Indicadores de riesgo de morbilidad prevenible causada por medicamentos en pacientes atendidos en un servicio de urgencias hospitalario / Risk indicators of preventable morbidity caused by medication in patients attended at a hospital emergency service

Objetivos: Los objetivos principales de este trabajo son: estudiar la frecuencia de los 43 indicadores de riesgo de morbilidad prevenible causada por medicamentos (RMPM), identificados previamente, en pacientes con tratamiento farmacológico que acuden a un servicio de urgencias hospitalario; describir las características de los pacientes en los que estaba presente el indicador, y establecer si el motivo de consulta y la gravedad de los pacientes coinciden con alguna de las situaciones clínicas descritas en los indicadores. Método: Estudio observacional descriptivo transversal que utiliza la base de datos de un estudio multicéntrico sobre prevalencia de resultados negativos de la medicación en el Hospital Universitario Central de Asturias. Criterios de inclusión de pacientes: a) estar tomando un medicamento relacionado con las situaciones clínicas descritas en los indicadores; b) presentar una enfermedad relacionada con los indicadores de resultados de problemas relacionados con medicamentos, y c) acudir a urgencias por un motivo relacionado con los indicadores. Resultados: Se estudiaron 436 pacientes. El perfil del paciente con indicador es una mujer mayor de 64 años que utiliza cuatro o más medicamentos. Cincuenta y siete pacientes (13,1%) presentaban alguna de las situaciones descritas en los indicadores. Un 28% tenía un indicador relacionado con AINE, un 26,3% con asma/EPOC, un 8,8% con osteoporosis y un 7% con uso de digoxina y medicamentos psicótropos. El 68,4% de los pacientes con indicador mostraban una gravedad leve, un 7% moderada y un 19,3% grave. Conclusiones: Se hallaron 17 indicadores (39,5%) en 57 pacientes (13%) de los que acudieron al servicio de urgencias. En más del 80% (46) de esos pacientes el motivo por el que acudieron a urgencias fue presentar alguna situación descrita en los indicadores. El 25% (14) de los pacientes con indicador presentaban una situación grave y tuvieron que ser ingresados. Los pacientes del grupo con indicador presente tenían más edad, ingresaban más y usaban más medicamentos de media (AU)

Objectives: The main objective of this study is to identify and determine the frequency of these 43 drugs related morbidity (PDRM) previously identifi ed in patients undergoing pharmacological treatment and who attended a hospital emergency department. Another objective is to describe the characteristics of the patients who present the indicator and establish whether the reason for attending the emergency department was related with the indicator (morbidity) and if the severity of the patients’ condition coincides with any of the clinical scenarios described in the indicators. Method: Cross-sectional, descriptive, observational study based on the database on the prevalence of drug-related negative clinical outcomes from a multicenter study conducted in the emergency department of the Hospital Universitario Central de Asturias (HUCA). Patients who complied with the following criteria were studied: a) use of a drug related to one of the clinical situations described in the indicators; b) present a disease associated with the result indicators of problems related with drugs; c) the reason for attending the emergency department is related to the indicators. Results: A total of 436 patients were studied. The profi le of a patient with a clinical condition matching an indicator is a woman aged 64 years old who uses 4 or more drugs. Fifty-seven patients (13.1%) presented one of the situations described in the indicators: 28% it was an indicator related with NSAIDs, 26.3% with asthma/COPD, in 8.8% with osteoporosis and 7% with the use of digoxin and psychotropic drugs. The 68.4% of the patients with an indicador showed mild severity, 7% moderate and 19.3% serious. Conclusions: 17 indicators (39.5%) were detected in 57 patients (13%) of those who attended the emergency department. In more than 80% of the patients (46) the reason for going to the emergency department was one of the situations described in the indicators. The condition of 25% of the patients (14) with an indicator showed a severe situation and had to be hospitalized. The patients of the group with a present indicator were older, where hospitalized more often and used more medications than the mean (AU)

[Pharmaceutical care in people who have had acute coronary episodes (TOMCOR study)]. / Atención farmacéutica en personas que han sufrido episodios coronarios agudos (Estudio TOMCOR).

BACKGROUND: This study evaluates the effects on coronary patients of a new practice in community pharmacies called Pharmaceutical Care (PhC) as compared to the traditional pattern of pharmacy practice. It attempts to ascertain whether pharmaceutical care is feasible in addition to ascertaining differences in effectiveness for coronary patients' pharmacotherapeutic health outcomes, potentially attributable to PhC. METHODS: A randomized prospective controlled-intervention study was conducted in 83 community pharmacies in the provinces of Asturias, Barcelona, Madrid and Biscay in a one-year monitoring of the drug-use of 735 patients at the start of the study (330 intervention patients and 405 control) and 600 at the end. RESULTS: Differences were fund in favor of the intervention group in: a) the use of health care services as a morbidity indicator such as frequency of hospital emergency room visits 1.27 I (CI95%; 1.10-1.44) and 1.63 C (CI95%; 1.36-1.90) or average length-of-stay in Intensive Care Units 2.46 I (CI95%; 1.56-3.36) and 5.87 C (CI95%; 3.57-8.17), both due to coronary causes; b) health-related quality of life score (physical functioning dimension difference of 4.7 (p < 0.05); c) average patient knowledge of coronary heart disease risk factors having improved by 10% (p < 0002-0.007 depending on dimension); d) patient knowledge of the name and identification of their drugs having improved by 10% (p < 0.001) along with their subjective perception of the antiagregans drugs relative importance having improved by 12% (p < 0.009) and effects of beta-blockers having improved by 25% (p < 0.02); e) average satisfaction with pharmaceutical care service and perception of pharmacist's professional competence having improved by 2% (p < 0.000 to 0.05 depending on dimension). CONCLUSIONS: A decrease in emergency health care demand due to coronary causes, a fewer number of patient hospitalizations and a shorter length-of-stay in Coronary Intensive Care Units due to hospitalization regarding coronary patients on pharmaceutical care would suggest that patients who suffered an acute coronary heart episode made a better use of drugs and would tend to be less ill. Furthermore, coronary patients who received pharmaceutical care services showed a better knowledge of the reasons for their pharmacotherapy and therefore took better advantage of health care resources and improved their health condition.