Revisión de la medicación en ancianos polimedicados en riesgo vascular: ensayo aleatorizado y controlado / A review of the medication in polymedicated elderly with vascular risk: a randomised controlled trial

Objetivo: Evaluar la efectividad de una intervención basada en la revisión de la medicación dirigida a mejorar la adecuación de los tratamientos a recomendaciones establecidas, el control tensional, lipídico y glucémico de pacientes mayores polimedicados en alto riesgo vascular, en comparación con la asistencia sanitaria habitual. Diseño: Estudio controlado, aleatorizado, con evaluación ciega. Emplazamiento: Catorce centros de salud de Andalucía. Participantes: Se incluyeron 323 personas mayores de 65 años con enfermedad o riesgo vascular alto y polimedicadas. Intervención: Un farmacéutico entrevista al paciente, revisa la adecuación de cada tratamiento teniendo en cuenta los datos de la historia clínica, elabora propuesta de modificaciones y las comunica al médico de familia o enfermera. El grupo control recibe asistencia habitual. Mediciones principales: Proporción de pacientes con uso adecuado de ácido acetilsalicílico en dosis bajas, presión arterial, colesterol LDL, hemoglobina glucosilada y calidad de vida. Resultados: De la población estudiada (edad media de 74 años, 61% mujeres), el 41% presenta enfermedad vascular. Diez meses después de la intervención (tasa de pérdidas del 18,3%) se observó que más pacientes del grupo intervenido frente al control tomaban ácido acetilsalicílico en bajas dosis (52,3 vs. 38,6%; p = 0,024). No se observaron diferencias significativas en otras variables. La calidad de vida percibida tiende a ser mejor, no significativamente, en los intervenidos en 6,1 puntos (escala de 100; p=0,051). Conclusión: La revisión sistemática de la medicación mejora la adecuación de uso del tratamiento antiagregante en ancianos polimedicados en alto riesgo vascular, sin afectar negativamente su calidad de vida. No se constatan mejoras en otras variables(AU)

Objective: To analyse the effectiveness of a medication review based on intervention directed at improving the appropriateness of drug treatments according to the established guidelines, as well as blood pressure, serum lipid and blood glucose control in elderly patients on multiple medication, and cardiovascular disease or high risk of cardiovascular disease. Design: A randomised controlled trial with blind evaluation. Setting: Fourteen Primary Health Care centres in Andalusia. Participants: A total of 323 patients older than 65 on polypharmacy and cardiovascular disease or high risk of cardiovascular disease. Intervention: A pharmacist interviewed the patient, reviewed the appropriateness of the drug treatment, taking in account health record data, proposed modifications and communicated them to the general practitioner or nurse. The control group received usual health care. Main measurements: Percentage of patients with appropriate use of low doses of acetylsalicylic acid, blood pressure, LDL-cholesterol, HbA1c, and quality of life scores. Results: A total of 41% of patients (average age 74, 61% women) had cardiovascular disease. Ten months after the intervention (18.3% withdrawals), more patients in the intervention group used low dose acetylsalicylic acid than in the control group (52.3% vs 38.6%; P=.024). There were no differences between groups in intermediate clinic outcomes. Quality of life scores improve in intervention group by 6.1 points (100 points scale), but was not statistically significant (P=.051). Conclusion: Clinical medication review improves the appropriateness of antiplatelet treatment in the elderly on polypharmacy and with high risk of cardiovascular disease. No improvement in biochemistry measurements was found(AU)

Prevalencia de polimedicación y riesgo vascular en la población mayor de 65 años / Prevalence of multiple medication and cardiovascular risk in patients over 65 years

Objetivo: Estudiar la prevalencia de polimedicación en mayores de 65 años. Diseño: Estudio descriptivo transversal. Emplazamiento: Distritos sanitarios de atención primaria Sevilla y Jerez-Costa Noroeste. Participantes: Población mayor de 65 años, seleccionada por un procedimiento aleatorio estratificando por centros. Se excluyeron pacientes institucionalizados, con trastornos de salud mental mayores y enfermedad terminal. Mediciones principales: Se definió polimedicación como el consumo de 5 o más fármacos de forma continuada durante los últimos 6 meses, basado en el registro en historia clínica. Se exploraron otras características de los pacientes mediante entrevista a una submuestra seleccionada aleatoriamente. Resultados: Se evaluaron las historias clínicas de 2.919 pacientes procedentes de 14 centros de salud. La prevalencia encontrada fue de 49,6% (IC 95%: 47,7-51,4), con un rango entre centros de un 33% (IC 95%: 26,8-39,3) a un 82% (IC 95%: 74,3-89,7). El 90,2% (IC 95%: 88,7-91,8) tenía criterios de entrada al Proceso Asistencial Integrado Riesgo Vascular. La entrevista confirmó un consumo promedio de 8,7 medicamentos (IC 95%: 8,4-9,0). Un 83,2% (IC 95%: 78,9-87,4) eran pacientes en riesgo vascular alto. Conclusiones: La prevalencia de polimedicación en mayores de 65 años es cercana al 50%, con amplia variabilidad entre centros. El consumo promedio de medicamentos por paciente es de 8 y la gran mayoría son pacientes en riesgo vascular alto(AU)

Objetive: To describe the prevalence of multiple medication in patients over 65 years. Design: Cross-sectional study. Setting: Sevilla and Jerez-Costa North-West Primary Health Care Districts. Participants: Patients older than 65 years randomly chosen from district databases. Patients in nursing homes, with major mental disease, or end-of- life situations were excluded. Main measurements: Multiple medication was defined as a prescription of five or more drugs during the last six months. We assessed the medication used by clinical health records audit. Other characteristics were studied by interviewing a subsample of patients. Results: A total of 2,919 clinical health records from 14 centres were reviewed. The prevalence of multiple medication was 49.6% (95% CI: 47.7-51.4) with a range from 33% (95% CI: 26.8-39.3) to 82% (95% CI: 74,3-89,7) between centres. The large majority of patients (90.2% [95% CI: 88.7-91.8]) of patients showed criteria to be included in Cardiovascular Risk Health Care Process. Interviewed patients confirmed taking an average of 8.7 drugs (95% CI: 8.4-9.0). Among them, 83.2% (95% CI: 78.9-87.4) were high cardiovascular risk patients. Conclusions: Prevalence of multiple medication in patients over 65 years is about 50% with wide variations between centres. The number of drugs per patient ratio was close to eight. A large majority of them were high risk cardiovascular patients(AU)

[A review of the medication in polymedicated elderly with vascular risk: a randomised controlled trial]. / Revisión de la medicación en ancianos polimedicados en riesgo vascular: ensayo aleatorizado y controlado.

OBJECTIVE: To analyse the effectiveness of a medication review based on intervention directed at improving the appropriateness of drug treatments according to the established guidelines, as well as blood pressure, serum lipid and blood glucose control in elderly patients on multiple medication, and cardiovascular disease or high risk of cardiovascular disease. DESIGN: A randomised controlled trial with blind evaluation. SETTING: Fourteen Primary Health Care centres in Andalusia PARTICIPANTS: A total of 323 patients older than 65 on polypharmacy and cardiovascular disease or high risk of cardiovascular disease. INTERVENTION: A pharmacist interviewed the patient, reviewed the appropriateness of the drug treatment, taking in account health record data, proposed modifications and communicated them to the general practitioner or nurse. The control group received usual health care. MAIN MEASUREMENTS: Percentage of patients with appropriate use of low doses of acetylsalicylic acid, blood pressure, LDL-cholesterol, HbA(1c), and quality of life scores. RESULTS: A total of 41% of patients (average age 74, 61% women) had cardiovascular disease. Ten months after the intervention (18.3% withdrawals), more patients in the intervention group used low dose acetylsalicylic acid than in the control group (52.3% vs 38.6%; P=.024). There were no differences between groups in intermediate clinic outcomes. Quality of life scores improve in intervention group by 6.1 points (100 points scale), but was not statistically significant (P=.051). CONCLUSION: Clinical medication review improves the appropriateness of antiplatelet treatment in the elderly on polypharmacy and with high risk of cardiovascular disease. No improvement in biochemistry measurements was found.

[Prevalence of multiple medication and cardiovascular risk in patients over 65 years]. / Prevalencia de polimedicación y riesgo vascular en la población mayor de 65 años.

OBJECTIVE: To describe the prevalence of multiple medication in patients over 65 years. DESIGN: Cross-sectional study. SETTING: Sevilla and Jerez-Costa North-West Primary Health Care Districts. PARTICIPANTS: Patients older than 65 years randomly chosen from district databases. Patients in nursing homes, with major mental disease, or end-of- life situations were excluded. MAIN MEASUREMENTS: Multiple medication was defined as a prescription of five or more drugs during the last six months. We assessed the medication used by clinical health records audit. Other characteristics were studied by interviewing a subsample of patients. RESULTS: A total of 2,919 clinical health records from 14 centres were reviewed. The prevalence of multiple medication was 49.6% (95% CI: 47.7-51.4) with a range from 33% (95% CI: 26.8-39.3) to 82% (95% CI: 74,3-89,7) between centres. The large majority of patients (90.2% [95% CI: 88.7-91.8]) of patients showed criteria to be included in Cardiovascular Risk Health Care Process. Interviewed patients confirmed taking an average of 8.7 drugs (95% CI: 8.4-9.0). Among them, 83.2% (95% CI: 78.9-87.4) were high cardiovascular risk patients. CONCLUSIONS: Prevalence of multiple medication in patients over 65 years is about 50% with wide variations between centres. The number of drugs per patient ratio was close to eight. A large majority of them were high risk cardiovascular patients.