Impact of pharmaceutical care in polymedicated patients admitted to a geriatric ward
DOI:
https://doi.org/10.23938/ASSN.0990Keywords:
Pluripathology, Polypharmacy, Pharmaceutical intervention, Drug-related problems, STOPP-START v.2Abstract
Background. The aim of the study was estimate the prevalence of potentially inappropriate prescribing (PIP) and drug related problems (DRP) in an acute geriatric ward, and to evaluate the impact of pharmaceutical intervention on their prevalence.
Methods. Quasi-experimental, interventional study in polymedicated patients (≥ 6 drugs) who were admitted to a Geriatric ward in 2018-2019. PIP were analyzed according to STOPP/START 2014 criteria and DRP on the Third Consensus of Granada. The PIP and DRP detected, and the possible actions to correct them, PI were sent to the physician in charge. The effect of the intervention was analyzed at hospital discharge; if the change of prevalence of PIP and DRP was ≥75%, the pharmaceutical intervention was considered to be accepted.
Results. Pharmaceutical intervention was performed on 218 patients, analyzing 1,837 prescriptions. On admission, PIP (90.8%) and DRP (99.5%) were observed. We carried out 1,227 interventions, 57.6% on DRP. More than half (53.6%) of the pharmaceutical interventions were accepted; the PIP according to the STOPP and START criteria was reduced by 49.7 and 22.1%, respectively; DRP decreased by 60.1%. The frequencies and medians of PRM and PPI according to the START and STOPP criteria decreased significantly at discharge. The variables most frequently associated with acceptance of the pharmaceutical intervention were the geriatrician at charge, the number of PPI START and the number of PPI STOPP.
Conclusion. The detection of PIP and DRP of chronic treatment during hospital admission by the pharmacist, and in collaboration with the patient’s doctor, helps to reduce the prevalence of PIP and DRP.
Downloads
References
BELLVER MONZÓ O, MORENO ROYO L, SALAR IBÁÑEZ L. Prescripciones potencialmente inadecuadas en pacientes ancianos polimedicados. Intervención y seguimiento del farmacéutico comunitario. Farm Comunitarios 2018; 10: 5-14. https://doi.org/10.5672/FC.2173-9218.(2018/Vol10).002.02
HERNÁNDEZ RODRÍGUEZ MÁ, SEMPERE VERDÚ E, VICENS CALDENTEY C, GONZÁLEZ RUBIO F, MIGUEL GARCÍA F, PALOP LARREA V et al. Evolution of polypharmacy in a Spanish population (2005-2015): a database study. Pharmacoepidemiol Drug Saf 2020; 29: 433-443. https://doi.org/10.1002/pds.4956
GONZÁLEZ-ROJANO E, MARCOTEGUI J, SAMPEDRO R, VALDEZ-ACOSTA S, ABAD-SANTOS F. Utility of a computer tool for detection of potentially inappropriate medications in older patients in a tertiary hospital. IBJ Clin Pharmacol 2020; 1: 00013. https://doi.org/10.24217/2530-4984.20v1s1.00013
VILLAFAINA BARROSO A, GAVILÁN MORAL E. Pacientes polimedicados frágiles, un reto para el sistema sanitario. Inf Ter Sist Nac Salud 2011; 35: 114-232. https://www.mscbs.gob.es/biblioPublic/publicaciones/recursos_propios/infMedic/docs/PolimedicadosVol35n4.pdf
DELGADO SILVEIRA E, MONTERO ERRASQUÍN B, MUÑOZ GARCÍA M, VÉLEZ-DÍAZ-PALLARÉS M, LOZANO MONTOYA I, SÁNCHEZ-CASTELLANO C et al. Mejorando la prescripción de medicamentos en las personas mayores: una nueva edición de los criterios STOPP-START. Rev Esp Geriatría Gerontol 2015; 50: 89-96. https://doi.org/10.1016/j.regg.2014.10.005
GÓMEZ-CORTIJO R, FLOTATS-DAM P, IPARRAGUIRRE-AZCONA MK, CUBÍ-MONTANYÀ D, SABARTÉS-FORTUNY O, CASTELLARNAU-FONT A et al. Adecuación de la prescripción farmacológica durante el ingreso en un centro sociosanitario: experiencia clínica con los criterios STOPP/START. J Health Qual Res 2020; 35: 95-101. https://doi.org/10.1016/j.jhqr.2020.02.001
RUIZ-MILLO O, CLIMENTE-MARTÍ M, NAVARRO-SANZ JR. Improvement on prescribing appropriateness after implementing an interdisciplinary pharmacotherapy quality programme in a long-term care hospital. Eur J Hosp Pharm 2018; 25: 267-273. https://doi.org/10.1136/ejhpharm-2017-001411
Comité de Consenso. Tercer Consenso de Granada sobre problemas relacionados con medicamentos (PRM) y resultados negativos asociados a la medicación (RNM). Ars Pharm 2007; 48: 5-17.
SANTOS-RAMOS B, OTERO-LÓPEZ MJ, GALVÁN-BANQUERI M, ALFARO-LARA ER, VEGA-COCA MD, NIETO-MARTÍN MD et al. Modelos de atención al paciente pluripatológico y el papel de la farmacia hospitalaria. Farm Hosp 2012; 36: 506-517. https://doi.org/10.7399/FH.2012.36.6.52
DELGADO SILVEIRA E, FERNÁNDEZ-VILLALBA EM, GARCÍA-MINA FREIRE M, ALBIÑANA PÉREZ MS, CASAJÚS LAGRANJA MP, PERIS MARTÍ JF. Impacto de la intervención farmacéutica en el tratamiento del paciente mayor pluripatológico. Farm Hosp 2015; 39: 192-202. https://doi.org/10.7399/fh.2015.39.4.8329
PARDO-CABELLO AJ, BERMUDO-CONDE S, MANZANO-GAMERO V. Prescripción potencialmente inapropiada en pacientes hospitalizados con estudio comparativo entre la prescripción realizada por internistas y geriatras. Farm Hosp 2014; 38: 65-68. https://doi.org/10.7399/FH.2014.38.1.871
FERNÁNDEZ REGUEIRO R, ESTRADA MENÉNDEZ C, MORÍS DE LA TASSA J. Impacto de un programa de intervención destinado a la mejora de la prescripción potencialmente inapropiada en pacientes ancianos hospitalizados. Rev Clínica Esp 2019; 219: 375-385. https://doi.org/10.1016/j.rce.2018.12.012
GAVILÁN-MORAL E, VILLAFAINA-BARROSO A, JIMÉNEZ-DE GRACIA L, GÓMEZ SANTANA MC. Ancianos frágiles polimedicados: ¿es la deprescripción de medicamentos la salida? Rev Esp Geriatría Gerontol 2012; 47: 162-167. https://doi.org/10.1016/j.regg.2012.01.003
LOZANO-MONTOYA I, VÉLEZ-DIAZ-PALLARÉS M, DELGADO-SILVEIRA E, MONTERO-ERRASQUIN B, CRUZ JENTOFT AJ. Potentially inappropriate prescribing detected by STOPP–START criteria: are they really inappropriate? Age Ageing 2015; 44: 861-866. https://doi.org/10.1093/ageing/afv079
DELGADO SILVEIRA E, ÁLVAREZ DÍAZ A, PÉREZ MENÉNDEZ-CONDE C, MUÑOZ GARCÍA M, CRUZ-JENTOFT A, BERMEJO VICEDO T. Resultados de la integración de la atención farmacéutica en una Unidad de Agudos de Geriatría. Rev Esp Geriatría Gerontol 2012; 47: 49-54. https://doi.org/10.1016/j.regg.2011.11.012
RODRÍGUEZ DEL RÍO E, PERDIGONES J, FUENTES FERRER M, GONZÁLEZ DEL CASTILLO J, GONZÁLEZ ARMENGOL J, BORREGO HERNANDO MI et al. Impacto de los resultados a medio plazo de la prescripción inadecuada en los pacientes ancianos dados de alta desde una unidad de corta estancia. Aten Primaria 2018; 50: 467-476. https://doi.org/10.1016/j.aprim.2017.03.018
DÍAZ-GONZÁLEZ A, MORERA-HERRERAS T, MEDIBIL-CRESPO I, PISÓN J, MARTÍN-LESENDE I. Prescripción inadecuada, crónica y a demanda, en pacientes pluripatológicos ≥65 años según los criterios STOPP-START. Gac Med Bilbao 2018; 115: 45-57.
THEVELIN S, MOUNAOUAR LE, MARIEN S, BOLAND B, HENRARD S, DALLEUR O. Potentially inappropriate prescribing and related hospital admissions in geriatric patients: a comparative analysis between the STOPP and START criteria versions 1 and 2. Drugs Aging 2019; 36: 453-459. https://doi.org/10.1007/s40266-018-00635-8
DAMOISEAUX-VOLMAN BA, MEDLOCK S, RAVEN K, SENT D, ROMIJN JA, VAN DER VELDE N et al. Potentially inappropriate prescribing in older hospitalized Dutch patients according to the STOPP/START criteria v2: a longitudinal study. Eur J Clin Pharmacol 2021; 77: 777-785. https://doi.org/10.1007/s00228-020-03052-2
THOMAS RE, THOMAS BC. A systematic review of studies of the STOPP/START 2015 and American Geriatric Society Beers 2015 criteria in patients ≥ 65 years. Curr Aging Sci 2019; 12: 121-154. https://doi.org/10.2174/1874609812666190516093742
SALGUEIRO E, ELIZARDE BC, ELOLA AI, GARCÍA-PULIDO B, NICIEZA-GARCÍA ML, MANSO G. Los criterios STOPP/START más frecuentes en España. Una revisión de la literatura. Rev Esp Geriatría Gerontol 2018; 53: 274-278. https://doi.org/10.1016/j.regg.2018.03.001
MA Z, TONG Y, ZHANG C, LIU L. Potentially inappropriate medications and potentially prescribing omissions in Chinese older patients: Comparison of two versions of STOPP/START. J Clin Pharm Ther. 2020; 45: 1405-1413. https://doi.org/10.1111/jcpt.13237
BLANCO-REINA E, GARCÍA-MERINO MR, OCAÑA-RIOLA R, AGUILAR-CANO L, VALDELLÓS J, BELLIDO-ESTÉVEZ I et al. Assessing potentially inappropriate prescribing in community-dwelling older patients using the updated version of STOPP-START criteria: a comparison of profiles and prevalences with respect to the original version. Plos One 2016; 11: e0167586. https://doi.org/10.1371/journal.pone.0167586
ENA J. Reducción del número de prescripciones inadecuadas: comunicación farmacia-prescriptor. Rev Clínica Esp 2019; 219: 401-402. https://doi.org/10.1016/j.rce.2019.03.001
GUTIÉRREZ VALENCIA M, MARTÍNEZ VELILLA N, LACALLE FABO E, BEOBIDE TELLERIA I, LARRAYOZ SOLA B, TOSATO M. Intervenciones para optimizar el tratamiento farmacológico en ancianos hospitalizados: una revisión sistemática. Rev Clínica Esp 2016; 216: 205-221. https://doi.org/10.1016/j.rce.2016.01.005
GUERRO-PRADO M. Prevalencia de problemas relacionados con la medicación en pacientes crónicos pluripatológicos complejos y oportunidades de mejora. Farm Hosp 2018; 42: 197-199. https://doi.org/10.7399%2Ffh.10899
HAILU BY, BERHE DF, GUDINA EK, GIDEY K, GETACHEW M. Drug related problems in admitted geriatric patients: the impact of clinical pharmacist intervention. BMC Geriatr 2020; 20: 13. https://doi.org/10.1186/s12877-020-1413-7
INIESTA-NAVALÓN C, URBIETA-SANZ E, GASCÓN-CÁNOVAS JJ. Análisis de las interacciones medicamentosas asociadas a la farmacoterapia domiciliaria en pacientes ancianos hospitalizados. Rev Clínica Esp 2011; 211: 344-351. https://doi.org/10.1016/j.rce.2011.04.005
GALINDO-OCAÑA J, GIL-NAVARRO MV, GARCÍA-MORILLO JS, BERNABEU-WITTEL M, OLLERO-BATURONE M, ORTIZ-CAMUNEZ MA. Interacciones medicamentosas en pacientes pluripatológicos. Rev Clin Esp 2010; 210: 270-278. https://doi.org/10.1016/j.rce.2009.12.008
O’SULLIVAN D, O’MAHONY D, O’CONNOR MN, GALLAGHER P, CULLINAN S, O’SULLIVAN R et al. The Impact of a Structured Pharmacist Intervention on the Appropriateness of Prescribing in Older Hospitalized Patients. Drugs Aging 2014; 31: 471-481. https://doi.org/10.1007/s40266-014-0172-6
ACOSTA-GARCIA H, ALFARO-LARA E, SÁNCHEZ-FIDALGO S, SEVILLA-SÁNCHEZ D, DELGADO-SILVEIRA E, JUANES-BORREGO A, SANTOS-RAMOS B. Intervention effectiveness by pharmacists integrated within an interdisciplinary health team on chronic complex patients. Eur J Public Health 2020; 30: 886-899. https://doi.org/10.1093/eurpub/ckz224
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Anales del Sistema Sanitario de Navarra
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
La revista Anales del Sistema Sanitario de Navarra es publicada por el Departamento de Salud del Gobierno de Navarra (España), quien conserva los derechos patrimoniales (copyright ) sobre el artículo publicado y favorece y permite la difusión del mismo bajo licencia Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional (CC BY-SA 4.0). Esta licencia permite copiar, usar, difundir, transmitir y exponer públicamente el artículo, siempre que siempre que se cite la autoría y la publicación inicial en Anales del Sistema Sanitario de Navarra, y se distinga la existencia de esta licencia de uso.
