Arritxu Etxeberria1, Josune Iribar2, Rafael Rotaeche3, Kalliopi Vrotsou4, Iosu Barral5. 1. Farmacia de Atención Primaria, Centro de Salud de Hernani, OSI Donostialdea, Hernani, España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España. 2. Farmacia de Atención Primaria, Centro de Salud de Hernani, OSI Donostialdea, Hernani, España. Electronic address: Josune.Iribarsorazu@osakidetza.eus. 3. Centro de Salud de Alza, San Sebastián, OSI Donostialdea, San Sebastián, España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España. 4. 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. 5. Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España.
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.
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.
Authors: Daniela A Rodrigues; Ana I Plácido; Ramona Mateos-Campos; Adolfo Figueiras; Maria Teresa Herdeiro; Fátima Roque Journal: Front Pharmacol Date: 2022-01-24 Impact factor: 5.810