Evaluación de la adecuación del tratamiento farmacológico en pacientes pluripatológicos / Evaluation of the appropriateness of pharmacotherapy in patients with high comorbidity

Objetivo: Analizar la adecuación del tratamiento farmacológico y realizar, si es necesario, intervenciones para su mejora en una cohorte de pacientes pluripatológicos. Diseño: Estudio descriptivo, prospectivo, de 21 meses de duración. Emplazamiento: Área Hospitalaria Virgen del Rocío. Participantes: Pacientes pluripatológicos incluidos para un proyecto de atención integrada. Métodos: La variable principal consistió en el número de inadecuaciones detectadas. Para evaluar la adecuación del tratamiento farmacológico el farmacéutico especialista siguió un procedimiento normalizado que consistía en la aplicación del cuestionario Medication Aproppriateness Index (MAI) modificado como método implícito y de la lista de criterios Screening Tool of Older Person's potentially inappropriate Prescription/Screening Tool to Alert doctors to the Right (STOPP-START) como método explícito. Resultados: Se incluyeron un total de 244 pacientes, con una edad media de 76 ± 8 (± DE) años siendo el 50% hombres. El número medio de diagnósticos por paciente fue de 8 ± 3 (± DE) y de fármacos de 12 ± 4 (± DE). Se detectaron un total de 840 inadecuaciones, siendo la mayoritaria la presencia de interacciones. Respecto a los criterios STOPP los más frecuentemente incumplidos fueron: clase de medicamento duplicada y uso prolongado de benzodiacepinas de vida media larga o con metabolitos de acción larga, y para los START los IECA en la insuficiencia cardiaca crónica y estatinas y antiagregantes en la diabetes mellitus si coexisten uno o más factores de riesgo. Conclusiones: El gran número de inadecuaciones detectadas pone de manifiesto la importancia de evaluar la adecuación del tratamiento farmacológico en el paciente pluripatológico. Para ello es recomendable utilizar una estrategia de intervención farmacéutica combinada que incluya tanto un método implícito como un método explícito (AU)

Objetive: To analyze the appropriateness of pharmacotherapy and, if necessary, carry out interventions for its improvement in a cohort of patients with multiple chronic conditions. Design: Descriptive, prospective study of 21 months duration. Location: Hospital Universitario Virgen del Rocío. Participants: Patients with multiple chronic conditions included in a project for integrated healthcare. Methods: The primary endpoint was the number of inappropriate treatments. To evaluate the appropriateness of pharmacotherapy, the specialist in hospital pharmacy followed a standardized procedure consisting of the Medication Appropriateness Index (MAI) questionnaire, modified as an implicit method, and the list of criteria of the Screening Tool of Older Person's Potentially Inappropriate Prescription/Screening Tool to Alert doctors to the Right (STOPP-START) as an explicit method. Results: A total of 244 patients were included, with a mean age of 76 ± 8 (± SD) years. Half (50%) of the patients were men. The mean number of diagnoses per patient was 8 ± 3 (± SD) and 12 ± 4 drugs (± SD). A total of 840 inappropriate treatments were detected, most of them being due to the presence of interactions. The STOPP criteria most not complied with, were duplicate drug class, and prolonged use of benzodiazepines with long half-life or long-acting metabolites, and START for ACE inhibitors in chronic heart failure and statins and antiplatelets in diabetes mellitus, if one or more coexisting risk factors. Conclusions: We detected a large number of inappropriate treatments. This highlights the importance of evaluating the appropriateness of drug treatment in patients with multiple conditions. It is advisable to use a combined pharmacist intervention strategy that includes both an implicit method and an explicit method (AU)

Errores de conciliación al ingreso hospitalario en pacientes pluripatológicos mediante metodología estandarizada / Medication reconciliation on hospital admission in patients with multiple chronic diseases using a standardised methodology

Objetivos: Conocer la incidencia de los errores de conciliación en el ingreso hospitalario en pacientes pluripatológicos a través de una metodología estandarizada. Material y método: Estudio observacional prospectivo en pacientes pluripatológicos ingresados en un hospital de tercer nivel. Se realizó conciliación al ingreso hospitalario siguiendo la metodología considerada como más adecuada para estos pacientes por un panel de expertos, según el método Delphi. La fuente de información principal utilizada fue la historia clínica digital, tanto la hospitalaria como la de atención primaria, recurriendo a la entrevista clínica en caso necesario. Se registraron tanto las discrepancias justificadas por el clínico como los errores de conciliación. Se analizó el tipo de error, los grupos farmacológicos implicados y se valoró la gravedad de cada uno de ellos. Resultados: Se incluyeron 114 pacientes, encontrándose errores de conciliación en el 75,4% de ellos. Los pacientes tenían 1.397 fármacos prescritos, de los cuales 234 presentaron discrepancias que requirieron aclaración con el clínico responsable. De estas 234 discrepancias, el clínico modificó la prescripción en 184 de ellas, consideradas errores de conciliación. Los tipos de error fueron: omisión de medicamentos (139), comisión (9), dosis, pauta o vía diferentes (24) y por prescripción incompleta (12). Entre los subgrupos farmacoterapéuticos más afectados por los errores se encontraron los antianémicos, vitaminas, y psicoanalépticos. Conclusiones: El porcentaje de pacientes pluripatológicos con errores de conciliación es elevado. El desarrollo de una metodología dirigida especialmente a los pacientes pluripatológicos consigue detectar y disminuir en un alto porcentaje los errores de medicación relacionados con los cambios de niveles asistenciales (AU)

Objectives: To determine the incidence of medication errors when admitting patients with multiple chronic conditions to hospital, using a standard method. Material and method: A prospective, observational study was conducted on patients with multiple chronic conditions admitted to a tertiary hospital. The medication reconciliation was performed using the standard method considered the most suitable for these patients by an expert panel, following the Delphi methodology. The main information source used for this was the computerised clinical notes, both in primary care and in the hospital, recurring to a clinical interview if necessary. Discrepancies justified by the clinician, as well as reconciliation errors were recorded. The type of error and the pharmacological group involved were analysed and the seriousness of each one of them was assessed. Results: A total of 114 patients were included, with reconciliation errors being found in 75.4% of cases. The patients had 1397 prescribed drugs, of which 234 had discrepancies that required clarification by the clinician responsible. The clinician modified the prescription in 184 of these discrepancies, which were considered reconciliation errors. The types of error were: medication omission (139), commission (9), dose, prescription or different routes (24) and by incomplete prescription (12). Anti-anaemic drugs, vitamins, and psychoanaleptics were among the pharmacotherapeutic groups most affected by the errors. Conclusions: The percentage of patients with multiple chronic conditions with errors is elevated. The development of methods particularly directed at patients with multiple chronic conditions manages to detect and decrease a high percentage of medication errors associated with changes of care levels (AU)

[Medication reconciliation on hospital admission in patients with multiple chronic diseases using a standardised methodology]. / Errores de conciliación al ingreso hospitalario en pacientes pluripatológicos mediante metodología estandarizada.

OBJECTIVES: To determine the incidence of medication errors when admitting patients with multiple chronic conditions to hospital, using a standard method. MATERIAL AND METHOD: A prospective, observational study was conducted on patients with multiple chronic conditions admitted to a tertiary hospital. The medication reconciliation was performed using the standard method considered the most suitable for these patients by an expert panel, following the Delphi methodology. The main information source used for this was the computerised clinical notes, both in primary care and in the hospital, recurring to a clinical interview if necessary. Discrepancies justified by the clinician, as well as reconciliation errors were recorded. The type of error and the pharmacological group involved were analysed and the seriousness of each one of them was assessed. RESULTS: A total of 114 patients were included, with reconciliation errors being found in 75.4% of cases. The patients had 1397 prescribed drugs, of which 234 had discrepancies that required clarification by the clinician responsible. The clinician modified the prescription in 184 of these discrepancies, which were considered reconciliation errors. The types of error were: medication omission (139), commission (9), dose, prescription or different routes (24) and by incomplete prescription (12). Anti-anaemic drugs, vitamins, and psychoanaleptics were among the pharmacotherapeutic groups most affected by the errors. CONCLUSIONS: The percentage of patients with multiple chronic conditions with errors is elevated. The development of methods particularly directed at patients with multiple chronic conditions manages to detect and decrease a high percentage of medication errors associated with changes of care levels.

[Evaluation of the appropriateness of pharmacotherapy in patients with high comorbidity]. / Evaluación de la adecuación del tratamiento farmacológico en pacientes pluripatológicos.

OBJECTIVE: [corrected] To analyze the appropriateness of pharmacotherapy and, if necessary, carry out interventions for its improvement in a cohort of patients with multiple chronic conditions. DESIGN: Descriptive, prospective study of 21 months duration. LOCATION: Hospital Universitario Virgen del Rocío. PARTICIPANTS: Patients with multiple chronic conditions included in a project for integrated healthcare. METHODS: The primary endpoint was the number of inappropriate treatments. To evaluate the appropriateness of pharmacotherapy, the specialist in hospital pharmacy followed a standardized procedure consisting of the Medication Appropriateness Index (MAI) questionnaire, modified as an implicit method, and the list of criteria of the Screening Tool of Older Person's Potentially Inappropriate Prescription/Screening Tool to Alert doctors to the Right (STOPP-START) as an explicit method. RESULTS: A total of 244 patients were included, with a mean age of 76 ± 8 (± SD) years. Half (50%) of the patients were men. The mean number of diagnoses per patient was 8 ± 3 (± SD) and 12 ± 4 drugs (± SD). A total of 840 inappropriate treatments were detected, most of them being due to the presence of interactions. The STOPP criteria most not complied with, were duplicate drug class, and prolonged use of benzodiazepines with long half-life or long-acting metabolites, and START for ACE inhibitors in chronic heart failure and statins and antiplatelets in diabetes mellitus, if one or more coexisting risk factors. CONCLUSIONS: We detected a large number of inappropriate treatments. This highlights the importance of evaluating the appropriateness of drug treatment in patients with multiple conditions. It is advisable to use a combined pharmacist intervention strategy that includes both an implicit method and an explicit method.