Prescripción inadecuada en pacientes polimedicados mayores de 64 años en atención primaria / Inappropriate prescribing in polymedicated patients over 64 years-old in primary care

OBJETIVO: Describir la prescripción inadecuada (PI) en la población polimedicada mayor de 64 años en atención primaria mediante los criterios STOPP/START. DISEÑO: Descriptivo, transversal y multicéntrico. Emplazamiento: Cuatro centros urbanos de atención primaria de Barcelona. PARTICIPANTES: Selección aleatoria de pacientes mayores de 64 años con más de 5 fármacos prescritos durante al menos 6 meses (n = 467). MEDICIONES PRINCIPALES: Se estudiaron los principales problemas de salud, fármacos prescritos de forma crónica y el porcentaje de PI mediante los criterios STOPP/START. Se consideró porcentaje de PI al porcentaje de pacientes con incumplimiento de al menos un criterio STOPP o START, y se calculó con un IC del 95%. Para el análisis estadístico se utilizó chi-cuadrado. RESULTADOS: La edad media fue de 77,3 (± 7,0 DE), con una media de 8,9 (± 2,8 DE) fármacos prescritos. La PI fue mayor a mayor número de fármacos prescritos (p < 0,01). Un total de 326 pacientes (76,4% [IC 95%: 72,2-80,6]) tenían al menos una PI, según los criterios STOPP/START. La PI STOPP afectó al 51,4% de los pacientes y la PI START al 53,6%. Las causas más frecuentes de PI fueron los antiagregantes -tanto por exceso de prescripción (10,2%) como por omisión (17,9%)-, el uso prolongado de benzodiacepinas (6,6%) y las duplicidades (6,4%). CONCLUSIONES: La PI en los pacientes polimedicados en atención primaria fue muy elevada. La PI fue similar respecto a fármacos que se deberían retirar o se deberían iniciar. Las causas más frecuentes de PI fueron antiagregantes, benzodiacepinas y duplicidades farmacológicas

OBJECTIVE: To describe inappropriate prescribing (IP) in the polymedicated population over 64 years-old in primary care using the STOPP/START criteria. DESIGN: The study design was descriptive, cross-sectional and multicenter. LOCATION: Four urban primary care centers in Barcelona. Participants Patients over 64 years-old with more than 5 prescribed drugs for at least 6 months (n = 467). Main measurements Major health problems, chronically prescribed drugs, and percentage of IP using the STOPP/START criteria were studied. Percentage of IP considered as the percentage of patients with at least one STOPP or START non-compliance criterion was calculated with a 95% CI. Chi-square was used for statistical analysis. RESULTS: The mean age was 77.3 (± 7.0 SD) with a mean of 8.9 (± 2.8 SD) prescribed drugs. IP was higher the greater the number of drugs prescribed (p < 0,01).326 patients (76.4% [95% CI: 72.2 to 80.6]) had at least one IP, according to STOPP/START criteria. STOPP IP affected 51.4% of the patients and START IP 53.6%. The most frequent causes of IP were antiplatelet agents, for both over-prescribing (10.2%) and omission (17.9%). Prolonged use of benzodiazepines (6.6%) and duplications (6.4%) followed in prevalence. CONCLUSIONS: IP in polymedicated patients in primary care was very high. IP was similar for drugs that should be withdrawn or started. The most common causes of IP were antiplatelet agents, benzodiazepines and drug duplication

[Inappropriate prescribing in polymedicated patients over 64 years-old in primary care]. / Prescripción inadecuada en pacientes polimedicados mayores de 64 años en atención primaria.

OBJECTIVE: To describe inappropriate prescribing (IP) in the polymedicated population over 64 years-old in primary care using the STOPP/START criteria. DESIGN: The study design was descriptive, cross-sectional and multicenter. LOCATION: Four urban primary care centers in Barcelona. Participants Patients over 64 years-old with more than 5 prescribed drugs for at least 6 months (n=467). Main measurements Major health problems, chronically prescribed drugs, and percentage of IP using the STOPP/START criteria were studied. Percentage of IP considered as the percentage of patients with at least one STOPP or START non-compliance criterion was calculated with a 95%CI. Chi-square was used for statistical analysis. RESULTS: The mean age was 77.3 (± 7.0 SD) with a mean of 8.9 (± 2.8 SD) prescribed drugs. IP was higher the greater the number of drugs prescribed (p<0,01). 326 patients (76.4% [95%CI: 72.2 to 80.6]) had at least one IP, according to STOPP/START criteria. STOPP IP affected 51.4% of the patients and START IP 53.6%. The most frequent causes of IP were antiplatelet agents, for both over-prescribing (10.2%) and omission (17.9%). Prolonged use of benzodiazepines (6.6%) and duplications (6.4%) followed in prevalence. CONCLUSIONS: IP in polymedicated patients in primary care was very high. IP was similar for drugs that should be withdrawn or started. The most common causes of IP were antiplatelet agents, benzodiazepines and drug duplication.

To wait or not to wait 1 min between office blood pressure readings.

OBJECTIVE: It is recommended to wait at least 1 min between blood pressure (BP) readings. However, there is insufficient evidence on the utility of this recommendation using a validated automatic device. The aim was to assess differences in BP according to the waiting time between BP readings. PATIENTS AND METHODS: The study was designed as a cross-sectional descriptive study in hypertensive patients attended in primary care.Patients were seated for 5 min before six baseline BP readings: three BP measurements with no waiting time [immediate readings (IR)] between them and three BP measurements with 1 min of waiting time [waiting readings (WR)] between each reading, in random order. The intraclass correlation coefficient was calculated between IR and WR mean BP measurements, with 95% confidence intervals (CIs). RESULTS: We included 150 hypertensive patients, 49.3% women, 65.6 (12.8) years of age. The mean systolic blood pressure (SBP) values for IR and WR measurements were 137.2 (95% CI 134.2-140.2) and 137.8 (95% CI 134.8-140.8) mmHg, respectively. The mean diastolic blood pressure (DBP) values for IR and WR measurements were 79.4 (95% CI 77.5-81.4) and 79.7 (95% CI 77.7-81.8) mmHg, respectively. Intraclass correlation coefficient between IR and WR was 0.959 (95% CI 0.943-0.970) and 0.926 (95% CI 0.898-0.946) for SBP and DBP, respectively. The mean difference between both methods for SBP and DBP was -0.60 (95% CI -1.79 to 0.5) and -0.27 (95% CI -1.33 to 0.77) mmHg, respectively. CONCLUSION: We found a good agreement between waiting or not waiting 1 min between office BP readings. This demonstrates that both methods of BP measurement appear to be interchangeable.