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Espaulella-Ferrer M, Molist-Brunet N, Espaulella-Panicot J, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Otero-Viñas M. Medication Assessment in an Older Population during Acute Care Hospitalization and Its Effect on the Anticholinergic Burden: A Prospective Cohort Study. Int J Environ Res Public Health 2023; 20:5322. [PMID: 37047938 PMCID: PMC10094232 DOI: 10.3390/ijerph20075322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/23/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
(1) Background: Anticholinergic and sedative drugs (ASDs) contribute to negative health outcomes, especially in the frail population. In this study, we aimed to assess whether frailty increases with anticholinergic burden and to evaluate the effects of medication reviews (MRs) on ASD regimens among patients attending an acute care for the elderly (ACE) unit. (2) Methods: A cohort study was conducted between June 2019 and October 2020 with 150 consecutive patients admitted to our ACE unit. Demographic, clinical, and pharmacological data were assessed. Frailty score was determined using the Frail-VIG index (FI-VIG), and ASD burden was quantified using the drug burden index (DBI). In addition, the MR was performed using the patient-centered prescription (PCP) model. We used a paired T-test to compare the DBI pre- and post-MR and univariate and multivariate regression to identify the factors associated with frailty. (3) Results: Overall, 85.6% (n = 128) of participants showed some degree of frailty (FI-VIG > 0.20) and 84% (n = 126) of patients received treatment with ASDs upon admission (pre-MR). As the degree of frailty increased, so did the DBI (p < 0.001). After the implementation of the MR through the application of the PCP model, a reduction in the DBI was noted (1.06 ± 0.8 versus 0.95 ± 0.7) (p < 0.001). After adjusting for covariates, the association between frailty and the DBI was apparent (OR: 11.42, 95% (CI: 2.77-47.15)). (4) Conclusions: A higher DBI was positively associated with frailty. The DBI decreased significantly in frail patients after a personalized MR. Thus, MRs focusing on ASDs are crucial for frail older patients.
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Affiliation(s)
- Mariona Espaulella-Ferrer
- Servei Territorial de Geriatria i Cures Pal·Liatives d’Osona i el Ripollés, Hospital Universitari de la Santa Creu de Vic, Hospital Universitari de Vic, 08500 Vic, Spain
- Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
| | - Nuria Molist-Brunet
- Servei Territorial de Geriatria i Cures Pal·Liatives d’Osona i el Ripollés, Hospital Universitari de la Santa Creu de Vic, Hospital Universitari de Vic, 08500 Vic, Spain
- Central Catalonia Chronicity Research Group (C3RG), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
| | - Joan Espaulella-Panicot
- Servei Territorial de Geriatria i Cures Pal·Liatives d’Osona i el Ripollés, Hospital Universitari de la Santa Creu de Vic, Hospital Universitari de Vic, 08500 Vic, Spain
- Central Catalonia Chronicity Research Group (C3RG), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
| | | | - Emma Puigoriol-Juvanteny
- Epidemiology Department, Hospital Universitari de Vic, 08500 Vic, Spain
- Multidisciplinary Inflamations Research Group (MIRG), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
| | - Marta Otero-Viñas
- Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
- Faculty of Science, Technology and Engineering, University of Vic-Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
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Elvira-Carrascal S, Rota-Musoll L, Bou-Folgarolas J, Homs-del Valle M, Puigoriol-Juvanteny E, Chirveches-Pérez E. Impacto de una intervención educativa nutricional para pacientes en hemodiálisis medido mediante la escala Malnutrición Inflamación y la bioimpedancia eléctrica. Enferm Nefrol 2022. [DOI: 10.37551/52254-28842022035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introducción: Los pacientes en hemodiálisis pueden presentar alteraciones en su composición corporal, para ello las unidades de nefrología cuentan con herramientas, como son la bioimpedancia y la escala “Malnutrition Inflamation Score” para prevenir, detectar y diagnosticar estados de desnutrición.Objetivos: Evaluar el impacto de una intervención educativa sobre el estado nutricional de los pacientes en hemodiálisis, medido mediante la escala Malnutrición Inflamación y la bioimpedancia.Material y Método: Estudio cuasiexperimental realizado en 48 pacientes sometidos a hemodiálisis. Se analizaron variables sociodemográficas y clínicas, de composición corporal de los pacientes en dos mediciones, mediante bioimpedancia y escala de malnutrición MIS.Los pacientes que presentaron una puntuación de la escala MIS≥6 recibieron una intervención nutricional, evaluándolos nuevamente a los 6 meses.Resultados: La media de edad fue de 69,9±13,6 años, 29 (60,41%) eran hombres. Los pacientes llevaban en tratamiento con hemodiálisis una mediana de tiempo de 24(P25:10,3-P75:59,3) meses.Los pacientes que presentaron valores de la escala MIS≥6 fueron 24(50%), recibiendo la intervención educativa.En los pacientes que no recibieron la intervención el resultado MIS empeoró a los 6 meses (3,4 vs 5,4, p=0,002).Conclusiones: Aquellas personas que no recibieron una intervención educativa empeoraron sus resultados nutricionales frente a quienes si la recibieron. Cabe destacar la importancia de utilizar de forma sistematizada instrumentos validados, como la bioimpedancia y la escala MIS, para hacer un seguimiento del estado nutricional de los pacientes en hemodiálisis.
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Molist-Brunet N, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Barneto-Soto M, González-Bueno J, Espaulella-Panicot J. Improving individualized prescription in patients with multimorbidity through medication review. BMC Geriatr 2022; 22:417. [PMID: 35549672 PMCID: PMC9096338 DOI: 10.1186/s12877-022-03107-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/02/2022] [Indexed: 02/07/2023] Open
Abstract
Background Older patients tend to have multimorbidity, represented by multiple chronic diseases or geriatric conditions, which leads to a growing number of prescribed medications. As a result, pharmacological prescription has become a major concern because of the increased difficulties to ensure appropriate prescription in older adults. The study’s main objectives were to characterize a cohort of older adults with multimorbidity, carry out a medication review and compare the pharmacological data before and after the medication review globally and according to the frailty index. Methods This was a quasi-experimental (uncontrolled pre-post) study with a cohort of patients ≥ 65 years old with multimorbidity. Data were collected from June 2019 to October 2020. Variables assessed included demographic, clinical, and pharmacological data, degree of frailty (Frail-VIG index), medication regimen complexity index, anticholinergic and or sedative burden index, and monthly drug expenditure. Finally, a medication review was carried out by an interdisciplinary team (primary care team and a consultant team with a geriatrician and a clinical pharmacist) by applying the Patient-Centered Prescription model to align the treatment with care goals. Results Four hundred twenty-eight patients were recruited [66.6% women; mean age 85.5 (SD 7.67)]. The mean frail index was 0.39 (SD 0.13), corresponding with moderate frailty. Up to 90% of patients presented at least one inappropriate prescription, and the mean of inappropriate prescriptions per patient was 3.14 (SD 2.27). At the three-month follow-up [mortality of 17.7% (n = 76)], the mean chronic medications per patient decreased by 17.96%, varying from 8.13 (SD 3.87) to 6.67 (SD 3.72) (p < 0.001). The medication regimen complexity index decreased by 19.03%, from 31.0 (SD 16.2) to 25.1 (SD 15.1), and the drug burden index mean decreased by 8.40%, from 1.19 (SD 0.82) to 1.09 (SD 0.82) (p < 0.001). A decrease in polypharmacy, medication regimen complexity index, and drug burden index was more frequent among frail patients, especially those with severe frailty (p < 0.001). Conclusions An individualized medication review in frail older patients, applying the Patient-Centered Prescription model, decreases pharmacological parameters related to adverse drug effects, such as polypharmacy, therapeutical complexity, and anticholinergic and, or sedative burden. The benefits are for patients with frailty.
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Affiliation(s)
- Núria Molist-Brunet
- Department of Geriatrics, Hospital Universitari de La Santa Creu de Vic, Vic, Spain. .,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.
| | - Daniel Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Pharmacy, Parc Sanitari Pere Virgili, Vic, Barcelona, Spain
| | - Emma Puigoriol-Juvanteny
- Department of Geriatrics, Hospital Universitari de La Santa Creu de Vic, Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Epidemiology, Hospital Universitari de Vic, Vic, Barcelona, Spain.,Laboratory of Tissue Repair and Regeneration (TR2Lab), University of Vic - Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de La Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain
| | - Matilde Barneto-Soto
- Department of Geriatrics, Hospital Universitari de La Santa Creu de Vic, Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
| | - Javier González-Bueno
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Pharmacy, Consorci Hospitalari de Vic, Vic, Barcelona, Spain
| | - Joan Espaulella-Panicot
- Department of Geriatrics, Hospital Universitari de La Santa Creu de Vic, Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
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Molist-Brunet N, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Bajo-Peñas L, Cantizano-Baldo I, Cabanas-Collell L, Espaulella-Panicot J. Individualized Medication Review in Older People with Multimorbidity: A Comparative Analysis between Patients Living at Home and in a Nursing Home. Int J Environ Res Public Health 2022; 19:ijerph19063423. [PMID: 35329110 PMCID: PMC8955931 DOI: 10.3390/ijerph19063423] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 01/27/2023]
Abstract
(1) Background: aging is associated with complex and dynamic changes leading to multimorbidity and, therefore, polypharmacy. A periodic medication review (MR) in frail older people leads to optimizing medication use. The aims of the study were to perform a comparative analysis of the impact of place of residence (own home versus nursing home) in a cohort of older patients on the characteristics of the baseline therapeutic plan and characteristics of the therapeutic plan after an MR; (2) Methods: Study with paired pre- and post-MR data based on person-centred prescription, with a follow-up assessment at three months. Patients who lived either in their own home or in a nursing home were recruited. We selected patients of 65 years or more with multimorbidity whose General Practitioner identified difficulties with the prescription management and the need for an MR. Each patient’s treatment was analysed by applying the Patient-Centred Prescription (PCP) model; (3) Results: 428 patients. 90% presented at least one inappropriate prescription (IP) in both settings. In nursing homes, a higher number of implemented optimization proposals was detected (81.6% versus 65.7% (p < 0.001)). After the MR, nursing-home patients had a greater decrease in their mean number of medications, polypharmacy prevalence, therapeutic complexity, and monthly drug expenditure (p < 0.001); (4) Conclusions: PCP model detected a high number of IP in both settings. However, after an individualized MR, nursing-home patients presented a greater decrease in some pharmacological parameters related to adverse events, such as polypharmacy and therapeutic complexity, compared to those living at home. Nursing homes may be regarded as a highly suitable scenario to carry out a periodic MR, due to its high prevalence of frail people and its feasibility to apply the recommendations of an MR. Prospective studies with a robust design should be performed to demonstrate this quasi-experimental study along with a longitudinal follow-up on clinical outcomes.
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Affiliation(s)
- Núria Molist-Brunet
- Geriatric Department, Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (L.B.-P.); (I.C.-B.); (J.E.-P.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic—University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
- Correspondence: ; Tel.: +34-938-833-300
| | - Daniel Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic—University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
- Pharmacy Department, Parc Sanitari Pere Virgili, 08023 Barcelona, Spain
| | - Emma Puigoriol-Juvanteny
- Epidemiology Department, Hospital Universitari de Vic, 08500 Vic, Spain;
- Tissue Repair and Regeneration Laboratory (TR2Lab), Research Group, University of Vic, 08500 Vic, Spain
| | - Lorena Bajo-Peñas
- Geriatric Department, Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (L.B.-P.); (I.C.-B.); (J.E.-P.)
| | - Immaculada Cantizano-Baldo
- Geriatric Department, Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (L.B.-P.); (I.C.-B.); (J.E.-P.)
| | | | - Joan Espaulella-Panicot
- Geriatric Department, Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (L.B.-P.); (I.C.-B.); (J.E.-P.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic—University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
- Geriatric and Palliative Care Department, Hospital Universitari de Vic, 08500 Vic, Spain
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Espaulella-Ferrer M, Espaulella-Panicot J, Noell-Boix R, Casals-Zorita M, Ferrer-Sola M, Puigoriol-Juvanteny E, Cullell-Dalmau M, Otero-Viñas M. Assessment of frailty in elderly patients attending a multidisciplinary wound care centre: a cohort study. BMC Geriatr 2021; 21:727. [PMID: 34922487 PMCID: PMC8684133 DOI: 10.1186/s12877-021-02676-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/25/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The incidence of frailty and non-healing wounds increases with patients' age. Knowledge of the relationship between frailty and wound healing progress is greatly lacking. METHODS The aim of this study is to characterize the degree of frailty in elderly patients attending a multidisciplinary wound care centres (MWCC). Additionally, we seek to assess the impact of frailty on the wound healing rate and wound healing time. An open cohort study was conducted on 51 consecutive patients aged > 70 years treated for wounds at an MWCC of an intermediate care hospital. The frailty score was determined according to the Frail-VIG index. Data were collected through patient questionnaires at the beginning of the study, and at 6 months or upon wound healing. Wounds were followed up every 2 weeks. To analyse the relationship between two variables was used the Chi-square test and Student's or the ANOVA model. The t-test for paired data was used to analyse the evolution of the frailty index during follow-up. RESULTS A total of 51 consecutive patients were included (aged 81.1 ± 6.1 years). Frailty prevalence was 74.5% according to the Frail-VIG index (47.1% mildly frail, 19.6% moderately frail, and 7.8% severely frail). Wounds healed in 69.6% of cases at 6 months. The frailty index (FI) was higher in patients with non-healing wounds in comparison with patients with healing wounds (IF 0.31 ± 0.15 vs IF 0.24 ± 0.11, p = 0.043). A strong correlation between FI and wound healing results was observed in patients with non-venous ulcers (FI 0.37 ± 0.13 vs FI 0.27 ± 0.10, p = 0.015). However, no correlation was observed in patients with venous ulcers (FI 0.17 ± 0.09 vs FI 0.19 ± 0.09, p = 0.637). Wound healing rate is statically significantly higher in non-frail patients (8.9% wound reduction/day, P25-P75 3.34-18.3%/day;AQ6 p = 0.044) in comparison with frail patients (3.26% wound reduction/day, P25-P75 0.8-8.8%/day). CONCLUSION Frailty is prevalent in elderly patients treated at an MWCC. Frailty degree is correlated with wound healing results and wound healing time.
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Affiliation(s)
- Mariona Espaulella-Ferrer
- Tissue Repair and Regeneration Laboratory (TR2Lab), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain.,Hospital Universitari de la Santa Creu de Vic, 08500, Vic, Barcelona, Spain
| | - Joan Espaulella-Panicot
- Hospital Universitari de la Santa Creu de Vic, 08500, Vic, Barcelona, Spain.,Central Catalonia Chronicity Research Group (C3RG), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain
| | - Rosa Noell-Boix
- Hospital Universitari de la Santa Creu de Vic, 08500, Vic, Barcelona, Spain.,Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), C. Sagrada Família, 7, Barcelona, 08500, Vic, Spain
| | - Marta Casals-Zorita
- Tissue Repair and Regeneration Laboratory (TR2Lab), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain.,Hospital Universitari de la Santa Creu de Vic, 08500, Vic, Barcelona, Spain
| | - Marta Ferrer-Sola
- Tissue Repair and Regeneration Laboratory (TR2Lab), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain.,Hospital Universitari de la Santa Creu de Vic, 08500, Vic, Barcelona, Spain
| | - Emma Puigoriol-Juvanteny
- Tissue Repair and Regeneration Laboratory (TR2Lab), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain.,Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain
| | - Marta Cullell-Dalmau
- Quantitative BioImaging (QuBI) Lab, University of Vic - Central University of Catalonia (UVIC-UCC), 08500, Vic, Barcelona, Spain.,Faculty of Sciences and Technology, University of Vic - Central University of Catalonia (UVIC-UCC), C. de la Laura, 13, 08500, Vic, Barcelona, Spain
| | - Marta Otero-Viñas
- Tissue Repair and Regeneration Laboratory (TR2Lab), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain. .,Faculty of Sciences and Technology, University of Vic - Central University of Catalonia (UVIC-UCC), C. de la Laura, 13, 08500, Vic, Barcelona, Spain.
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Catalán-Ibars RM, Martín-Delgado MC, Puigoriol-Juvanteny E, Zapater-Casanova E, Lopez-Alabern M, Lopera-Caballero JL, González de Velasco JP, Coll-Solà M, Juanola-Codina M, Roger-Casals N. Incidents related to critical patient safety during in-hospital transfer. Med Intensiva 2021; 46:14-22. [PMID: 34802990 DOI: 10.1016/j.medine.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN A prospective, observational and non-intervention cohort study was carried out. SETTING A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.
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Affiliation(s)
- R M Catalán-Ibars
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain; Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de Cataluña, Spain
| | - M C Martín-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid, Spain; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), Madrid, Spain.
| | - E Puigoriol-Juvanteny
- Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de Cataluña, Spain; Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - E Zapater-Casanova
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Lopez-Alabern
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - J L Lopera-Caballero
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - J P González de Velasco
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Coll-Solà
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Juanola-Codina
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - N Roger-Casals
- Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain; Facultad de Medicina, Universidad de Vic-Central de Cataluña, Spain
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7
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Molist-Brunet N, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Espaulella-Ferrer M, Amblàs-Novellas J, Espaulella-Panicot J. Factors Associated with the Detection of Inappropriate Prescriptions in Older People: A Prospective Cohort. Int J Environ Res Public Health 2021; 18:11310. [PMID: 34769827 PMCID: PMC8582657 DOI: 10.3390/ijerph182111310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/11/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022]
Abstract
(1) Background: Ageing is associated with complex and dynamic changes leading to multimorbidity and, therefore, polypharmacy. The main objectives were to study an older community-dwelling cohort, to detect inappropriate prescriptions (IP) applying the Patient-Centred Prescription model, and to evaluate the most associated factors. (2) Methods: This was a prospective, descriptive, and observational study conducted from June 2019 to October 2020 on patients ≥ 65 years with multimorbidity who lived in the community. Demographic, clinical and pharmacological data were assessed. Variables assessed were: degree of frailty, using the Frail-VIG index; therapeutical complexity and anticholinergic and sedative burden; and the number of chronic drugs to determine polypharmacy or excessive polypharmacy. Finally, a medication review was carried out through the application of the Patient-Centred Prescription model. We used univariate and multivariate regression to identify the factors associated with IP. (3) Results: We recruited 428 patients (66.6% women; mean age 85.5, SD 7.67). A total of 50.9% of them lived in a nursing home; the mean Barthel Index was 49.93 (SD 32.14), and 73.8% of patients suffered some degree of cognitive impairment. The prevalence of frailty was 92.5%. Up to 90% of patients had at least one IP. An increase in IP prevalence was detected when the Frail-VIG index increased (p < 0.05). With the multivariate model, the relationship of polypharmacy with IP detection stands out above all. (4) Conclusions: 90% of patients presented one IP or more, and this situation can be detected through the PCP model. Factors with higher association with IP were frailty and polypharmacy.
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Affiliation(s)
- Núria Molist-Brunet
- Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (M.E.-F.); (J.A.-N.); (J.E.-P.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic. University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
| | - Daniel Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic. University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
- Pharmacy Department, Parc Sanitari Pere Virgili, 08023 Barcelona, Spain
| | - Emma Puigoriol-Juvanteny
- Epidemiology department. Hospital Universitari de Vic, 08500 Vic, Spain;
- Tissue Repair and Regeneration Laboratory (TR2Lab), University of Vic-Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500 Vic, Spain
| | - Mariona Espaulella-Ferrer
- Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (M.E.-F.); (J.A.-N.); (J.E.-P.)
- Tissue Repair and Regeneration Laboratory (TR2Lab), University of Vic-Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500 Vic, Spain
| | - Jordi Amblàs-Novellas
- Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (M.E.-F.); (J.A.-N.); (J.E.-P.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic. University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
- Chair of Palliative Care, University of Vic, 08500 Vic, Spain
| | - Joan Espaulella-Panicot
- Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (M.E.-F.); (J.A.-N.); (J.E.-P.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic. University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
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8
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González-Bueno J, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Molist-Brunet N, Codina-Jané C, Espaulella-Panicot J. Factors Associated with Medication Non-Adherence among Patients with Multimorbidity and Polypharmacy Admitted to an Intermediate Care Center. Int J Environ Res Public Health 2021; 18:9606. [PMID: 34574530 PMCID: PMC8464705 DOI: 10.3390/ijerph18189606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022]
Abstract
Identifying determinants of medication non-adherence in patients with multimorbidity would provide a step forward in developing patient-centered strategies to optimize their care. Medication appropriateness has been proposed to play a major role in medication non-adherence, reinforcing the importance of interdisciplinary medication review. This study examines factors associated with medication non-adherence among older patients with multimorbidity and polypharmacy. A cross-sectional study of non-institutionalized patients aged ≥65 years with ≥2 chronic conditions and ≥5 long-term medications admitted to an intermediate care center was performed. Ninety-three patients were included (mean age 83.0 ± 6.1 years). The prevalence of non-adherence based on patients' multiple discretized proportion of days covered was 79.6% (n = 74). According to multivariable analyses, individuals with a suboptimal self-report adherence (by using the Spanish-version Adherence to Refills and Medications Scale) were more likely to be non-adherent to medications (OR = 8.99, 95% CI 2.80-28.84, p < 0.001). Having ≥3 potentially inappropriate prescribing (OR = 3.90, 95% CI 0.95-15.99, p = 0.059) was barely below the level of significance. These two factors seem to capture most of the non-adherence determinants identified in bivariate analyses, including medication burden, medication appropriateness and patients' experiences related to medication management. Thus, the relationship between patients' self-reported adherence and medication appropriateness provides a basis to implement targeted strategies to improve effective prescribing in patients with multimorbidity.
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Affiliation(s)
- Javier González-Bueno
- Pharmacy Department, Consorci Hospitalari de Vic, 08500 Barcelona, Spain;
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
| | - Daniel Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
- Pharmacy Department, Parc Sanitari Pere Virgili, 08023 Barcelona, Spain
| | - Emma Puigoriol-Juvanteny
- Epidemiology Unit, Consorci Hospitalari de Vic, 08500 Barcelona, Spain;
- Tissue Repair and Regeneration Laboratory (TR2Lab) Group, Faculty of Sciences and Technology & Faculty of Medicine, University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain
| | - Núria Molist-Brunet
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
- Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de la Santa Creu de Vic, 08500 Barcelona, Spain
| | - Carles Codina-Jané
- Pharmacy Department, Consorci Hospitalari de Vic, 08500 Barcelona, Spain;
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
| | - Joan Espaulella-Panicot
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
- Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de la Santa Creu de Vic, 08500 Barcelona, Spain
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9
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González-Bueno J, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Molist-Brunet N, Codina-Jané C, Espaulella-Panicot J. Improving medication adherence and effective prescribing through a patient-centered prescription model in patients with multimorbidity. Eur J Clin Pharmacol 2021; 78:127-137. [PMID: 34448906 DOI: 10.1007/s00228-021-03207-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to assess the impact of the patient-centered prescription (PCP) model in medication adherence and effective prescribing in patients with multimorbidity. METHODS Uncontrolled before-after study in an intermediate care facility in a mixed urban-rural district. Inpatients aged ≥ 65 years with multimorbidity exposed to polypharmacy before hospital admission were consecutively enrolled. Every patient's treatment plan was analyzed through the PCP model, which includes interventions aimed at improving medication adherence. The primary endpoint was the change in the proportion of adherent patients between pre-admission and after discharge for all regularly scheduled long-term medications, using the proportion of days covered (PDC). Secondary endpoints included the change on mean PDC for all long-term medications, number of long-term medications, proportion of patients with hyperpolypharmacy, medication regimen complexity index (MRCI) score, drug burden index (DBI) score, number of potential inappropriate prescribing (PIP), and proportion of patients with ≥ 2 PIPs. RESULTS Ninety-three non-institutionalized patients were included (mean age 83.0 ± SD 6.1 years). The proportion of adherent patients increased from 22.1 to 51.9% (P < 0.001). Intervention also improved mean PDC [mean difference (95% CI) 10.6 (7.7, 13.5)] and effective prescribing through a reduction on the number of long-term medications [- 1.3 (- 1.7, - 0.9)], proportion of patients exposed to hyperpolypharmacy (- 16.1%, P < 0.001), MRCI score [- 2.2 (- 3.4, - 1.0)], DBI score [- 0.16 (- 1.8, - 1.3)], number of PIPs [- 1.6 (- 1.8, - 1.3)], and proportion of patients with ≥ 2 PIPs (- 53.7%, P < 0.001). CONCLUSION Studied intervention provides significant effective prescribing and medication adherence enhancements in non-institutionalized older patients with multimorbidity and polypharmacy.
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Affiliation(s)
- J González-Bueno
- Pharmacy Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain. .,Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.
| | - D Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Pharmacy Department, Parc Sanitari Pere Virgili, Barcelona, Spain
| | - E Puigoriol-Juvanteny
- Epidemiology Unit, Consorci Hospitalari de Vic, Vic, Barcelona, Spain.,Tissue Repair and Regeneration Laboratory (TR2Lab) Group, Faculty of Sciences and Technology & Faculty of Medicine, University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
| | - N Molist-Brunet
- Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de La Santa Creu de Vic, Vic, Barcelona, Spain
| | - C Codina-Jané
- Pharmacy Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain.,Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
| | - J Espaulella-Panicot
- Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de La Santa Creu de Vic, Vic, Barcelona, Spain
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10
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Minaya-Freire A, Subirana-Casacuberta M, Puigoriol-Juvanteny E, Ramon-Aribau A. Pain management nursing practice assessment in older adults with dementia. Nurs Open 2021; 8:3349-3357. [PMID: 33826237 PMCID: PMC8510716 DOI: 10.1002/nop2.880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/29/2021] [Accepted: 03/21/2021] [Indexed: 01/13/2023] Open
Abstract
Aim To assess pain management nursing practice in older adults with dementia through electronic health records (EHR). Design Retrospective study. Methods Data were collected from EHR related to pain management in older adults with dementia treated at the Acute Geriatrics Unit (AGU) of a university hospital in early 2018. Results EHR related to the pain of 111 patients were reviewed. Pain intensity was assessed at admission in 88% of patients and a median of 1.9 times per day of stay. A disproportionate number of the assessments (39%) occurred during the late shift. A median of 1 drug per day was administered. Pain was recorded in 28% of patients’ care plans, and non‐pharmacological interventions were recorded in 12%. In conclusion, exist variability in pain management nursing practice in older adults with dementia. Admission diagnosis correlated with the analgesic administration schedule, the number of drugs administered and the number of pain nursing annotations.
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Affiliation(s)
- Alícia Minaya-Freire
- University Hospital Of Vic-Vic Hospital Consortium (HUV-CHV). C. Francesc Plà "El Vigatà", Vic, Barcelona, Spain.,Research Group on Methodology, Methods, Models and Health and social Outcomes (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC). C. Sagrada Família, Vic, Barcelona, Spain
| | - Mireia Subirana-Casacuberta
- Research Group on Methodology, Methods, Models and Health and social Outcomes (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC). C. Sagrada Família, Vic, Barcelona, Spain.,Nursing Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Emma Puigoriol-Juvanteny
- University Hospital Of Vic-Vic Hospital Consortium (HUV-CHV). C. Francesc Plà "El Vigatà", Vic, Barcelona, Spain.,Tissue Repair and Regeneration Laboratory (TR2Lab), Faculty of Sciences and Technology, University of Vic - Central University of Catalonia, Faculty of Medicine, University of Vic - Central University of Catalonia. C. Sagrada Família, Vic, Barcelona, Spain
| | - Anna Ramon-Aribau
- Research Group on Methodology, Methods, Models and Health and social Outcomes (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC). C. Sagrada Família, Vic, Barcelona, Spain
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11
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Molist-Brunet N, Sevilla-Sánchez D, Puigoriol-Juvanteny E, González-Bueno J, Solà-Bonada N, Cruz-Grullón M, Espaulella-Panicot J. Optimizing drug therapy in frail patients with type 2 diabetes mellitus. Aging Clin Exp Res 2020; 32:1551-1559. [PMID: 31494916 DOI: 10.1007/s40520-019-01342-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/27/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is closely linked with ageing. In frail diabetic patients, the risks of intensive antidiabetic therapy outweigh the potential benefits. AIMS To study the prevalence of T2DM in frail elderly patients, to identify inappropriate prescription (IP) of antidiabetic drugs and to study the relationship between patients' frailty index (FI) with polypharmacy and IP. METHODS This was a prospective, descriptive, observational study of elderly patients. Each patient's antidiabetic treatment was analysed by applying the patient-centred prescription model (PCP), which centres therapeutic decisions on the patient's global assessment and individual therapeutic goal. RESULTS 210 patients with T2DM were included (25.15% prevalence). They were characterised by high multimorbidity and frailty. 93.3% presented polypharmacy and 51% excessive polypharmacy. IP was identified in 66.2% of patients. A statistically significant relationship was found between the progression in FI degree and IP prevalence (p < 0.05. During the admission, drug therapy regimens were modified in 97.1% of cases with IP (n = 136). DISCUSSION These results suggest that in clinical practice T2DM treatment is not individualised, but rather is based on the same general recommendations for the population as a whole. CONCLUSIONS There is a high prevalence of T2DM in the elderly. As the frailty of patients increases, so does the prevalence of IP. The application of PCP model enables drug therapy optimization in frail patients according to their main therapeutic goal, and contributes to provide clinical evidences on the applicability of a set of knowledge areas from the theoretical framework to the daily clinical practice.
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Affiliation(s)
- N Molist-Brunet
- Hospital Universitari de la Santa Creu de Vic, Rambla Hospital, 52, 08500, Vic, Barcelona, Spain.
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Spain.
| | - D Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Spain
- Hospital Universitari de Vic, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Barcelona, Spain
| | - E Puigoriol-Juvanteny
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Spain
- Hospital Universitari de Vic, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Barcelona, Spain
| | - J González-Bueno
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Spain
- Hospital Universitari de Vic, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Barcelona, Spain
| | - N Solà-Bonada
- Hospital Universitari de Vic, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Barcelona, Spain
| | - M Cruz-Grullón
- Hospital Universitari de la Santa Creu de Vic, Rambla Hospital, 52, 08500, Vic, Barcelona, Spain
| | - J Espaulella-Panicot
- Hospital Universitari de la Santa Creu de Vic, Rambla Hospital, 52, 08500, Vic, Barcelona, Spain
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Spain
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12
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Catalán-Ibars RM, Martín-Delgado MC, Puigoriol-Juvanteny E, Zapater-Casanova E, Lopez-Alabern M, Lopera-Caballero JL, González de Velasco JP, Coll-Solà M, Juanola-Codina M, Roger-Casals N. Incidents related to critical patient safety during in-hospital transfer. Med Intensiva 2020; 46:S0210-5691(20)30215-1. [PMID: 32682510 DOI: 10.1016/j.medin.2020.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN A prospective, observational and non-intervention cohort study was carried out. SETTING A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.
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Affiliation(s)
- R M Catalán-Ibars
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España; Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de CataluñaEspaña
| | - M C Martín-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid, España; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), MadridEspaña.
| | - E Puigoriol-Juvanteny
- Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de CataluñaEspaña; Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - E Zapater-Casanova
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Lopez-Alabern
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - J L Lopera-Caballero
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - J P González de Velasco
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Coll-Solà
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Juanola-Codina
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - N Roger-Casals
- Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España; Facultad de Medicina, Universidad de Vic-Central de Cataluña, España
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13
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Solé-Casals M, Chirveches-Pérez E, Puigoriol-Juvanteny E, Nubó-Puntí N, Chabrera-Sanz C, Subirana-Casacuberta M. Profile and results of frail patient assessed by advanced practice nursing in an Emergency Department. Enferm Clin (Engl Ed) 2017; 28:365-374. [PMID: 28583833 DOI: 10.1016/j.enfcli.2017.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 04/13/2017] [Accepted: 04/15/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the profile of patients evaluated by Nurse Care Management in an Emergency Department and identify the type of alternative healthcare resource assigned and report the results of clinical practice. MATERIAL AND METHODS Prospective follow-up, on admission to the Emergency Department in an acute hospital and on discharge from the alternative healthcare resource, of patients assessed by Nurse Care Management, from July to December 2015. The patient characteristics, social environment and results of clinical practice were studied. RESULTS 190 patients were included of whom 13 were readmitted (6.8%). 122 (59.8%) cases from the Emergency Department were referred to to intermediate care facilities, 71 (34.8%) cases for domiciliary care, 10 (4.9%) cases were referred to an acute care hospital and 1 (0.5%) died. Patients referred to intermediate care were more complex, presented geriatric syndromes as their reason for admission and diagnosed with dementia, while those referred to home care presented more respiratory and cardiovascular illnesses (p <0.05). The mean Barthel Index and polypharmacy before emergency admission were higher than at the time of discharge from the alternative healthcare resource (p <0.05). CONCLUSIONS Patients presenting with advanced age, complexity, comorbidity, are referred to intermediate care facilities or domiciliary care, they are admitted to acute care hospitasl and are readmitted less than other patients. After being discharged from the alternative resource, they lose functional capacity and present less polypharmacy.
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Affiliation(s)
- Montserrat Solé-Casals
- Dirección de Enfermería, Centre Integral de Salut Cotxeres, Barcelona, España; Grupo de Investigación en "Methodology, Methods, Models and Health and Social Outcomes" (M3O), Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, España.
| | - Emilia Chirveches-Pérez
- Grupo de Investigación en "Methodology, Methods, Models and Health and Social Outcomes" (M3O), Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, España; Unidad de Epidemiología Clínica, Hospital Universitari Vic, Vic, Barcelona, España
| | | | - Núria Nubó-Puntí
- Gestión de Continuidad de Cuidados, Hospital Universitari de Vic, Vic, Barcelona, España
| | - Carolina Chabrera-Sanz
- Escola Superior de Ciències de la Salut Tecnocampus, Universitat Pompeu Fabra, Mataró, Barcelona, España
| | - Mireia Subirana-Casacuberta
- Grupo de Investigación en "Methodology, Methods, Models and Health and Social Outcomes" (M3O), Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, España; Dirección de Cuidados, Hospital Universitari de Vic, Vic, Barcelona, España
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14
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Chirveches-Pérez E, Roca-Closa J, Puigoriol-Juvanteny E, Ubeda-Bonet I, Subirana-Casacuberta M, Moreno-Casbas MT. [Care and implications for caregivers of surgical patients at home]. Enferm Clin 2014; 24:330-8. [PMID: 25240988 DOI: 10.1016/j.enfcli.2014.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/03/2014] [Accepted: 07/31/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify the care given by informal caregivers to patients who underwent abdominal surgery in the Consorci Hospitalari of Vic (Barcelona). To compare the responsibility burden for those caregivers in all the different stages of the surgical process. To determine the consequences of the care itself on the caregiver's health and to identify the factors that contribute to the need of providing care and the appearance of consequences for the caregivers in the home. METHODOLOGY A longitudinal observational study with follow-up at admission, at discharge and 10 days, of 317 non-paid caregivers of patients who suffer underwent surgery. The characteristics of caregivers and surgical patients were studied. The validated questionnaire, ICUB97-R based on the model by Virginia Henderson, was used to measure the care provided by informal caregivers and its impact on patient quality of life. RESULTS Most of the caregivers were women, with an average age of 52.9±13.7 years without any previous experience as caregivers. The greater intensity of care and impact was observed in the time when they arrived home after hospital discharge (p<0.05). The predictive variables of repercussions were being a dependent patient before the surgical intervention (β=2.93, p=0.007), having a cancer diagnosis (β=2.87, p<.001) and time dedicated to the care process (β=0.07, p=0.018). CONCLUSIONS Caregivers involved in the surgical process provide a great amount of care at home depending on the characteristics of patients they care for, and it affects their quality of life.
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Affiliation(s)
| | - Josep Roca-Closa
- Servicio de Cirugía General, Consorci Hospitalari de Vic, Vic, Barcelona, España
| | | | - Inmaculada Ubeda-Bonet
- Departamento de Salud Pública, Mental y Maternoinfantil, Universidad de Barcelona, Barcelona, España
| | | | - María Teresa Moreno-Casbas
- Unidad de Investigación en Cuidados de Salud (Investén-isciii), Instituto de Salud Carlos III, Madrid, España
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Palmarola-Ginesta J, Chirveches-Pérez E, Puigoriol-Juvanteny E, Bleda-García F, Villa-Ribas E, Arrufat-Nebot FX. [Medication adherence and use of health services in patients with psychosis in the region of Osona (Catalonia, Spain)]. Rev Enferm 2014; 37:50-57. [PMID: 24864415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To describe and analyze sociodemographic and clinical characteristics, medication adherence and use of health resources by country of birth of psychosis diagnosed patients treated with long-term antipsychotic injectable drugs in the region of Osona (Catalonia, Spain). METHOD Descriptive observational study in psychosis diagnosed patients over 18 years old, receiving long-term antipsychotic injectable treatment and treated at a Mental Health Center for adults in Vic (Catalonia, Spain). RESULTS 185 patients were included, of them: 163 (88.1%) were born in Spain and 22 (17.9%) abroad. The sample was gender homogeneous with differences in age, employment status, family situation and diagnosis (p < 0.05). Findings about medication adherence to long-term antipsychotic injectable ambulatory treatment reflected good compliance in both populations. 57.7% of Spain-born patients and 9.1% of abroad-born patients received the injectable treatment at Primary Care Center (p < 0.001). The rest of them received the treatment at Mental Health Center for adults. 22 patients (711.9%) were admitted at psychiatry hospitalization ward, 16 (9.8%) of them were born in Spain and 6 (27.3%) abroad (p = 0.012). CONCLUSIONS All patients diagnosed with psychosis, either born or not in Spain, describe good adherence to long-term antipsychotic injectable treatment, with similar use of health resources from a quantitative point of view and some differences in the type of visits.
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Chirveches-Pérez E, Roca-Closa J, Puigoriol-Juvanteny E, Pons-Baños J, Iserin-Farrés O, Fernández-Burgos P, Bisquert-Illa C, Quer-Vall X, Clotet-Argemir G, Dot-Suárez I. [Descriptive study of the results of nursing interventions applied to surgical patients]. Rev Enferm 2012; 35:22-28. [PMID: 23390873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Knowing the evolution of health outcomes of surgical patients during their hospital stay, evaluating NOC outcome criteria at admission and discharge. MATERIAL AND METHODS Prospective observational study conducted in the surgical hospital wards of the Hospital General de Vic, with patients who required surgical intervention of any specialty, of 18 or more years old and anesthetic risk levels I, II or III. The main outcome variables were indicators associates with each NOC of a standard of care based on the "patient type" concept. RESULTS Four hundred and six patients participated. Of these, 69 (15%) were operated of the musculoskeletal system and 391 (85%) were operated on the digestive or urinary systems, male/ female genitalia, skin, integuments, and endocrine system. NOC scores high of all patients were maintained or improved, never worse and in all patients the number of falls and recurrent infections was constant, virtually no patient fell or became infected. CONCLUSIONS The majority of surgical patients at the time of hospital discharge improves or maintain their conditions of admission and patients who never worse substantially.
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