ABSTRACT
Background: "Triple whammy" (TW) refers to the simultaneous use of diuretics, renin-angiotensin-aldosterone system inhibitors and nonsteroidal anti-inflammatory drugs (NSAIDs). To date, the risk of developing acute kidney injury (AKI) associated to this combination has not been deeply investigated. The objectives are to analyze the incidence of AKI associated to the exposure to "triple whammy" including all NSAIDs versus non-exposure to this combination. Secondarily, the risk of hospitalization, severe adverse events, requirement of renal replacement therapy and mortality will be assessed. Also, the incidence of AKI associated to the exposure to "triple whammy" versus non-exposure will be analyzed, including only metamizole as NSAID. Methods: A systematic literature search of intervention studies and analytical observational studies will be conducted in the Cochrane Library, Medline and EMBASE, among others. AKI 12 months after the last prescription of the triple combination will be the main outcome. Relative frequencies, risk of bias and certainty of evidence will be analyzed. Additionally, sensitivity and subgroup analyses will be performed. Results: Once this systematic review has been completed, the results are expected to provide an estimate of the risk associated with this triple combination and the renal variables, in addition to new guidance on the renal treatment of patients potentially receiving triple therapy. Conclusions: This is intended to be the first systematic review of observational studies to analyse TW combination and AKI's risk based on well-validated epidemiological databases exploring drug safety issues.
Subject(s)
Acute Kidney Injury , Angiotensin-Converting Enzyme Inhibitors , Humans , Angiotensin Receptor Antagonists , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Diuretics/adverse effects , Acute Kidney Injury/chemically induced , Systematic Reviews as TopicABSTRACT
OBJECTIVE: To work out a system of indicators for improvement of primary care prescription, by incorporating the values and views of the professionals issuing prescriptions. DESIGN: Qualitative technique to search for consensus among experts, based on nominal groups. SETTING: All primary care areas in the Health Service of Aragon, Spain. PARTICIPANTS: Primary care doctors, doctors in primary care management teams, specialists, primary care pharmacists. METHOD: Two parallel groups involving a total of 24 experts were formed. In the session these questions were posed: "what indicators focusing on the drug and what indicators relating diagnosis and treatment do you think most useful for evaluating prescription quality?" Each panellist put forward indicators that were then discussed and placed on a scale of 1 to 9. RESULTS: One hundred and thirty six indicators were generated, 81 drug-focused and 55 relating diagnosis and treatment; 56% were given a weighting above 5. The 2 groups coincided in 11 cases. The most valued indicators were generally those that brought a greater degree of consensus. CONCLUSION: It is feasible, through this technique, to produce a set of agreed indicators for evaluating primary care doctors' prescription.
Subject(s)
Drug Prescriptions/standards , Primary Health Care/standards , Quality Indicators, Health Care , Adult , Consensus , Drug Utilization/standards , Female , Humans , Male , Middle Aged , Pharmaceutical Preparations/administration & dosage , SpainABSTRACT
Objetivo. Elaborar un sistema de indicadores que permita mejorar la evaluación de la prescripción en atención primaria, incorporando los valores y la opinión de los profesionales implicados en la prescripción. Diseño. Técnica cualitativa de búsqueda de consenso entre expertos basada en el grupo nominal. Emplazamiento. Todas las áreas de atención primaria del Servicio Aragonés de Salud. Participantes. Médicos de atención primaria, médicos del equipo directivo de atención primaria, médicos de atención especializada, farmacéuticos de atención primaria. Método. Se forman dos grupos paralelos en los que en total participaron 24 expertos. En la sesión se planteó la pregunta: «¿Qué indicadores centrados en el fármaco y qué indicadores que relacionen diagnóstico y tratamiento consideras más útiles para evaluar la calidad de la prescripción?» Cada panelista propuso indicadores que se discutieron y ponderaron en una escala de 1 a 9. Resultados. Se generaron 136 indicadores, 81 centrados en el fármaco y 55 que relacionan diagnóstico y tratamiento. El 56% obtuvo una ponderación mayor que 5. Ambos grupos coincidieron en 11. Los indicadores más valorados en general fueron los que suscitaron un mayor grado de consenso. Conclusión. Mediante esta técnica es factible producir un conjunto de indicadores consensuados para la evaluación de la prescripción de los médicos de atención primaria
Objective. To work out a system of indicators for improvement of primary care prescription, by incorporating the values and views of the professionals issuing prescriptions. Design. Qualitative technique to search for consensus among experts, based on nominal groups. Setting. All primary care areas in the Health Service of Aragon, Spain. Participants. Primary care doctors, doctors in primary care management teams, specialists, primary care pharmacists. Method. Two parallel groups involving a total of 24 experts were formed. In the session these questions were posed: "what indicators focusing on the drug and what indicators relating diagnosis and treatment do you think most useful for evaluating prescription quality?" Each panellist put forward indicators that were then discussed and placed on a scale of 1 to 9. Results. One hundred and thirty six indicators were generated, 81 drug-focused and 55 relating diagnosis and treatment; 56% were given a weighting above 5. The 2 groups coincided in 11 cases. The most valued indicators were generally those that brought a greater degree of consensus. Conclusion. It is feasible, through this technique, to produce a set of agreed indicators for evaluating primary care doctors' prescription
