ABSTRACT
Objetivo: Análisis de las prescripciones potencialmente inapropiadas en un servicio de medicina interna según los criterios de Beers. Métodos: Se realizó un estudio de único centro, transversal, en pacientes de consulta externa, hospitalización y emergencia del servicio de Medicina Interna del Hospital Central del Instituto Venezolano de los Seguros Sociales (IVSS) "Dr. Miguel Pérez Carreño", aplicando los criterios de Beers en pacientes mayores de 65 años. Resultados: La población estuvo representada por 300 pacientes, con una edad media de 73 ± 7, un 51,7% correspondió al sexo femenino, la mayoría de los pacientes provinieron de la unidad de consulta externa con 55,3% y presentaban un grado de instrucción en el nivel de primaria con 51,6% (n = 155). El antecedente personal más relevante fue la HTA con 69,7%. Los AINES se constituyeron los fármacos más formulados con 35.3%, el principal rango de prescripción inadecuada de medicamentos (PIM) se ubicó entre de 2 4 medicamentos con 53,5%, y la relación de PIM y multimorbilidad el principal grupo fue de 2 4 medicamentos con 50,7%, no siendo estadísticamente significativo (p= 0,310), Conclusión: Se observo que los pacientes > 65 años de consulta externa y hospitalización, tuvieron una elevada prescripción inadecuada de medicamentos según los criterios de Beers, con predominio del sexo femenino.
Objective: Analysis of potentially inappropriate prescriptions in an internal medicine service according to the Beers criteria. Methods: A single-center, cross-sectional study was conducted in outpatient, hospitalization and emergency patients of the Internal Medicine service of the Central Hospital of the Venezuelan Institute of Social Security (IVSS) "Dr. Miguel Pérez Carreño", applying the Beers criteria in patients over 65 years of age. Results: The population was represented by 300 patients, with a mean age of 73 ± 7, 51.7% were female, most of the patients came from the outpatient unit with 55.3% and had a grade of instruction at the primary level with 51.6% (n = 155). The most relevant personal history was hypertension with 69.7%. NSAIDs were the most formulated drugs with 35.3%, the main range of inappropriate prescription of drugs (PIM) was between 2 - 4 drugs with 53.5%, and the relationship of PIM and multimorbidity in the main group was 2 - 4 medications with 50.7%, not being statistically significant (p = 0.310), Conclusion: It was observed that patients> 65 years of outpatient consultation and hospitalization, had a high inappropriate prescription of medications according to the Beers criteria, with a predominance of the female sex.
Subject(s)
Mediation Analysis , Scientific and Technical Activities , Potentially Inappropriate Medication ListABSTRACT
OBJECTIVE: To compare the detection of potentially inappropriate medication (PIM) using the original Beers criteria, a global reference for evaluating prescriptions in the elderly, and their Spanish version. DESIGN: Retrospective observational study LOCATION: A Primary Care area in the province of Murcia, Spain. PARTICIPANTS: A total of 7,856 subjects aged 65 and over, with at least one drug prescribed in a Primary Care Area of Spain during study period. METHOD: Illnesses and treatments registered in the Primary Care computerised medical history of patients were analysed during a 12month study period (2012). The original Beers criteria and their Spanish adaptation were used to evaluate PIM, considering both sets of criteria overall, and individually. RESULTS: The median age of the patients was 76.0years, with the majority females (56.6%). Patients received a median of 13 active substances and 66 medical prescriptions. The percentage of patients prescribed PIM ranged from 44.8% according to the original Beers criteria to 49.4% with the Spanish adaptation. CONCLUSIONS: PIMs are frequent in our context. The original Beers criteria, if not adapted to the local drug catalogue, underestimated the frequency of PIM in the elderly population studied.
Subject(s)
Inappropriate Prescribing/statistics & numerical data , Potentially Inappropriate Medication List/statistics & numerical data , Aged , Female , Humans , Male , Retrospective Studies , SpainABSTRACT
INTRODUCCIÓN La población adulta mayor es un grupo de riesgo asociado con la pluripatología, con la polifarmacia y mayor riesgo de efectos adversos. La medicación potencialmente inapropiada (PIM) es aquella en la que el riesgo de eventos adversos es superior a los beneficios clínicos. Existen diferentes métodos para medir prescripciones PIMs, los más utilizados son Criterios de Beers; de STOPP y el Indice de Medicación Apropiada (MAI). OBJETIVO Evaluar la prevalencia de prescripciones PIM en una población de adultos mayores que reciben su medicación en centros de atención primaria de la salud de Rosario. MATERIAL Y MÉTODOS Estudio retrospectivo observacional de corte transversal de 106 pacientes mayores de 65 años de una muestra aleatoria de seis centros de salud. RESULTADOS Se analizaron 492 prescripciones, encontrándose una prevalencia de PIM de 35.85% según Beers, 45.28% según STOPP y 76.00% con el índice MAI. Solo se halló asociación estadísticamente significativa entre prescripciones PIM y polimedicación mayor con los criterios STOPP. Las PIMs más frecuentemente observadas correspondieron a los grupos farmacológicos de los antiulcerosos, AINES, glibenclamida, benzodiacepinas y antipsicóticos. A través del índice MAI, los pacientes con PIM presentaron para cada uno de los criterios diferentes prevalencias, siendo las más frecuentes; el uso de medicamento inapropiado por la edad o no tenían diagnóstico 76.00%, interacciones fármaco-fármaco; 44.00% interacciones fármacos-enfermedad 24.00% y las duplicaciones innecesarias 4.00%., se encontró que el 76% fueron interacciones fármaco-fármaco, 44% fármaco-enfermedad y hubo un 4% de duplicaciones innecesarias. DISCUSIÓN Los resultados obtenidos muestran una alta prevalencia de PIM utilizando todos los criterios y están en concordancia a la escasa literatura nacional. De los criterios explícitos los de STOPP mostraron una mejor adaptación para ser utilizados en la estimación de PIM en nuestra población
Subject(s)
Primary Health Care , Aged , Polypharmacy , Drugs for Primary Health Care , Inappropriate Prescribing , Medication Reconciliation , Potentially Inappropriate Medication ListABSTRACT
A descriptive, cross-sectional study of data from 15 elderly users of the Medication Therapy Management (MTM) service, delivered as a university extension project at a primary health unit in the city of Minas Gerais, Brazil was carried out. The objective of the study was to assess the use of potentially inappropriate medication (PIM) according to the Beers criteria (2015 version) and its relationship with drug-related problems (DRPs) identifed both theoretically and by the students during the process of service provision. The MTM service adopted the methodology recommended in the theoretical framework of Pharmaceutical Care Practice. In addition, the knowledge on PIMs held by the Pharmacy students involved in the service was assessed by applying a semi-structured questionnaire. The majority of the patient population was in use of at least one PIM (60%), with a total of 10 PIMs prescribed to 9 patients. Each PIM corresponded to a single DRP (n=10). However, the Pharmacy students providing the service identifed only three DRPs. All of the students interviewed reported knowing the PIM concept. However, the majority of students were unable to identify the PIMs in the pharmacotherapy of their patients. These results highlight the importance of the Beers criteria for identifying DRPs and the need for greater focus on these criteria during Pharmacy training.(AU)
Este estudo transversal descritivo foi realizado com dados de 15 idosos acompanhados em um Serviço de Gerenciamento da Terapia Medicamentosa ofertado como projeto de extensão universitária em uma unidade de atenção primária à saúde em um município de Minas Gerais, Brasil. Teve como objetivo avaliar a utilização de medicamentos potencialmente inadequados (MPI) de acordo com os critérios de Beers (versão 2015) e sua relação com problemas relacionados ao uso de medicamentos (PRM) identifcados teoricamente bem como aqueles identifcados pelos estudantes durante o processo de provisão do serviço. O serviço seguiu a metodologia preconizada no arcabouço teórico de Pharmaceutical Care Practice. Além disso, por meio de um questionário semiestruturados, foi avaliado o conhecimento dos estudantes de Farmácia envolvidos no serviço acerca de MPI. A maioria da população utilizava pelo menos um MPI (60%), sendo que foram identifcados 10 MPI que estavam prescritos para 9 idosos. Cada MPI correspondeu a um PRM teórico (n=10). No entanto, os estudantes de Farmácia oferecendo o serviço identifcaram apenas três PRM. Todos os estudantes entrevistados relataram conhecer o conceito de MPI. Porém, a maioria não os identifcou na farmacoterapia de seus pacientes. Estes resultados demonstram a importância dos critérios de Beers para identifcação de PRM e a necessidade de melhorias na sua abordagem durante a graduação em Farmácia.(AU)
Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Pharmaceutical Services/statistics & numerical data , Drug Therapy , Potentially Inappropriate Medication List , Brazil , Health Centers , Cross-Sectional StudiesABSTRACT
In recent decades, the elderly population in Brazil has grown rapidly, as has concern for the health of this population. Institutionalization in nursing homes has appeared as an alternative form of health care for frail elderly that live alone. The present study evaluated the pharmacotherapy and inappropriate drug prescriptions for institutionalized elderly patients living in long-term institutions in southeastern Brazil. This research was conducted at five institutions with a total sample of 151 individuals aged at least 60 years. Databases were used to identify drug interactions, defined daily dose and inappropriate prescriptions. The prevalence of drug intake among the elderly was 95.36%, and there were an average of 3.31 ± 1.80 drug prescriptions per individual. Based on Beers criteria, the prevalence of inappropriate prescriptions was 25.83%. In addition, 70.2% of prescriptions were prescribed at a higher dosage than the defined daily dose (ATC/WHO). Potential drug interactions were identified for 54.11% of prescriptions; 81.42% of these were of moderate severity. The main inappropriate drugs were prescribed for cardiovascular and nervous system problems. Institutionalized elderly individuals presented a high consumption and misuse of medications, requiring professional intervention to monitor prescriptions and improve the quality of service for this population.
Nas últimas décadas, o número de idosos no Brasil cresceu rapidamente, bem como, a preocupação com a saúde desta parcela da população. Neste cenário, a institucionalização em casas de repouso aparece como uma alternativa para os cuidados com a saúde dos idosos debilitados ou que vivem sozinhos. O presente estudo avaliou a farmacoterapia e a prescrição inadequada para idosos que residem em instituições de longa permanência no sudeste do Brasil. Esta pesquisa foi realizada em cinco instituições, totalizando uma amostra de 151 indivíduos com idade a partir de 60 anos. O banco de dados foi analisado para identificação de interações medicamentosas, dose diária definida e critérios de Beers. Dentre os indivíduos avaliados, 95,36% consomem algum tipo de medicamento, sendo 3,31 ± 1,80 medicamentos prescritos por indivíduo. Com base nos critérios de Beers, a prevalência de prescrições inapropriadas foi de 25,83%, sendo também encontradas 70,2% das prescrições com doses superiores à dose diária definida (ATC/WHO). Interações medicamentosas potenciais estavam presentes em 54,11% das prescrições, sendo 81,42% com grau moderado de gravidade. Os principais medicamentos inapropriados foram prescritos para problemas cardiovasculares e do sistema nervoso. Os idosos institucionalizados apresentam alto consumo e uso inadequado de medicamentos, sendo necessária a intervenção profissional para monitorar as prescrições médicas e melhorar a qualidade do serviço de distribuição de medicamentos a esta parte da população.
