Fidaxomicina en el tratamiento de la infección por Clostridium difficile en el paciente oncohematológico / Fidaxomicin in the treatment of Clostridium difficile infection in oncohematology patients

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Intervención farmacéutica para reducir el riesgo de iatrogenia asociada a la combinación triple whammy / Pharmaceutical intervention to reduce the iatrogenic risk associated with the triple whammy combination

OBJETIVO: Analizar el efecto de una intervención para reducir el riesgo de iatrogenia asociada a prescripciones crónicas concomitantes de inhibidores de la enzima de conversión de angiotensina (iECA) y/o antagonistas del receptor de la angiotensina II (ARA-II) con diuréticos y antiinflamatorios no esteroideos (AINE), combinación denominada triple whammy (TW). DISEÑO: Estudio de intervención antes-después. Emplazamiento: Quince centros de salud de un sector sanitario (población de referencia de 292.746 pacientes). PARTICIPANTES: Un total de 260 pacientes con edad ≥18 años y prescripciones crónicas concomitantes de fármacos de los grupos terapéuticos (código ATC): diuréticos (C03), iECA/ARA-II (C09) y AINE (M01), en enero de 2015. INTERVENCIONES: Intervención doble durante febrero y marzo de 2015: educacional (sesión informativa) e individualizada (revisión de historias clínicas y recomendaciones al médico de cabecera). Mediciones principales: Se analizó el número de pacientes en los que se aceptó al menos una recomendación y el número de pacientes que continuaban con la combinación TW prescrita en junio de 2015. Se analizaron los datos mediante estadística descriptiva y se comparó la prevalencia de TW en junio de 2015 con la inicial mediante método híbrido de Newcombe-Wilson. RESULTADOS: Se incluyeron 260 pacientes. En 165 (63,5%) se realizó alguna recomendación, y en 97 (58,8%) se aceptó al menos una. En junio de 2015, 184 pacientes continuaban con la combinación TW. La prevalencia de TW tras la intervención disminuyó en 0,19/1.000 pacientes (IC 95%: 0,04/1.000 a 0,34/1.000; p = 0,017). CONCLUSIONES: La intervención realizada mejoró la prescripción y redujo el número de pacientes con la combinación TW

OBJECTIVE: To analyze the effect of an intervention to reduce the iatrogenic risk associated with concomitant treatment with angiotensin converting enzyme inhibitors (ACEi) and/or angiotensin-II receptor blockers (ARB) with diuretics and nonsteroidal anti-inflamatory drugs (NSAID), combination known as triple whammy (TW). DESIGN: Uncontrolled before-after intervention study. LOCATION: 15 health centers from a health area (reference population of 292.746 habitants). PARTICIPANTS: 260 patients ≥18 years old with chronic and concomitant prescriptions of drugs from the therapeutic groups (ATC code): diuretics (C03), ACEi/ARBs (C09) and NSAID (M01) during the month of January 2015. INTERVENTIONS: A double intervention was conducted during February and March 2015: an educational part, which consisted of an informative session, and an individualized part, in which recommendations to general practitioner were assessed after reviewing medical records. MAIN MEASUREMENTS: The number of patients in whom at least one intervention was accepted and the number of patients who continued on TW combination in June 2015, were analyzed. Results were analyzed using descriptive statistics and the prevalence of TW was compared with the one in June 2015 using the Newcombe-Wilson's hybrid method. RESULTS: 260 patients were included in the study. Recommendations were made in 165 patients (63.5%) and at least one was accepted in 97 (58.8%) patients. In June 2015, 184 patients continued with the TW combination. The TW prevalence decreased by 0.19/1,000 patients (IC 95%: 0.04/1,000 to 0.34/1,000; P=0.017) after the intervention. CONCLUSIONS: The intervention improved the prescription and reduced the number of patients on TW combination

[Pharmaceutical intervention to reduce the iatrogenic risk associated with the triple whammy combination]. / Intervención farmacéutica para reducir el riesgo de iatrogenia asociada a la combinación triple whammy.

OBJECTIVE: To analyze the effect of an intervention to reduce the iatrogenic risk associated with concomitant treatment with angiotensin converting enzyme inhibitors (ACEi) and/or angiotensin-II receptor blockers (ARB) with diuretics and nonsteroidal anti-inflamatory drugs (NSAID), combination known as triple whammy (TW). DESIGN: Uncontrolled before-after intervention study. LOCATION: 15 health centers from a health area (reference population of 292.746 habitants). PARTICIPANTS: 260 patients ≥18 years old with chronic and concomitant prescriptions of drugs from the therapeutic groups (ATC code): diuretics (C03), ACEi/ARBs (C09) and NSAID (M01) during the month of January 2015 INTERVENTIONS: A double intervention was conducted during February and March 2015: an educational part, which consisted of an informative session, and an individualized part, in which recommendations to general practitioner were assessed after reviewing medical records. MAIN MEASUREMENTS: The number of patients in whom at least one intervention was accepted and the number of patients who continued on TW combination in June 2015, were analyzed. Results were analyzed using descriptive statistics and the prevalence of TW was compared with the one in June 2015 using the Newcombe-Wilson's hybrid method. RESULTS: 260 patients were included in the study. Recommendations were made in 165 patients (63.5%) and at least one was accepted in 97 (58.8%) patients. In June 2015, 184 patients continued with the TW combination. The TW prevalence decreased by 0.19/1,000 patients (IC 95%: 0.04/1,000 to 0.34/1,000; P=0.017) after the intervention. CONCLUSIONS: The intervention improved the prescription and reduced the number of patients on TW combination.