Pharmacist comprehensive review of treatment compared with STOPP-START criteria to detect potentially inappropriate prescription in older complex patients.

OBJECTIVES: To compare potentially inappropriate prescribing (PIP) according to the clinical judgement of the pharmacist with PIP according to explicit STOPP-START criteria in institutionalised and hospitalised patients with multiple pathologies. To describe and compare the main pharmacological groups involved and determine the factors associated with the detection of PIP in these patients. METHOD: A prospective multicentre observational study of institutionalised and hospitalised multipathology patients aged >65 years. A specialised pharmacist used his best clinical judgement to detect PIP based on a comprehensive review of the complete chronic treatment of patients, which is an essential activity in interdisciplinary care. STOPP-START criteria were used as an aid tool to detect PIP. The main variable was the number of PIP incidents detected. RESULTS: Detected PIP incidents were analysed in 338 patients. Clinical judgement detected more PIP incidents (35%) than did STOPP-START criteria. More PIP incidents unrelated to these criteria were detected in institutionalised patients than in hospitalised patients. Clinical judgement mainly detected PIP incidents related to incorrect doses and drug interactions (p<0.001); however, STOPP-START criteria mainly detected PIP incidents related to drug duplication and insufficiently treated diagnosis or symptoms (p=0.001 and p<0.001). In total, 93.8% of the PIP incidents were detected in polypharmacy patients (≥5 drugs). Institutionalised and high-level polypharmacy (≥10 drugs) patients were at the highest risk of PIP. CONCLUSIONS: A large number of PIP incidents were detected in institutionalised and hospitalised patients with multiple pathologies. The inclusion of a pharmacist in the multidisciplinary team facilitated the detection of PIP incidents, particularly in the institutionalised population and patients treated with high-level polypharmacy which were not detected by explicit STOPP-START criteria.

[Pharmaceutical care in a social-healthcare center]. / Atención farmacéutica en un centro socio-sanitario.

OBJECTIVE: To reflect the activity of the pharmacy department within the nursing home s multidisciplinary team, and to assess care improvements received by residents, including a better use of drugs. METHOD: In addition to pharmacotherapeutical guidelines and a standardized work procedure listing generic and therapeutic replacements to be implemented, selected procedures were specified in order to ensure a rational use of drugs and to increase the quality of care received by residents in our center. Such procedures will be performed by the center s multidisciplinary team and will focus on caring the caring for so-called geriatric syndromes. RESULTS: After an assessment of treatments for 125 patients and a 3-month follow-up, 10 interventions per patient were performed, out of which 4.74 were pharmacist interventions and 5.26 were to increase quality of care. CONCLUSIONS: The presence of the pharmacy department within the multidisciplinary team ensures a better use of drugs and a safe delivery system. Its activity contributes to improve quality of care, most notably procedures regarding nutritional status, and the prevention and treatment of pressure ulcers.

Atención farmacéutica en un centro socio-sanitario / Pharmaceutical care in a social-healthcare center

Objetivo: Reflejar la actuación del servicio de farmacia, dentrodel equipo multidisciplinar de la residencia, evaluando la mejoraasistencial que reciben los residentes, incluyendo una mejor utilizaciónde los medicamentos.Método: Además de una guía farmacoterapéutica y un procedimientonormalizado de trabajo en el que se enumeran las sustitucionesgenéricas y terapéuticas que se van a realizar, se concretandeterminadas intervenciones para asegurar el uso racional delos medicamentos e incrementar la calidad de los cuidados recibidospor los residentes de nuestro centro. Estas intervencionesserán realizadas por el equipo multidisciplinar del centro y se centranen el cuidado de los llamados síndromes geriátricos.Resultados: Después de valorar los tratamientos de 125pacientes y realizar un seguimiento de tres meses, se efectúan 10intervenciones por paciente, diferenciando 4,74 intervencionesfarmacéuticas y 5,26 enfocadas a incrementar la calidad asistencial.Conclusiones: La presencia del servicio de farmacia en elequipo multidisciplinar asegura una mejor utilización de medicamentosy un sistema seguro de distribución. Su actuación contribuyea mejorar la calidad asistencial, destacando las intervencionessobre el estado nutricional y la prevención y tratamiento deúlceras por presión

Objective: To reflect the activity of the pharmacy departmentwithin the nursing home's multidisciplinary team, and to assesscare improvements received by residents, including a better use ofdrugs.Method: In addition to pharmacotherapeutical guidelines anda standardized work procedure listing generic and therapeuticreplacements to be implemented, selected procedures were specifiedin order to ensure a rational use of drugs and to increase thequality of care received by residents in our center. Such procedureswill be performed by the center’s multidisciplinary team andwill focus on caring the caring for so-called geriatric syndromes.Results: After an assessment of treatments for 125 patientsand a 3-month follow-up, 10 interventions per patient were performed,out of which 4.74 were pharmacist interventions and5.26 were to increase quality of care.Conclusions: The presence of the pharmacy departmentwithin the multidisciplinary team ensures a better use of drugs anda safe delivery system. Its activity contributes to improve quality ofcare, most notably procedures regarding nutritional status, andthe prevention and treatment of pressure ulcers