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P-306
Hekimlerin Osteoartrit Tedavisindeki Reçeteleme
Performanslar›n›n De¤erlendirilmesi
Salih Mollahalilo¤lu 1, Ali Alkan1, Baflak Dönertafl 2, fienay Özgülcü 1, Ahmet Ak›c› 2
1 Refik Saydam H›fz›ss›hha Merkezi Baflkanl›¤› H›fz›ss›hha Mektebi Müdürlü¤ü, Ankara
2 Marmara Üniversitesi T›p Fakültesi T›bbi Farmakoloji Anabilim Dal›, ‹stanbul
AMAÇ: Osteoartrit (OA), tedavisinde yaz›lan reçetelerin içeri¤inin incelenmesi, ak›lc› ilaç kullan›m›
(A‹K) ilkelerinin yayg›nlaflt›r›lmas› bak›m›ndan önemlidir. Bu araflt›rmada, birinci basamak
(BB) düzeyinde (aile sa¤l›¤› merkezleri, sa¤l›k ocaklar›) ve hastaneler (H) düzeyinde (devlet,
özel ve üniversite hastanelerinde) çal›flan hekimlerin OA’da yazd›klar› reçetelerin incelenmesi
amaçland›.
GEREÇ-YÖNTEM: Türkiye’nin 10 ilinde, 2009 Kas›m-Aral›k aylar›nda yaz›lm›fl OA tan›l› toplam
139 reçetenin (50’si BB’de, 89’u H’de yaz›lm›fl) fotokopisi eczanelerden topland›. BB ve H’de
yaz›lm›fl olan bu reçeteler, içeri¤inde s›k yaz›lm›fl ilaçlar, reçete bafl›na düflen ilaç say›s›
(RBD‹S), reçete bafl›na düflen tedavi maliyeti (RBDTM), analjezik/antiinflamatuvar, enjekte
edilebilen preparat (EP) ve gastroprotektif ilaç yaz›lma göstergeleri aç›s›ndan de¤erlendirildi.
BULGULAR: RBD‹S’nin 2,97±0,99 (BB=2,98±1,12, H=2,97±0,92) oldu¤u, RBDTM’nin ise
42,38±56,13 TL (BB=44,64±65,11, H=41,11±50,75) oldu¤u saptand›. Reçetelere analjezik/antiinflamatuvarlar›n
%53,5; EP’nin %3,9; gastroprotektiflerin %6,1 oran›nda yaz›ld›¤› saptand›.
BB ve H’de gastroprotektiflerin genel olarak birbirine yak›n oranda yaz›ld›¤› (s›ras›yla %6,7 ve
%5,7) ancak H’de BB’ye göre analjezik/antiinflamatuvar ilaçlar›n (H=%61,4 ve BB=%39,6) ve
EP’nin (H=%5,7 ve BB=%0,7) daha yüksek oranda yaz›ld›¤› saptand›. Reçetelere en s›k yaz›lm›fl
ilk 5 ilac›n diklofenak (%8,5); tiyokolflikosid (%7,0); flurbiprofen (%5,1); etodolak (%4,4);
parasetamol (%3,6) oldu¤u saptand›. BB’de ve H’de reçetelere en s›k yaz›lm›fl ilac›n birbirine
benzer flekilde (s›ras›yla %8,7 ve 8,3) diklofenak olmas›na karfl›n; 2. s›k yaz›lan ilaçlardan itibaren
s›ralaman›n gruplar aras›nda de¤iflkenlik gösterdi¤i saptand›. Örne¤in “parasetamolün
tek bafl›na kullan›ld›¤› preparat”›n›n H’de 5. s›rada yaz›lm›fl olmas›na karfl›n, BB’de ilk 10 s›ralamas›na
girmedi¤i saptand›.
SONUÇ: OA reçetelerinde ilaç say›s›, maliyeti ve gastroprotektif ilaç yazma oranlar› bak›m›ndan
BB’de ve H’de yaz›lan reçetelerin benzerlik gösterdi¤i, enjekte edilebilen preparat kullan›m›n›n
ise H’de daha yayg›n oldu¤u söylenebilir. Hekimlerin OA tedavisinde en s›k “diklofenak”›
tercih etmesi, parasetamolün (tek bafl›na) BB’de s›k kullan›lan ilaçlar aras›nda bulunmamas›,
H’de ise 5. s›rada yer almas› dikkat çekicidir. OA tedavisinin A‹K ilkeleri do¤rultusunda
gelifltirilmesinde bu tespitlerden yararlan›lmal›d›r.
Anahtar Kelimeler: Ak›lc› ilaç kullan›m›, osteoartrit, reçete
P-307
Pelvik ‹skion-Pubis Kol Stres K›r›¤›: Olgu Sunumu
Ece Aydo¤, Gülcan Öztürk, Duygu Geler Külcü
Yeditepe Üniversitesi T›p Fakültesi Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, ‹stanbul
Kemiklerin al›fl›k olmad›¤› tekrarlay›c› ve uzun süren egzersiz sonucu oluflan k›r›klar›na stres
k›r›¤› denir. Yorgunluk ve yetmezlik k›r›¤› olmak üzere iki tür stres k›r›¤› mevcuttur. Yetmezlik
k›r›¤› genellikle yafll› ve osteoporotik bireylerde ortaya ç›kar ve s›kl›kla pelvis kemiklerini etkiler.
Yorgunluk k›r›¤› ise al›fl›lmad›k mekanik yüklenmeye ba¤l› olarak sa¤l›kl› kemikte oluflur.
Genellikle genç eriflkinlerde ve sporcularda görülür. Ço¤unlukla tibia, metatars, fibula etkilenir.
Biz burada 63 yafl›nda osteopenisi olan bayan hastada sol kalkaneal spur nedeni ile 6 hafta
boyunca sürekli sa¤ tarafa yük verme sonucu sa¤ inferior pubik rami ve sa¤ süperior iskial
rami düzeyinde meydana gelen fraktürü sunduk ve literatürle iliflkisini gözden geçirdik.
Anahtar Kelimeler: Stres k›r›¤›, osteopeni, manyetik rezonans görüntüleme
305
23. Ulusal Fiziksel T›p ve Rehabilitasyon Kongresi / 23 rd National Physical Medicine & Rehabilitation Congress
Türk Fiz Rehab Derg 2011:57Özel Say›; 1-334 /Turk J Phys Med Rehab 2011:57Suppl; 1-334
P-306
Evaluation of the Prescribing Performance of the
Physicians in Osteoarthritis Treatment
Salih Mollahalilo¤lu 1, Ali Alkan 1, Baflak Dönertafl 2, fienay Özgülcü 1, Ahmet Ak›c› 2
1 Turkish Ministry of Health School of Public Health, Ankara
2 Marmara University School of Medicine Department of Pharmacology, Istanbul
OBJECTIVE: Prescription analysis is important in the extension of rational pharmacotherapy
principles (RPP) for osteoarthritis (OA). This study, aims to evaluate OA diagnosed
prescriptions, which were written by physicians practicing at primary care (PC), (family
health centers, health centers) and hospital (H) level (public, private and university hospitals).
MATERIALS-METHODS: Total 139 scripts’ photocopies (89 of them from H), written in 10
provinces of Turkey in 2009 November-December, were collected in pharmacies. The most
frequently prescribed medicines, number of medicines per prescription (NMPP), treatment
cost per prescription (TCPP), percentage of analgesic/anti-inflammatory drugs (PAD),
injection preparations (IP) and gastroprotectives were assessed.
RESULTS: NMPP was 2.97±0.99 (PC=2.98±1.12, H=2.97±0.92) and TCPP was 42.38±56.13 TL
(PC=44.64±65.11, H=41.11±50.75). PAD was 53.5%, IP was 3.9%, gastroprotectives was 6.1%.
The percentage of gastroprotectives was similar in PC and H (6.7% and 5.7% respectively)
but analgesic/anti-inflammatory drugs (H=61.4% and PC=39.6%) and IP (H=5.7% and
PC=0.7%) were prescribed more commonly in H than PC. The most frequently prescribed 5
medicines were diclofenac (8.5%), thiocolchicoside (7.0%), flurbiprofen (5.1%), etodolac
(4.4%) and paracetamol (3.6%). Diclofenac was the most frequently prescribed medicine
both in PC and H (8.7% and 8.3%) but there were variations between the groups from the
second frequently prescribed medicine. For instance, “paracetamol” was fifth in H for ten
most prescribed medicines, but it wasn’t seen in PC.
CONCLUSION: It can be deduced that the prescriptions written in PC and H showed
similarity regarding the number of medicines, cost and proportion of gastroprotectives but
IP use was more common in H. Physicians’ preference of “diclofenac” as the first drug
choice in OA treatment, and absence of paracetamol (uncombined) among commonly
prescribed medicines in PC and being in H at the fifth place were also notable. These findings
should be taken into consideration for the improvement of OA treatment within RPP.
Keywords: Rational drug use, osteoarthritis, prescription
P-307
Stress Fracture of the Ischion and Pubic Ramus
Ece Aydo¤, Gülcan Öztürk, Duygu Geler Külcü
Yeditepe University Medical Faculty Department ofPhysical Medicine and Rehabilitation, Istanbul
Fracture resulting from unusual long term exercise and repetitive mechanical overloading is
called a stress fracture. There are two kinds of stress fracture: insufficiency fracture and
fatigue fracture. ‹nsufficiency fracture most often affects pelvic bones and this type of
fracture is seen particularly in elder and osteoporotic persons. Fatigue fracture appears in healthy
bone which sustained by unusual mechanical stress. This type of fracture, appears in
young persons and athletes and mostly affects tibia, metatarsals, fibula. Herein, we report a
case 63 years old osteopenic women who had right inferior pubic rami and right superior
ischial rami fracture. From her medical history it is learned that she had calcaneal spur on the
left side and she loaded her right lower extremity for 6 weeks. In this respect we reviewed
literature about the stress fracture.
Keywords: Stress fracture, osteopenia, magnetic resonance imaging