Identification of potential clinically significant drug interactions in HIV-infected patients: a comprehensive therapeutic approach.

OBJECTIVES: The aim of the study was to determine the prevalence of potential clinically significant drug interactions (CSDIs) in HIV-positive individuals and to identify associated risk factors. METHODS: A cross-sectional study was conducted including all HIV-infected out-patients attending the Pharmacy Service of a regional reference hospital in Murcia, south-eastern Spain. The complete treatment was screened for possible CSDIs using the Spanish College of Pharmacists' online software resource, bot. Additionally, the severity level of the CSDIs involving antiretroviral (ARV) drugs was compared with that established in the specific antiretroviral database InteraccionesHIV.com. Multivariate logistic regression was used to identify associated risk factors. RESULTS: Two hundred and sixty-eight patients were included in the study. A total of 292 potential drug interactions were identified, of which 102 (34.9%) were CSDIs, of which 52.9% involved ARV drugs. Seven therapeutic drug classes were involved in 75% of CSDIs (protease inhibitors, benzodiazepines, nonsteroidal anti-inflammatory drugs, nonnucleoside reverse transcriptase inhibitors, corticosteroids, antithrombotics and proton pump inhibitors). Factors independently associated with CSDIs were treatment with more than five drugs [odds ratio (OR) 15.1; 95% confidence interval (CI) 6.3-36.2], and treatment with a protease inhibitor (OR 5.3; 95% CI 2.4-11.74). CONCLUSIONS: The findings of this study suggest that the prevalence of clinically relevant drug-drug interactions is high in HIV-infected patients, and could represent a major health problem. Awareness, recognition and management of drug interactions are important in optimizing the pharmaceutical care of HIV-infected patients and helping to prevent adverse events and/or loss of efficacy of the drugs administered.

[Risk prescription associated to treatment at home of the elderly patient when admitted to the hospital]. / Prescripciones de riesgo asociadas al tratamiento domiciliario del paciente anciano al ingreso hospitalario.

OBJECTIVE: To determine the prevalence, the incidence of error, and the potential harm associated to particular prescriptions identified as a risk for medication error in the home treatment of elderly patients admitted to the hospital, as well as factors associated to their occurrence. MATERIAL AND METHODS: Cross-sectional, descriptive study. Patients aged 65 years and older, being admitted to the hospital from the emergency department in the last quarter of 2009. The SPSS software version 15.0 was used for the statistical analysis. RESULTS: 324 patients were included in the study. 1,176 (47%) prescriptions were identified as risk prescriptions in 91% of the patients. The most relevant risk prescription was prescription of high-risk medications (51.5% patients) that accounted for an error incidence of 88/100 patients with high-risk medications, being severe in 68 patients. Factors associated to the occurrence of moderate/high risk error due to risk prescriptions were suffering from a chronic respiratory illness, diabetes or polymedication. CONCLUSIONS: Actions aimed at decreasing the errors due to high risk medications should be prioritized.

Objetivo: Determinar la prevalencia, la incidencia de error y el daño potencial asociado a determinadas prescripciones señaladas como de riesgo de error de medicación en el tratamiento domiciliario de pacientes ancianos que ingresan en el hospital, así como los factores asociados a su aparición. Material y métodos: Estudio transversal descriptivo. Se incluyeron los pacientes de edad igual o mayor a 65 años que ingresaron en el hospital desde el servicio de urgencias durante el último trimestre de 2009.Para el análisis estadístico se utilizó el programa SPSSv15.0. Resultados: Se incluyeron en el estudio 324 pacientes. Se identificaron 1176 (47%) prescripciones de riesgo en el 91% de los pacientes. La prescripción de riesgo más relevante fue la prescripción de medicamentos de alto riesgo (51.5% pacientes) que presentó una incidencia de error de 88/100 pacientes con medicamentos de alto riesgo, de los cuales en 68 pacientes fue grave. Los factores asociados a la presencia de error grave/moderado ocasionado por prescripciones de riesgo fueron tener enfermedad respiratoria crónica o diabetes y la polimedicación. Conclusiones: Se deben priorizar actuaciones dirigidas a disminuir errores por medicamentos de alto riesgo.

Prescripciones de riesgo asociadas al tratamiento domiciliario del paciente anciano al ingreso hospitalario / Risk prescriptions associated to treatment at home of the elderly patient when admitted to the hospital

Objetivo: Determinar la prevalencia, la incidencia de error y el daño potencial asociado a determinadas prescripciones señaladas como de riesgo de error de medicación en el tratamiento domiciliario de pacientes ancianos que ingresan en el hospital, así como los factores asociados a su aparición. Material y métodos: Estudio transversal descriptivo. Se incluyeron los pacientes de edad igual o mayor a 65 años que ingresaron en el hospital desde el servicio de urgencias durante el último trimestre de 2009. Para el análisis estadístico se utilizó el programa SPSSv15.0. Resultados: Se incluyeron en el estudio 324 pacientes. Se identificaron 1176 (47%) prescripciones de riesgo en el 91% de los pacientes. La prescripción de riesgo más relevante fue la prescripción de medicamentos de alto riesgo (51.5% pacientes) que presentó una incidencia de error de 88/100 pacientes con medicamentos de alto riesgo, de los cuales en 68 pacientes fue grave. Los factores asociados a la presencia de error grave/moderado ocasionado por prescripciones de riesgo fueron tener enfermedad respiratoria crónica o diabetes y la polimedicación. Conclusiones: Se deben priorizar actuaciones dirigidas a disminuir errores por medicamentos de alto riesgo (AU)

Objective: To determine the prevalence, the incidence of error, and the potential harm associated to particular prescriptions identified as a risk for medication error in the home treatment of elderly patients admitted to the hospital, as well as factors associated to their occurrence. Material and methods: Cross-sectional, descriptive study. Patients aged 65 years and older, being admitted to the hospital from the emergency department in the last quarter of 2009. The SPSS software version 15.0 was used for the statistical analysis. Results: 324 patients were included in the study. 1,176 (47%) prescriptions were identified as risk prescriptions in 91% of the patients. The most relevant risk prescription was prescription of high-risk medications (51.5% patients) that accounted for an error incidence of 88/100 patients with high-risk medications, being severe in 68 patients. Factors associated to the occurrence of moderate/high risk error due to risk prescriptions were suffering from a chronic respiratory illness, diabetes or polymedication. Conclusions: Actions aimed at decreasing the errors due to high risk medications should be prioritized (AU)

Evaluación de la anamnesis farmacoterapéutica realizada en el servicio de urgencias al ingreso hospitalario / Medication history taking on admission to a hospital emergency department

Objetivo: Determinar la calidad y la precisión de la historia farmacoterapéutica realizada al ingreso en el servicio de urgencias y los factores asociados a la presencia de discrepancias. Método: Estudio transversal descriptivo. Se incluyeron los pacientes mayores de 64 años que ingresaron en el hospital desde el servicio de urgencias durante el último trimestre de 2009. Para determinar la presencia de discrepancias se cotejó la historia farmacoterapéutica realizada por un farmacéutico clínico con la obtenida por el urgenciólogo al ingreso hospitalario. Los factores asociados a de discrepancias se identificaron mediante un análisis de regresión logística univariante con el paquete estadístico SPSS versión 15.0. Resultados: Se incluyeron en el estudio 324 pacientes (53,4% mujeres) con una edad media de 78,3 años. Se identificaron 2.928 discrepancias que afectaron al 95,1%(IC95%: 92,7-97,4%) de los pacientes. Los grupos terapéuticos con mayor número de las discrepancias detectadas fueron los antiulcerosos (10,8%), los antitrombóticos (9,5%) y psicolépticos (7,2%). Se detectaron 257 discrepancias (8,8%) en medicamentos de alto riesgo en el 33,3% (IC95%: 28,2-38,5%) de los pacientes. La polimedicación fue la única variable independiente asociada a una mayor prevalencia de discrepancias [OR: 8,02 (IC95%: 2,79-23,02)].Conclusiones: Nuestros resultados muestran que existe un amplio margen de mejora,en la historia farmacoterapéutica realizada en urgencias, y debe extremarse la precaución en la población anciana y polimedicada (AU)

Objectives: To determine the quality and accuracy of medication histories taken during admission to the emergency department (ED) and to analyze the factors that may be related to the presence of discrepancies. Methods: Descriptive cross-sectional study. Patients over the age of 64 years were enrolled on admission to the hospital from the during the last quarter of 2009. To detect the presence of discrepancies we compared the medication histories taken by a clinical pharmacist to the ones taken by an emergency physician on admission. Regression analysis was used to identify factors associated with the presence of discrepancies. Results: A total of 324 patients (53.4% women) with a mean age of 78.3 years were enrolled. We detected 2928 discrepancies affecting 95.1% (95% confidence interval [CI], 92.7%-97.4%) of the patients. The medication groups with the largest numbers of discrepancies were antiulcer drugs (10.8%), antithrombotic drugs (9.5%), and psycholeptics(7.2%). We detected discrepancies in the recording of 257 high-risk drugs (8.8%) in 33.3% (95% CI, 28.2%-38.5%) of the patients. The only independent variable associated with a higher prevalence of discrepancies was the use of multiple medications (odds ratio, 8.02 (95% CI, 2.79-23.02).Conclusion: Our findings demonstrate that there is ample room for improvement, on medication history taken at ED, and increased cuation should be taken for patients of advanced age and those taking multiple medications (AU)

Análisis de las interacciones medicamentosas asociadas a la farmacoterapia domiciliaria en pacientes ancianos hospitalizados / Analysis of the drug interactions associated to domiciliary drug therapy in elderly hospitalized patients

Objetivo. Determinar la prevalencia de interacciones medicamentosas clínicamente relevantes asociadas al tratamiento crónico de pacientes mayores de 64 años que ingresan en el hospital, así como los factores asociados a una mayor presencia de éstas. Sujetos y método. Estudio observacional y transversal realizado en un hospital de referencia de área. Se incluyeron todos los pacientes mayores de 64 años que ingresaron en el hospital durante el último trimestre de 2009. Se identificaron las interacciones y su nivel potencial de relevancia clínica mediante la base de datos de interacciones BOT del Consejo General del Colegio de Farmacéuticos. Para identificar las variables asociadas a una mayor prevalencia de interacciones medicamentosas se realizaron análisis de correlaciones y de regresión lineal univariable y análisis de regresión logística uni y multivariable mediante el paquete estadístico SPSS, versión 15.0. Resultados. Se incluyeron 382 pacientes, con una edad media de 77,7 años. El 45,3% de los pacientes fueron pluripatológicos y el 78,8% tomaban 5 o más medicamentos. Las combinaciones por pares supusieron 272 interacciones clínicamente relevantes que corresponden a 159 (41,6%) pacientes. Siete grupos farmacológicos fueron responsables del 80,6% de las interacciones medicamentosas. Las variables con asociación estadísticamente significativa a la presencia de interacciones fueron: polimedicación, presencia de insuficiencia respiratoria, estar en tratamiento con inhibidores de la bomba de protones (IBPs), antagonistas de la vitamina K, diuréticos o antiagregantes. Conclusiones. Existe una elevada prevalencia de interacciones medicamentosas relevantes en pacientes ingresados de edad avanzada. Dado que éstas son una causa reconocible y por tanto prevenible de eventos adversos, pueden establecerse estrategias para su detección y actuaciones consecuentes, especialmente en pacientes de alto riesgo(AU)

Objective. To determine the prevalence of potentially relevant drug-drug interactions associated with chronic treatment of elderly patients over 64-years of age on hospital admission and the factors associated with an increased presence of these. Subjects and methods. Cross-sectional observational study in a hospital referral area. All patients aged 65 or over admitted to the hospital in the last three months in 2009 were included. Based on the drug database of the General Council of Colleges of Pharmacy (BOT), drug-drug interactions and their potential clinical relevance were identified. To identify the variables associated with a higher prevalence of drug-drug interactions, analyses of correlation and of univariable linear regression and uni-and multivariable logistic regression analyses were performed using the SPSS, version 15.0. Results. We analyzed the drug prescription data of 382 patients, whose mean age was 7.7 years. A total of 45.3% of patients had comorbidities and 78.8% had taken 5 or more drugs. We identified 272 clinically relevant drug-drug interactions that involved 159 patients (41.6%). Seven pharmacological groups accounted for 80.6% of the drug-drug interactions. The variables that had a statistically significant association to a higher prevalence of relevant interactions were polypharmacy, respiratory insufficiency, and treatment with proton-pump inhibitors, vitamin K antagonists, diuretics or anti-platelet drugs. Conclusions. A high prevalence of relevant drug-drug interactions was found in elderly hospitalized patients. Our findings suggest that prevention strategies should be implemented to avoid their associated adverse events, especially in high risk populations(AU)

[Analysis of the drug interactions associated to domiciliary drug therapy in elderly hospitalized patients]. / Análisis de las interacciones medicamentosas asociadas a la farmacoterapia domiciliaria en pacientes ancianos hospitalizados.

OBJECTIVE: To determine the prevalence of potentially relevant drug-drug interactions associated with chronic treatment of elderly patients over 64-years of age on hospital admission and the factors associated with an increased presence of these. SUBJECTS AND METHODS: Cross-sectional observational study in a hospital referral area. All patients aged 65 or over admitted to the hospital in the last three months in 2009 were included. Based on the drug database of the General Council of Colleges of Pharmacy (BOT), drug-drug interactions and their potential clinical relevance were identified. To identify the variables associated with a higher prevalence of drug-drug interactions, analyses of correlation and of univariable linear regression and uni-and multivariable logistic regression analyses were performed using the SPSS, version 15.0. RESULTS: We analyzed the drug prescription data of 382 patients, whose mean age was 7.7 years. A total of 45.3% of patients had comorbidities and 78.8% had taken 5 or more drugs. We identified 272 clinically relevant drug-drug interactions that involved 159 patients (41.6%). Seven pharmacological groups accounted for 80.6% of the drug-drug interactions. The variables that had a statistically significant association to a higher prevalence of relevant interactions were polypharmacy, respiratory insufficiency, and treatment with proton-pump inhibitors, vitamin K antagonists, diuretics or anti-platelet drugs. CONCLUSIONS: A high prevalence of relevant drug-drug interactions was found in elderly hospitalized patients. Our findings suggest that prevention strategies should be implemented to avoid their associated adverse events, especially in high risk populations.

[Nutritional assessment at the time of hospital-admission: study initiation among different methodologies]. / Valoración nutricional al ingreso hospitalario: iniciación al estudio entre distintas metodologías.

BACKGROUND AND OBJECTIVES: The elevated prevalence figures of hyponutrition in hospitalized patients--near 40%--is an issue of concern. This allows deducing that early identification of malnourished, or at risk for hyponutrition, patients by means of effective nutritional assessment methods may represent an essential tool for nutritional planning. The aim of this study was applying to a same group of patients different nutritional assessment methods (objective and subjective) at the time of hospital admission in order to assess the degree of effectiveness for its clinical application. SETTING, PATIENTS AND INTERVENTIONS: A prospective randomized study is designed, in which 50 admitted patients of our hospital are included between October 1st and December 31st of 2004, 9 of them being rejected for laboratory errors. During the first 3 days of hospital staying, anthropometrics (weight, height, arm circumference, and tricipital fold measure), biochemistry (full blood count, albumin, pre-albumin, retinol-bound protein, transferrin, and cholesterol), two nutritional assessment questionnaires (Global Subjective Assessment (GSA) and Mini Nutritional Assessment (MNA). RESULTS: Thechi-squared2 test has been applied to compare the results obtained from the different objective methods, separately and globally, with the MNA and GSA questionnaires, establishing the following anthropometrical comparisons: anthropometrics/MNA, Biochemistry/MNA, Chang/MNA, anthropometrics/GSA, Biochemistry/GSA, Chang/GSA, and MNA/GSA. Statistical significance has been set at p < 0.05. Statistical analysis has been done with the SPSS v.11 software. We have not observed a statistical significance between any of the three objective parameters studied: biochemistry, anthropometrics and immunology separately considered in the two nutritional assessment questionnaires. However, the significance is positive when we relate the results obtained by the Chang method, which comprises the three types of objective parameters, with those from the MNA and GSA. A statistical significance was also reached when relating both subjective methods between each other: MNA and GSA. CONCLUSIONS: Both the GSA and MNA represent a good indicator to determine high-risk patients for developing complications attributable to hyponutrition. We can attribute them a predictive power similar to that of objective data considered as a whole.

Valoración nutricional al ingreso hospitalario: iniciación al estudio entre distintas metodologías / Nutritional assessment at the time of hospital-admission: study initiation among different methodologies

Antecedentes y Objetivos: Las altas cifras iniciales de prevalencia de desnutrición en los enfermos hospitalizados-cercanos al 40%- es un dato preocupante. Esto permite deducir que la identificación precoz de enfermos desnutridos o en riesgo de estarlo, mediante métodos de valoración nutricional eficaces puede constituir una herramienta fundamental de cara a la planificación nutricional. El objetivo del presente trabajo ha sido aplicar a un mismo grupo de pacientes distintos métodos de valoración nutricional (objetivos y subjetivos) a su ingreso hospitalario, a fin de valorar el grado de efectividad para su aplicación en la clínica. Ámbito, Pacientes e Intervenciones: Se diseña un estudio prospectivo y aleatorio, en el cual se incluyen 50 pacientes ingresados en nuestro hospital entre el 1 de octubre y el 31 de diciembre del 2004, siendo desestimados 9 casos por fallos en las analíticas. En los tres primeros días de estancia hospitalaria se les realiza antropometría(peso, talla, circunferencia del brazo y medida del pliegue tricipital), bioquímica (hemograma, albúmina, prealbúmina,proteína ligada al retinol, transferrina y colesterol) dos encuestas de valoración nutricional (Valoración Subjetiva Global (VSG) y Mini Nutricional Assessment (MNA). Resultados: Se ha aplicado el test de χ2 para comparar los resultados obtenidos de los diferentes métodos objetivos, por separado y en conjunto, con métodos MNA y VSG, estableciéndose las siguientes comparaciones:Antropometría/MNA, Bioquímica/MNA, Inmunología/ MNA, Chang/MNA, Antropometría/VSG, Bioquímica/VSG, Inmunología/VSG, Chang/VSG y MNA/VSG.La significación estadística se ha considerado para un valor de p < 0,05. El análisis estadístico se ha realizado con ayuda del programa SPSS v.11. No se ha observado significación estadística en la relación entre cualquiera de los tres tipos de parámetros objetivos estudiados: (bioquímica, antropometría e inmunología) considerados aisladamente y las dos encuestas de valoración nutricional. En cambio, la significación es positiva al relacionar los resultados obtenidos por el método de Chang que engloba los tres tipos de parámetros objetivos, con los resultados de la MNA y de la VSG. También se alcanzó significación estadística al relacionar entre sí los dos métodos subjetivos empleados: la MNA y la VSG. Conclusiones: Tanto la VSG como la MNA constituyen un buen indicador para determinar los pacientes en alto riesgo de desarrollar complicaciones atribuibles a la desnutrición. Podemos atribuirles un poder predictivo igual al de los datos de objetivos considerados en conjunto (AU)

Background and objectives: The elevated prevalence figures of hyponutrition in hospitalized patients -near 40%- is an issue of concern. This allows deducing that early identification of malnourished, or at risk for hyponutrition, patients by means of effective nutritional assessment methods may represent an essential tool for nutritional planning.The aim of this study was applying to a same group of patients different nutritional assessment methods (objective and subjective) at the time of hospital admission in order to assess the degree of effectiveness for its clinical application. Setting, Patients and Interventions: A prospective randomized study is designed, in which 50 admitted patients of our hospital are included between October 1st and December 31st of 2004, 9 of them being rejected for laboratory errors. During the first 3 days of hospital staying, anthropometrics (weight, height, arm circumference,and tricipital fold measure), biochemistry (full blood count, albumin, pre-albumin, retinol-bound protein, transferrin, and cholesterol), two nutritional assessment questionnaires (Global Subjective Assessment (GSA) and Mini Nutritional Assessment (MNA). Results: The χ2 test has been applied to compare the results obtained from the different objective methods, separately and globally, with the MNA and GSA questionnaires, establishing the following anthropometrical comparisons: anthropometrics/MNA, Biochemistry/ MNA, Chang/MNA, anthropometrics/GSA, Biochemistry/GSA, Chang/GSA, and MNA/GSA. Statistical significance has been set at p < 0.05. Statistical analysis has been done with the SPSS v.11 software.We have not observed a statistical significance between any of the three objective parameters studied: biochemistry, anthropometrics and immunology separately considered in the two nutritional assessment questionnaires. However, the significance is positive when we relate the results obtained by the Chang method, which comprises the three types of objective parameters, with those from the MNA and GSA. A statistical significance was also reached when relating both subjective methods between each other: MNA and GSA. Conclusions: Both the GSA and MNA represent a good indicator to determine high-risk patients for developing complications attributable to hyponutrition. We can attribute them a predictive power similar to that of objective data considered as a whole (AU)

Valoración nutricional en el enfermo oncológico: estudio sobre metodología objetiva-subjetiva / Nutritional valuation on oncologic patient: objective-subjective methodology research

Fundamentos: En la práctica clínica, el objetivo de la valoración nutricional es identificar los pacientes con malnutrición o con riesgo que pueden beneficiarse de un adecuado abordaje nutricional posterior. Para ello, es necesario disponer de un método de valoración del estado nutricional sencillo de realizar, reproducible, que pueda ser llevado a cabo por cualquier terapeuta, de bajo coste y capaz de identificar a pacientes con déficit nutricional o riesgo de malnutrición. El objetivo de nuestro estudio ha sido aplicara un mismo grupo de pacientes distintos métodos de valoración nutricional (objetivos y subjetivos) para determinar la variación entre los resultados obtenidos por cada uno de ellos y encontrar un método sencillo y fiable que se pueda utilizar como método de rutina aplicado apacientes oncológicos cuando ingresan en el hospital. Métodos: Se ha diseñado un estudio prospectivo y aleatorio, seleccionando al azar 25pacientes oncológicos a los que se les aplicaron en los tres primeros días de estancia hospitalaria las medidas de estudio: antropometría(peso, talla, circunferencia del brazo y medida del pliegue tricipital), analítica (hemograma, albúmina, prealbúmina, proteína ligada al retinol, transferrina y colesterol) y dos encuestas de valoración nutricional (VSG-GP y MNA).Resultados: No hemos encontrado significación estadística entre cualquiera de los tres tipos de parámetros objetivos estudiados aisladamente(bioquímica, antropometría e inmunología)con ninguna de las dos encuestas de valoración nutricional (Tabla IV). En cambio, sí se han podido relacionar los resultados obtenidos por el método de Chang que engloba dichos parámetros objetivos, con los resultados de la MNA y los de la VSG (Tabla IV). Conclusiones: Tanto la VSG-GP como la MNA son dos métodos subjetivos de valoración nutricional fáciles de realizar y con una buena correlación respecto a los métodos objetivos (AU)

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