Prescripción inapropiada en adultos mayores hospitalizados / Inappropriate prescription in elderly inpatients

Una de las causas prevenibles de los eventos adversos a medicamentos (EAM) en la población adulta mayor es la prescripción inapropiada, (PIM), es decir aquella prescripción donde los riesgos superan los beneficios clínicos. Se propone conocer la incidencia de PIM con los criterios de Beers, los Screening tool of older person´s prescriptions (STOPP), la omisión de prescripción apropiada (PPO) con Screening tool to alert doctors to right treatment (START) y los costos medios de hospitalización. Es un estudio de incidencia de una muestra de pacientes > 64 años, internados en el periodo enero-julio 2014 en un hospital universitario. Se halló una incidencia de PIM de 61.4% con los criterios de Beers, 65.4% con STOPP y 27.6% de PPO con START. Se calculó una tasa de EAM de 15.2 EAM/100 admisiones y 18.6 EAM/1000 días paciente. El OR de EAM con PIM según Beers y STOPP fue 1.49 (IC95% 1.68-4.66) y 1.17 (IC95% 0.62-2.24) respectivamente. El costo de hospitalización en pacientes con EAM fue mayor que sin EAM (p = 0.020). Los resultados de PIM son similares a la mayoría de los estudios publicados, aunque levemente mayores para Beers y STOPP y menores para START. La tasa de EAM es inferior a la encontrada por Kanaan (18.7% vs. 15.2%). Hay una contribución de PIM a la aparición de EAM.

One of the causes of preventable adverse drug events (EAM) in the older adult population is the inappropriate prescription (PIM), i.e. that prescription where risks outweigh clinical benefits. The aim of this study is to determine the incidence of PIM with Beers criteria and Screening Tool of older person´s prescriptions (STOPP), Potentially Prescribing Omissions (PPO) with Screening Tool to alert doctors to Right Treatments (START), and the average costs of hospitalization. This is an incidence study on a sample of patients over 64 years hospitalized, from January to July 2014 at a university hospital. According to Beers criteria, PIM incidence was 61.4%, 65.4% with STOPP and 27.6% PPO with START. The EAM rate calculated was 15.2/100 admissions and 18.6 EAM / 1000 patient days. The OR of EAM with PIM according to Beers and STOPP was 1.49 (IC95% 1.68-4.66) and 1.17 (IC95% 0.62-2.24) respectively. The average cost of hospitalization in patients with EAM were higher than without EAM (p = 0.020). PIM results are in line with most of the studies cited, but slightly higher for Beers and STOPP and lower for START, and the rate of EAM is lower than the data found by Kanaan (18.7% vs. 15.2%). PIM contributes to the appearance of EAM. The costs of hospitalizations with EAM are higher than those without EAM, achieving level of significance.

The cost of excessive postoperative use of antimicrobials: the context of a public hospital / Consequências do uso excessivo de antimicrobianos no pós-operatório: o contexto de um hospital público

OBJECTIVE: To evaluate the improper use of antimicrobials during the postoperative period and its economic impact. METHODS: We conducted a prospective cohort study by collecting data from medical records of 237 patients operated on between 01/11/08 and 31/12/08. RESULTS: from the 237 patients with the information collected, 217 (91.56%) received antimicrobials. During the postoperative period, 125 (57.7%) patients received more than two antimicrobials. On average, 1.7 ± 0.6 antimicrobials were prescribed to patients, the most commonly prescribed antibiotic being cephalothin, in 41.5% (154) of cases. The direct cost of antimicrobial therapy accounted for 63.78% of all drug therapy, this large percentage being attributed in part to the extended antimicrobial prophylaxis. In the case of clean operations, where there was a mean duration of 5.2 days of antibiotics, antimicrobials represented 44.3% of the total therapy cost. CONCLUSION: The data illustrate the impact of overuse of antimicrobials, with questionable indications, creating situations that compromise patient safety and increasing costs in the assessed hospital. .

OBJETIVO: avaliar o emprego de antimicrobianos relacionado ao seu uso inadequado e impacto econômico durante o período pós-operatório. MÉTODOS: foi desenvolvido um estudo de coorte prospectivo por meio da coleta de dados de 237 prontuários de pacientes operados entre 01/11/08 e 31/12/08. RESULTADOS: dos 237 pacientes com informações coletadas no estudo 217 (91,56%) fizeram uso de antimicrobianos. Durante o pós-operatório, 125 (57,7%) pacientes utilizaram mais de dois antimicrobianos. Foi prescrito, em média, 1,7 ± 0,6 antimicrobianos por paciente, sendo o antimicrobiano mais prescrito a cefalotina, em 41,5% (154) dos casos. O custo direto da terapia antimicrobiana representou 63,78% de toda a terapia farmacológica, sendo esta grande porcentagem atribuída em parte ao prolongamento da profilaxia antimicrobiana. No caso das operações limpas, onde houve um tempo médio de uso de antimicrobianos de 5,2 dias, os gastos com antimicrobianos representaram 44,3% do custo total da terapia. . CONCLUSÃO: os dados exemplificam o impacto do uso excessivo de antimicrobianos, com indicações questionáveis e criando situações que comprometem a segurança dos pacientes e aumento os custos no hospital avaliado. .

Inequalities in prescription of hydrochlorothiazide for diabetic hypertensive patients in Colombia / Desigualdades en la prescripción de hidroclorotiazida en pacientes hipertensos diabéticos en Colombia

Objective Evaluating differences in the suitable prescription of thiazides in hypertense patients, according to affiliation regime. Materials and methods This was an analytical cross-sectional study. The database from a previous study was used regarding two groups of hypertense patients (subsidised regime and contributory regime) who had attended out-patient consultation between 01-09-2007 and 29-02-2008. Ideal therapy was evaluated in both groups. Univariate and multivariate analysis was carried out. Results 136 patients (contributory: 41.9 percent; subsidised: 58.1 percent). Subsidised regime patients were older (mean=68.8±10) than those from the contributory regime (mean=64.1±11.1) (t-test, p=0.0110). Prescribing antihypertensive drugs was ideal in 49/136 of the patients (36.0 percent). Ideal prescription accounted for 24/79 (30 percent) of the patients in the subsidised regime and 25/57 (43.8 percent) in the contributory one (OR=1.79; 95 percent CI:0.88-3.64). Older people (aged ≥ 65yo) were at risk of receiving a non-ideal prescription (OR=2.12; 95 percentCI:1.02-4.38) whilst this was not so in the subsidised regime (OR=1.62; 95 percent CI:0.78-3.35). Conclusions Ideal prescription of antihypertensive drugs was low in the population being studied. There were differences regarding age ideal prescription but not concerning affiliation regime. It is suggested that a longitudinal study be carried out in the future.

Objetivo Evaluar las diferencias en la adecuada prescripción de tiazidas en pacientes hipertensos, según régimen de afiliación. Materiales y métodos Estudio de corte transversal analítico. Se utilizó la base de datos de un estudio previo, dos grupos de pacientes hipertensos: régimen subsidiado y régimen contributivo que asistieron a consulta externa entre el 01-09-2007 y el 29-02-2008. Se evaluó terapia ideal en los dos grupos. Se realizó análisis univariado y multivariado. Resultados Se estudiaron 136 pacientes (contributivo: 41,9 por ciento; subsidiado: 58,1 por ciento). Los pacientes del régimen subsidiado fueron mayores (promedio= 68,8±10) que los del contributivo (promedio=64,1±11.1) (t-test, p=0,0110). La prescripción de antihipertensivos fue ideal en 49/136 (36,0 por ciento). En el régimen subsidiado la prescripción fue ideal en 24/79 (30 por ciento) y en el contributivo en 25/57 (43,8 por ciento) (OR: 1,79 IC95 por ciento (0,88-3,64)). La edad ≥65años fue riesgo de prescripción no ideal (OR: 2.12, IC95 por ciento(1,02-4,38)), mientras que no lo fue estar en el régimen subsidiado (OR=1,62, IC95 por ciento(0,78-3,35). Conclusiones La prescripción ideal de antihipertensivos es baja. Hay diferencias en la edad, en la prescripción ideal, mas no por régimen de afiliación. Se sugiere un estudio longitudinal en el futuro.