Cross-sectional analysis of a cohort of people over 65 years of age living with HIV

INTRODUCTION

This study aims to describe and analyze the characteristics of aged people who are living with HIV (APHIV) and evaluate their association on the comorbidities they currently have.

METHODS

Cross-sectional analysis of APHIV under active follow-up at the Infectious Diseases Unit of the University Clinical Hospital of Santiago de Compostela. Demographic and clinical data were analyzed, along with their association with the development of comorbidities in this population. A correlation and multiple linear regression analysis were performed for this purpose.

RESULTS

Eighty-five APHIV, 65 males and 20 females, with an average age of 69 years (IQR 8) and a duration of living with HIV of 17 years (SD 7), were studied. 41% of them had their initial diagnosis with AIDS. The most common comorbidities are hypertension and dyslipidemia in 55% and 52%, respectively. 40% of APHIV take at least 5 medications. 35% have received more than 5 lines of antiretroviral treatment. At the time of analysis, all APHIV have an undetectable viral load. No significant association was observed between the number of comorbidities and various characteristics of APHIV; however, a weak correlation was noted among age, the cumulative number of antiretroviral treatments received throughout their lives, and the number of comorbidities.

CONCLUSIONS

This analysis highlights the substantial burden of comorbidities and polypharmacy experienced by APHIV. Further studies are needed to better understand the characteristics and variables influencing their development.

Cognitive and functional trajectories in geriatric outpatients after a pharmacologic multidisciplinary intervention: A study protocol

BACKGROUND

Polypharmacy is a common condition among older adults and is associated with adverse drug reactions and health outcomes, including falls, functional and cognitive impairment, and frailty.

METHODS

A prospective observational study will be conducted on older adults with polypharmacy. The aim is to assess the impact of a specialized outpatient clinic focused on pharmacotherapy optimization recently integrated into daily clinical practice in a Spanish public tertiary teaching hospital on patients' functional and cognitive abilities. Patients who attend a first consultation and meet inclusion criteria (≥75 years old, have a life expectancy≥3 months, and polypharmacy (≥5 prescribed medications) will be invited to participate in the study, until reach a calculated sample size of 104 participants. Patients will be excluded if they are enrolled in a clinical trial related to medication or in the event of a no-show or cancellation of the appointment at the first visit. Participants will receive usual care: a first consultation including multidisciplinary pharmacological optimization in the context of a CGA and subsequent face-to-face and/or telephone follow-up (∼3 and ∼6 months). The primary endpoint will be the functional (Barthel index) and cognitive change in capacities (IPCR - Índice de Incapacidad psíquica de la Cruz Roja). Secondary endpoints include medication changes, changes in patients' quality of life, rate of falling, and use of healthcare resources.

DISCUSSION

We expect that the close collaboration between professionals from different disciplines working together will be an effective strategy to improve the functional and cognitive abilities of older adults.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05408598 (March 1, 2022).

Disease-modifying treatments for patients with multiple sclerosis in Spain

Multiple sclerosis is a chronic demyelinating disease of the central nervous system and long-term disabling. Different disease-modifying treatments are available. These patients, despite being generally young, have high comorbidity and risk of polymedication due to their complex symptomatology and disability.

OBJECTIVE PRIMARY

To determine the type of disease-modifying treatment in patients seen in Spanish hospital pharmacy departments.

SECONDARY OBJECTIVES

To determine concomitant treatments, determine the prevalence of polypharmacy, identify the prevalence of interactions and analyse pharmacotherapeutic complexity.

METHOD

Observational, cross-sectional, multicentre study. All patients with a diagnosis of multiple sclerosis and active disease-modifying treatment who were seen in outpatient clinics or day hospitals during the second week of February 2021 were included. Modifying treatment, comorbidities and concomitant treatments were collected to determine multimorbidity pattern, polypharmacy, pharmacotherapeutic complexity (Medication Regimen Complexity Index) and drug-drug interactions.

RESULTS

1,407 patients from 57 centres in 15 autonomous communities were included. The most frequent form of disease presentation was the relapsing remitting form (89.3%). The most prescribed disease-modifying treatment was dimethyl fumarate (19.1%), followed by teriflunomide (14.0%). Of the parenteral disease-modifying treatments, the two most prescribed were glatiramer acetate and natalizumab with 11.1% and 10.8%. 24.7% of the patients had one comorbidity and 39.8% had at least 2 comorbidities. 13.3% belonged to at least one of the defined patterns of multimorbidity and 16.5% belonged to 2 or more patterns. The concomitant treatments prescribed were psychotropic drugs (35.5%); antiepileptic drugs (13.9%) and antihypertensive drugs and drugs for cardiovascular pathologies (12.4%). The presence of polypharmacy was 32.7% and extreme polypharmacy 8.1%. The prevalence of interactions was 14.8%. Median pharmacotherapeutic complexity was 8.0 (IQR: 3.3 -- 15.0).

CONCLUSIONS

We have described the disease-modifying treatment of patients with multiple sclerosis seen in Spanish pharmacy services and characterised concomitant treatments, the prevalence of polypharmacy, interactions, and their complexity.

[Longitudinality in Primary Care and Polypharmacy. A Systematic Review]

The aim of this work was to collect, evaluate and interpret the available evidence on the relationship between continuity in primary care (i.e., longitudinality), and the prevalence of polypharmacy and its associated problems. Following the PRISMA reporting statement, we carried out a systematic review of the literature searching PubMed and Scopus databases. The screening of titles and summaries and the review of references carried out independently by two authors detected 16 works of potential interest, of which 4 were discarded after the independent review of all the originals because they did not meet inclusion criteria. The 12 papers selected studied the relationship between Longitudinality, measured with various quantitative indices, and the rate of polypharmacy or various associated problems, such as duplicate drugs, inadequate prescriptions or drug interactions. They all showed a significant relationship, often strong (RR>2 or<0.5), between longitudinality indicators and the various dependent variables. Although our knowledge could be improved by prospective studies that more directly evaluate longitudinality and its impact on problems due to excess medication, with the existing evidence, we can affirm that the protection and promotion of continuity in primary care can be a key element for the control of polypharmacy and associated problems.

Influence of polypharmacy in the simultaneous presence of high pharmacotherapeutic complexity, drug interactions and non-adherence to medication in patients with HIV infection. Project 3-HIT

INTRODUCTION

The high pharmacotherapeutic complexity, drug interactions and lack of adherence to concomitant medication are circumstances with negative consequences in the clinical evolution of patients with HIV infection. The 3-HIT phenomenon refers to the simultaneous occurrence of these situations. The objective of the study is to determine the prevalence of the phenomenon 3-HIT in the polymedicated HIV population as well as to determine factors related to its occurrence.

METHODS

Observational, retrospective and single-center study that included all elderly patients on active antiretroviral treatment in pharmacotherapeutic follow-up between January and March 2020. A logistic regression model was carried out to evaluate the factors associated with the occurrence of the 3-HIT concept with the variables significantly associated with this phenomenon and those considered clinically relevant.

RESULTS

428 patients were included, registering a prevalence of polypharmacy in 25.9% of the study sample. The 3-HIT phenomenon was detected in 6.3% of the patients. For each concomitant drug prescribed the risk of developing the phenomenon 3-HIT increases 1.5 times.

CONCLUSION

Prevalence of the phenomenon 3-HIT is high in HIV patients with polymedication. A change in the pharmaceutical care model to a multidimensional setting is essential, together with pharmacotherapeutic optimization strategies to improve patient health outcomes.

Temporal trends in characteristics, treatment, and outcomes of heart failure in octogenarians over two decades

INTRODUCTION AND OBJECTIVES

Octogenarians represent the most rapidly expanding population segment in Europe. The prevalence of heart failure (HF) in this group exceeds 10%. We assessed changes in clinical characteristics, therapy, and 1-year outcomes over 2 decades in chronic HF outpatients aged ≥ 80 years enrolled in a nationwide cardiology registry.

METHODS

We included 2520 octogenarians with baseline echocardiographic ejection fraction measurements and available 1-year follow-up, who were recruited at 138 HF outpatient clinics (21% of national hospitals with cardiology units), across 3 enrolment periods (1999-2005, 2006-2011, 2012-2018).

RESULTS

At recruitment, over the 3 study periods, there was an increase in age, body mass index, ejection fraction, the prevalence of obesity, diabetes, dyslipidemia, pre-existing hypertension, and atrial fibrillation history. The proportion of patients with preserved ejection fraction rose from 19.4% to 32.7% (P for trend <.0001). Markers of advanced disease became less prevalent. Prescription of beta-blockers and mineralocorticoid receptor antagonists increased over time. During the 1-year follow-up, 308 patients died (12.2%) and 360 (14.3%) were admitted for cardiovascular causes; overall, 591 (23.5%) met the combined primary endpoint of all-cause mortality or cardiovascular hospitalization. On adjusted multivariable analysis, enrolment in 2006 to 2011 (HR, 0.70; 95%CI, 0.55-0.90; P=.004) and 2012 to 2018 (HR, 0.61; 95%CI, 0.47-0.79; P=.0002) carried a lower risk of the primary outcome than recruitment in 1999 to 2005.

CONCLUSIONS

Among octogenarians, over 2 decades, risk factor prevalence increased, management strategies improved, and survival remained stable, but the proportion hospitalized for cardiovascular causes declined. Despite increasing clinical complexity, in cardiology settings the burden of hospitalizations in the oldest old with chronic HF is declining.

[Deprescription in old people: It's time to take action]

El uso de fármacos conlleva innegables beneficios en las personas mayores, pero no está exento de efectos indeseables. La deprescripción es el proceso de revisión sistemática de la medicación con el objetivo de lograr la mejor relación riesgo-beneficio en base a la mejor evidencia disponible. Este proceso es especialmente importante en mayores polimedicados, sobretratados, frágiles, con enfermedades terminales y en el final de la vida.

La deprescripción debe hacerse de forma escalonada, estableciendo un seguimiento estrecho por si aparecen problemas tras la retirada. En la toma de decisiones es muy importante contar con la opinión del paciente y de los cuidadores, valorando los objetivos del tratamiento según la situación clínica, funcional y social del enfermo.

Existen múltiples herramientas para facilitar a los clínicos la tarea de seleccionar qué fármacos deprescribir (criterios Beers, STOPP-START…). Los grupos farmacológicos más susceptibles de intervención son: antihipertensivos, antidiabéticos, estatinas, benzodiacepinas, antidepresivos, anticolinérgicos, anticolinesterásicos y neurolépticos.

Prevalence of PIMDINAC criteria and associated factors in elderly HIV patients

INTRODUCTION

Aging of people living with HIV could be related to potentially inappropiate medication prescriptions, drugs interactions and lack of drugs adherence. PIMDINAC criteria seek to jointly analyze these problems. The objective of this study is to determine the prevalence of PIMDINAC criteria in an elderly HIV population.

METHODS

Observational, cross-sectional, multicenter study that included patients older than 65 years in pharmacotherapeutic follow-up between February-April 2020. The main endpoint was the percentage of PIMDINAC criteria identified in the study population.

RESULTS

Forty-seven patientes were included, identifying total PIMDINAC in 12.5%. Non-adherence to concomitant treatment was detected in 65.6% of patients, potentially inappropiate medication in 48.9% and drugs interactions in 25.2%. The number of concomitant drugs and polypharmacy were associated with a higher appearance of PIMDINAC criteria.

CONCLUSION

The prevalence of PIMDINAC criteria in elderly HIV patients is high.

[Potentially inappropriate prescribing: Usefulness of STOPP/START criteria version 2 in Catalonian elderly population]

OBJECTIVE

To measure the prevalence of potentially inappropriate prescribing (PIP) among the elderly population in Catalonia using criteria Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) version 2. In addition, to evaluate the association between PIP and several factors (polypharmacy, gender, age and sociodemographic conditions).

MATERIALS AND METHODS

Design: Retrospective cross sectional population study.

SETTINGS

Primary Health Care, Catalonia, Spain.

PARTICIPANTS

The study population comprised of participants 70 years old and over, who attended primary health care centres in Catalonia in 2014 (700.058 patients).

MAIN ANALYSIS

55 STOPP and 19 START criteria are applied to analyse PIP prevalence. Logistic regression models are adjusted to determine PIP association with several factors.

RESULTS

The mean age is 79. 2±6.5. 58.5% being female. 38.7% of patients have 7 or more prescribed drugs, whereas 50% go to a primary care centre 10 or more times during one year. The most frequent PIP among STOPP criteria are related to nonsteroidal anti-inflammatory drug intake, antiplatelet and anticoagulants use, and benzodiazepines. According to START, the most frequent omissions are vitamin D and calcium supplements, antidepressants, and cardiovascular medications. Factors that increase PIP are: female gender, living in a nursing home, receiving home health care, polypharmacy and frequent visits to primary care centres.

CONCLUSIONS

The overall prevalence of PIP is 89.6%. PPI is significantly related to certain drugs and patient's conditions. The knowledge of this association is important for the implementation of security measures for medical prescription.

Prevalence of polypharmacy and associated factors among patients living with HIV infection in Spain: The POINT study

PURPOSE

Survival in people living with HIV (PLWH) has increased and thus people are aging with HIV, increasing the frequency of multimorbidity and polypharmacy. This cross-sectional study was conducted to evaluate the prevalence of polypharmacy among PLWH who were on antiretroviral treatment and were followed in an outpatient setting by the pharmacy department of several hospitals across Spain. In addition, we aimed to evaluate factors associated with polypharmacy and treatment complexity among this population.

MATERIAL AND METHODS

We recorded information on demographic data, data on disease control including viral load and CD4 count at the time of inclusion, comorbidities, pharmacologic treatment and drugs interactions. Polypharmacy was defined as the use of 6 or more different drugs, including antiretroviral medication; major polypharmacy was defined as the use of ≥11 different drugs.

RESULTS

Overall, 1225 PLWH were eligible in the study. The median (IQR) age was 49 (40-54). Comorbidities were present in 819 (67%) PLWH and 571 (47%) had two or more comorbidities. Overall, 397 (32.4%, 95% CI 29.8-34.9) PLWH met the criteria for polypharmacy, and 67 (5.5%, 95% CI, 4.2-6.7) had major polypharmacy. Several factors were associated with polypharmacy such as type of antiretroviral treatment, presence of potential interactions, the use of several types of medications and the number of comorbidities. Treatment complexity was also a factor strongly associated with polypharmacy; for each point increase in the medication regimen complexity index (MRCI), the likelihood of polypharmacy increased 2.3-fold.

CONCLUSIONS

Polypharmacy is frequent among PLWH in Spain and contributes to a relevant extent to treatment complexity.

[Risk factors associated with emergency service re-visits in frailty diabetic patients who consult for hypoglycaemia]

INTRODUCTION AND OBJECTIVES

Emergency department (ED) visits due to hypoglycaemia are frequent in elderly patients. The main objective of the study is to evaluate the risk factors associated to ED re-visits at 90days in elderly patients who visited ED with an episode of hypoglycaemia.

MATERIAL AND METHODS

A retrospective observational study was designed, including elderly diabetic patients (>65years) attended in a fragility area of an ED for an episode of hypoglycaemia. To evaluate the risk factors associated to ED re-visits at 90days a multivariate analysis with logistic regression was performed, including those variables related to comorbidity and antidiabetic treatment with a P<0.2 in a previous univariate analysis.

RESULTS

106 patients were included. %HbA1c value was available in 87 (82.1%) patients. Ten (11.5%) patients presented a value of HbA1c ≤5.5%. Antidiabetic treatment was changed to 63 (59.4%) patients at discharge. Thirty-eight (36.1%) patients re-visited the ED at 90days, 9 for glycaemic alterations. The risk factors associated to 90days ED re-visit were: being man (OR: 3.62 [95%CI: 1.24-10.51)), treatment modified at discharge (OR: 0.31 [0.11-0.91]) and to present an HbA1c value ≤5.5% (OR: 5.33 [1.16-14.51]).

CONCLUSIONS

Fragile patients with diabetes who visit ED for hypoglycaemia present, in high frequency, HbA1c values lower than those recommended, being associated to an increase of ED re-visit risk at 90days.

[Proton-pump inhibitors treatment. Does your patient really need it?]

INTRODUCTION

Proton-pump inhibitors (PPI) are frequently prescribed for wide gastrointestinal disorders. The indications are well established, although a high rate of misuse has been reported.

METHODS

Observation cross-sectional study conducted a tertiary hospital. Adult patients who attended the emergency department were eligible. The appropriate indication was evaluated. Also, the prescription period, dosage and the prescribing clinician were reviewed.

RESULTS

300 patients were included. The indication was adequate in 142 patients (47.3%). The main indication was the primary prophylaxis for NSAIDs/ASA-induced enteropathy (n=95 patients, 31.7%). Polypharmacy was the main misuse indication (n=82 patients, 27.3%). The median prescription duration was 31 months (IQR 9-72), ranging from one month to 360 months. The duration was lower in those with correct indication (42.3 vs 59.6 months, P=.02). The primary care physician was the main responsible for prescription (n=165 patients, 55%), followed by gastroenterologist (n=38 patients, 12.7%) without significant differences in appropriateness by speciality.

CONCLUSIONS

Studies like this raise awareness about the PPI overuse and misuse. Deprescribing should be considered as essential to reduce iatrogenic risk and redundant health expenditure.

Health-related quality of life in diabetes mellitus patients in primary health care

OBJECTIVE

To analyse the relationship between health-related quality of life (HRQoL) and sociodemographic and clinical factors in patients with diabetes mellitus, also comparing with Spanish population-based reference values.

METHOD

Cross-sectional descriptive-analytical observational study through nonprobability sampling on diabetic patients from San Roque Primary Health Centre (Badajoz, Spain), using a questionnaire regarding sociodemographic and diabetes care data, SF-36 and Duke-UNC questionnaires, and clinical history data.

RESULTS

Sixty patients (55% women) fundamentally with type 2 diabetes and a mean age of 68.67 ± 11.09 years were studied. Women older than 75 presented poorer HRQoL than their reference group. Women showed worse HRQoL than men. Age, evolution of diabetes, presence of acute and chronic complications, and comorbidities, pharmacological treatment, and glycaemic control affect HRQoL in these patients. Living alone, having a low socioeconomic status, and needing help with diabetes-related self-care can negatively affect quality of life.

CONCLUSIONS

HRQoL assessment allows us to detect alterations in the different domains and perform an early intervention. This way, we can incorporate these aspects into the nursing evaluation and interventions in the nursing care plan; allowing us to develop individualized care strategies and diabetes education programmes that contribute to improving HRQoL in patients with diabetes.

[Descriptive study of delirium in the emergency department]

Objetivo

Conocer mejor las variables clínicas, funcionales y analíticas que se asocian al síndrome confusional agudo (SCA) en urgencias y la evolución de las mismas con el fin de obtener una mejora en el abordaje terapéutico del paciente anciano previniendo así la morbimortalidad en este tipo de pacientes.

Diseño

Se trata de un estudio descriptivo prospectivo de SCA en urgencias.

Emplazamiento

Hospital General Universitario de Ciudad Real.

Participantes

Se incluyó, en el intervalo de las 24 h siguientes al ingreso en el Servicio de Geriatría, a todos los pacientes procedentes del Servicio de Urgencias con diagnóstico de SCA.

Mediciones principales

Se realizó un análisis de las variables del conjunto de datos (variables sociodemográficas y clínicas), calculando tablas de frecuencias para variables de tipo cualitativo y estadísticos descriptivos para las variables cuantitativas. Posteriormente, se han empleado técnicas de inferencia estadística.

Resultados

El antecedente médico más frecuente fueron la enfermedad neurológica y la HTA, seguida de las enfermedades reumatológicas. Los motivos de consulta principales fueron el deterioro del estado general, la disnea, la disminución del nivel de consciencia y la fiebre. Se debe destacar la incidencia de la polifarmacia, especialmente de fármacos como los diuréticos, benzodiacepinas o hipnóticos. En relación con la etiología principal, destaca el papel de las infecciones de tipo urinario y respiratorio.

Conclusiones

Se destaca el papel fundamental de las enfermedades neurológicas (especialmente la demencia), la HTA, la polifarmacia (uso inadecuado de benzodiacepinas e hipnóticos) y las infecciones urinarias y respiratorias como factores tratables o prevenibles del delirium en el paciente de Atención Primaria en nuestro medio.

Prevalence of PIMDINAC criteria and associated factors in elderly HIV patients

INTRODUCTION

Aging of people living with HIV could be related to potentially inappropriate medication prescriptions, drugs interactions and lack of drugs adherence. PIMDINAC criteria seek to jointly analyze these problems. The objective of this study is to determine the prevalence of PIMDINAC criteria in an elderly HIV population.

METHODS

Observational, cross-sectional, multicenter study that included patients older than 65 years in pharmacotherapeutic follow-up between February-April 2020. The main endpoint was the percentage of PIMDINAC criteria identified in the study population.

RESULTS

Forty-seven patientes were included, identifying total PIMDINAC in 12.5%. Non-adherence to concomitant treatment was detected in 65.6% of patients, potentially inappropriate medication in 48.9% and drugs interactions in 25.2%. The number of concomitant drugs and polypharmacy were associated with a higher appearance of PIMDINAC criteria.

CONCLUSION

The prevalence of PIMDINAC criteria in elderly HIV patients is high.

Prevalence of polypharmacy and associated factors among patients living with HIV infection in Spain: The POINT study

PURPOSE

Survival in people living with HIV (PLWH) has increased and thus people are aging with HIV, increasing the frequency of multimorbidity and polypharmacy. This cross-sectional study was conducted to evaluate the prevalence of polypharmacy among PLWH who were on antiretroviral treatment and were followed in an outpatient setting by the pharmacy department of several hospitals across Spain. In addition, we aimed to evaluate factors associated with polypharmacy and treatment complexity among this population.

MATERIAL AND METHODS

We recorded information on demographic data, data on disease control including viral load and CD4 count at the time of inclusion, comorbidities, pharmacologic treatment and drugs interactions. Polypharmacy was defined as the use of 6 or more different drugs, including antiretroviral medication; major polypharmacy was defined as the use of ≥11 different drugs.

RESULTS

Overall, 1225 PLWH were eligible in the study. The median (IQR) age was 49 (40-54). Comorbidities were present in 819 (67%) PLWH and 571 (47%) had two or more comorbidities. Overall, 397 (32.4%, 95% CI 29.8-34.9) PLWH met the criteria for polypharmacy, and 67 (5.5%, 95% CI, 4.2-6.7) had major polypharmacy. Several factors were associated with polypharmacy such as type of antiretroviral treatment, presence of potential interactions, the use of several types of medications and the number of comorbidities. Treatment complexity was also a factor strongly associated with polypharmacy; for each point increase in the medication regimen complexity index (MRCI), the likelihood of polypharmacy increased 2.3-fold.

CONCLUSIONS

Polypharmacy is frequent among PLWH in Spain and contributes to a relevant extent to treatment complexity.

Anticholinergic burden in patients treated for constipation in an emergency department

OBJECTIVES

To evaluate the anticholinergic burden on discharge of patients treated for constipation in an emergency department (ED) and to assess the effect on emergency revisiting within 30 days.

MATERIAL AND METHODS

Observational retrospective cohort study. We collected cases with a discharge diagnosis of constipation after ED treatment between September 2018 and June 2019 and recorded information on all drugs taken and the anticholinergic burden of treatment. A revisit to the ED within 30 days was the primary outcome.

RESULTS

We included 104 patients. A high anticholinergic burden of treatment was identified in 47 (56.6%), an intermediate burden in 30 (36.1%), and a low burden in 6 (7.2%). Twenty-nine (27.9%) patients revisited the ED within 30 days of discharge. An intermediate anticholinergic burden (23 patients [31.1%] vs 4 [13.3%]; P = .061) and high burden (19 [40.4%] vs 8 [14.1%]; P = .002] was associated with revisiting within 30 days in the univariate analysis. On multivariate analysis, a high anticholinergic burden was independently associated with a higher rate of revisiting than a low burden: adjusted odds ratio (aOR), 4.21; 95% CI, 1.07-16.5; P = .039. An intermediate load was not associated with more revisits, however: aOR, 1.27; 95% CI, 0.25-6.41; P = .776. Prescription of long-term treatment with laxatives on discharge did not reduce revisiting withing 30-days in the group with a high anticholinergic load (OR, 0.86; 95% CI, 0.48-3.27; P = .526), but it did have an effect in patients an intermediate burden (OR, 0.13; 95% CI, 0.02-0.99; P = .049).

CONCLUSION

The prescription of drugs leading to a high anticholinergic burden was a factor associated with ED revisits within 30 days in patients treated for constipation.

Integrated health intervention on polypharmacy and inappropriate prescribing in elderly people with multimorbidity: Results at the end of the intervention and at 6 months after the intervention

BACKGROUND AND OBJECTIVE

To analyse the impact of an integrated health intervention focused on polypharmacy and inappropriate prescribing (IP) in elderly people with multimorbidity.

MATERIAL AND METHODS

Patients were referred for assessment and intervention from primary care or hospital to an interdisciplinary team composed of primary and hospital medical staff and nurses. Pharmacological assessment was centred on polypharmacy and IP using the STOPP/START criteria. Changes in polypharmacy and in IP were analysed at the end of the intervention and at 6 months.

RESULTS

One hundred consecutive patients (mean (SD) age 81.5(8.0) years, 54(54%) male) were analysed. Mean prescribed medicines at baseline was > 10. There were no significant changes at the end of the intervention and at 6 months. The proportion of patients with two or more STOPP criteria reduced from 37% at the beginning of the intervention to 18% at the end (p< .001), and the proportion of those with START criteria from 13% to 6% (p = .004). These differences persisted at 6 months. The number of STOPP and START criteria before the intervention was associated with a decrease in the STOPP and START criteria at the end of the intervention and at 6 months. A reduction in polypharmacy (p= .041) and in falls (p= .034) was observed at 6 months in those with a decrease in the STOPP criteria at the end of the intervention.

CONCLUSIONS

An integrated health intervention centred on polypharmacy and IP in elderly people improves inappropriate prescribing that persists beyond the intervention.

Seriousness of medication reconciliation errors in patients of advanced age in the emergency department

OBJECTIVES

To analyze the seriousness of medication reconciliation errors (MREs) in the treatment of older patients admitted to an emergency department's acute geriatric unit. To identify and describe discrepancies, including the drug groups involved, and to explore risk factors.

MATERIAL AND METHODS

Prospective, observational 6-month study. A pharmacist recorded medications in each patient's history and compared the patient's usual treatment to the regimen prescribed in the emergency department; discrepancies were flagged for evaluation as possible MREs. A geriatric medicine specialist evaluated MRE seriousness.

RESULTS

Three hundred twenty-eight discrepancies were detected (93.8% of the total of 351 patients); 151 patients (43.02%) had at least 1 MRE. Three hundred MREs were identified, 248 (82.7%) reached the patient, and 27 (9%) caused reversible injury. No errors led to prolonged injury or death.

CONCLUSION

MREs were common but not serious, and the injuries caused were reversible.

[Usefulness of the summary of product characteristics as a tool to improve prescription in elderly patients]

BACKGROUND AND OBJECTIVE

The Drug Technical Data Sheet should contribute to a safe and effective use of medications in the elderly, providing accurate information on the prescription, on the possible benefits or risks of the medications, or failing that, communicating the lack of information on their use in this group. The aim of this article was to quantify the specific information for people over 65 years of age included in the data sheets of the drugs available in Spain, and enables an adequate prescription in this population.

MATERIALS AND METHODS

A multidisciplinary group reviewed all the Technical Data Sheets of drugs approved by the Spanish Agency for Medicines and Health Devices (AEMPS). The quality of the information was classified into 4 categories: information specifically referring to the population over 65 years old; information specifically referring to the population over 80 years old; recommendations not specific to the elderly; and specific information for the elderly.

RESULTS

A total of 1,462 Technical Sheets were reviewed, of which 48% had information regarding prescription in the elderly. Information on the use in patients over 80 years old was present in 1.23% of the sheets. Only 6.83% of all the sheets reviewed included specific recommendations for the elderly.

CONCLUSIONS

There is little specific information regarding prescription in the elderly in the technical data sheets of drugs prescribed/sold in Spain. To improve knowledge in this field, data must be provided in the sheets that are based on the scientific literature, clinical trials for the elderly, or pharmacovigilance studies focused on this population.

Effect on the adherence to concomitant medications after initiation of treatment with direct-acting antiviral agents against hepatitis C virus

INTRODUCTION

Many patients with hepatitis C virus (HCV) have associated comorbidities that require complex treatments. We sought to determine the impact of treatment with direct-acting antiviral agents (DAAs) for HCV on adherence to prescribed concomitant medications for associated comorbidities and to identify predictors of non-adherence to comedications.

PATIENTS AND METHODS

HCV-infected patients treated with DAAs in a Spanish hospital between January 2015 and December 2016 and followed-up by the pharmacy unit were included in the study. Adherence to concomitant comedication prescribed before and during HCV therapy with DAAs was compared to adherence during the same number of weeks before DAA initiation. Demographic, clinical and pharmacotherapy variables were analyzed to determine factors associated with non-adherence. A multivariate regression model was created for prediction of non-adherence to concomitant medication.

RESULTS

Data from 214 patients using prescribed concomitant therapies were analyzed. Significant reduction on adherence to comedications was observed after initiation of DAA treatment compared with a similar period before therapy initiation (29.9% vs. 36.9%, p=0.032). The univariate analysis showed that polypharmacy and presence of vascular disease were associated negatively with adherence to concomitant medications (87.8%, p=0.006 and 84.7%, p<0.001, respectively). Multivariate analysis indicated that HIV/HBV coinfection was associated with adherence (OR 0.19; 95% CI 0.09-0.39), while polypharmacy was a predictor for non-adherence (OR 4.54; 95% CI 1.48-13.92).

DISCUSSION

Adherence to concomitant medications decreases in HCV-infected patients when DAA therapy is initiated. Polypharmacy is a predictor for non-adherence, while HIV/HBV coinfection reduce non-adherence rates. Polymedicated patients on DAAs might benefit from close follow-up and educational programmes to improve their adherence.

[Very elderly institutionalised population of Barcelona: Evaluation of frailty according to the Frail-VIG index and analysis of therapeutic appropriateness according to the STOPP-frail criteria]

INTRODUCTION

As frailty and multiple drug therapy often coexists in institutionalised elderly patients, it is important to assess the level of frailty and therapeutic appropriateness in this population group. The aim of the study is to: assess the frailty level of institutionalised elderly patients and to analyse their prescriptions.

MATERIAL AND METHODS

An observational and cross-sectional study of a geriatric population of 85 years or older, institutionalised in a nursing home in Barcelona. Frailty was assessed using the Frail-VIG index, and the adequacy of the prescription of each group was done according to the STOPP-Frail Criteria.

RESULTS

The study included 79 patients, with a mean age of 90.9±4.2 years. Most of them (96.2%) had some degree of frailty. Slight frailty was observed in 21.5%, moderate in 37.7%, and advanced in 38%. The patients were prescribed a median of 7 drugs. No statistically significant differences were found in the majority of the prescriptions of the frailty groups. Differences were only found for those who had difficulty taking the medication, those who took medication for prostatic hypertrophy, and nutritional supplements. In all 3 groups, it was found that up to one third of the prescription was inappropriate, and some were even contraindicated in the most frail patients.

CONCLUSION

The elderly study population has a high frailty index with a high prevalence of multiple drug therapy with inappropriate prescription. The poor individualisation of these prescriptions in relation to the level of frailty, especially in those with short life prognosis, is a situation that should be improved.

[Inappropriate drug use in palliative care: SPANISH version of the STOPP-Frail criteria (STOPP-Pal)]

Multiple medication and inappropriate drug prescription are prevalent and challenging problems in older patients in end-of-life situations, and increases both preventable adverse events and health care costs. Recent literature recommends de-prescribing some drugs in patients with short life expectancy, when the aim of drug treatments is not prevention or cure, but symptom control. Recently, a list of explicit criteria (STOPP-Frail) intended to guide prescribing physicians in decision making on the use of drugs in older patients with terminal conditions. This article presents a Spanish version of such criteria, which have been named STOPP-Pal to avoid confusion with the current concept of frailty.

[Severe methotrexate toxicity in elderly: 7 years experience]

Methotrexate is one of the most widely used drugs in rheumatology due to its high efficacy-to-toxicity. However, patients treated with this drug are sometimes elderly, which increases toxicity risks, as well as mistakes in taking the medication. The case is presented of an 87 year-old patient, on multiple medications, with a history of cognitive impairment and low social support, who suffered acute methotrexate toxicity. A description is also presented on the characteristics of the toxicity cases due this drug admitted to this hospital in the last 7 years.

Adherence to treatment of hypertension, hypercholesterolaemia and diabetes in an elderly population of a Spanish cohort

BACKGROUND AND OBJECTIVE

Sub-optimal adherence to treatment in the general population has been highlighted in several studies, especially in the elderly and/or chronic patients. This study aims to describe the adherence to treatment of diabetes mellitus, dyslipidaemia and hypertension, and to identify the factors that influence adherence.

MATERIAL AND METHOD

Retrospective, cross-sectional observational study on 16,208 patients aged ≥65 years from the EpiChron Cohort who initiated monotherapy treatment of an antidiabetic, a lipid-lowering or an antihypertensive medication in 2010. Adherence was measured by calculating the medication possession ratio during one year, considering those cases with medication possession ratio ≥80% to be adherent. We performed a descriptive study, and a logistic regression model was used to identify the predictors of low adherence.

RESULTS

Adherence to antidiabetics, antihypertensive and lipid-lowering drugs was 72.4%, 50.7% and 44.3%, respectively. An increase in adherence of 3-8% was observed for each additional chronic disease suffered by the patient. The presence of mental illness did not affect adherence, and sex, age and number of prescribed drugs did not present consistent effects.

CONCLUSION

The results obtained show a sub-optimal adherence to treatment for the 3chronic diseases studied. Adherence increased with the number of chronic diseases, while sex, age and number of drugs did not show a consistent effect. It is necessary to investigate if there are other factors that may influence therapeutic adherence, since improving adherence may have a greater impact on health than any progress in therapies.

[Evaluation of an educational intervention and a structured review of polypharmacy in elderly patients in Primary Care]

BACKGROUND AND OBJECTIVE

Several interventions have been shown to reduce polypharmacy and potentially inappropriate prescription (PIP). The objective of the study was to evaluate the number of drugs and PIP before and after an educational intervention with the Primary Care physician (PCP), with electronic identification of PIP and structured medication review, in elderly patients with excessive polypharmacy (≥10 drugs).

MATERIAL AND METHODS

A before-after intervention study was conducted in the Gipuzkoa district of Osakidetza (Basque Country Health System), in a random sample of patients older than 80 years taking ≥ 10 drugs, and whose PCP attended training sessions. Primary outcomes: change in the number of drugs and PIP, registered in computerised health records.

SECONDARY OUTCOMES

benefit/risk ratio assessed by the PCP, safety problems, and therapeutic decision.

RESULTS

Of the 591 eligible patients, 88 were excluded (41: PCP did not attend training sessions, 47: death/transfer/admission), including a total of 503 patients with mean age of 84.9 years, with 67.7% women. The mean number of drugs and PIP per patient decreased significantly, -0.88 (95% CI: -1.04 to -0.72) and -0.19 (95% CI: -0.29 to -0.09), respectively (p<.0001), with a 25.8% reduction in the number of patients with excessive polypharmacy.

SECONDARY OUTCOMES

data collection sheets of 365 patients and 4,168 prescriptions were collected. The benefit-risk ratio was favourable for 75% of the prescriptions, with the most frequent decision being to maintain them (83%). Among the 911 prescriptions with an unfavourable/uncertain benefit/risk ratio, 47.3% were maintained.

CONCLUSIONS

The intervention is associated with a reduction in excessive polypharmacy and PPI under real-world conditions.

Anticholinergic drugs and cognitive impairment in the elderly

OBJECTIVE

Describe the prevalence of the anticholinergic drugs (AD) used in patients who consult in regard to loss of memory. Assess the cognitive and functional repercussion of these drugs.

PATIENTS AND METHODS

Retrospective review of the clinic history of the patients who consulted the clinic in 2015 and 2016. We used the Anticholinergic Cognitive Burden Scale. We explored cognition with the Mini Mental State Examination (MMSE) and function with the Barthel Index and the Lawton and Brody Scale. We compared the difference of scale scores between the patients exposed and not exposed to AD.

RESULTS

Sample size of 610 patients (mean age=81.1years), 71% female. 37.2% of patients took AD. The mean (SD) difference between exposed and not exposed patients and the year-on-year worsening rate of the Barthel Index and the Lawton and Brody Scale and MMSE were -4 (4.5), -0.3 (0.4) and -1 (0.9), respectively.

CONCLUSIONS

One third of patients who consulted for cognitive loss are taking AD. Patients exposed to AD show a greater tendency to impairment.

Reduction of pharmaceutical expenditure by a drug appropriateness intervention in polymedicated elderly subjects in Catalonia (Spain)

OBJECTIVE

To assess the monetary savings resulting from a pharmacist intervention on the appropriateness of prescribed drugs in community-dwelling polymedicated (≥8 drugs) elderly people (≥70 years).

METHOD

An evaluation of pharmaceutical expenditure reduction was performed within a randomised, multicentre clinical trial. The study intervention consisted of a pharmacist evaluation of all drugs prescribed to each patient using the "Good Palliative-Geriatric Practice" algorithm and the "Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment" criteria (STOPP/START). The control group followed the routine standard of care. A time horizon of one year was considered and cost elements included human resources and drug expenditure.

RESULTS

490 patients (245 in each group) were analysed. Both groups experienced a decrease in drug expenditure 12 months after the study started, but this decrease was significantly higher in the intervention group than in the control group (-14.3% vs.-7.7%; p=0.041). Total annual drug expenditure decreased 233.75 €/patient (95% confidence interval [95%CI]: 169.83-297.67) in the intervention group and 169.40 €/patient (95%CI: 103.37-235.43) in the control group over a one-year period, indicating that 64.30 € would be the drug expenditure savings per patient a year attributable to the study intervention. The estimated return per Euro invested in the programme would be 2.38 € per patient a year on average.

CONCLUSIONS

The study intervention is a cost-effective alternative to standard care that could generate a positive return of investment.

[Patient-centred prescription model to improve adequate prescription and therapeutic adherence in patients with multiple disorders]

Patients with multiple disorders and on multiple medication are often associated with clinical complexity, defined as a situation of uncertainty conditioned by difficulties in establishing a situational diagnosis and decision-making. The patient-centred care approach in this population group seems to be one of the best therapeutic options. In this context, the preparation of an individualised therapeutic plan is the most relevant practical element, where the pharmacological plan maintains an important role. There has recently been a significant increase in knowledge in the area of adequacy of prescription and adherence. In this context, we must find a model must be found that incorporates this knowledge into clinical practice by the professionals. Person-centred prescription is a medication review model that includes different strategies in a single intervention. It is performed by a multidisciplinary team, and allows them to adapt the pharmacological plan of patients with clinical complexity.

[Identifying potentially inappropriate prescriptions in patients over 65 years-old using original Beers criteria and their Spanish adaptation]

OBJECTIVE

To compare the detection of potentially inappropriate medication (PIM) using the original Beers criteria, a global reference for evaluating prescriptions in the elderly, and their Spanish version.

DESIGN

Retrospective observational study LOCATION: A Primary Care area in the province of Murcia, Spain.

PARTICIPANTS

A total of 7,856 subjects aged 65 and over, with at least one drug prescribed in a Primary Care Area of Spain during study period.

METHOD

Illnesses and treatments registered in the Primary Care computerised medical history of patients were analysed during a 12month study period (2012). The original Beers criteria and their Spanish adaptation were used to evaluate PIM, considering both sets of criteria overall, and individually.

RESULTS

The median age of the patients was 76.0years, with the majority females (56.6%). Patients received a median of 13 active substances and 66 medical prescriptions. The percentage of patients prescribed PIM ranged from 44.8% according to the original Beers criteria to 49.4% with the Spanish adaptation.

CONCLUSIONS

PIMs are frequent in our context. The original Beers criteria, if not adapted to the local drug catalogue, underestimated the frequency of PIM in the elderly population studied.

Polypathology, polypharmacy, medication regimen complexity and drug therapy appropriateness

Polypathological patients are usually elderly and take numerous drugs. Polypharmacy affects 85% of these individuals and is not associated with greater survival. On the contrary, polypharmacy exposes these individuals to more adverse effects, such as weight loss, falls, functional and cognitive impairment and hospitalisations. The complexity of a drug regimen covers more aspects than the simple number of drugs consumed. The galenic form, the dosage and the method for preparing the drug can impede the understanding of and compliance with prescriptions. Both polypharmacy and therapeutic complexity are associated with poorer adherence by patients. To prevent polypharmacy, reduce complexity and improve adherence, the appropriate use of drugs is needed. Proper prescribing consists of selecting drugs that have clear evidence for their use in the indication, which are appropriate for the patient's circumstances, are well tolerated and cost-effective and whose benefits outweigh the risks. To improve the drug prescription, periodic reviews of the drugs need to be conducted, especially when the patient changes doctor and during healthcare transitions. The Beers and STOPP/START (Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria are effective tools for this improvement. Deprescription for polymedicated polypathological patients that considers their clinical circumstances, prognosis and preferences can contribute to a more appropriate use of drugs.

[Prevalence of polypharmacy among the population older than 65 years in Spain: Analysis of the 2006 and 2011/12 National Health Surveys]

INTRODUCTION

Polypharmacy in older people is the result of several inter-connected factors, and is very common despite the associated risks. Not many population-based studies have been conducted in Spain to ascertain the magnitude of polypharmacy in this population.

MATERIAL AND METHODS

A descriptive, cross-sectional study was conducted with individualised data for non-institutionalised older people (65 or older) of both sexes from the Spanish National Health Surveys (SNHS) 2006 (N=7,835) and 2011/12 (N=5,896). The prevalence of polypharmacy (use of 4 or more drugs within the 2 weeks preceding the survey) was ascertained for the 2 surveys used, as well as by sex and age groups. The prevalence of use of the different drug groups was also estimated in the elderly who used polypharmacy.

RESULTS

Polypharmacy occurred in about a third of the older people in the 2006 SNHS (32.54%), and was significantly higher in the 2011/12 SNHS (36.37%) (P<.05). In both surveys, the prevalence of polypharmacy was higher in women than men and among the older individuals (≥85 years) compared to the less old. The type of drugs most commonly used were analgesics (2006 SNHS: 71.93%, 2011/12 SNHS: 76.27%; P<.05), and antihypertensive drugs 2006 SNHS: 70.26%, 2011/12 SNHS: 78.10%; P<.05).

CONCLUSIONS

The magnitude of polypharmacy is considerable in older people and increasing over time. Further research on this issue is needed to identify those individuals who are at higher risk of using multiple drugs concomitantly.

[Implantation of a program for polymedicated patients within the framework of the Galician Strategy for Integrated Chronic Care]

INTRODUCTION

A total of 22.8% of citizens in Galicia are older than 65 years and, compared with the Spanish population as a whole, they represent a more elderly population with a higher prevalence of chronic diseases. The SERGAS 2014 strategy and the Galician Strategy for Integrated Chronic Care envision the development of a specific program to improve the health and quality of life of older polymedicated patients.

AIM

To describe the program for the improvement of the quality of care of chronic polymedicated patients, as well as the initial results after its implantation.

RESULTS

A pilot program was started in 11 health centers in April 2011. The program was progressively developed, until reaching 100% implantation in 480 health centers and consulting rooms in Galicia. The initial target population consisted of patients chronically taking more than 15 prescribed medications. By 31 December 2013, 20,319 patients were included in the program, representing 88% of the population taking more than 12 medications. The demographic pattern consisted mainly of women (60%) older than 70 years (70%). Evaluation of the results obtained by reviewing the medication and interventions performed in the patients included since the start of the program showed a reduction of 47%, 32.7% and 22% in the number of patients with > 15, > 12 and > 10 chronically prescribed medications, respectively. The primary care pharmacist proposed at least one intervention in 72% of the patients, and > 1 START criterion (Screening Tool to Alert doctors to Right Treatment) was detected in 6% and > 1 STOPP criterion (Screening Tool of Older Persons' Prescriptions) in 27% of the patients. A total of 35% of the patients included had a nursing medication review (7,092 reports).

CONCLUSIONS

The program to improve the quality of care provided to chronic polymedicated patients in Galicia is a timely and necessary initiative, given the high percentage of the population with multiple comorbidities receiving polymediation. The program has clear benefits: the quality of prescription and patient safety improved due to the reduction in the number of medications administered and the detection of potentially inappropriate prescriptions.

[Potentially inappropriate prescribing in older Spanish population according to STOPP/START criteria (STARTREC study)]

Objetivo

Racionalizar la prescripción en la población anciana es una prioridad de los sistemas sanitarios. Los criterios STOPP/START permiten detectar la prescripción potencialmente inadecuada (PPI) a nivel individual. Su aplicación a nivel poblacional permite determinar la prevalencia de PPI y su relación con diversas variables del paciente y del sistema sanitario. El objetivo de este estudio es analizar la prevalencia de PPI en población anciana a partir de bases de datos clínicos y de farmacia.

Diseño

Estudio descriptivo transversal.

Emplazamiento

Ámbito de atención primaria de la Región Sanitaria de Lleida, España.

Participantes

Se incluyen 45.408 pacientes de 70 años o más atendidos en los centros de salud como mínimo una vez en el último año.

Mediciones principales

Se calcula la frecuencia de incumplimiento de 43 indicadores STOPP y 12 indicadores START, a partir de los fármacos prescritos durante un año y se ajustan modelos de regresión logística para evaluar su asociación con diversas variables.

Resultados

El 58% son mujeres. La edad media es de 79,7 años. El 58,1% incumplen como mínimo un criterio STOPP y/o START, relacionados principalmente con el uso de benzodiacepinas, antiinflamatorios no esteroideos e inhibidores de la bomba de protones por exceso, y los tratamientos para la osteoporosis, antiagregantes, estatinas, metformina y betabloqueantes por omisión. La PPI aumenta con la edad y la polifarmacia y es superior en pacientes ingresados en centros geriátricos y domiciliarios que en los ambulatorios.

Conclusiones

Los criterios STOPP/START identifican PPI en más de la mitad de pacientes ancianos de una región sanitaria española.

[Interventions to optimize pharmacologic treatment in hospitalized older adults: a systematic review]

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.

[Drug related colonic perforation: Case report]

BACKGROUND

Acute pseudo-obstruction of the colon is a disorder characterised by an increase in intra-luminal pressure that leads to ischaemia and necrosis of the intestinal wall. The mechanism that produces the lesion is unknown, although it has been associated with: trauma, anaesthesia, or drugs that alter the autonomic nervous system. The pathophysiology of medication induced colon toxicity can progress to a perforated colon and potentially death.

OBJECTIVE

Present a case of a colonic pseudo-obstruction in a patient with polypharmacy as the only risk factor and to review the medical literature related to the treatment of this pathology.

CLINICAL CASE

The case is presented of a 67 year old woman with colonic pseudo-obstruction who presented with diffuse abdominal pain and distension. The pain progressed and reached an intensity of 8/10, and was accompanied by fever and tachycardia. There was evidence of free intraperitoneal air in the radiological studies. The only risk factor was the use of multiple drugs. The colonic pseudo-obstruction progressed to intestinal perforation, requiring surgical treatment, which resolved the problem successfully.

CONCLUSION

It is important to consider drug interaction in patients with multiple diseases, as it may develop complications that can be avoided if detected on time.

[Potentially inappropriate prescription according to the "STOPP" Criteria in heavily polymedicated elderly patients]

INTRODUCTION

Appropriate prescribing is especially relevant in elderly people. The objective of this study is to analyse the potentially inappropriate prescription (PIP) in heavily polymedicated elderly patients according to the criteria Screening Tool of Older Person's Prescriptions.

PATIENTS AND METHODS

A descriptive cross-sectional study was conducted in Primary Care on patients assigned to the Siero-Sariego (Asturias) Health Centre, who were over 64 years old and heavily polymedicated (consumption >10 drugs for six months). The 65 Screening Tool of Older Person's Prescriptions criteria were reviewed in the electronic Primary Care patient records, collecting sociodemographic variables, prescribed medications, and chronic diseases. Frequency distributions were made for each criterion, and causes related to PIP were explored using contingency tables, the Spearman correlation coefficient, and logistic regression.

RESULTS

A total of 349 polymedicated elderly patients were analysed with a prevalence of 6.4 (95% CI:5.76-7.08), a mean age of 79.2 years (SD:3.7), 62.2% were female, 14% institutionalised, a Charlson index of 2.9. The mean of number of drugs was 11.5 (SD:1.7), and the most frequent pathologies were high blood pressure (64%), diabetes (46%), and osteoarticular diseases (41%). There was at least one PIP in 72.9% of heavily polymedicated elderly patients [(Mean: 1.32 (SD:1.2)]. The Screening Tool of Older Person's Prescriptions criteria least complied with were: therapeutic duplication (25.2%), use of long-acting benzodiazepines (15.8%), and inappropriate use of aspirin (10.9%). An association was found between having any inappropriate prescription and the number of medications prescribed (OR=1.22 [95% CI:1.04-1.43]) and inversely to the Charlson index (OR=0.76 [95% CI:0.65-0.89]).

CONCLUSIONS

PIP is common in heavily polymedicated elderly patients. Special attention must be paid to the use of psychotropic drugs, which are implicated in a high volume of PIP.

[Benzodiazepine prescription in the elderly in different health care levels: characteristics and related factors]

OBJECTIVES

To determine the prevalence of benzodiazepine (BZD) prescription and the factors related to prescribing them in the elderly in the community, in an acute general hospital (AH) and in a convalescence geriatric unit (CGU).

MATERIAL AND METHODS

Retrospective study of 334 CGU inpatients discharged from an AH. A comprehensive geriatric assessment included functional and cognitive evaluation before hospitalization, at admission and at discharge from CGU (Barthel index, Lawton index and Folstein Mini-Mental State Examination), as well as comorbidity (Charlson index), polypharmacy and social situation. The percentage of benzodiazepine prescriptions at the different healthcare levels was compared and their related factors were evaluated (Chi-squared test).

RESULTS

The prevalence of benzodiazepine prescriptions in the community was 23.6%, and being female and polypharmacy were related factors to prescribing at this level. During AH admission, this proportion increased up to 38.6%, and after CGU admission decreased to 21.,9%. Factors related to prescription in AH were, being female, polypharmacy and osteoarticular-fracture related diagnosis, and in CGU, being female and polypharmacy.

CONCLUSIONS

The prevalence of benzodiazepine prescribing was high among elderly people at every healthcare level (community, AH and CGU), and polypharmacy was one of the significant factors associated with prescribing. This prescribing was increased during AH admission due to a medical or surgical process.

[Relationship of polymedication in controlling blood pressure: compliance, persistence, costs and incidence of new cardiovascular events]

BACKGROUND AND OBJECTIVE

To determine the relationship of polypharmacy on blood pressure (BP) control, compliance, persistence, the cost and incidence of cardiovascular events (CVD) in patients with moderate/severe hypertension.

PATIENTS AND METHODS

An observational multicenter retrospective study. We evaluated patients > 30 years who started a third antihypertensive treatment during 2004-2006. Depending on the number of chronic medications, we established 3 groups: regular consumption of 3-6 drugs, including between 7-10 and ≥ 11. Top-measures: sociodemographic, comorbidity, BP, compliance and persistence. For each group we determined the incidence of new CVD totals and total costs.

RESULTS

We evaluated 1,906 patients, 765 between 3-6 drugs, 624 between 7-10 and 517 in ≥ 11 (P<.001). Overage age: 69.4 years and 55.5% women. The group of 3-6 drugs showed better BP control (51.8 vs. 47.0 and 41.1%, P<.001), compliance (71.4 vs. 69.9 and 67.1%, P=.017), persistence (50.1 vs. 45.5 and 46.2%, P=.044) and lower incidence of CVD (12.2 vs. 19.7 and 30.2%, P<.001), respectively. The average/unit total costs was 3,369.1 vs. 4,362.1 and € 4,902.3 (P<.001). The presence of CVD was associated with therapy noncompliance (odds ratio [OR] 1.9, 95% confidence interval [95%CI] 1.1 to 3.6) and controlled by the lower BP control (OR 1.4 (95%CI 1.1-2.0) (P < .05). The use of antihypertensive fixed dose has greater compliance (72.8 vs. 68.2%), persistence (64.4 vs. 39.3%) and degree of BP control (52.6 vs. 43, 8%) (p<.001).

CONCLUSIONS

Polypharmacy is associated with lower compliance and persistence to antihypertensive treatment, cardiovascular disease and increased health care costs.