[Negative results associated with medication in the emergency department of a hospital]. / Resultados negativos asociados con la medicación en un servicio de urgencias hospitalario.

OBJECTIVE: To find out the prevalence of negative results associated with medication (herein referred to as NRM) in patients attending the emergency department. To classify the results by severity, avoidability and cost, as well as to establish the factors associated with their appearance. METHOD: Observational, descriptive and cross-sectional study carried out in the emergency department of a tertiary hospital. Patient surveys and emergency department records were used as sources of information. The Dader Method and guidelines from the Third Consensus of Granada were used. Pearson's chi2 test was used to find the association between age, gender and number of drugs and showing signs of NRM. Avoidability was measured using Baena et al's criteria and severity was assessed according to whether or not the patient had been admitted into an observation stall or on to a hospital ward. RESULTS: 24.4% of patients visited the emergency department because of NRM. 16.1% needed to be hospitalised to solve their health issue. 83.9% of all patients with NRM and 77.3% of those hospitalised due to NRM could have been avoided. Statistically, there was a higher prevalence of NRM in patients taking 5 or more different drugs. An estimated euro 14,666,178 was spent on treating avoidable NRM cases in 2003. CONCLUSIONS: The prevalence of NRM in those who attended the emergency department, the high percentage of avoidability and the cost imposed on the Health Service seem to sufficiently argue a case for the consideration that NRM as a problem which requires the implementation of prevention programmes based on drug-treatment monitoring.

Resultados negativos asociados con la medicación en un servicio de urgencias hospitalario / Negative results associated with medication in the emergency department of a hospital

Objetivo: Conocer la prevalencia de los resultados negativos asociadoscon la medicación (RNM) entre los usuarios del servicio de urgencias.Caracterizarlos por su gravedad, evitabilidad y coste, asícomo encontrar factores asociados con su aparición.Método: Estudio observacional, descriptivo y transversal en el serviciode urgencias de un hospital de tercer nivel. Como fuentes de informaciónse emplearon la entrevista a los pacientes y la historia deurgencias. Se trabajó según el método Dáder y las directrices del TercerConsenso de Granada. Se empleó el test de la c2 de Pearson parabuscar la asociación entre edad, sexo o número de medicamentos ypresentar los RNM. La evitabilidad se estableció según el criterio deBaena et al y la gravedad por el ingreso o no del paciente en boxesde observación o planta de hospitalización.Resultados: El 24,4% de los pacientes acudió a urgencias a causa deun RNM. El 16,1% necesitó hospitalización para resolver el problemade salud. El 83,9% de todos los RNM y el 77,3% de los ingresos causadospor RNM fueron evitables. Se encontró estadísticamente másprevalencia de RNM entre los pacientes que tomaban 5 o más medicamentos.Se estimó un gasto de 14.666.178 e en el tratamiento delos RNM evitables del año 2003.Conclusiones: La prevalencia de RNM en la población atendida, suelevado porcentaje de evitabilidad y el coste que suponen para elservicio de salud parecen argumentos suficientes para considerar losRNM como un problema para el cual es necesario establecer programasde prevención basados en el seguimiento farmacoterapéutico

Objective: To find out the prevalence of negative results associatedwith medication (herein referred to as NRM) in patients attendingthe emergency department. To classify the results by severity, avoidabilityand cost, as well as to establish the factors associated with theirappearance.Method: Observational, descriptive and cross-sectional study carriedout in the emergency department of a tertiary hospital. Patient surveysand emergency department records were used as sources of information.The Dader Method and guidelines from the Third Consensusof Granada were used. Pearson’s c2 test was used to find theassociation between age, gender and number of drugs and showingsigns of NRM. Avoidability was measured using Baena et al’s criteriaand severity was assessed according to whether or not the patienthad been admitted into an observation stall or on to a hospital ward.Results: 24.4% of patients visited the emergency department becauseof NRM. 16.1% needed to be hospitalised to solve their healthissue. 83.9% of all patients with NRM and 77.3% of those hospitaliseddue to NRM could have been avoided. Statistically, there was ahigher prevalence of NRM in patients taking 5 or more differentdrugs. An estimated e 14,666,178 was spent on treating avoidableNRM cases in 2003.Conclusions: The prevalence of NRM in those who attended theemergency department, the high percentage of avoidability and thecost imposed on the Health Service seem to sufficiently argue a casefor the consideration that NRM as a problem which requires the implementationof prevention programmes based on drug-treatmentmonitoring

[Comparison of two models of prescription quality indicators in primary care]. / Comparación de dos modelos de indicadores de la calidad de la prescripción farmacéutica en atención primaria.

OBJECTIVES: To assess the quality of prescriptions in primary care area through indicators established by a team of physicians and to analyze the relationship between these indicators and those used by the Spanish public health system (INSALUD) in the same area. METHODS: An observational, cross sectional study was performed in a primary care area in Asturias with 156,614 inhabitants and 9 health centers. An overall quality score was obtained for each of the physicians in the primary care area by using quality indicators and standards agreed on by the prescribers themselves. The relationship between the score obtained and the indicators normally used in the area by INSALUD and pharmaceutical cost was also analyzed. RESULTS: Mean compliance with the optimal standard was 29%. The mean overall quality score was 3.24. None of the physicians achieved the maximum score of 11. No significant association was found between the score and the indicators for drugs of limited clinical value. Adherence to the pharmaceutical guide for the area was positively correlated with quality (r = 0.44, p < 0.001). A negative linear association (p < 0.001) was found between the overall quality score and incurred cost. The adjusted coefficient of determination was 0.29. CONCLUSIONS: Poor prescribing quality was widespread. Indicators for drugs of limited clinical value, frequently used as a measure of quality, showed no relationship with quality. Adherence to the area's pharmaceutical guide remains a valid indicator of prescribing quality. Overall, there was a correlation between higher quality and lower prescribing cost, although this correlation was not found for individual physicians.

Comparación de dos modelos de indicadores de la calidad de la prescripción farmacéutica en atención primaria / Comparison of two models of prescription quality indicators in primary care

Objetivo: Evaluar la calidad de prescripción en un área de atención primaria (AP) a partir de indicadores elaborados por los médicos de equipo y estudiar su relación con los indicadores de prescripción usados por el Insalud en el área. Métodos: Estudio de tipo observacional transversal. Se llevó a cabo en un área de AP de Asturias con 156.614 habitantes y 9 centros de salud. Se obtuvo una puntuación global de calidad para cada uno de los médicos de equipo de AP a partir de unos indicadores y estándares de calidad consensuados por los prescriptores. Se estudió la relación de la puntuación con los indicadores medidos de forma habitual en el área por el Insalud y con el gasto farmacéutico. Resultados: El promedio de cumplimiento del estándar óptimo se situó en un 29 por ciento. Se obtuvo un valor promedio para la puntuación global de calidad de 3,24. Ningún médico alcanzó la máxima puntuación de 11.No se encontró ninguna asociación significativa de la puntuación con el indicador de fármacos con utilidad terapéutica baja. La adhesión a la Guía Farmacoterapéutica del Área se correlacionó positivamente con la calidad (r = 0,44; p < 0,001).Se halló una asociación lineal negativa (p < 0,001) entre la puntuación global de calidad y el gasto. El coeficiente de determinación ajustado fue de 0,29.Conclusiones: Se halló una baja calidad de prescripción de forma generalizada. El indicador de fármacos con utilidad terapéutica baja, frecuentemente usado para medir la calidad, no demostró tener una relación con la misma. La adhesión a la Guía Farmacoterapéutica del Área mantiene su validez como indicador de calidad de prescripción. Además, aunque no individualizadamente, existió una correlación entre la mayor calidad y el menor coste de la prescripción. (AU)