RESUMO
Objetivo. Resumir la evidencia sobre las intervenciones orientadas a optimizar el tratamiento farmacológico en ancianos hospitalizados. Material y métodos. Se realizó una búsqueda en las principales bases de datos bibliográficas, seleccionando estudios prospectivos en pacientes mayores de 65 años hospitalizados que realizaran intervenciones dirigidas a optimizar el tratamiento farmacológico, disminuir la polifarmacia y mejorar la adecuación terapéutica, los resultados en salud o el aprovechamiento del sistema sanitario. Resultados. Se seleccionaron 18 estudios. Las intervenciones consistieron en revisiones de medicación, detección de medicamentos predefinidos como potencialmente inadecuados en ancianos, asesoramiento de un equipo especializado en geriatría, uso de un sistema informático de apoyo a la prescripción o formación específica al equipo de enfermería. Hasta 14 estudios evaluaron la adecuación terapéutica, demostrando 13 de ellos una mejoría en alguno de los parámetros. Siete estudios midieron el impacto de la intervención sobre la polifarmacia, pero solo uno mejoró los resultados respecto al control. Otros siete estudios analizaron la mortalidad, no demostrándose una disminución de la misma en ninguno. Solo uno de seis estudios mostró una reducción de reingresos hospitalarios y uno de cuatro estudios una disminución de las visitas a urgencias. Conclusiones. Pese a la heterogeneidad de las intervenciones y de las variables analizadas, se obtuvieron mejores resultados en las variables de proceso, especialmente en la adecuación terapéutica, que en aquellas que midieron resultados en salud, donde hubo una mayor variabilidad (AU)
Objective. To summarise the evidence on interventions aimed at optimising the drug treatment of hospitalised elderly patients. Material and methods. We conducted a search in the main medical literature databases, selecting prospective studies of hospitalised patients older than 65 years who underwent interventions aimed at optimising drug treatment, decreasing polypharmacy and improving the medication appropriateness, health outcomes and exploitation of the healthcare system. Results. We selected 18 studies whose interventions consisted of medication reviews, detection of predefined drugs as potentially inappropriate for the elderly, counselling from a specialised geriatric team, the use of a computer support system for prescriptions and specific training for the nursing team. Up to 14 studies assessed the medication appropriateness, 13 of which showed an improvement in one or more of the parameters. Seven studies measured the impact of the intervention on polypharmacy, but only one improved the outcomes compared with the control. Seven other studies analysed mortality, but none of them showed a reduction in that rate. Only 1 of 6 studies showed a reduction in the number of hospital readmissions, and 1 of 4 studies showed a reduction in the number of emergency department visits. Conclusions. Despite the heterogeneity of the analysed interventions and variables, we obtained better results in the process variables (especially in medication appropriateness) than in those that measured health outcomes, which had greater variability (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Avaliação de Resultado de Intervenções Terapêuticas/métodos , Avaliação de Resultado de Intervenções Terapêuticas/tendências , Hospitalização/estatística & dados numéricos , Polifarmacologia , Prescrição Inadequada/prevenção & controle , Prescrição Inadequada/estatística & dados numéricos , Prescrição Inadequada/tendências , Análise de Dados/métodos , Saúde do Idoso , Idoso Fragilizado/estatística & dados numéricosRESUMO
OBJECTIVE: To summarise the evidence on interventions aimed at optimising the drug treatment of hospitalised elderly patients. MATERIAL AND METHODS: We conducted a search in the main medical literature databases, selecting prospective studies of hospitalised patients older than 65 years who underwent interventions aimed at optimising drug treatment, decreasing polypharmacy and improving the medication appropriateness, health outcomes and exploitation of the healthcare system. RESULTS: We selected 18 studies whose interventions consisted of medication reviews, detection of predefined drugs as potentially inappropriate for the elderly, counselling from a specialised geriatric team, the use of a computer support system for prescriptions and specific training for the nursing team. Up to 14 studies assessed the medication appropriateness, 13 of which showed an improvement in one or more of the parameters. Seven studies measured the impact of the intervention on polypharmacy, but only one improved the outcomes compared with the control. Seven other studies analysed mortality, but none of them showed a reduction in that rate. Only 1 of 6 studies showed a reduction in the number of hospital readmissions, and 1 of 4 studies showed a reduction in the number of emergency department visits. CONCLUSIONS: Despite the heterogeneity of the analysed interventions and variables, we obtained better results in the process variables (especially in medication appropriateness) than in those that measured health outcomes, which had greater variability.
