that benzodiazepine consumption in the Region of Murcia increased from 81 DHD in 2014 to 83 DHD in 2017, with the highest figures in Noroeste (area 4; 97-103 DHD), Cartagena (area 2; 95-100 DHD) and Vega Alta del Segura (area 9; 93-99 DHD), while the lowest figures were in the areas of Mar Menor (area 8; 67-62 DHD) and Altiplano (area 5; 69-68 DHD). The Basic Health Areas with the highest consumption were: Cartagena/Casco Antiguo (area 2; 133-132 DHD); Cartagena Este (area 2; 122-130 DHD); Calasparra (area 4; 118-122 DHD); Cartagena/Los Barreros (area 2; 111-112); Cehegín (area 4; 109-115); Archena (area 6; 112-110 DHD); Cartagena Oeste (area 2; 109-112 DHD); and Abarán (area 9; 104-108 DHD). Some of these ZBS have lower incomes, and the majority of the population is very elderly. On the other hand, the most commonly used active ingredients were lorazepam (26-27 DHD), lormetazepam (15-16 DHD), alprazolam (13 DHD), zolpidem (8 DHD), diazepam (7 DHD) and bromazepam (3 DHD). This pattern is practically identical in all areas and ZBS, demonstrating that prescription protocols according to pharmaceutical indications are similar. Furthermore, these are mainly short-acting benzodiazepines with rapid onset of action, high bioavailability and a similar half-life (10-20 hours), which do not produce active metabolites. They are prescribed for many conditions, such as anxiety, insomnia, or substance abuse withdrawal. The months with the highest number of benzodiazepine withdrawals in community pharmacies are February, June, September, and October, with statistically significant differences compared to August. When comparing by biological sex, we obtained 104-107 DHD in females and 57-59 DHD in males. The diagnosis of anxiety problems is higher in women, so higher results were expected, but not as significant. In terms of classification by type of financial contribution, our results show that there is statistically significant benzodiazepine consumption in patients with TSI 001 and TSI 002 (>200 DHD), who show up to 6 times higher consumption compared to TSI 003 and TSI 004 (approximately 31-36 DHD). In terms of age, consumption increases from the 45-49 age group to the 64-age group, exceeding values of 200 DHD from the age of 65 onwards, which is the retirement age for many people.
Benzodiazepines are pharmacological treatments that have a wide therapeutic range, acting as anxiolytics, hypnotics, sedatives, anticonvulsants and muscle relaxants, as well as in the treatment of withdrawal syndrome from various substances of abuse. However, their continued use can have adverse effects such as cognitive impairment, falls, abuse and dependence. Although these drugs are recommended for short-term use (maximum three months), chronic and prolonged treatment is very common, which can expose patients to abuse and dependence. Previous studies suggest a recent increase in their dispensing. Therefore, the overall objective of this study was to examine the evolution of benzodiazepine consumption between 2014 and 2017 in the Autonomous Community of the Region of Murcia (CARM), including basic health areas and zones, and to relate this to different sociodemographic variables such as gender, age and TSI. For this purpose, anonymous individual data on the dispensing of these pharmacological subgroups has been compiled by the Directorate-General for Planning, Research, Pharmacy and Citizen Services in Defined Daily Dose (DDD) format, which has been converted in our study to DHD (DDD per 1,000 inhabitants per day). Our results show that benzodiazepine consumption in the Region of Murcia increased from 81 DHD in 2014 to 83 DHD in 2017, with the highest figures in Noroeste (area 4; 97-103 DHD), Cartagena (area 2; 95-100 DHD) and Vega Alta del Segura (area 9; 93-99 DHD), while the lowest figures were in the areas of Mar Menor (area 8; 67-62 DHD) and Altiplano (area 5; 69-68 DHD). The Basic Health Areas with the highest consumption were: Cartagena/Casco Antiguo (area 2; 133-132 DHD); Cartagena Este (area 2; 122-130 DHD); Calasparra (area 4; 118-122 DHD); Cartagena/Los Barreros (area 2; 111-112); Cehegín (area 4; 109-115); Archena (area 6; 112-110 DHD); Cartagena Oeste (area 2; 109-112 DHD); and Abarán (area 9; 104-108 DHD). Some of these ZBS have lower incomes, and the majority of the population is very elderly. On the other hand, the most commonly used active ingredients were lorazepam (26-27 DHD), lormetazepam (15-16 DHD), alprazolam (13 DHD), zolpidem (8 DHD), diazepam (7 DHD) and bromazepam (3 DHD). This pattern is practically identical in all areas and ZBS, demonstrating that prescription protocols according to pharmaceutical indications are similar. Furthermore, these are mainly short-acting benzodiazepines with rapid onset of action, high bioavailability and a similar half-life (10-20 hours), which do not produce active metabolites. They are prescribed for many conditions, such as anxiety, insomnia, or substance abuse withdrawal. The months with the highest number of benzodiazepine withdrawals in community pharmacies are February, June, September, and October, with statistically significant differences compared to August. When comparing by biological sex, we obtained 104-107 DHD in females and 57-59 DHD in males. The diagnosis of anxiety problems is higher in women, so higher results were expected, but not as significant. In terms of classification by type of financial contribution, our results show that there is statistically significant benzodiazepine consumption in patients with TSI 001 and TSI 002 (>200 DHD), who show up to 6 times higher consumption compared to TSI 003 and TSI 004 (approximately 31-36 DHD). In terms of age, consumption increases from the 45-49 age group to the 64-age group, exceeding values of 200 DHD from the age of 65 onwards, which is the retirement age for many people.
publication.page.subject
Citation
item.page.embargo
Collections
Ir a Estadísticas
Este ítem está sujeto a una licencia Creative Commons. http://creativecommons.org/licenses/by-nc-nd/4.0/