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Fernández Alonso C, Fuentes Ferrer ME, García-Lamberechts EJ, Aguiló Mir S, Jiménez S, Jacob J, Piñera Salmerón P, Gil-Rodrigo A, Llorens P, Burillo-Putze G, Alquezar-Arbé A, Bretones Baena S, Fernández Cardona M, Hernández González R, Moreno Martín M, Barnes Parra A, El Farh I, Valle Borrego B, Quero Motto E, Artieda Larrañaga A, Soy Ferrer E, Hong Cho JU, Gros Bañeres B, Gayoso Martín S, Sánchez Sindín G, Prieto Zapico A, Cirera Lorenzo I, Guardiola Tey JM, Llauger L, González Del Castillo J, Miró Ò. Impact of dementia on 30-, 180-, and 365-day mortality during the first pandemic wave in older adults seen in spanish emergency departments diagnosed with or without COVID-19. Aging Ment Health 2024; 28:1110-1118. [PMID: 38597417 DOI: 10.1080/13607863.2024.2337144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES To assess whether dementia is an independent predictor of death after a hospital emergency department (ED) visit by older adults with or without a COVID-19 diagnosis during the first pandemic wave. METHOD We used data from the EDEN-Covid (Emergency Department and Elderly Needs during Covid) cohort formed by all patients ≥65 years seen in 52 Spanish EDs from March 30 to April 5, 2020. The association of prior history of dementia with mortality at 30, 180 and 365 d was evaluated in the overall sample and according to a COVID-19 or non COVID diagnosis. RESULTS We included 9,770 patients aged 78.7 ± 8.3 years, 51.1% men, 1513 (15.5%) subjects with prior history of dementia and 3055 (31.3%) with COVID-19 diagnosis. 1399 patients (14.3%) died at 30 d, 2008 (20.6%) at 180 days and 2456 (25.1%) at 365 d. The adjusted Hazard Ratio (aHR) for age, sex, comorbidity, disability and diagnosis for death associated with dementia were 1.16 (95% CI 1.01-1.34) at 30 d; 1.15 at 180 d (95% CI 1.03-1.30) and 1.19 at 365 d (95% CI 1.07-1.32), p < .001. In patients with COVID-19, the aHR were 1.26 (95% CI: 1.04-1.52) at 30 days; 1.29 at 180 d (95% CI: 1.09-1.53) and 1.35 at 365 d (95% CI: 1.15-1.58). CONCLUSION Dementia in older adults attending Spanish EDs during the first pandemic wave was independently associated with 30-, 180- and 365-day mortality. This impact was lower when adjusted for age, sex, comorbidity and disability, and was greater in patients diagnosed with COVID-19.
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Affiliation(s)
- Cesáreo Fernández Alonso
- Emergency Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Manuel E Fuentes Ferrer
- Investigation Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Sira Aguiló Mir
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Sònia Jiménez
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Adriana Gil-Rodrigo
- Emergency Department, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Pere Llorens
- Emergency Department, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | | | - Aitor Alquezar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | - Ana Barnes Parra
- Emergency Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Imane El Farh
- Emergency Department, Hospital Francecs de Borja, Gandía, Spain
| | | | - Eva Quero Motto
- Emergency Department, Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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Vicente-Escrig E, Bonastre PT, Barrueta OI, Izquierdo MM, Fernández-Llamazares CM, Morillo-Verdugo R. [Translated article] Analysis 2016-2021 of the development of the MAPEX outpatient pharmaceutical care Project by Regions in Spain. FARMACIA HOSPITALARIA 2024; 48:T64-T69. [PMID: 38151407 DOI: 10.1016/j.farma.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVE To analyse the evolution of the MAPEX Project (Strategic Map of Pharmaceutical Care for Outpatients) by regions in Spain, through the results of the comparative situation survey between 2016 and 2021. METHODS A committee of national experts belonging to the Spanish Society of Hospital Pharmacy prepared the MAPEX Survey on the situation of Outpatient Units, which consisted of 43 specific questions on aspects related to structure, context, integration, processes, results and training, teaching, and investigation. It was carried out in 2 periods, one in 2016 and another in 2021 (with 3 additional questions in 2021, related to the progress of the MAPEX initiative and the priority lines to follow). A comparative analysis of results was carried out at the national level and by regions in Spain. RESULTS 141 hospitals participated in 2016 and 138 in 2021, with representation from the 17 autonomous communities. The analysis of the results shows significant improvements in all the dimensions of the survey, with variability between the different regions. Among the most important improvements, the development and consolidation of telepharmacy stood out, the greater specialisation of pharmacists by areas of knowledge and their integration into multidisciplinary teams. The improvement of the healthcare model was considered the greatest advance at a general level (65%), and remote pharmaceutical care at the hospital level (48.2%). Priority lines of work were considered the expansion and practical application of the pharmaceutical care methodology (66.4%), research (58.4%), and training in all MAPEX initiatives (53.3%). CONCLUSIONS The implementation and development of the MAPEX initiatives has had a positive impact on the evolution in all healthcare areas of pharmaceutical care for outpatients. The situation survey makes it possible to identify by regions the significant points for improvement, as well as those areas to be developed through strengthening and corrective actions. The expansion of the project in the coming years will mean progress toward excellence in care and in the improvement of health results.
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Affiliation(s)
| | | | - Olatz Ibarra Barrueta
- Servicio de Farmacia, Hospital Universitario Galdakao-Usansolo, Osi Barrualde Galdakao, Spain
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Vicente-Escrig E, Taberner Bonastre P, Ibarra Barrueta O, Murillo Izquierdo M, Fernández-Llamazares CM, Morillo-Verdugo R. Analysis 2016-2021 of the development of the MAPEX outpatient pharmaceutical care Project by regions in Spain. FARMACIA HOSPITALARIA 2024; 48:64-69. [PMID: 37749003 DOI: 10.1016/j.farma.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Analyse the evolution of the MAPEX Project (Strategic Map of Pharmaceutical Care for Outpatients) by regions in Spain, through the results of the comparative situation survey between the years 2016 and 2021. METHODS A committee of national experts belonging to the Spanish Society of Hospital Pharmacy prepared the MAPEX Survey on the situation of Outpatient Units, which consisted of 43 specific questions on aspects related to structure, context, integration, processes, results and training, teaching and investigation. It was carried out in two periods, one in 2016 and another in 2021 (with 3 additional questions in 2021, related to the progress of the MAPEX initiative and the priority lines to follow). A comparative analysis of results was carried out at the national level and by regions in Spain. RESULTS 141 hospitals participated in 2016 and 138 in 2021, with representation from the 17 autonomous communities. The analysis of the results shows significant improvements in all the dimensions of the survey, with variability between the different regions. Among the most important improvements, the development and consolidation of telepharmacy stood out, the greater specialization of pharmacists by areas of knowledge and their integration into multidisciplinary teams. The improvement of the healthcare model was considered the greatest advance at a general level (65%), and remote pharmaceutical care at the hospital level (48.2%). Priority lines of work were considered the expansion and practical application of the pharmaceutical care methodology (66.4%), research (58.4%), and training in all MAPEX initiatives (53.3%). CONCLUSIONS The implementation and development of the MAPEX initiatives has had a positive impact on the evolution in all healthcare areas of pharmaceutical care for outpatients. The situation survey makes it possible to identify by regions the significant points for improvement, as well as those areas to be developed through strengthening and corrective actions. The expansion of the project in the coming years will mean progress towards excellence in care and in the improvement of health results.
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Affiliation(s)
| | | | - Olatz Ibarra Barrueta
- Servicio de Farmacia, Hospital Universitario Galdakao-Usansolo, Osi Barrualde Galdakao, España
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Fernández Alonso C, Fuentes Ferrer M, Llorens P, Burillo G, Alquézar-Arbé A, Jacob J, Montero-Pérez FJ, Aguiló S, Abad Cuñado V, Amer Al Arud L, Escudero Sánchez C, Poch Ferret EA, Hong Cho JU, Escolar Martínez-Berganza MT, Gayoso Martín S, Sánchez Sindín G, Prieto Zapico A, Petrus Rivas MC, Doi Grande AL, Llauger L, Rodríguez Valles C, Marquez Quero L, Juárez González R, Ruescas E, Fernández Salgado F, Ríos Gallardo R, de Juan Gómez MÁ, Masid Barco M, González Del Castillo J, Miró Ò. Impact of First Wave of COVID-19 Pandemic on Mortality at Emergency Department in Older Patients with COVID and Non-COVID Diagnoses. Gerontology 2023; 70:379-389. [PMID: 38160663 DOI: 10.1159/000535913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Mortality in emergency departments (EDs) is not well known. This study aimed to assess the impact of the first-wave pandemic on deaths accounted in the ED of older patients with COVID and non-COVID diseases. METHODS We used data from the Emergency Department and Elderly Needs (EDEN) cohort (pre-COVID period) and from the EDEN-COVID cohort (COVID period) that included all patients ≥65 years seen in 52 Spanish EDs from April 1 to 7, 2019, and March 30 to April 5, 2020, respectively. We recorded patient characteristics and final destination at ED. We compared older patients in the pre-COVID period, with older patients with non-COVID and with COVID-19. ED-mortality (before discharge or hospitalization) is the prior outcome and is expressed as an adjusted odds ratio (aOR) with 95% interval confidence. RESULTS We included 23,338 older patients from the pre-COVID period (aged 78.3 [8.1] years), 6,715 patients with non-COVID conditions (aged 78.9 [8.2] years) and 3,055 with COVID (aged 78.3 [8.3] years) from the COVID period. Compared to the older patients, pre-COVID period, patients with non-COVID and with COVID-19 were more often male, referred by a doctor and by ambulance, with more comorbidity and disability, dementia, nursing home, and more risk according to qSOFA, respectively (p < 0.001). Compared to the pre-COVID period, patients with non-COVID and with COVID-19 were more often to be hospitalized from ED (24.8% vs. 44.3% vs. 79.1%) and were more often to die in ED (0.6% vs. 1.2% vs. 2.2%), respectively (p < 0.001). Compared to the pre-COVID period, aOR for age, sex, comorbidity and disability, ED mortality in elderly patients cared in ED during the COVID period was 2.31 (95% confidence interval [CI]: 1.76-3.06), and 3.75 (95% CI: 2.77-5.07) for patients with COVID. By adding the variable qSOFA to the model, such OR were 1.59 (95% CI: 1.11-2.30) and 2.16 (95% CI: 1.47-3.17), respectively. CONCLUSIONS During the early first pandemic wave of COVID-19, more complex and life-threatening older with COVID and non-COVID diseases were seen compared to the pre-COVID period. In addition, the need for hospitalization and the ED mortality doubled in non-COVID and tripled in COVID diagnosis. This increase in ED mortality is not only explained by the complexity or severity of the elderly patients but also because of the system's overload.
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Affiliation(s)
- Cesáreo Fernández Alonso
- Emergency Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Manuel Fuentes Ferrer
- Investigation Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Pere Llorens
- Emergency Department, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Guillermo Burillo
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Santa Cruz de Tenerife, Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Sira Aguiló
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Vanesa Abad Cuñado
- Emergency Department, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Lilia Amer Al Arud
- Emergency Department, Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | - Lluís Llauger
- Emergency Department, Hospital Universitari de Vic, Barcelona, Spain
| | | | | | | | - Esther Ruescas
- Emergency Department, Hospital Universitario Vinalopó, Elche, Spain
| | | | | | | | - Marta Masid Barco
- Emergency Department, Hospital Univeristario Son Espases, Palma de Mallorca, Spain
| | | | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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González-Munguía S, Munguía-López O, Sánchez Sánchez E. Pharmacist comprehensive review of fall-risk-increasing drugs and polypharmacy in elderly Spanish community patients using RStudio®. Heliyon 2023; 9:e17079. [PMID: 37383189 PMCID: PMC10293665 DOI: 10.1016/j.heliyon.2023.e17079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023] Open
Abstract
Objective The aim of this study is to identify and analyze adults aged ≥65 years living in the Canary Islands, Spain, who are prescribed medications that increase the risk of falls and are polymedicated. To do so we have made use of the electronic prescription and the RStudio®. Method For the detection of Fall-Risk-Increasing Drugs (FRIDs), outpatient electronic prescription dispensing data were used in two pharmacies. A total of 118,890 dispensations grouped into 15,601 treatment plans for 2,312 patients were analyzed. The FRIDs analyzed were antipsychotics (APSI), benzodiazepines (BZPN), antidepressants (DEPR), opioids (OPIO) and Z-hypnotics (ZHIP). For the development of the algorithms for the construction of tables and data screening, the statistical programming language RStudio® was used. Results Of the total number of patients and prescriptions analyzed, 46.6% were polymedicated and 44.3% had prescribed an FRID. 28.7% of the patients presented both factors, had a dispensation from an FRID and were polymedicated. Of the 14,278 dispensations with FRID, 49% had a benzodiazepine, 22.7% opioids, 18% antidepressants, 5.6% hypnotics, and finally 4.4% antipsychotics. At least 32% of the patients had been dispensed a benzodiazepine together with another FRID and 23% an opioid together with another FRID. Conclusions The method of analysis developed and applied in RStudio® allows to detect and determine in a simple and fast way polymedicated patients, as well as the number and therapeutic class of drugs in their treatment plan and identify prescriptions that can increase the risk of falls. Our results show a high number of prescriptions for benzodiazepines and opioids.
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Affiliation(s)
- Silvia González-Munguía
- Hospital Universitario Nuestra Señora de la Candelaria. Servicio de Farmacia. Carretera General del Rosario, 145 Santa Cruz de Tenerife, 38010 Tenerife, Spain
- Programa de Doctorado en Ciencias de la Salud. Universidad de La Laguna, 38200 San Cristóbal de La Laguna. Tenerife, Spain
| | - Obdulia Munguía-López
- Departamento de Ingeniería Química y Tecnología Farmacéutica, UD Farmacia y Tecnologia Farmacéutica. Facultad de Farmacia, Universidad de La Laguna, 38200 San Cristóbal de La Laguna. Tenerife, Spain
| | - Esther Sánchez Sánchez
- Departamento de Ingeniería Química y Tecnología Farmacéutica, UD Farmacia y Tecnologia Farmacéutica. Facultad de Farmacia, Universidad de La Laguna, 38200 San Cristóbal de La Laguna. Tenerife, Spain
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Pinar Manzanet JM, Fico G, Merino‐Barbancho B, Hernández L, Vera‐Muñoz C, Seara G, Torrego M, Gonzalez H, Wastesson J, Fastbom J, Mayol J, Johnell K, Gómez‐Gascón T, Arredondo MT. Feasibility study of a clinical decision support system for polymedicated patients in primary care. Healthc Technol Lett 2023; 10:62-72. [PMID: 37265836 PMCID: PMC10230557 DOI: 10.1049/htl2.12046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 06/03/2023] Open
Abstract
Age-related changes in pharmacokinetics and pharmacodynamics, multimorbidity, frailty, and cognitive impairment represent challenges for drug treatments. Moreover, older adults are commonly exposed to polypharmacy, leading to increased risk of drug interactions and related adverse events, and higher costs for the healthcare systems. Thus, the complex task of prescribing medications to older polymedicated patients encourages the use of Clinical Decision Support Systems (CDSS). This paper evaluates the CDSS miniQ for identifying potentially inappropriate prescribing in poly-medicated older adults and assesses the usability and acceptability of the system in health care professionals, patients, and caregivers. The results of the study demonstrate that the miniQ system was useful for Primary Care physicians in significantly improving prescription, thereby reducing potentially inappropriate medication prescriptions for elderly patients. Additionally, the system was found to be beneficial for patients and their caregivers in understanding their medications, as well as usable and acceptable among healthcare professionals, patients, and caregivers, highlighting the potential to improve the prescription process and reduce errors, and enhancing the quality of care for elderly patients with polypharmacy, reducing adverse drug events, and improving medication management.
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Affiliation(s)
- Juan Manuel Pinar Manzanet
- Doctorando en Epidemiología y Salud Pública. Universidad Rey Juan Carlos. Madrid. Centro de Salud Miguel ServetMadridSpain
| | - Giuseppe Fico
- Universidad Politécnica de Madrid, Life Supporting Technologies Research GroupMadridSpain
| | | | - Liss Hernández
- Universidad Politécnica de Madrid, Life Supporting Technologies Research GroupMadridSpain
| | - Cecilia Vera‐Muñoz
- Universidad Politécnica de Madrid, Life Supporting Technologies Research GroupMadridSpain
| | - Germán Seara
- Unidad de Innovación, Hospital Clínico San Carlos, Fundación para la Investigación BiomédicaMadridSpain
| | - Macarena Torrego
- Unidad de Innovación, Hospital Clínico San Carlos, Fundación para la Investigación BiomédicaMadridSpain
| | - Henar Gonzalez
- Unidad de Innovación, Hospital Clínico San Carlos, Fundación para la Investigación BiomédicaMadridSpain
| | - Jonas Wastesson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Aging Research CenterKarolinska InstitutetSolnaSweden
| | - Johan Fastbom
- Aging Research CenterKarolinska InstitutetSolnaSweden
| | - Julio Mayol
- Unidad de Innovación, Hospital Clínico San Carlos, Fundación para la Investigación BiomédicaMadridSpain
| | - Kristina Johnell
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Tomás Gómez‐Gascón
- Fundación para la Investigación e Innovación Biosanitaria de Atención PrimariaInstituto de Investigación Sanitaria Hospital 12 de Octubre (imas12)MadridSpain
| | - María Teresa Arredondo
- Universidad Politécnica de Madrid, Life Supporting Technologies Research GroupMadridSpain
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Cebrino J, Portero de la Cruz S. Polypharmacy and associated factors: a gender perspective in the elderly Spanish population (2011-2020). Front Pharmacol 2023; 14:1189644. [PMID: 37153776 PMCID: PMC10160439 DOI: 10.3389/fphar.2023.1189644] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/14/2023] [Indexed: 05/10/2023] Open
Abstract
Background: Few studies have examined the epidemiology of polypharmacy in non-institutionalized elderly adults with regard to sex differences. This study aimed to identify the prevalence of polypharmacy among people ≥65 years old residing in Spain, analyze trends in that prevalence from 2011/12 to 2020, describe the use of the medicines involved and study the possible relationship between polypharmacy and certain sociodemographic, health-related variables, as well as the use of care services by sex. Methods: A nationwide cross-sectional study with 21,841 non-institutionalized people ≥65 years old from the Spanish National Health Survey (2011/2012 and 2017) and the European Health Survey in Spain (2014 and 2020) was performed. We used descriptive statistics, performing two binary logistic regressions to determine the factors related to polypharmacy. Results: The prevalence of polypharmacy was 23.2% (women: 28.1%, men: 17.2%; p < 0.001). The most commonly consumed medicines were analgesics and tranquillizers, relaxants or sleeping pills in elderly women, compared with antihypertensives, antacids and antiulcer drugs and statins for elderly men. In both sexs, the positive predictors of polypharmacy included average, poor and very poor self-perceived states of health, people with overweight and obesity, being severely/non-severely limited due to a health problem, having ≥ three chronic conditions, visits to the family doctor and hospitalization. Among elderly women, negative predictors were alcohol intake, whereas in elderly men positive predictors were being 75-84 years old, being current smokers and having 1, 2 chronic conditions. Conclusion: Polypharmacy has a prevalence of 23.2%, with women accounting for 28.1% and men 17.2% of the total. Knowledge of positive and negative predictors of polypharmacy have important implications for public health efforts to develop or improve health guidelines and strategies for promoting the proper use of medication, particularly in the elderly population by sex.
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Affiliation(s)
- Jesús Cebrino
- Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Silvia Portero de la Cruz
- Department of Nursing, Pharmacology and Physiotherapy, University of Córdoba, Córdoba, Spain
- Research Group GC12 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
- *Correspondence: Silvia Portero de la Cruz,
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Muñoz-Contreras MC, Segarra I, López-Román FJ, Galera RN, Cerdá B. Role of caregivers on medication adherence management in polymedicated patients with Alzheimer's disease or other types of dementia. Front Public Health 2022; 10:987936. [PMID: 36353281 PMCID: PMC9638151 DOI: 10.3389/fpubh.2022.987936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/07/2022] [Indexed: 01/26/2023] Open
Abstract
Background Alzheimer's disease (AD) and other dementia patients may have severe difficulties to ensure medication adherence due to their generally advanced age, polymedicated and multi-pathological situations as well as certain degree of cognitive impairment. Thus, the role of patient caregivers becomes crucial to warrantee treatment compliance. Purpose To assess the factors associated to patients and caregivers on medication adherence of patients with AD and other types of dementia as well as the degree of caregiver satisfaction with respect to treatment. Methods An observational, descriptive, cross-sectional study among the caregivers of 100 patients with AD and other types of dementia of the "Cartagena and Region Association of Relatives of Patients with Alzheimer's Disease and other Neurodegenerative Diseases" was conducted to assess patient and caregiver factors that influence medication adherence evaluated with the Morisky-Green-Levine test. Results Overall, adherence to treatment was 71%, with similar proportions between male and female patients. Greater adherence was found in married or widowed patients (49.3%), first degree (85.9%) or female (81.7%) caregivers but lower in AD patients (75.9%). Multivariate analysis showed a statistically significant positive association between non-adherence and male sex of the caregiver (OR 3.512 [95%IC 1.124-10.973]), dementia (OR 3.065 [95%IC 1.019-9.219]), type of caregiver (non-first-degree relative) (OR 0.325 [95%IC 0.054-0.672]) and civil status of the patient (OR 2.011 [95%IC 1.155-3.501]) favorable for married or widowed patients. No or week association was found with gender, age, education level, number of drugs used or polymedicated status of the patient. Caregivers considered the use (90%) and administration (91%) of the treatment easy or very easy and rarely interfered with their daily life, especially for female caregivers (p = 0.016). Finally, 71% indicated that they were satisfied or very satisfied with the treatment received by the patient. Conclusions Caregivers influence therapeutic management with predictors for improved adherence including female gender and first-degree kinship, together with patient's marital status. Thus, training caregivers about the disease and the importance of medication adherence in AD patients may ensure optimal treatment.
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Affiliation(s)
- María Cristina Muñoz-Contreras
- Hospital Pharmacy, Hospital La Vega, Murcia, Spain,‘Pharmacokinetics, Patient Care and Translational Bioethics' Research Group, UCAM – Catholic University of Murcia, Murcia, Spain
| | - Ignacio Segarra
- ‘Pharmacokinetics, Patient Care and Translational Bioethics' Research Group, UCAM – Catholic University of Murcia, Murcia, Spain,Department of Pharmacy, Faculty of Pharmacy, UCAM – Catholic University of Murcia, Guadalupe, Spain,*Correspondence: Ignacio Segarra
| | - Francisco Javier López-Román
- Health Sciences Department, UCAM – Catholic University of Murcia, Guadalupe, Spain,Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
| | | | - Begoña Cerdá
- Department of Pharmacy, Faculty of Pharmacy, UCAM – Catholic University of Murcia, Guadalupe, Spain,‘Nutrition, Oxidative Stress and Bioavailability' Research Group, UCAM – Catholic University of Murcia, Murcia, Spain
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Reus X, Sastre ML, Leiva A, Sánchez B, García-Serra C, Ioakeim-Skoufa I, Vicens C. LESS-PHARMA Study: Identifying and Deprescribing Potentially Inappropriate Medication in the Elderly Population with Excessive Polypharmacy in Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13241. [PMID: 36293832 PMCID: PMC9603607 DOI: 10.3390/ijerph192013241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Potentially inappropriate medication (PIM) increases adverse drug reactions and mortality, especially in excessively polymedicated patients. General practitioners are often in charge of this process. Some tools have been created to support them in this matter. This study aimed to measure the amount of potentially inappropriate medication among excessively polymedicated patients using several supporting tools and assess the feasibility of these tools in primary care. Several explicit deprescribing criteria were used to identify potentially inappropriate medications. The level of agreement between all the criteria and the acceptance by the general practitioner (GP) was also measured. We analysed whether the drugs proposed for deprescribing were eventually withdrawn after twelve months. The total number of drugs prescribed was 2038. Six hundred and forty-nine drugs (31.8%) were considered potentially inappropriate by at least one of the tools. GPs agreed with the tools in 56.7% of the cases. In a 12-month period, 109 drugs, representing 29.6% of the drugs that GPs agreed to deprescribe, were withdrawn. Elderly excessively polymedicated patients accumulated a great number of PIMs. The use of deprescribing supporting tools, such as explicit criteria, is feasible in primary care, and these tools are well accepted by the GPs. However, eventual withdrawal was carried out in less than half of the cases.
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Affiliation(s)
- Xisco Reus
- Balearic Health Service IbSalut Son Serra-La Vileta Healthcare Centre, 07013 Palma, Spain
| | - Maria Lluisa Sastre
- Balearic Health Service IbSalut Son Serra-La Vileta Healthcare Centre, 07013 Palma, Spain
| | - Alfonso Leiva
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Balearic Islands Health Research Institute (IdISBa), 07120 Palma, Spain
- Balearic Health Service IbSalut, Reseach Unit Primary Care Mallorca, 07013 Palma, Spain
| | - Belén Sánchez
- Balearic Health Service IbSalut Son Serra-La Vileta Healthcare Centre, 07013 Palma, Spain
| | - Cristina García-Serra
- Balearic Health Service IbSalut Son Serra-La Vileta Healthcare Centre, 07013 Palma, Spain
| | - Ignatios Ioakeim-Skoufa
- Department of Drug Statistics, Division of Health Data and Digitalisation, Norwegian Institute of Public Health, 0213 Oslo, Norway
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), 08009 Barcelona, Spain
- EpiChron Research Group, IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Caterina Vicens
- Balearic Health Service IbSalut Son Serra-La Vileta Healthcare Centre, 07013 Palma, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Balearic Islands Health Research Institute (IdISBa), 07120 Palma, Spain
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), 08009 Barcelona, Spain
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10
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Kardas P, Urbański F, Lichwierowicz A, Chudzyńska E, Kardas G, Czech M. Prevalence and Age Structure of Polypharmacy in Poland: Results of the Analysis of the National Real-World Database of 38 Million Citizens. Front Pharmacol 2021; 12:655364. [PMID: 33935769 PMCID: PMC8082447 DOI: 10.3389/fphar.2021.655364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/15/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction: Polypharmacy is a risk factor for adverse health outcomes, higher use of medical services and additional costs. The problem has gained attention as a consequence of aging and related multimorbidity. Therefore, there is an urgent need to adopt effective interventions aimed at reducing its burden. In order to achieve this, in-depth understanding of the prevalence of polypharmacy is required. Of particular interest is, however, assessing prevalence of polypharmacy in various age groups, to reach the right target for these interventions. So far, only limited data on polypharmacy among non-elderly individuals have been available. Aim of study: To assess overall prevalence of polypharmacy in Poland as well as its distribution in various age groups using real-world data. Methodology: A retrospective analysis of complete dispensation data of national payer organization for the years 2018–2019. The analyzed dataset included data on dispensation of reimbursed drugs, and exclusively for 2019, also non-reimbursed drugs. Polypharmacy was defined as dispensation of ≥5 prescription medications within six months. Results: In the analyzed national cohort of 38 million Polish citizens, the prevalence of polypharmacy was found to be 11.7% in 2018 and 11.6% in 2019. With age, the prevalence of polypharmacy increased, reaching the value of 56.0% in those aged 80+ in 2018, and 55.0% in 2019. Altogether, among those aged 65+, the polypharmacy was present in 43.1% in 2018, and 42.1% in 2019. In the youngest group of citizens, i.e., among those aged below 20 years, polypharmacy was found in 0.9%, and 0.8% in 2018 and 2019, respectively. Prevalence of polypharmacy, calculated for 2019 according to dispensation of five or more reimbursed and non-reimbursed drugs for the whole Polish population, was 21.8% for January-June, and 22.4% for July-December 2019. Among those aged 65+, the relevant numbers were 62.3%, and 62.9%, respectively. Conclusion: This study, being the first nationwide assessment of polypharmacy in Poland, confirmed its high prevalence. We found polypharmacy present in over one fifth of Polish society. Peaking in the elderly, polypharmacy occurred in each age group. These results lay the foundations for future interventions focused on reducing the scope of this problem in Poland.
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Affiliation(s)
- Przemysław Kardas
- Department of Family Medicine, Medical University of Lodz, Łódź, Poland
| | | | | | | | - Grzegorz Kardas
- Department of Internal Diseases, Asthma and Allergy, Medical University of Lodz, Łódź, Poland
| | - Marcin Czech
- Department of Pharmacoeconomics, Institute of Mother and Child, Warsaw, Poland
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11
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Garin N, Sole N, Lucas B, Matas L, Moras D, Rodrigo-Troyano A, Gras-Martin L, Fonts N. Drug related problems in clinical practice: a cross-sectional study on their prevalence, risk factors and associated pharmaceutical interventions. Sci Rep 2021; 11:883. [PMID: 33441854 PMCID: PMC7807048 DOI: 10.1038/s41598-020-80560-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/22/2020] [Indexed: 12/31/2022] Open
Abstract
Drug-related problems (DRP) cause preventable negative health outcomes, especially during hospital admissions. The aim of our study was to examine the prevalence and characteristics of DRP in regular clinical pharmacy, as well as to determine those factors associated with a higher risk of DRP in the hospital setting. We analyzed data from a standardized registry database of regular pharmacy practice (2015- 2016). DRP were classified according to the Pharmaceutical Care Network Europe v6.2 classification. Cross-sectional data were obtained from 1602 adults admitted to medical wards. Crude and adjusted binary logistic regressions were performed to identify associations between potential risk factors and DRP. Overall DRP prevalence was high across medical specialties (45,1%), in a population characterized by advanced age, polypharmacy and multimorbidity. Problems leading to DRP were mainly classified into two domains (effectiveness and adverse reactions), being drug and dose selection the most frequent causes. Interventions were accepted and DRP were totally or partially solved in 74.1% and 4.81% of cases, respectively. In the adjusted model polypharmacy, allergies, BMI > 25 kg/m2 and clearance < 30 mL/min were associated with a higher risk of DRP. The participation of clinical pharmacists into multidisciplinary teams promotes the detection and solution of DRP. Polypharmacy, obesity, renal impairment and allergy are associated with a higher risk of DRP during admission.
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Affiliation(s)
- Noe Garin
- Department of Pharmacy, Hospital de La Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain. .,School of Health Science Blanquerna, Universitat Ramon Llull, Barcelona, Spain.
| | - Nuria Sole
- Department of Pharmacy, Hospital de La Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Beatriz Lucas
- Department of Pharmacy, Hospital de La Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Matas
- Department of Internal Medicine, Hospital de La Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Desiree Moras
- Department of Internal Medicine, Hospital de La Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Rodrigo-Troyano
- Department of Respiratory Medicine, Hospital de La Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Gras-Martin
- Department of Pharmacy, Hospital de La Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Fonts
- Department of Pharmacy, Hospital de La Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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12
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Juárez Soto A. Treatment for castration-resistant prostate cancer and drug interaction risk in polymedicated patients. Actas Urol Esp 2020; 44:641-643. [PMID: 32829931 DOI: 10.1016/j.acuro.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/30/2020] [Indexed: 11/27/2022]
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13
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Jacob J, Peña B, Herrero-Puente P. About polypharmacy in older adults. Med Clin (Barc) 2020; 156:307. [PMID: 32340744 DOI: 10.1016/j.medcli.2019.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, Barcelona, España.
| | - Bárbara Peña
- Servicio de Urgencias, Hospital General Universitari d'Alacant, Alicante, España
| | - Pablo Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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14
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Gutiérrez-Valencia M, Aldaz Herce P, Lacalle-Fabo E, Contreras Escámez B, Cedeno-Veloz B, Martínez-Velilla N. Prevalencia de polifarmacia y factores asociados en adultos mayores en España: datos de la Encuesta Nacional de Salud 2017. Med Clin (Barc) 2019; 153:141-150. [DOI: 10.1016/j.medcli.2018.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 12/22/2022]
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15
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Tkacheva ON, Ostroumova OD, Krasnov GS, Isaev RI, Kotovskaya YV. [Evidence database for deprescribing of antipsychotic drugs in elderly and senile patients]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:162-172. [PMID: 31317906 DOI: 10.17116/jnevro2019119051162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review deals with the problem of polypragmasia and associated adverse drug reactions, which is very relevant for the elderly and senile age. Based on the frequent unjustified prescription of antipsychotic drugs in clinical practice and the serious consequences associated with it, especially in elderly people with cognitive impairment, the aim of this review was to analyze the current literature and an evidence base for antipsychotic therapy optimization in elderly. One of the most effective way to decrease drug-associated harm is deprescribing, the planned process of decreasing dose, discontinuation of drug or switching to another one aimed to improve quality of life of the patient. The article describes different types of deprescribing, presents the results of the analysis of literature on deprescribing of antipsychotics in long-term use in elderly patients with dementia. Central to this is the analysis of a systematic review of Cochrane E. Van Leeuwen and co-authors (2018), the leading research in the evidence base of deprescribing. Based on the available literature, the authors make the conclusion about the safety of deprescribing of antipsychotic drugs. The effect of abrupt discontinuation of treatment with antipsychotic drugs was evaluated in available literature. Most of the evidence relates only to residents of nursing homes or to patients in long-term psychogeriatric or geriatric wards (in-patient treatment). However, the evidence base of deprescribing of antipsychotic drugs is small, many studies have methodological limitations, the initial characteristics of the patients included in the study are extremely heterogeneous, methodologies for diagnosing and determining the severity of dementia, types and dosages of antipsychotic drugs, duration of observation periods differed greatly. Attention is drawn to the short duration of observation periods. All of the above dictates the need for specially planned randomized clinical trials, the results of which will develop detailed algorithms for deprescribing antipsychotics.
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Affiliation(s)
- O N Tkacheva
- Pirogov Russian National Research Medical University of Ministry of Healthcare of the Russian Federation
| | - O D Ostroumova
- Pirogov Russian National Research Medical University of Ministry of Healthcare of the Russian Federation
| | - G S Krasnov
- Pirogov Russian National Research Medical University of Ministry of Healthcare of the Russian Federation
| | - R I Isaev
- Pirogov Russian National Research Medical University of Ministry of Healthcare of the Russian Federation
| | - Yu V Kotovskaya
- Pirogov Russian National Research Medical University of Ministry of Healthcare of the Russian Federation
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16
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Gonzalez-Colaço Harmand M, Aldea-Perona AM, Boada-Fernández del Campo C, Areosa-Sastre A, Rodríguez-Jiménez C, García Sánchez-Colomer M, Fernández Quintana E, Plasencia-Nuñez M, Masiero-Aparicio P, Grillo-Grillo C, Orellana-Mobilli A, García Sáiz M, Duarte Diéguez C, Hornillos Calvo M, Avellana Zaragoza JA, Martínez Velilla N, de Guzmán Pérez Hernández D, Ruiz González M, Blanco Reina E, Asensio Ostos C, Peiró A, Cabrera García L, Hortigüela Moro F, Pérez Alayón H, Espárrago García I, Santana Quilez J, Alonso Ramírez J, Fernández Oropesa C, López Varona MJ, Acín Gerico MT, Sanz Alvarez E, Martín de la Sierra MÁ, Peñalver MJ, Falomir Gómez T, Ruiz Salazar J, Rivas GE, Rey Rodríguez E. Spanish list of potentially inappropriate drugs in the elderly (ES-PIA project). Eur J Clin Pharmacol 2019; 75:1161-1176. [DOI: 10.1007/s00228-019-02684-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 04/15/2019] [Indexed: 12/20/2022]
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17
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Bellver-Domingo Á, Maldonado-Devis M, Hernández-Sancho F, Carmona E, Picó Y. Identification of effective parameters for anti-inflammatory concentration in València City's wastewater using fuzzy-set qualitative comparative analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 663:110-124. [PMID: 30711579 DOI: 10.1016/j.scitotenv.2019.01.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/14/2019] [Accepted: 01/26/2019] [Indexed: 06/09/2023]
Abstract
The current literature about pharmaceutical and personal care compounds (PPCPs) focuses on identifying their concentration and toxicological risk both in surface water and in wastewater. However, the influence of urban areas (population ageing, income level, hospitals and others) has not yet been analysed. Knowing how a population (and its facilities) affects PPCPs' presence in wastewater is important to identify the conditions that are responsible for their presence. In this work, the influence of water consumption, population ageing, income level, hospitals and nursing homes on the anti-inflammatory concentration have been analysed. To fill the gap between the quantitative data on PPCPs' concentration and the qualitative reasoning of the influence of urban areas on the anti-inflammatory concentration, the use of fuzzy-set qualitative comparative analysis (fsQCA) is proposed. The fsQCA results are presented as recipes that show the different causal combinations of conditions that explain the presence of anti-inflammatories in wastewater. Using fsQCA for urban wastewater management with the aim of explaining the presence of anti-inflammatories in wastewater treatment plants (WWTPs) is a novelty in the literature. The results obtained here show the influence of water consumption (WATCON), hospitals (HOSP) and population ageing (POPAG) as the main conditions for the anti-inflammatory concentration in Valèncian wastewater. Specifically, these conditions are present in all the recipes obtained with consistency of 99%. Through the results obtained, it would be possible to identify that HOSP are the main facilities that discharge anti-inflammatories into urban wastewater. Hence, the necessity of preventive measures to avoid the anti-inflammatory discharge into water bodies has been showed. Furthermore, under a methodological point of view, this work highlights the eligibility of fsQCA as a wastewater cycle management tool.
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Affiliation(s)
- Águeda Bellver-Domingo
- Water Economic Group, Faculty of Economics, University of Valencia, Avda. dels Tarongers, s/n, 46022 València, Spain.
| | - Mónica Maldonado-Devis
- Water Economic Group, Faculty of Economics, University of Valencia, Avda. dels Tarongers, s/n, 46022 València, Spain
| | - Francesc Hernández-Sancho
- Water Economic Group, Faculty of Economics, University of Valencia, Avda. dels Tarongers, s/n, 46022 València, Spain
| | - Eric Carmona
- Environmental and Food Safety Research Group (SAMA-UV), Desertification Research Centre (CIDE-GV-UV), Faculty of Pharmacy, University of Valencia, Spain
| | - Yolanda Picó
- Environmental and Food Safety Research Group (SAMA-UV), Desertification Research Centre (CIDE-GV-UV), Faculty of Pharmacy, University of Valencia, Spain
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18
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[Appropriate medications: Also at the end of life]. Rev Esp Geriatr Gerontol 2019; 54:127-128. [PMID: 30971344 DOI: 10.1016/j.regg.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 11/21/2022]
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19
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Li JW, Hsieh HM, Weng SF, Lee IC. Polypharmacy and Utilization of Health Care Services: A Cohort Study of People Aged Over 50 Years in Taiwan. Asia Pac J Public Health 2019; 31:257-266. [PMID: 30803259 DOI: 10.1177/1010539519828077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study aimed to understand the changes and correlation in the long-term trends of polypharmacy and the utilization of health care services in a population over the age of 50 years through the use of a national database. A total of 2813 subjects who participated in surveys in 1999, 2003, and 2007 were selected as the samples. Each subject was followed-up for the period of 9 years. From 1999 to 2007, the proportion of mild and severe polypharmacy cases increased from 41.5% (1999) to 51.3% (2003) and 57.1% (2007), respectively. This study found that the more severe the polypharmacy was, the higher the risk of health care service utilization would be. The Generalized Estimating Equation model of multivariate analysis showed that the incidence rate ratio of medical utilization increased with the severity of polypharmacy, as did the use of advanced medical resources (ie, the number of hospitalizations). In particular, the increase in incidence rate ratio was more significant in 3 aspects: (1) number of pharmacy visits; (2) number of emergency room admissions; and (3) number of hospitalizations. The government should establish policies and guidance for the safe use of medicines to ensure reduced risk for older people.
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Affiliation(s)
- Ji-Wen Li
- 1 Kaohsiung Medical University, Kaohsiung
| | | | | | - I-Chen Lee
- 1 Kaohsiung Medical University, Kaohsiung
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20
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Etxeberria A, Iribar J, Rotaeche R, Vrotsou K, Barral I. [Evaluation of an educational intervention and a structured review of polypharmacy in elderly patients in Primary Care]. Rev Esp Geriatr Gerontol 2018; 53:319-325. [PMID: 30097319 DOI: 10.1016/j.regg.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 05/10/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
- Arritxu Etxeberria
- Farmacia de Atención Primaria, Centro de Salud de Hernani, OSI Donostialdea, Hernani, España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España
| | - Josune Iribar
- Farmacia de Atención Primaria, Centro de Salud de Hernani, OSI Donostialdea, Hernani, España.
| | - Rafael Rotaeche
- Centro de Salud de Alza, San Sebastián, OSI Donostialdea, San Sebastián, España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España
| | - Kalliopi Vrotsou
- Unidad de Investigación de Atención Primaria - OSIS Gipuzkoa , San Sebastián, España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Vizcaya, España; Centro de Investigación en Cronicidad Kronikgune, Barakaldo, Vizcaya, España
| | - Iosu Barral
- Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España
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21
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Riera-Mestre A, Formiga F. Medication regimen complexity: A new challenge. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Riera-Mestre A, Formiga F. Complejidad terapéutica: un nuevo reto. Rev Clin Esp 2018; 218:356-357. [DOI: 10.1016/j.rce.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/17/2018] [Indexed: 11/30/2022]
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23
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Carmona-Torres JM, Cobo-Cuenca AI, Recio-Andrade B, Laredo-Aguilera JA, Martins MM, Rodríguez-Borrego MA. Prevalence and factors associated with polypharmacy in the older people: 2006-2014. J Clin Nurs 2018; 27:2942-2952. [PMID: 29603814 DOI: 10.1111/jocn.14371] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2018] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To analyse the prevalence, risk factors and evolution over time of polypharmacy and self-medication in the older people in Spain from 2006-2014. BACKGROUND Polypharmacy is a public health problem for older people worldwide which causes different negative effects on their health, increasing health costs and pharmaceutical spending. However, previous studies do not include nationally representative samples and none of them provide updated data. DESIGN Cross-sectional study with community-dwelling older adults (N = 26,277) who participated in the National Health Survey in Spain in 2006 and 2011/2012 and the European Health Survey in Spain in 2009 and 2014. METHODS Polypharmacy (defined as use of five or more medications in the last 2 weeks), excessive polypharmacy (defined as use of ten or more medications in the last 2 weeks) and self-medication (defined as use of medications without a prescription) were evaluated. A logistic regression was used for to know the association between polypharmacy and self-medication with the sociodemographic characteristic. RESULTS The participants were 62% female and 38% male. The mean medication consumption was 2.96 (SD ± 2.11). Prevalence of polypharmacy was present in 21.9%, prevalence of excessive polypharmacy was 0.6%, and prevalence of self-medication was 10.7%. The most commonly used medications were for blood pressure (51.6%), pain (42.8%) and cholesterol (28.2%). Polypharmacy is associated with sex (females), age, being separated/divorced/widowed, lack of education, higher body mass index, being bedridden during the last 2 weeks and self-medication. CONCLUSIONS The prevalence of polypharmacy and prevalence of self-medication are considerable, and they increased significantly from 2006-2014. RELEVANCE TO CLINICAL PRACTICE To deal with polypharmacy is a big challenge for nurses. These data suggest to establish innovative clinical strategies in which the health professionals and the patients are involved to improve the personal behaviour with medicines and to reduce the risks and costs of polypharmacy and self-medication.
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Affiliation(s)
- Juan Manuel Carmona-Torres
- E. U. Enfermería y Fisioterapia de Toledo, Universidad de Castilla-La Mancha, Toledo, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Ana Isabel Cobo-Cuenca
- E. U. Enfermería y Fisioterapia de Toledo, Universidad de Castilla-La Mancha, Toledo, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | | | - José Alberto Laredo-Aguilera
- Facultad de Terapia Ocupacional, Logopedia y Enfermería de Talavera de la Reina, Universidad de Castilla-La Mancha, Talavera de la Reina, Spain
| | - María Manuela Martins
- Escola de Enfermagem do Porto/ICBAS, UP - Grupo de Investigação - NursID: Inovação e Desenvolvimento em Enfermagem, CINTESIS - center for health technology and services research - FMUP, Porto, Portugal
| | - María Aurora Rodríguez-Borrego
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain.,Hospital Universitario Reina Sofía, Córdoba, Spain
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Espaulella-Panicot J, Molist-Brunet N, Sevilla-Sánchez D, González-Bueno J, Amblàs-Novellas J, Solà-Bonada N, Codina-Jané C. [Patient-centred prescription model to improve adequate prescription and therapeutic adherence in patients with multiple disorders]. Rev Esp Geriatr Gerontol 2017; 52:278-281. [PMID: 28476211 DOI: 10.1016/j.regg.2017.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 06/07/2023]
Abstract
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.
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Affiliation(s)
- Joan Espaulella-Panicot
- Hospital Universitari de la Santa Creu, Vic, Barcelona, España; Hospital Universitari de Vic, Vic, Barcelona, España.
| | - Núria Molist-Brunet
- Hospital Universitari de la Santa Creu, Vic, Barcelona, España; Hospital Universitari de Vic, Vic, Barcelona, España
| | - Daniel Sevilla-Sánchez
- Hospital Universitari de la Santa Creu, Vic, Barcelona, España; Hospital Universitari de Vic, Vic, Barcelona, España
| | | | - Jordi Amblàs-Novellas
- Hospital Universitari de la Santa Creu, Vic, Barcelona, España; Hospital Universitari de Vic, Vic, Barcelona, España
| | | | - Carles Codina-Jané
- Hospital Universitari de Vic, Vic, Barcelona, España; Hospital Clínic de Barcelona, Barcelona, España
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Agustí A, Formiga F, San-José A. [Polypharmacy and inappropriate prescription of medicines in the elderly]. Rev Esp Geriatr Gerontol 2017; 52:233-234. [PMID: 28131400 DOI: 10.1016/j.regg.2016.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Antònia Agustí
- Servicio de Farmacología Clínica, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Barcelona, España; Departamento de Farmacología, Terapéutica y Toxicología, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, España.
| | - Francesc Formiga
- Servicio de Medicina Interna, IDIBELL, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Antonio San-José
- Servicio de Medicina Interna, Hospital Universitari Vall d'Hebron, Barcelona, España
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