Integrated health intervention on polypharmacy and inappropriate prescribing in elderly people with multimorbidity: Results at the end of the intervention and at 6 months after the intervention

Background and objective: To analyse the impact of an integrated health intervention focused on polypharmacy and inappropriate prescribing (IP) in elderly people with multimorbidity.Material and methodsPatients were referred for assessment and intervention from primary care or hospital to an interdisciplinary team composed of primary and hospital medical staff and nurses. Pharmacological assessment was centred on polypharmacy and IP using the STOPP/START criteria. Changes in polypharmacy and in IP were analysed at the end of the intervention and at 6 months.ResultsOne hundred consecutive patients (mean (SD) age 81.5(8.0) years, 54(54%) male) were analysed. Mean prescribed medicines at baseline was > 10. There were no significant changes at the end of the intervention and at 6 months. The proportion of patients with two or more STOPP criteria reduced from 37% at the beginning of the intervention to 18% at the end (p< .001), and the proportion of those with START criteria from 13% to 6% (p = .004). These differences persisted at 6 months. The number of STOPP and START criteria before the intervention was associated with a decrease in the STOPP and START criteria at the end of the intervention and at 6 months. A reduction in polypharmacy (p= .041) and in falls (p= .034) was observed at 6 months in those with a decrease in the STOPP criteria at the end of the intervention.ConclusionsAn integrated health intervention centred on polypharmacy and IP in elderly people improves inappropriate prescribing that persists beyond the intervention. (AU)

Fundamento y objetivo: Analizar el impacto de una intervención sanitaria integrada centrada en la polifarmacia y la prescripción inapropiada (PI) en pacientes de edad avanzada con multimorbilidad.Material y métodosLos pacientes fueron remitidos desde la atención primaria o el hospital a un equipo interdisciplinar compuesto por médicos y enfermeras de atención primaria y del hospital para la valoración e intervención. La valoración farmacológica se centró en la polifarmacia y en la PI utilizando los criterios STOPP/START. Se analizaron cambios en la polifarmacia y en la PI al final de la intervención y a los 6 meses.ResultadosSe analizaron 100 pacientes consecutivos con una edad media de 81,5 (8,0) años de los cuales el 54% fueron varones. La media de medicamentos basales fue >10. No hubo diferencias significativas al finalizar la intervención ni a los 6 meses. La proporción de pacientes con 2 o más criterios STOPP se redujo del 37% al comienzo de la intervención al 18% al final (p<0,001), y la proporción de aquellos con criterios START del 13 al 6% (p=0,004). Estos resultados se mantuvieron a los 6 meses. El número de criterios STOPP y START antes de la intervención se asoció a un descenso de los criterios STOPP y START, al final de la intervención y a los 6 meses. En aquellos con una disminución de los criterios STOPP al finalizar la intervención, se observó a los 6 meses una disminución en la polifarmacia (p=0,041) y en las caídas (p=0,034).ConclusionesUna intervención sanitaria integrada centrada en la polifarmacia y en la PI en pacientes de edad avanzada mejora la prescripción inapropiada, y dichas mejoras persisten después de la intervención. (AU)

Integrated health intervention on polypharmacy and inappropriate prescribing in elderly people with multimorbidity: Results at the end of the intervention and at 6 months after the intervention.

BACKGROUND AND OBJECTIVE: To analyse the impact of an integrated health intervention focused on polypharmacy and inappropriate prescribing (IP) in elderly people with multimorbidity. MATERIAL AND METHODS: Patients were referred for assessment and intervention from primary care or hospital to an interdisciplinary team composed of primary and hospital medical staff and nurses. Pharmacological assessment was centred on polypharmacy and IP using the STOPP/START criteria. Changes in polypharmacy and in IP were analysed at the end of the intervention and at 6 months. RESULTS: One hundred consecutive patients (mean (SD) age 81.5(8.0) years, 54(54%) male) were analysed. Mean prescribed medicines at baseline was > 10. There were no significant changes at the end of the intervention and at 6 months. The proportion of patients with two or more STOPP criteria reduced from 37% at the beginning of the intervention to 18% at the end (p< .001), and the proportion of those with START criteria from 13% to 6% (p = .004). These differences persisted at 6 months. The number of STOPP and START criteria before the intervention was associated with a decrease in the STOPP and START criteria at the end of the intervention and at 6 months. A reduction in polypharmacy (p= .041) and in falls (p= .034) was observed at 6 months in those with a decrease in the STOPP criteria at the end of the intervention. CONCLUSIONS: An integrated health intervention centred on polypharmacy and IP in elderly people improves inappropriate prescribing that persists beyond the intervention.

[Prevalence of iodine deficiency and related factors in 4 year-old schoolchildren]. / Prevalencia del déficit de yodo y factores asociados en escolares de 4 años.

BACKGROUND AND OBJECTIVE: Iodine deficiency in early years of life can cause important disorders in body growth and development. The aim of this study was to determine the prevalence of iodine deficiency in 4 year-old schoolchildren from the town of Mataró (Barcelona, Spain) and to know the factors associated with this nutritional deficiency. PATIENTS AND METHOD: A population-based cross-sectional study was designed, which included all 4 year-old schoolchildren of this town. A physicians team performed a basic physical examination and collected urine samples for iodine determination. Parents were asked to answer a nutritional habits questionnaire. RESULTS: Eight hundred and sixty urine samples were obtained from 987 participants. Mean urinary iodine levels were 214.1 g/l (SD = 103.3 g/l) and the median was 189.0 g/l. Prevalence of iodine deficiency was 7.8% at a 100 g/l cut-off point and 1.2% at a 50 g/l cut-off point. Statistical differences in the prevalence of iodine deficiency were observed between ethnic groups: while natives had a prevalence of 7.0%, in Magrebins it was 18.4%, Subsaharians 20.0% and other ethnical groups 14.3% (p = 0.016). CONCLUSIONS: Schoolchildren in Mataró have adequate urinary iodine levels according to WHO recommendations with a relatively low prevalence of iodine deficiency. However, even after adjustments for the knowledge of the existence of iodized salt, iodine deficiency correlates with the child's ethnic origin (native or immigrant).

Prevalencia del déficit de yodo y factores asociados en escolares de 4 años / Prevalence of iodine deficiency and related factors in 4 year-old schoolchildren

FUNDAMENTO Y OBJETIVO: El déficit de yodo durante los primeros años de vida puede tener consecuencias graves para el correcto crecimiento y desarrollo del organismo. El objetivo de este estudio es conocer la prevalencia del déficit de yodo en los escolares de la ciudad de Mataró (Barcelona), así como conocer los factores asociados a este déficit nutricional. PACIENTES Y MÉTODO: Se diseñó un estudio transversal de base poblacional que incluyó a todos los niños y niñas de 4 años escolarizados en la ciudad de Mataró. Un equipo de médicos realizó la exploración física básica y recogió la muestra de orina para la determinación de yoduria y la encuesta sobre hábitos alimentarios que se había entregado previamente a los padres. RESULTADOS: Se obtuvieron 860 muestras de orina de los 987 niños que participaron en el estudio, observándose una yoduria media (DE) de 214,1 (103,3) µg/l y una mediana de 189,0 µg/l. Un 7,8 por ciento de los escolares tenía una yoduria igual o menor de 100 µg/l y un 1,2 por ciento, menor o igual a 50 µg/l. Se observaron diferencias según origen, de modo que los autóctonos presentaron una prevalencia (yoduria inferior o igual a 100 µg/l) del 7,0 por ciento, los magrebíes del 18,4 por ciento, los subsaharianos del 20,0 por ciento y los de otros grupos étnicos del 14,3 por ciento (p = 0,016). CONCLUSIONES: La población escolar estudiada tiene buenas concentraciones de yodo, con una prevalencia de déficit de este nutriente que puede considerarse relativamente baja. Aun ajustando por el conocimiento de la existencia de la sal yodada, este déficit se asocia con el origen (autóctono o inmigrante) de los niños. (AU)