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1.
Rev Esp Quimioter ; 36(6): 584-591, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37724451

ABSTRACT

OBJECTIVE: To determine the effectiveness of a pharmaceutical intervention, based on the CMO methodology (capacity, motivation and opportunity), to decrease the prevalence of the PIMDINAC concept (potentially inappropriate medication+drug interactions+non-adherence to concomitant medication) in people living with HIV infection. METHODS: Longitudinal prospective multicenter study, conducted between October 2021 and October 2022. Patients living with HIV older than 65 years, on antiretroviral treatment and concomitant drug prescription were included. Demographic, clinical, and pharmacotherapeutic variables were collected. Pharmaceutical care was provided for6 months according to the CMO model in each patient. The main variable was the percentage of patients who simultaneously fulfilled the PIMDINAC concept, comparing the baseline value with the same value at the end of the study. In addition, the percentage of patient's adherent to concomitant and antiretroviral treatment and the percentage of patients meeting the pharmacotherapeutic targets established for the prescribed medicationat 24 weeks of follow-up were compared. RESULTS: Sixty-eight patients were included. Seventy-two percent were men, with a median age of 68 years. The median number of concomitant drugs was 7. A 60.6% of the patients had polypharmacy. The prevalence of the presence of the PIMDINAC concept decreased significantly (10.3 vs. 0%). In isolation, each of the aspects also decreased significantly (p<0.031). The percentage of patients who met the objectives improved significantly from 48,5 at baseline to 88.2 (p<0.001). CONCLUSIONS: The pharmaceutical intervention based onarmaceutical intervention based on the CMO methodology significantly decreased the prevalence of the PIMDINAC concept and increased the number of patients who achieved the objectives, optimising their pharmacotherapy.


Subject(s)
HIV Infections , Pharmaceutical Services , Male , Humans , Aged , Female , HIV Infections/drug therapy , Prospective Studies , Motivation , Medication Adherence , Anti-Retroviral Agents/therapeutic use , Polypharmacy , Pharmaceutical Preparations
2.
Farm Hosp ; 38(4): 305-16, 2014 Jul 01.
Article in Spanish | MEDLINE | ID: mdl-25137164

ABSTRACT

INTRODUCTION: Potentially inappropriate medication (PIM) prescribing in older adults is quite prevalent and is associated with an increased risk for adverse drug events, morbidity, and utilization of health care resources. The aim of this study was to determine the prevalence and type of PIM in polypharmacy elderly patients on admission and discharge and the factors associated with their prescription. Just as the applicability of various explicit criteria selected from the literature and adapted to our area. METHODS: We performed a cross-sectional study for 12 months (March 2010-February 2011) on 179 polypharmacy elderly patients admitted to an Internal Medicine Department. We created a list of 50 PIM using a Delphi approach based on previous published criteria (Beers, Stopp, BMC and Priscus). Through patient interviews, review of medical records and discharge reconciliation report, we identified the prevalence of PIM in the patients. We also analyzed the relationship between different factors and the prescription of PIM. RESULTS: The prevalence of patients with PIM on admission and discharge were 71% and 48%, respectively. Out of the 50 selected PIM, 27 and 26 were detected on admission and discharge, respectively (55.5% and 57.69% included on STOPP criteria). We detected two factors associated with PIM prescription at discharge: severe-total dependence (OR = 1.8) and prescription of more than 11 drugs (OR = 2). CONCLUSIONS: PIM prevalence in our population is very high (70%), especially at hospital admission. These findings support the need for measures aimed at improving the quality of prescriptions, especially on dependent patients with polypharmacy.


INTRODUCCIÓN: En personas mayores la prescripción de medicamentos potencialmente inapropiados (PIM) es muy elevada y se asocia con mayor riesgo de eventos adversos, morbilidad y utilización de recursos sanitarios. El objetivo del presente estudio es conocer la prevalencia y tipo de PIM en pacientes ancianos polimedicados al ingreso y alta hospitalaria, los factores asociados a su prescripción y la aplicabilidad de distintos criterios explícitos seleccionados de la bibliografía y adaptados a nuestro ámbito. MÉTODO: Se realiza estudio observacional transversal durante 12 meses (marzo 2010-febrero 2011), sobre 179 pacientes ancianos polimedicados, ingresados en un servicio de Medicina Interna. Como herramienta para detectar la prescripción inadecuada se seleccionaron 50 PIM a partir de la bibliografía (criterios Beers, Stopp, BMC y Priscus) utilizando una técnica Delphi. A través de entrevista con el paciente, revisión de historias clínicas e informe de conciliación se identificaron los PIM previamente seleccionados. Posteriormente se analizó la relación entre distintos factores y la prescripción de PIM. RESULTADOS: La prevalencia de pacientes con PIM al ingreso fue de 71% y al alta de 48%. De 50 PIM seleccionados, sólo se detectaron 27 y 26 tipos (55,5% y 57,69% criterios STOPP) al ingreso y al alta respectivamente. Los factores asociados a la prescripción de PIM al alta fueron: dependencia severa-total (OR = 1,8; IC 95% 1,0-3,4) y nº de medicamentos mayor de 11 (OR = 2; IC 95% 1,1-3,7). CONCLUSIONES: La prevalencia de PIM en nuestra población es muy elevada (70%) especialmente al ingreso hospitalario, estos resultados apoyan la necesidad de adoptar medidas enfocadas a mejorar la calidad de la prescripción prioritariamente en pacientes dependientes y polimedicados.


Subject(s)
Polypharmacy , Potentially Inappropriate Medication List/statistics & numerical data , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Hospitalization , Humans , Male
3.
Farm. hosp ; 38(4): 305-316, jul.-ago. 2014. ilus, tab
Article in Spanish | IBECS | ID: ibc-131328

ABSTRACT

Introducción: En personas mayores la prescripción de medicamentos potencialmente inapropiados (PIM) es muy elevada y sea socia con mayor riesgo de eventos adversos, morbilidad y utilización de recursos sanitarios. El objetivo del presente estudio es conocer la prevalencia y tipo de PIM en pacientes ancianos polimedicados al ingreso y alta hospitalaria, los factores asociados a su prescripción y la aplicabilidad de distintos criterios explícitos seleccionados de la bibliografía y adaptados a nuestro ámbito. Método: Se realiza estudio observacional transversal durante 12 meses (marzo 2010-febrero 2011), sobre 179 pacientes ancianos polimedicados, ingresados en un servicio de Medicina Interna. Como herramienta para detectar la prescripción inadecuada se seleccionaron 50 PIM a partir de la bibliografía (criterios Beers, Stopp, BMC y Priscus) utilizando una técnica Delphi. A través de entrevista con el paciente, revisión de historias clínicas e informe de conciliación se identificaron los PIM previamente seleccionados. Posteriormente se analizó la relación entre distintos factores y la prescripción de PIM. Resultados: La prevalencia de pacientes con PIM al ingreso fue de 71% y al alta de 48%. De 50 PIM seleccionados, sólo se detectaron 27 y 26 tipos (55,5% y 57,69% criterios STOPP) al ingreso y al alta respectivamente. Los factores asociados a la prescripción de PIM al alta fueron: dependencia severa-total (OR = 1,8; IC 95% 1,0-3,4) y nº de medicamentos mayor de 11 (OR = 2; IC 95% 1,1-3,7). Conclusiones: La prevalencia de PIM en nuestra población es muy elevada (70%) especialmente al ingreso hospitalario, estos resultados apoyan la necesidad de adoptar medidas enfocadas a mejorar la calidad de la prescripción prioritariamente en pacientes dependientes y polimedicados (AU)


Introduction: Potentially inappropriate medication (PIM) prescribing in older adults is quite prevalent and is associated with an increased risk for adverse drug events, morbidity, and utilization of health care resources. The aim of this study was to determine the prevalence and type of PIM in polypharmacy elderly patients on admission and discharge and the factors associated with their prescription. Just as the applicability of various explicit criteria selected from the literature and adapted to our area. Methods: We performed a cross-sectional study for 12 months(March 2010-February 2011) on 179 polypharmacy elderly patients admitted to an Internal Medicine Department. We created a list of 50 PIM using a Delphi approach based on previous published criteria (Beers, Stopp, BMC and Priscus). Through patient interviews, review of medical records and discharge reconciliation report, we identified the prevalence of PIM in the patients. We also analyzed the relationship between different factors and the prescription of PIM. Results: The prevalence of patients with PIM on admission and discharge were 71% and 48%, respectively. Out of the 50selected PIM, 27 and 26 were detected on admission and discharge, respectively (55.5% and 57.69% included on STOPP criteria). We detected two factors associated with PIM prescription at discharge: severe-total dependence (OR = 1.8) and prescription of more than 11 drugs (OR = 2). Conclusions: PIM prevalence in our population is very high(70%), especially at hospital admission. These findings support the need for measures aimed at improving the quality of prescriptions, especially on dependent patients with polypharmacy (AU)


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Inappropriate Prescribing/statistics & numerical data , Medication Errors/statistics & numerical data , Drug Therapy, Combination , Hospitalization/statistics & numerical data , Patient Discharge/statistics & numerical data , Chronic Disease/epidemiology , Frail Elderly/statistics & numerical data
4.
J Endocrinol Invest ; 34(10): 747-52, 2011 Nov.
Article in English | MEDLINE | ID: mdl-21606671

ABSTRACT

BACKGROUND: Gonadotropins administration have been demonstrated effective for the treatment of idiopathic male infertility, even if no clear data regarding their specific mechanism of action on semen quality are at the moment available. AIM: To evaluate the effect of highly purified FSH (hpFSH) administration on standard semen parameters, sperm oxidative stress, and sperm chromatin structure and DNA fragmentation. MATERIAL AND METHODS: In the current prospective baseline-controlled study, 36 subjects with male idiophatic infertility were enrolled. Baseline clinical and biochemical data were evaluated. Before and after 3 months of treatment with hpFSH, sperm samples were collected and standard semen analysis, reactive oxygen species (ROS) assessment and sperm DNA fragmentation were evaluated. RESULTS: A significant (p<0.05) improvement from baseline in standard seminal parameters was observed. A significant (p<0.05) reduction in sperm ROS levels and DNA fragmentation was observed. Statistically significant (p<0.05) correlations between variation in ROS levels and both seminal parameters and DNA fragmentation variations were detected. CONCLUSIONS: Three months of hpFSH administration seems to reduce ROS and DNA damage in subjects with male idiopathic subfertility improving semen parameters. Further evidences from well-designed randomized double-blind placebo- controlled studies are needed in order to confirm our preliminary results.


Subject(s)
Follicle Stimulating Hormone/therapeutic use , Infertility, Male/drug therapy , Spermatozoa/drug effects , Adult , DNA Fragmentation/drug effects , Humans , Infertility, Male/genetics , Male , Oxidative Stress/drug effects , Pilot Projects , Prospective Studies , Reactive Oxygen Species/metabolism , Semen Analysis
5.
Farm. hosp ; 34(6): 265-270, nov.-dic. 2010.
Article in Spanish | IBECS | ID: ibc-107079

ABSTRACT

Objetivo Implantar una estrategia coordinada entre la unidad de atención familiar y el servicio de farmacia que posibilite la revisión del tratamiento en pacientes polimedicados. Para ello se ha desarrollado una herramienta informática que permite al médico responsable del paciente visualizar de forma rápida y resumida la descripción del tratamiento farmacológico actualizado, así como la detección de riesgos de iatrogenias y/o ajuste de dosis y consejo farmacoterapéutico. Métodos Para el estudio se ha considerado paciente polimedicado aquel que toma 10 o más medicamentos durante, al menos, un mes. Fases de desarrollo: Diseño de un formulario guía para revisión de tratamientos por el médico de familia. Desarrollo de un informe farmacoterapéutico (IFT) como documento de apoyo al médico para la revisión del tratamiento. Puesta en marcha del circuito coordinado médico de familia-farmacéutico: redacción de instrucciones de trabajo y difusión entre los profesionales implicados. Resultados La población diana del estudio corresponde a 1.897 pacientes polimedicados. Se han emitido 1.897 informes, en los que se recogen: 8.530 recomendaciones (10% alertas de agencias reguladoras, 31% recomendaciones sobre medicación de alto riesgo en paciente anciano, 7% información sobre novedades terapéuticas y 52% recomendaciones sobre uso adecuado del medicamento); 399 interacciones de alta relevancia clínica y 5.036 recomendaciones de ajuste posológico. Estos informes farmacoterapéuticos están permitiendo la revisión del tratamiento de prácticamente el 100% de la población seleccionada. Conclusión El desarrollo e implantación de herramientas informáticas en el seguimiento de pacientes polimedicados permite la elaboración de IFT que facilitan la revisión médica rutinaria del tratamiento farmacológico en un censo de pacientes relativamente amplio (AU)


Objective Implement a coordinated strategy for the family care unit and the pharmacy division in order to enable revising treatment in polymedicated patients. To this end, we have developed a software tool permitting the patient's primary doctor to have a quick, summarised description of the patient's updated pharmacological treatments, and detect iatrogenic risks and/or dosage adjustments and pharmacotherapy advice. Methods In this study, polymedicated patients are defined as those taking 10 or more medications during at least one month. Development phases: Design of a guide form to assist the family doctor in reviewing treatments. Development of a pharmacotherapy report (FTR) as a complementary document to assist the doctor in reviewing treatments. Implementation of a coordinated loop between the family doctor and the pharmacist. Review of work instructions and distribution to involved staff members. Results The target population of the study consists of 1897 polymedicated patients. We issued 1897 reports, containing the following: 8530 recommendations (10% alerts from regulatory authorities, 31% recommendations regarding high-risk drugs in elderly patients, 7% information on new treatments and 52% recommendations on proper drug use); 399 highly relevant drug interactions; and 5036 recommendations for dose adjustment. These pharmacotherapy reports permit treatment to be revised for nearly 100% of the selected population. Conclusion The development and implementation of software tools for monitoring polymedicated patients enables us to create FTRs that facilitate routine medical reviews of pharmacological treatment in a fairly wide range of patients (AU)


Subject(s)
Humans , Aged , Hospital Units , Drug Monitoring , Polypharmacy
6.
Farm Hosp ; 34(6): 265-70, 2010.
Article in Spanish | MEDLINE | ID: mdl-20620089

ABSTRACT

OBJECTIVE: Implement a coordinated strategy for the family care unit and the pharmacy division in order to enable revising treatment in polymedicated patients. To this end, we have developed a software tool permitting the patient's primary doctor to have a quick, summarised description of the patient's updated pharmacological treatments, and detect iatrogenic risks and/or dosage adjustments and pharmacotherapy advice. METHODS: In this study, polymedicated patients are defined as those taking 10 or more medications during at least one month. Development phases: Design of a guide form to assist the family doctor in reviewing treatments. Development of a pharmacotherapy report (FTR) as a complementary document to assist the doctor in reviewing treatments. Implementation of a coordinated loop between the family doctor and the pharmacist. Review of work instructions and distribution to involved staff members. RESULTS: The target population of the study consists of 1897 polymedicated patients. We issued 1897 reports, containing the following: 8530 recommendations (10% alerts from regulatory authorities, 31% recommendations regarding high-risk drugs in elderly patients, 7% information on new treatments and 52% recommendations on proper drug use); 399 highly relevant drug interactions; and 5036 recommendations for dose adjustment. These pharmacotherapy reports permit treatment to be revised for nearly 100% of the selected population. CONCLUSION: The development and implementation of software tools for monitoring polymedicated patients enables us to create FTRs that facilitate routine medical reviews of pharmacological treatment in a fairly wide range of patients.


Subject(s)
Drug Monitoring , Polypharmacy , Aged , Hospital Units , Humans
7.
Z Parasitenkd ; 69(4): 507-15, 1983.
Article in English | MEDLINE | ID: mdl-6624198

ABSTRACT

A retrospective survey of hospital cases to obtain baseline data on hydatid disease in the northwest of the Province of Chubut, Argentina, from 1973 to 1979 revealed annual mean rates that varied between 13.4 and 75.8 confirmed new cases per 100.000 population. Inclusion of data on parasitologically confirmed non-surgical cases and on the geographic origin of patients permitted a more accurate estimate of cases in the four Departments comprised in the study area. Information on cyst location, clinical status at admission, mortality, number of re-operations and length of hospitalization was obtained to assess the public health impact of hydatidosis within the area. The criteria established and methods used to collect this information are described and discussed.


Subject(s)
Echinococcosis/epidemiology , Adolescent , Adult , Argentina , Child , Child, Preschool , Echinococcosis/pathology , Echinococcosis/surgery , Echinococcosis, Hepatic/epidemiology , Echinococcosis, Pulmonary/epidemiology , Humans , Infant , Middle Aged , Retrospective Studies
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