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. 2013 May;45(5):235-43.
doi: 10.1016/j.aprim.2012.11.010. Epub 2013 Jan 18.

[Evaluation of the appropriateness of pharmacotherapy in patients with high comorbidity]

[Article in Spanish]
Mercedes Galván-Banqueri  1 , Ana Isabel González-Méndez, Eva Rocío Alfaro-Lara, María Dolores Nieto-Martín, Concepción Pérez-Guerrero, Bernardo Santos-Ramos
Affiliations

[Evaluation of the appropriateness of pharmacotherapy in patients with high comorbidity]

[Article in Spanish]
Mercedes Galván-Banqueri et al. Aten Primaria. 2013 May.

Abstract
in English, Spanish

Objective: [corrected] To analyze the appropriateness of pharmacotherapy and, if necessary, carry out interventions for its improvement in a cohort of patients with multiple chronic conditions.

Design: Descriptive, prospective study of 21 months duration.

Location: Hospital Universitario Virgen del Rocío.

Participants: Patients with multiple chronic conditions included in a project for integrated healthcare.

Methods: The primary endpoint was the number of inappropriate treatments. To evaluate the appropriateness of pharmacotherapy, the specialist in hospital pharmacy followed a standardized procedure consisting of the Medication Appropriateness Index (MAI) questionnaire, modified as an implicit method, and the list of criteria of the Screening Tool of Older Person's Potentially Inappropriate Prescription/Screening Tool to Alert doctors to the Right (STOPP-START) as an explicit method.

Results: A total of 244 patients were included, with a mean age of 76 ± 8 (± SD) years. Half (50%) of the patients were men. The mean number of diagnoses per patient was 8 ± 3 (± SD) and 12 ± 4 drugs (± SD). A total of 840 inappropriate treatments were detected, most of them being due to the presence of interactions. The STOPP criteria most not complied with, were duplicate drug class, and prolonged use of benzodiazepines with long half-life or long-acting metabolites, and START for ACE inhibitors in chronic heart failure and statins and antiplatelets in diabetes mellitus, if one or more coexisting risk factors.

Conclusions: We detected a large number of inappropriate treatments. This highlights the importance of evaluating the appropriateness of drug treatment in patients with multiple conditions. It is advisable to use a combined pharmacist intervention strategy that includes both an implicit method and an explicit method.

Objetivo: Analizar la adecuación del tratamiento farmacológico y realizar, si es necesario, intervenciones para su mejora en una cohorte de pacientes pluripatológicos.

Diseño: Estudio descriptivo, prospectivo, de 21 meses de duración.

Emplazamiento: Área Hospitalaria Virgen del Rocío.

Participantes: Pacientes pluripatológicos incluidos para un proyecto de atención integrada.

Métodos: La variable principal consistió en el número de inadecuaciones detectadas. Para evaluar la adecuación del tratamiento farmacológico el farmacéutico especialista siguió un procedimiento normalizado que consistía en la aplicación del cuestionario Medication Aproppriateness Index (MAI) modificado como método implícito y de la lista de criterios Screening Tool of Older Person's potentially inappropriate Prescription/Screening Tool to Alert doctors to the Right (STOPP-START) como método explícito.

Resultados: Se incluyeron un total de 244 pacientes, con una edad media de 76 ± 8 (± DE) años siendo el 50% hombres. El número medio de diagnósticos por paciente fue de 8 ± 3 (± DE) y de fármacos de 12 ± 4 (± DE). Se detectaron un total de 840 inadecuaciones, siendo la mayoritaria la presencia de interacciones. Respecto a los criterios STOPP los más frecuentemente incumplidos fueron: clase de medicamento duplicada y uso prolongado de benzodiacepinas de vida media larga o con metabolitos de acción larga, y para los START los IECA en la insuficiencia cardiaca crónica y estatinas y antiagregantes en la diabetes mellitus si coexisten uno o más factores de riesgo.

Conclusiones: El gran número de inadecuaciones detectadas pone de manifiesto la importancia de evaluar la adecuación del tratamiento farmacológico en el paciente pluripatológico. Para ello es recomendable utilizar una estrategia de intervención farmacéutica combinada que incluya tanto un método implícito como un método explícito.

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Figures

Figura 1
Figura 1
Circuito de trabajo.
Figura 2
Figura 2
Cuestionario MAI modificado.
See this image and copyright information in PMC

Comment in

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