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Torijano Casalengua ML, Calvo Pita C, Maderuelo-Fernández JÁ. [A safe use of medications in Primary Care, in COVID-19 pandemic as well]. Aten Primaria 2021; 53 Suppl 1:102223. [PMID: 34961581 DOI: 10.1016/j.aprim.2021.102223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/21/2022] Open
Abstract
The third Global Patient Safety Challenge, Medication Without Harm, was launched in 2017 by the World Health Organization with the goal of reducing the already well-known severe preventable medication-related harm by 50% over the next 5 years. Nothing suggested that, two years later, the world would suffer a terrible pandemic, which has been a much greater challenge than the aforementioned one and that would put it to test from the first stages of the medication use process. The rapid pace imposed by the pandemic has created new risks in the use of medication in those affected by COVID-19 and in the population due to organizational changes in the provision of health care in health services. Therefore, prudent prescribing is becoming more important than ever in health systems. This article aims to analyze the main risks produced during the pandemic period and offer Primary Care professionals an update and a reminder of the main aspects related to the safety use of medications.
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Escobar C, Aranda U, Palacios B, Capel M, Sicras A, Sicras A, Hormigo A, Alcázar R, Manito N, Botana M. Epidemiology, clinical profile, management, and two-year risk complications among patients with chronic kidney disease in Spain. Nefrologia 2021; 41:670-688. [PMID: 36165157 DOI: 10.1016/j.nefroe.2022.01.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/20/2021] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To describe the epidemiology, clinical profile, treatments, and to determine cardiovascular and renal outcomes after two years of follow-up in a contemporary chronic kidneay disease (CKD) population in Spain. This was also analyzed among the DAPA-CKD-like population (patients who met most inclusion criteria of DAPA-CKD trial). METHODS Observational, retrospective, population-based study using BIG-PAC database. The CKD population was defined as patients ≥18 years, with at least one diagnostic code of CKD prior to the index date (January 1st, 2018). CKD was defined as estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2 (CKD-EPI), or albuminuria >30mg/g. RESULTS We identified 56,435 CKD patients after exclusions (76.4 years, 52.2% men, urine albumin-to-creatinine ratio 390.8mg/g, eGFR 49.7mL/min/1.73m2). CKD prevalence was 4.91% and incidence 2.10 per 1000 patient-years. Regarding treatments, 69.2% were taking renin-angiotensin system inhibitors (only 4.2% at maximal doses) and 3.5% of diabetic patients SGLT-2 inhibitors. During the two years of follow-up, rates of heart failure, all-cause death, myocardial infarction, stroke, and CKD were 17.9, 12.1, 7.2, 6.3, and 5.9 events per 100 patient-years, respectively. During this period, 44% of patients were hospitalized, and 6.8% died during hospitalization. Cardiovascular outcomes were more common in the DAPA-CKD-like population. CONCLUSIONS In Spain, CKD population is older and comorbidities, including diabetes and heart failure, are common. Cardiovascular and renal outcomes are frequent. There is room for improvement in CKD management, particularly through the use of drugs with proven cardiovascular and renal benefit.
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Affiliation(s)
| | | | | | | | - Antoni Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | - Aram Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | | | | | - Nicolás Manito
- Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Escobar C, Varela L, Palacios B, Capel M, Sicras-Mainar A, Sicras-Navarro A, Hormigo A, Alcázar R, Manito N, Botana M. Clinical characteristics, management, and one-year risk of complications among patients with heart failure with and without type 2 diabetes in Spain. Rev Clin Esp 2021; 222:195-204. [PMID: 34511336 DOI: 10.1016/j.rceng.2021.04.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This work aims to describe the clinical characteristics and therapeutic management and to determine cardiovascular outcomes after one year of follow-up in a contemporaneous population with heart failure (HF) with and without type 2 diabetes in Spain. These factors were also analyzed in the DAPA-HF-like population (patients who met most inclusion criteria of the DAPA-HF trial) and in patients treated with SGLT2 inhibitors at baseline. METHODS This work is an observational, retrospective, population-based study using the BIG-PAC database. The index date was January 1, 2019. People aged ≥ 18 years who received care for HF in 2019 were selected. Events that occurred in 2019 were analyzed. RESULTS We identified 21,851 patients with HF (age 78.0 ± 11.3 years, 53.0% men, 50.9% with HF with reduced left ventricular ejection fraction, 44.5% in NYHA functional class II). HF prevalence was 1.88% and incidence was 2.83 per 1,000 person-years. Regarding HF treatments, 66.1% were taking renin-angiotensin system inhibitors, 69.4% beta blockers, 31.2% aldosterone antagonists, and 7.5% sacubitril/valsartan. During the year of follow-up, 29.8% had HF decompensation which led to hospitalization (mean time to first event of 120.9 ± 72.5 days), 12.3% died, and 8.1% died during hospitalization. Events were more common among patients with type 2 diabetes. Hospitalizations for HF were more common in the DAPA-HF-like population. CONCLUSIONS In Spain, the population with HF is elderly and has many comorbidities. Approximately half of patients have HF with reduced left ventricular ejection fraction. There is room for improvement in HF management, particularly through the use of drugs that reduce both HF hospitalization and mortality, in order to reduce the burden of HF.
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Affiliation(s)
- C Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
| | - L Varela
- Departamento médico, AstraZeneca Spain
| | | | - M Capel
- Departamento médico, AstraZeneca Spain
| | - A Sicras-Mainar
- Investigación sobre economía y resultados de la salud, Atrys Health, Barcelona, Spain
| | - A Sicras-Navarro
- Investigación sobre economía y resultados de la salud, Atrys Health, Barcelona, Spain
| | - A Hormigo
- Centro de Salud de Atención Primaria Puerta Blanca, Málaga, Spain
| | - R Alcázar
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - N Manito
- Unidad de Insuficiencia Cardíaca Avanzada y Trasplante Cardíaco, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M Botana
- Servicio de Endocrinología, Hospital Universitario Lucus Augusti, Lugo, Spain
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Escobar C, Aranda U, Palacios B, Capel M, Sicras A, Sicras A, Hormigo A, Alcázar R, Manito N, Botana M. Epidemiology, clinical profile, management, and two-year risk complications among patients with chronic kidney disease in Spain. Nefrologia 2021; 41:S0211-6995(21)00101-6. [PMID: 34148667 DOI: 10.1016/j.nefro.2021.03.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/07/2021] [Accepted: 03/20/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To describe the epidemiology, clinical profile, treatments, and to determine cardiovascular and renal outcomes after two years of follow-up in a contemporary chronic kidneay disease (CKD) population in Spain. This was also analyzed among the DAPA-CKD-like population (patients who met most inclusion criteria of DAPA-CKD trial). METHODS Observational, retrospective, population-based study using BIG-PAC database. The CKD population was defined as patients ≥18 years, with at least one diagnostic code of CKD prior to the index date (January 1st, 2018). CKD was defined as estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2 (CKD-EPI), or albuminuria >30mg/g. RESULTS We identified 56,435 CKD patients after exclusions (76.4 years, 52.2% men, urine albumin-to-creatinine ratio 390.8mg/g, eGFR 49.7mL/min/1.73m2). CKD prevalence was 4.91% and incidence 2.10 per 1000 patient-years. Regarding treatments, 69.2% were taking renin-angiotensin system inhibitors (only 4.2% at maximal doses) and 3.5% of diabetic patients SGLT-2 inhibitors. During the two years of follow-up, rates of heart failure, all-cause death, myocardial infarction, stroke, and CKD were 17.9, 12.1, 7.2, 6.3, and 5.9 events per 100 patient-years, respectively. During this period, 44% of patients were hospitalized, and 6.8% died during hospitalization. Cardiovascular outcomes were more common in the DAPA-CKD-like population. CONCLUSIONS In Spain, CKD population is older and comorbidities, including diabetes and heart failure, are common. Cardiovascular and renal outcomes are frequent. There is room for improvement in CKD management, particularly through the use of drugs with proven cardiovascular and renal benefit.
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Affiliation(s)
- Carlos Escobar
- Cardiology department, University hospital La Paz, Madrid, Spain.
| | - Unai Aranda
- Medical Department, AstraZeneca Farmaceutica, Madrid, Spain
| | | | - Margarita Capel
- Pricing & Health Economics and Outcomes Research, AstraZeneca Farmaceutica, Madrid, Spain
| | - Antoni Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | - Aram Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | | | - Roberto Alcázar
- Nephrology department, University hospital Infanta Leonor, Madrid, Spain
| | - Nicolás Manito
- Department of Heart Failure and Transplant, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Botana
- Endocrine department, University Hospital Lucus Augusti, Lugo, Spain
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Sicras Mainar A, Navarro Artieda R, Hernández I, Morillo R. Prevalence of the potential drug-drug interactions between pangenotypic direct-acting antivirals and the concomitant medications associated with patients with chronic hepatitis C virus infection in Spain. Gastroenterol Hepatol 2019; 42:465-475. [PMID: 31451229 DOI: 10.1016/j.gastrohep.2019.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 03/11/2019] [Accepted: 03/29/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the comorbidity and potential for drug-drug interactions (DDIs) among pangenotypic direct-acting-antivirals (pDAAs) and the concomitant medications associated with chronic hepatitis C (CHC) patients in routine clinical practice in Spain. METHODS Retrospective observational study. Included patients were ≥18 years, diagnosed with CHC, on antiviral treatment and required medical attention during 2017. Two groups were differentiated according to age ranges (<50 and ≥50 years). The variables collected were: age, gender, general/specific comorbidity, concomitant medication and potential DDIs (www.hep-druginteractions.org). The pDAAs analysed were: a) Sofosbuvir/Velpatasvir (SOF/VEL), b) Glecaprevir/Pibrentasvir (GLE/PIB) and c) Sofosbuvir/Velpatasvir/Voxilaprevir (SOF/VEL/VOX). Bivariate statistical analysis, P<.05. RESULTS 3,430 patients with a mean age of 56.9 years and 60.3% males were enrolled. The average Charlson index was 0.8. Age range distribution: 18-49 years (28.9%) and ≥50 years (71.1%). The average number of medications per patient/year was 3.1 (SD 2.6). The total percentage of potential DDIs was: 8.6% minor DDIs, 40.5% clinically significant DDIs and 10.0% contraindicated medication. These DDIs were greater in patients ≥50 years (8.6%, 43.8% and 12.4%, respectively, P<.001). For all ages, SOF/VEL showed a lower percentage of: minor interactions (1.3% vs. 6.6% and 5.9%, P<.001); clinically significant interactions (53.4%, vs. 77.4% and 66.3%, P<.001) and contraindicated medication (1.7% vs. 8.3% and 10.7%, P<.001) compared to GLE/PIB and SOF/VEL/VOX, respectively. CONCLUSIONS Patients with CHC present high comorbidity and concomitant medication use, particularly elderly patients, thus implying a greater exposure to potential DDIs. Although the DDI rate was considerable with the three combinations analysed, SOF/VEL showed a lower number of clinically significant interactions.
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Affiliation(s)
| | - Ruth Navarro Artieda
- Documentación Médica. Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - Ignacio Hernández
- Health Economics & Outcomes Research, Real Life Data, Madrid, España
| | - Ramón Morillo
- Farmacia Hospitalaria, Hospital de Valme, AGS Sur de Sevilla, España
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Moreno Juste A, Gimeno Miguel A, Poblador Plou B, González Rubio F, Aza Pascual-Salcedo MM, Menditto E, Prados Torres A. Adherence to treatment of hypertension, hypercholesterolaemia and diabetes in an elderly population of a Spanish cohort. Med Clin (Barc) 2018; 153:1-5. [PMID: 30503066 DOI: 10.1016/j.medcli.2018.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/10/2018] [Revised: 10/11/2018] [Accepted: 10/18/2018] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Aida Moreno Juste
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España; Servicio Aragonés de Salud (SALUD), Zaragoza, España.
| | - Antonio Gimeno Miguel
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España
| | - Beatriz Poblador Plou
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España
| | - Francisca González Rubio
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España; Servicio Aragonés de Salud (SALUD), Zaragoza, España; Grupo de Trabajo de Utilización de Fármacos de la semFYC, España
| | - María Mercedes Aza Pascual-Salcedo
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España; Servicio Aragonés de Salud (SALUD), Zaragoza, España
| | - Enrica Menditto
- CIRFF, Centro de Farmacoeconomía, Universidad de Nápoles Federico II, Nápoles, Italia
| | - Alexandra Prados Torres
- Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, España
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Malo S, Aguilar-Palacio I, Feja C, Menditto E, Lallana MJ, Andrade E, Casasnovas JA, Rabanaque MJ. Persistence With Statins in Primary Prevention of Cardiovascular Disease: Findings From a Cohort of Spanish Workers. ACTA ACUST UNITED AC 2017; 71:26-32. [PMID: 28473266 DOI: 10.1016/j.rec.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 12/21/2016] [Accepted: 03/21/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to assess patterns of treatment persistence in a cohort of male Spanish workers receiving statin therapy for primary prevention of cardiovascular disease. METHODS This descriptive study was conducted within the framework of the prospective longitudinal Aragon Workers' Health Study (N = 5400). Incident male statin users were identified based on data collected from the regional government's medication consumption information system. Patterns of treatment persistence with statins prescribed for primary cardiovascular disease prevention were assessed and the relevance of potential predictors explored. RESULTS Among the 725 new statin users, less than one third remained persistent during the 1 year of follow-up. About 15% of nonpersistent users discontinued statin therapy after dispensation of the first prescription; of these, 42.1% did not recommence treatment within the following year. Factors reducing the likelihood of treatment discontinuation were older age (HR, 0.55; 95%CI, 0.39-0.77) and cotreatment with antihypertensive drugs (HR, 0.68; 95%CI, 0.56-0.82). No association was observed between treatment persistence and cotreatment with antidiabetic or antithrombotic drugs, baseline low-density lipoprotein levels, or total cholesterol levels. However, persistence was influenced by the type of statin first prescribed. CONCLUSIONS Our analysis of a cohort of healthy male workers revealed poor statin persistence. These findings underscore the need for a better understanding of patterns of statin use, especially in apparently healthy individuals, and for the incorporation of patient behavior into prescribing decisions.
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Affiliation(s)
- Sara Malo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
| | - Isabel Aguilar-Palacio
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Cristina Feja
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Enrica Menditto
- Centro Interdipartimentale di Ricerca in Farmacoeconomia e Farmacoutilizzazione (CIRFF), Università degli Studi di Napoli Federico II, Napoli, Italy
| | - María Jesús Lallana
- Servicio Aragonés de Salud, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Elena Andrade
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz y CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - José Antonio Casasnovas
- Departamento de Medicina, Psiquiatría y Dermatología, Universidad de Zaragoza, Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - María José Rabanaque
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
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Naveiro-Rilo JC, Diez-Juárez D, Flores-Zurutuza ML, Molina-Mazo R, Alberte-Pérez C. [Intervention in elderly patients with multiple morbidities and multiple medications: results of the prescription and the quality of life]. ACTA ACUST UNITED AC 2014; 29:256-62. [PMID: 25129527 DOI: 10.1016/j.cali.2014.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 02/24/2014] [Revised: 06/16/2014] [Accepted: 06/16/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the effect of an intervention using STOPP/START criteria and the Garfinkel algorithm on prescription and the health-related quality of life (HRQoL) in elderly patients with multimorbidity and prescribed multiple medications. MATERIAL AND METHOD A before-after intervention study on 381 patients over 67 years old and prescribed multiple medications by 71 Primary Care doctors. INTERVENTION The doctors were trained in the STOPP / START criteria and Garfinkel algorithm. Each doctor then reviewed all the drugs of their selected patients and then made appointments with them for an initial medical consultation and clinical assessment. Treatment was modified according to the criteria and the HRQoL measured using the SF-12 questionnaire. Two months later, in a second medical consultation, a new clinical assessment was made and the HRQoL was measured. The dimensions of the HRQoL between the first and the second consultation were compared using the paired Student-t test. RESULTS The intervention involved the removal of a mean of 1.5 drugs per patient. The dose was modified in 4% of drugs, and 8.9% of patients were prescribed a new drug. Non-Steroidal Anti-inflammatory drugs (NSAID), psychoactive drugs and proton pump inhibitors were the most modified. Social Function and Physical Component Summary of the HRQOL improved significantly (P<.05) after intervention. CONCLUSION The intervention using the Garfinkel algorithm and STOPP -START criteria improved HRQoL and reduced the number of prescribed drugs.
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