Enhancing patient outcomes: Integrating electronic cardiology consultation in primary care for cancer patients.

BACKGROUND: The prevalence of cancer patients with concomitant cardiovascular (CV) disease is on the rise due to improved cancer prognoses. The aim of this study is to evaluate the long-term outcomes of cancer patients referred to a cardiology department (CD) via primary care using e-consultation. METHODS: We analysed data from cancer patients with prior referrals to a CD between 2010 and 2021 (n = 6889) and compared two care models: traditional in-person consultations and e-consultations. In e-consultation model, cardiologists reviewed electronic health records (e-consultation) to determine whether the demand could be addressed remotely or necessitated an in-person consultation. We used an interrupted time series regression model to assess outcomes during the two periods: (1) time to cardiology consultation, (2) rates of all-cause and CV related hospital admissions and (3) rates of all-cause and CV-related mortality within the first year after the initial consultation or e-consultation at the CD. RESULTS: Introduction of e-consultation for cancer patients referred to cardiology care led to a 51.8% reduction (95%CI: 51.7%-51.9%) in waiting times. Furthermore, we observed decreased 1-year incidence rates, with incidence rate ratios (iRRs) [IC95%] of .75 [.73-.77] for CV-related hospitalizations, .43 [.42-.44] for all-cause hospitalizations, and .87 [.86-.88] for all-cause mortality. CONCLUSIONS: Compared to traditional in-person consultations, an outpatient care program incorporating e-consultation for cancer patients significantly reduced waiting times for cardiology care and demonstrated safety, associated with lower rates of hospital admissions.

Analysis of drug-related problems in polymedicated patients over the age of 64 in primary care. A cross-sectional descriptive study. / Análisis de los problemas relacionados con la medicación en pacientes polimedicados mayores de 64 años en atención primaria. Un estudio descriptivo transversal.

OBJECTIVE: To identify drug-related problems using the STOPP/START criteria of patients over 64 years polymedicated with 12 or more drugs. METHOD: Descriptive cross-sectional. We analysed 172 cases randomly selected from the register of 1500 polymedicated patients of the Quality Improvement Programme for Chronic and Polymedicated Patients of the Galician Health Service for the area of Santiago in 2017. Drug-related problems and the negative results associated with medication were recorded. Treatment compliance was assessed by the Morisky-Green-Levine test. Nursing interventions were recorded based on the Programme's nursing report. Bivariate analysis of the data was performed and the association between the variables was estimated by calculating the odds ratio (OR). RESULTS: The 56.4% of the patients were women. The mean age was 77.34±10.11 years. The most common problem was the likelihood of presenting adverse effects, observed in 64.1% of the patients. Women were more likely to have this problem than men (OR: 1.37; 95% CI: 1.06-1.78). Eighteen percent of the patients were considered non-compliant with the prescribed treatment, according to the Morisky-Green-Levine test. Of the patients, 25.6% had received health education interventions. CONCLUSIONS: Nurses must periodically re-evaluate patient medication to check adherence to treatment and determine whether it is causing any type of adverse effect, as well as incorporate health education interventions in this field into their activity.

[Evaluation of the pilot program of medicine dispensation in customized doses in Galicia [Spain]]. / Evaluación del Programa Piloto de Dispensación de Medicamentos en Dosis Personalizada en Galicia.

OBJECTIVE: To quantify, from an economic perspective, the results of the Pilot Program of Dispensation of Medicines in Unitary Dose in Galicia, Spain. PATIENTS AND METHODS: Retrospective study from 35,923 antibiotic prescriptions in customized doses corresponding to 5 active principles (amoxicillin, amoxicilin/clavulanic, claritromicin, cefuroxima axetil and ciprofloxacin). The program, which worked during 12 months, included 292 physicians from 46 units of primary care of the Galician Health Service and 167 offices of pharmacy. RESULTS: 60.57% of the prescribed treatments did not adjust exactly to the conventional presentations existing in the market. Savings in units of antibiotic of the dispensation in customized doses compared with the conventional one has been of 14.32%. Registered economic saving has been of 29.94%. The inclusion of 2 new presentations in amoxiciline and amoxiciline/clavulanic (of 15 and 21 tablets) and of one in the other 3 (cefuroxime and ciprofloxacin of 14 tablets and clarithromycin of 16) would avoid 86.5% of the leftover units without having to implement individualized dispensation. CONCLUSIONS: An important antibiotic stock is being generated in home medicine cabinets as a result of the leftovers of prescribed treatments that in the case of Galicia are equivalent to more than 1,800,000 doses of antibiotic in 2004. This problem could be reduced with the dispensation in customized dose and partially with new presentations.

[Heterozygous family hypercholesterolemia: study of use of statins under clinical practice conditions]. / Hipercolesterolemia familiar heterocigota: estudio de utilización de estatinas en condiciones de práctica clínica.

OBJECTIVES: To compare the use profile of statins in patients with clinical diagnosis of heterozygous family hypercholesterolaemia (HFH) and the use profile of the general population treated with statins. DESIGN. Retrospective, observational study. SETTING: Galician Health Service, Spain. PARTICIPANTS: Patients under 65 years old treated with statins. MAIN MEASUREMENTS: In patients with HFH: number of patients, age, gender, statins used and defined daily dose per patient and day (DDD/patient/day). Variables in the rest of the population treated with statins: number of patients, statins used and DDD/patient/day. RESULTS: In a sample of 331 under-65 patients with HFH, 185 were men (55.86%) and 146 women (44.14%). Their average age was 44.56 years old (95% CI, 43.33-45.80), without statistically significant differences between men and women. Relevant differences in the daily mean consumption (DDD/patient/day) of statins between the studied sample and the rest of the under-65 population treated with statins were found (3.03 DDD/patient/day [95% CI, 2.70-3.36] vs 1.33 DDD/patient/day [95% CI, 1.16-1.40]; P< .001). These differences were caused by atorvastatin: 70% of HFH patients were being treated with atorvastatin (versus 37.6% of the rest of the population treated with statins). Differences in daily mean consumption of atorvastatin between HFH and the rest of the statin-treated population were also found (3.58 DDD/patient/day [95% CI, 3.15-4.02] vs 1.64 DDD/patient/day [95% CI, 1.37-1.90]; P< .001). CONCLUSIONS: The DDD/patient/day of statins in HFH patients is double that of the rest of the population treated with statins. The different pattern of use of atorvastatin in HFH is the main reason for these results.