[Evaluation of the collaboration between Primary and Hospital Care in order to improve inappropriate prescription]. / Evaluación de la colaboración entre atención primaria y hospitalaria para mejorar la polimedicación inapropiada.

INTRODUCTION AND OBJECTIVES: To evaluate the implementation of a collaborative experience between Primary (PC) and Hospital Care (HC) aimed at reducing potentially inappropriate prescribing (PIP) in patients with polypharmacy. MATERIALS AND METHODS: Collaborative experience including a controlled before-after intervention study, carried out in the Donostialdea Integrated Health Organization (IHO), with Bilbao Basurto IHO as control group, Osakidetza, Basque Health Service. Participant were 227 PC physicians and physicians from 7 hospital services, and patients with 5 or more drugs meeting at least one PIP criteria. The intervention consisted of communication and knowledge between professionals, PC-HC consensus, training, identification of patients at risk, medication review, evaluation and feed-back. The collaboration process (agreements, consensus documents, training activities) and the change in the prevalence of PIP in polymedicated patients (using computerised health records) were evaluated. RESULTS: A total of 21 PIP criteria and 6 recommendation documents were agreed. An analysis was performed on 15,570 PIP from OSI Donostialdea and 24,866 from the control group. The prevalence of PIP in polymedicated patients was reduced by -4.53% (95% CI: -4.71 to -4.36, P< .0001) in comparison with the control group. The before-after differences were statistically significant across the 7 services. CONCLUSIONS: PC-HC collaboration is feasible and, along with other intervention components, reduces inappropriate polypharmacy in the context of a recently integrated healthcare organisation. The collaboration process is complex and requires continuous monitoring, policy involvement, leadership that encourages health professional participation, and intensive use of information systems.

Uso de hierro en forma de medicamento en gestantes colombianas / Pregnant Colombian females' iron in take in drug form

Objetivo Caracterizar el consumo de hierro en forma de medicamento en un grupo de embarazadas colombianas. Metodología Estudio observacional descriptivo, se obtuvo información de mujeres en control prenatal y/o atención del parto en 4 ciudades de Colombia. Las fuentes de información fueron entrevistas a gestantes y registros de historia clínica. Resultados La muestra fue de 1 637 mujeres en 15 instituciones. A 1 396 mujeres (85,3 %) les recomendaron consumir hierro, recomendación realizada por médico al 85,3 % de ellas, el 86,8 % tuvo adherencia al tratamiento. Al 84,7 % el hierro fue suministrado por la empresa aseguradora de salud, el 11,9 % lo compró a sus expensas. El 90,0 % de gestantes anémicas y el 82,8 % de las no anémicas consumieron hierro en forma de medicamento, en conjunto, en el 37,2 % de las gestantes el consumo de suplencia de hierro fue pertinente (es decir, lo necesitaban, se les recomendó y lo consumieron o no le necesitaban, no se recomendó y/o no lo consumieron). Discusión Se recomienda y se consume hierro independientemente de presentar anemia. Se invita a reflexionar sobre la utilidad de los programas que promueven el consumo masivo de esta sustancia en forma de medicamento durante el embarazo, programas que parecen desconocer las causas fundamentales de los problemas nutricionales que aquejan a la población.

Objective Describing a group of pregnant Colombian females' iron intake, in drug form. Methodology This was an observational descriptive study; information was collected in 4 Colombian cities regarding pregnant females during antenatal control or when giving birth. Information sources consisted of interviews with pregnant women and their clinical records. Results The sample consisted of 1,637 female sat tending 15 institutions. An iron intake was recommended for1, 396 women (85.3 %); a doctor made such recommendation in 85.3 % of cases and adherence was 86.8 %. Health insurance was used by 84.7 % of the females for supplying iron; 11.9 % of them bought it themselves. Iron intake as medication for anemic pregnant females was 90.0 % and 82.8 % in non-anemic ones. Iron intake supply was appropriate in 37.2 % of the pregnant females (i.e. they needed it, someone recommended it for them and they consumed it, or they didn't need it, someone didn't recommend it to them and/or they did not take it). Discussion Iron intake was recommended and consumed regardless of anemia status. The results invite to think on the usefulness of programs promoting the mass intake of iron as a medication during pregnancy. Such programs seem to be unaware of the fundamental causes of people's nutritional problems.