Adaptación española de los criterios Beers / Spanish adaptation of Beers criteria

Fundamento: Los Criterios de Beers, de procedencia estadounidense y actualizados en 2012, son una herramienta asesora en la prescripción en pacientes ancianos. Dadas las diferencias entre nuestro catálogo de medicamentos y el norteamericano, el objetivo del estudio fue obtener una adaptación española de dichos criterios. Material y método: La comparación de los Criterios de Beers con el catálogo español de medicamentos de 2012 permitió detectar los principios activos, presentes en los criterios, no comercializados en España. Además se buscaron medicamentos comercializados en España similares a los presentes en los criterios. Se asume que los medicamentos comercializados en Estados Unidos ya fueron evaluados en la elaboración de los Beers. Así, sobre los medicamentos similares, disponibles en España y no en Estados Unidos, se realizó una evaluación de acuerdo a 3 tipos de fuentes: los artículos presentados por la American Geriatrics Society para avalar la evidencia de los Beers; las fichas técnicas y prospectos; y los criterios europeos STOPP/START, NORGEP y PRISCUS. Resultados: De los 199 principios activos presentes en los criterios Beers, se detectaron 54 (27,0%) no comercializados en España. Además se incorporaron 50 principios activos. Entre el grupo de los "Criterios Directos" se detectaron 47 (34,3%) no disponibles y 40 posibles inclusiones, y en el grupo de los "Criterios Dependientes de Enfermedad" 33 (21,3%) y 48 respectivamente. Conclusiones: Se ha detectado una importante presencia de medicamentos no comercializados en España, así como un elevado número de principios activos no incluidos en la versión original. Este trabajo facilita una adaptación de los Criterios de Beers a los profesionales de nuestro entorno (AU)

Background: The Beers criteria, which were drawn up in the USA and updated in 2012, were developed to detect potentially inappropriate prescriptions in older adults. Since there are significant differences between the Spanish and North American drug catalogues, our aim was to produce a Spanish adaptation of the criteria. Patients and methods: A comparison of the drugs mentioned in the Beers list with the 2012 Spanish Drugs Catalogue identified those active substances that were on the list in the USA but not commercially available in Spain. We also searched for Spanish drugs that were similar to those listed in the criteria. If these drugs were available in the USA, it was assumed that they had been evaluated by the Beers authors. On the other hand, if similar active substances were not available in the USA, they were evaluated by reference to three information sources: articles reviewed by the American Geriatrics Society in support of the Beers criteria, the product characteristics and information leaflets, and the European STOPP/START, NORGEP and PRISCUS criteria. Results: Of the 199 active substances listed in the Beers criteria, 54 (27.0%) were not commercially available in Spain, but 50 new active substances could be included. These figures differed when "Direct Criteria" were considered: 47 (34.3%) active substances were not commercially available in Spain and 40 new ones could be included in the Beers list. As regards "Disease Dependent Criteria" the figures were 33 (21.3%) and 48, respectively. Conclusions: A great number of drugs on the Beers list were not commercially available in Spain, and we added many active substances not included in the original version. This study is thus an adaptation of the Beers Criteria to the Spanish health care scenario (AU)

[Spanish adaptation of Beers criteria]. / Adaptación española de los criterios Beers.

BACKGROUND: The Beers criteria, which were drawn up in the USA and updated in 2012, were developed to detect potentially inappropriate prescriptions in older adults. Since there are significant differences between the Spanish and North American drug catalogues, our aim was to produce a Spanish adaptation of the criteria. PATIENTS AND METHODS: A comparison of the drugs mentioned in the Beers list with the 2012 Spanish Drugs Catalogue identified those active substances that were on the list in the USA but not commercially available in Spain. We also searched for Spanish drugs that were similar to those listed in the criteria. If these drugs were available in the USA, it was assumed that they had been evaluated by the Beers authors. On the other hand, if similar active substances were not available in the USA, they were evaluated by reference to three information sources: articles reviewed by the American Geriatrics Society in support of the Beers criteria, the product characteristics and information leaflets, and the European STOPP/START, NORGEP and PRISCUS criteria. RESULTS: Of the 199 active substances listed in the Beers criteria, 54 (27.0%) were not commercially available in Spain, but 50 new active substances could be included. These figures differed when "Direct Criteria" were considered: 47 (34.3%) active substances were not commercially available in Spain and 40 new ones could be included in the Beers list. As regards "Disease Dependent Criteria" the figures were 33 (21.3%) and 48, respectively. CONCLUSIONS: A great number of drugs on the Beers list were not commercially available in Spain, and we added many active substances not included in the original version. This study is thus an adaptation of the Beers Criteria to the Spanish health care scenario.

[Analysis of the errors associated with the prescription, preparation and administration of cytostatic drugs]. / Errores asociados con la prescripción, validación, preparación y administración de medicamentos citostáticos.

OBJECTIVE: To analyse errors relating to the process of prescription, validation, preparation, dispensing and administration of cytostatic drugs, set out in the risk management programme regarding cytostatic drugs at our hospital. METHODS: Prospective, descriptive and cross-sectional study, of three-year duration (2003-2005) on the total number of errors reported in the chemotherapy risk management programme.The dosing of cytostatic drugs is centralised in the Pharmacy Department, which prepared an average of 12,966 cytostatic preparations per annum during the study period. The prescription validation procedure for chemotherapy is therefore centralised at the Pharmacy Department and is the responsibility of the area pharmacist who detects the majority of prescription errors and keeps a record of all the errors detected in the circuit. Most chemotherapy dosing errors are detected when the preparations are checked prior to dispensing. Pharmaceutical validation errors are detected in the clinical units after the checking of the prescription by the nursing staff and administration errors are gathered through voluntary communication by nursing staff or, occasionally, by the patients themselves. The classification used for errors "by error type" is in accordance with the Spanish adaptation of the National Coordinating Causal for Medication Error Reporting and Prevention prepared by Otero. The qualitative variables analysed were measured as rates and/or percentages. RESULTS: During the study period (between 2003-2005), 268 errors were reported, 87.91% of which were detected in the medical day hospital. An increase in errors was seen in 2005, affecting 13.91% of the patients as opposed to 6.69% and 4.81% in the years 2003 and 2004. The largest number of errors was reported by the nursing staff (54.08%) followed by the pharmacist with 39.55% and the doctor 4.47%. Prescription errors (45.14%) were the most frequent, followed by validation (33.58%) and preparation (16.41%) errors. Among the prescription errors, the greatest percentages correspond to underdosing (32.32%), overdosing (16.16%) and dose reversal (11.11%). A total of 11.94% (32) of these reached the patient and 88.06% were prevented. CONCLUSIONS: The assessment of care practices and the critical, constructive analysis of the errors detected therein can be used as a tool that will enable the continuous improvement of procedures and the increased clinical safety of the patients. The collaboration of all the personnel involved in the circuits with known and shared objectives can enable a more exact dimension to be obtained of our current care situation in aspects for the clinical safety of patients.

Errores asociados con la prescripción, validación, preparación y administración de medicamentos citostáticos / Analysis of the errors associated with the prescription, preparation and administration of cytostatic drugs

Objetivo: Analizar los errores relacionados con el proceso de prescripción,validación, preparación, dispensación y administración demedicamentos citostáticos, recogidos en el programa de gestión deriesgos con medicamentos citostaticos en nuestro hospital.Métodos: Estudio prospectivo, descriptivo y transversal, de 3 años deduración (2003-2005), sobre la totalidad de los errores comunicadosen el programa de gestión de riesgos asociados con quimioterapia.La dosificación de medicamentos citostáticos está centralizada en elservicio de farmacia, que elaboró una media anual de 12.966 mezclascitostáticas en este período de estudio. El procedimiento de validaciónde la prescripción de quimioterapia está, asimismo, centralizadoen el servicio de farmacia y es responsabilidad del farmacéuticodel área, que detecta mayoritariamente errores de prescripción yasume a su vez el registro de todos los errores detectados en el circuito.La detección de errores de dosificación de la quimioterapiaproviene en su mayoría de la revisión de las mezclas elaboradas, previaa la dispensación. Los de validación farmacéutica se detectan enlas unidades clínicas tras la revisión de la prescripción por parte delpersonal de enfermería, y los de administración se recogen a partirde la comunicación voluntaria por parte del personal de enfermeríao, en ocasiones, del propio paciente. La clasificación utilizada para loserrores «por tipo de error» sigue la adaptación española de la clasificaciónNacional Coordinating Causal for Medication Error Reportingand Prevention realizada por Otero. Las variables cualitativas analizadasse midieron como tasas y/o porcentajes.Resultados: En el período de estudio 2003-2005 los errores registradosfueron 268, el 87,91% de los cuales se detectó en hospital de díamédico. Se observa un incremento de los errores en 2005, que afectana un 13,91% de los pacientes atendidos frente a un 6,69 y un 4,81% delos años 2003 y 2004. El mayor número de errores fue comunicadopor el personal de enfermería (54,08%), seguido del farmacéutico conun 39,55% y el médico en un 4,47%. El error de prescripción, con 45casos (14%) fue el más frecuente, seguido de la validación (33,58%) yla elaboración (16,41%). Entre los errores de prescripción, los mayoresporcentajes corresponden a infradosis (32,32%), extradosis (16,16%)e inversión de dosis (11,11%). Un 11,94% (32) de éstos llegaron al pacientey el restante 88,06% se previno.Conclusiones: La evaluación de la práctica asistencial y el análisis críticoy constructivo de los defectos que en ella confluyen pueden seruna herramienta que permita la mejora continua de los procedimientosy el incremento de la seguridad clínica de los pacientes.La colaboración de todo el personal implicado en los circuitos conobjetivos conocidos y compartidos permite obtener una dimensiónmás exacta de nuestra realidad asistencial en los aspectos de la seguridadclínica de los pacientes

Objective: To analyse errors relating to the process of prescription,validation, preparation, dispensing and administration of cytostaticdrugs, set out in the risk management programme regarding cytostaticdrugs at our hospital.Methods: Prospective, descriptive and cross-sectional study, ofthree-year duration (2003-2005) on the total number of errors reportedin the chemotherapy risk management programme.The dosing ofcytostatic drugs is centralised in the Pharmacy Department, whichprepared an average of 12,966 cytostatic preparations per annumduring the study period. The prescription validation procedure forchemotherapy is therefore centralised at the Pharmacy Departmentand is the responsibility of the area pharmacist who detects the majorityof prescription errors and keeps a record of all the errors detectedin the circuit. Most chemotherapy dosing errors are detectedwhen the preparations are checked prior to dispensing. Pharmaceuticalvalidation errors are detected in the clinical units after the checkingof the prescription by the nursing staff and administration errors are gathered through voluntary communication by nursing staff or,occasionally, by the patients themselves. The classification used forerrors «by error type» is in accordance with the Spanish adaptation ofthe National Coordinating Causal for Medication Error Reporting andPrevention prepared by Otero.The qualitative variables analysed were measured as rates and/orpercentages.Results: During the study period (between 2003-2005), 268 errorswere reported, 87.91% of which were detected in the medical dayhospital. An increase in errors was seen in 2005, affecting 13.91% ofthe patients as opposed to 6.69% and 4.81% in the years 2003 and2004. The largest number of errors was reported by the nursing staff(54.08%) followed by the pharmacist with 39.55% and the doctor4.47%. Prescription errors (45.14%) were the most frequent, followedby validation (33.58%) and preparation (16.41%) errors. Amongthe prescription errors, the greatest percentages correspond to underdosing(32.32%), overdosing (16.16%) and dose reversal(11.11%). A total of 11.94% (32) of these reached the patient and88.06% were prevented.Conclusions: The assessment of care practices and the critical, constructiveanalysis of the errors detected therein can be used as a toolthat will enable the continuous improvement of procedures and theincreased clinical safety of the patients. The collaboration of all thepersonnel involved in the circuits with known and shared objectivescan enable a more exact dimension to be obtained of our currentcare situation in aspects for the clinical safety of patients

[Effectiveness of an intervention to improve medical prescription quality in specialized care]. / Efectividad de una intervención en la mejora de la calidad de prescripción con receta médica en atención especializada.

OBJECTIVE: The study was designed to research whether providing doctors with customized reports on prescription indicators,plus a presentation of the project to clinical departments and hospital boards, would improve prescription quality in specialized care. MATERIAL AND METHODS: Quasi experimental intervention study. During three periods of time we observed whether any differences between physicians receiving said reports (intervention group) and physicians not receiving said reports (control group)occurred in three overall quality markers (94 physicians)--generic drugs, low therapeutic value drugs, and irrelevant novel drugs-and two specific indicators--angiotensin converting enzyme inhibitors (109 physicians) and omeprazole (169 physicians). Indicators were assessed using mean values (95% Cl) and differences between groups with the z test. RESULTS: Prior to the intervention, indicators had no significant differences. At 4-6 months after delivering the report, generic drug prescription improved in the intervention group - 3.13%(1.79-4.47) versus 1.81% (1.08-2.54) in the control group,p = 0.041. After 10-12 months the intervention group had significantly improved versus the control group regarding: generic drugs, 4.01% (2.28-5.73) versus 2.22% (1.56-2.87), p = 0.025;ACE inhibitors, 58.89% (47.56-70.21) versus 45.91% (36.03-55.79), p = 0.042; and low therapeutic utility drugs, 8.57%(5.56-11.6) versus 12.35% (8.96-15.74), p = 0.047. Improvement regarding omeprazole did not reach statistical significance,and novel medications remained virtually unchanged. CONCLUSION: The intervention proved effective for the improvement of qualitative prescription indicators in specialized care.

Efectividad de una intervención en la mejora de la calidad de prescripción con receta médica en atención especializada / Effectivity of an intervention for improving medical prescription quality in specialized care

Objetivo: El estudio se diseñó para investigar si proporcionar a los médicos informes personalizados de indicadores de prescripción, reforzados con la presentación del proyecto en servicios clínicos y comisiones hospitalarias, mejoraría la calidad de prescripción con receta médica en atención especializada. Material y métodos: Estudio de intervención cuasiexperimental. Se comprobó, en tres periodos, si existían diferencias entre los médicos que recibieron la información (grupo intervención) y los que no la recibieron (grupo control) en tres indicadores globales de calidad (94 médicos): medicamentos genéricos, de baja utilidad terapéutica y novedades terapéuticas sin aportación relevante, y dos indicadores específicos: inhibidores de la enzima convertidora de angiotensina (109 médicos) y omeprazol (169 médicos). Los indicadores se valoraron con la media (IC del 95%) y las diferencias entre grupos con la prueba z. Resultados: Antes de la intervención los indicadores no presentaron diferencias significativas. A los 4-6 meses de la distribución de los informes, mejoró la prescripción de genéricos en el grupo intervención: 3,13% (1,79-4,47) frente a 1,81% (1,08-2,54) del grupo control, p = 0,041. A los 10-12 meses, el grupo intervención mejoró significativamente respecto al control en: genéricos 4,01% (2,28-5,73) frente al 2,22% (1,56-2,87), p = 0,025; inhibidores de la enzima convertidora de angiotensina 58,89% (47,56-70,21) frente al 45,91% (36,03- 55,79), p = 0,042; medicamentos de utilidad terapéutica baja 8,57% (5,56-11,6) frente al 12,35% (8,96-15,74), p = 0,047. La mejora de omeprazol no alcanzó significación y las novedades terapéuticas prácticamente no variaron. Conclusión: la intervención se mostró efectiva en la mejora de los indicadores cualitativos de prescripción con receta en atención especializada

Objective: The study was designed to research whether providing doctors with customized reports on prescription indicators, plus a presentation of the project to clinical departments and hospital boards, would improve prescription quality in specialized care. Material and methods: Quasiexperimental intervention study. During three periods of time we observed whether any differences between physicians receiving said reports (intervention group) and physicians not receiving said reports (control group) occurred in three overall quality markers (94 physicians) – generic drugs, low therapeutic value drugs, and irrelevant novel drugs – and two specific indicators – angiotensin converting enzyme inhibitors (109 physicians) and omeprazole (169 physicians). Indicators were assessed using mean values (95% CI) and differences between groups with the z test. Results: Prior to the intervention, indicators had no significant differences. At 4-6 months after delivering the report, generic drug prescription improved in the intervention group – 3.13% (1.79-4.47) versus 1.81% (1.08-2.54) in the control group, p = 0.041. After 10-12 months the intervention group had significantly improved versus the control group regarding: generic drugs, 4.01% (2.28-5.73) versus 2.22% (1.56-2.87), p = 0.025; ACE inhibitors, 58.89% (47.56-70.21) versus 45.91% (36.03- 55.79), p = 0.042; and low therapeutic utility drugs, 8.57% (5.56-11.6) versus 12.35% (8.96-15.74), p = 0.047. Improvement regarding omeprazole did not reach statistical significance, and novel medications remained virtually unchanged. Conclusion: The intervention proved effective for the improvement of qualitative prescription indicators in specialized care

Utilización de antihipertensivosen Atención Primaria / Antihypertensive drug use in Primary Health Care

Objetivo. Analizar el uso de antihipertensivos en Atención Primaria en el período comprendido entre 1999 y 2001 y valorar la introducción de los antagonistas de los receptores de la angiotensina II (ARA-II).Métodos. Estudio observacional retrospectivo. Se seleccionaron todas las prescripciones de antihipertensivos mediante recetas de la Seguridad Social en la gerencia de Atención Primaria de Murcia. Las fuentes de datos fueron las cintas de facturación mensual de recetas de la Seguridad Social, nomenclator digitalis de noviembre de 2001, bases de datos de médicos y población con tarjeta sanitaria. Los resultados se expresan en dosis diaria definida (DDD) por 1.000 habitantes y día (DHD).Resultados. El consumo de antihipertensivos se incrementó de 161,7 DHD en 1999 a 183,22 en 2001 (13,3 por ciento).Las prescripciones de antihipertensivos supusieron el 11,67 por ciento del total de recetas. Los fármacos más utilizados fueron los inhibidores de la enzima de conversión de la angiotensina (IECA) (28 por ciento de las DHD totales) y los de mayor crecimiento los ARA-II (incremento del 108 por ciento).Aunque en 2001 los IECA duplicaron a los ARA-II en DHD, el consumo por precio de venta al público (PVP) fue prácticamente el mismo. El uso de diuréticos y betabloqueantes fue del 12,3 por ciento y 8,8 por ciento, respectivamente, en DHD. El fármaco más consumido en todo el período fue enalapril, seguido a distancia por amlodipino, captopril, atenolol y valsartán en 2001.Conclusiones. Los antihipertensivos mantienen una tendencia ascendente de consumo determinada por el incremento de ARA-II. Los IECA continúan siendo los más prescritos y los diuréticos y betabloqueantes probablemente estén infrautilizados. El incremento de ARA-II ha originado un cambio cualitativo en la terapéutica antihipertensiva: se ha detenido la tendencia ascendente de los IECA y se ha incrementado el coste del tratamiento. (AU)