An Ontology-Based Approach to Improving Medication Appropriateness in Older Patients: Algorithm Development and Validation Study.

Background: Inappropriate medication in older patients with multimorbidity results in a greater risk of adverse drug events. Clinical decision support systems (CDSSs) are intended to improve medication appropriateness. One approach to improving CDSSs is to use ontologies instead of relational databases. Previously, we developed OntoPharma-an ontology-based CDSS for reducing medication prescribing errors. Objective: The primary aim was to model a domain for improving medication appropriateness in older patients (chronic patient domain). The secondary aim was to implement the version of OntoPharma containing the chronic patient domain in a hospital setting. Methods: A 4-step process was proposed. The first step was defining the domain scope. The chronic patient domain focused on improving medication appropriateness in older patients. A group of experts selected the following three use cases: medication regimen complexity, anticholinergic and sedative drug burden, and the presence of triggers for identifying possible adverse events. The second step was domain model representation. The implementation was conducted by medical informatics specialists and clinical pharmacists using Protégé-OWL (Stanford Center for Biomedical Informatics Research). The third step was OntoPharma-driven alert module adaptation. We reused the existing framework based on SPARQL to query ontologies. The fourth step was implementing the version of OntoPharma containing the chronic patient domain in a hospital setting. Alerts generated from July to September 2022 were analyzed. Results: We proposed 6 new classes and 5 new properties, introducing the necessary changes in the ontologies previously created. An alert is shown if the Medication Regimen Complexity Index is ≥40, if the Drug Burden Index is ≥1, or if there is a trigger based on an abnormal laboratory value. A total of 364 alerts were generated for 107 patients; 154 (42.3%) alerts were accepted. Conclusions: We proposed an ontology-based approach to provide support for improving medication appropriateness in older patients with multimorbidity in a scalable, sustainable, and reusable way. The chronic patient domain was built based on our previous research, reusing the existing framework. OntoPharma has been implemented in clinical practice and generates alerts, considering the following use cases: medication regimen complexity, anticholinergic and sedative drug burden, and the presence of triggers for identifying possible adverse events.

OntoPharma: ontology based clinical decision support system to reduce medication prescribing errors.

BACKGROUND: Clinical decision support systems (CDSS) have been shown to reduce medication errors. However, they are underused because of different challenges. One approach to improve CDSS is to use ontologies instead of relational databases. The primary aim was to design and develop OntoPharma, an ontology based CDSS to reduce medication prescribing errors. Secondary aim was to implement OntoPharma in a hospital setting. METHODS: A four-step process was proposed. (1) Defining the ontology domain. The ontology scope was the medication domain. An advisory board selected four use cases: maximum dosage alert, drug-drug interaction checker, renal failure adjustment, and drug allergy checker. (2) Implementing the ontology in a formal representation. The implementation was conducted by Medical Informatics specialists and Clinical Pharmacists using Protégé-OWL. (3) Developing an ontology-driven alert module. Computerised Physician Order Entry (CPOE) integration was performed through a REST API. SPARQL was used to query ontologies. (4) Implementing OntoPharma in a hospital setting. Alerts generated between July 2020/ November 2021 were analysed. RESULTS: The three ontologies developed included 34,938 classes, 16,672 individuals and 82 properties. The domains addressed by ontologies were identification data of medicinal products, appropriateness drug data, and local concepts from CPOE. When a medication prescribing error is identified an alert is shown. OntoPharma generated 823 alerts in 1046 patients. 401 (48.7%) of them were accepted. CONCLUSIONS: OntoPharma is an ontology based CDSS implemented in clinical practice which generates alerts when a prescribing medication error is identified. To gain user acceptance OntoPharma has been designed and developed by a multidisciplinary team. Compared to CDSS based on relational databases, OntoPharma represents medication knowledge in a more intuitive, extensible and maintainable manner.

Factors Associated with Medication Non-Adherence among Patients with Multimorbidity and Polypharmacy Admitted to an Intermediate Care Center.

Identifying determinants of medication non-adherence in patients with multimorbidity would provide a step forward in developing patient-centered strategies to optimize their care. Medication appropriateness has been proposed to play a major role in medication non-adherence, reinforcing the importance of interdisciplinary medication review. This study examines factors associated with medication non-adherence among older patients with multimorbidity and polypharmacy. A cross-sectional study of non-institutionalized patients aged ≥65 years with ≥2 chronic conditions and ≥5 long-term medications admitted to an intermediate care center was performed. Ninety-three patients were included (mean age 83.0 ± 6.1 years). The prevalence of non-adherence based on patients' multiple discretized proportion of days covered was 79.6% (n = 74). According to multivariable analyses, individuals with a suboptimal self-report adherence (by using the Spanish-version Adherence to Refills and Medications Scale) were more likely to be non-adherent to medications (OR = 8.99, 95% CI 2.80-28.84, p < 0.001). Having ≥3 potentially inappropriate prescribing (OR = 3.90, 95% CI 0.95-15.99, p = 0.059) was barely below the level of significance. These two factors seem to capture most of the non-adherence determinants identified in bivariate analyses, including medication burden, medication appropriateness and patients' experiences related to medication management. Thus, the relationship between patients' self-reported adherence and medication appropriateness provides a basis to implement targeted strategies to improve effective prescribing in patients with multimorbidity.

Medication regimen complexity on hospital admission in patients with advanced chronic conditions in need of palliative care.

OBJECTIVES: To evaluate characteristics of the medication complexity, risk factors associated with high medication complexity and their clinical consequences in patients with advanced chronic conditions. METHODS: A 10-month cross-sectional study was performed in an acute-hospital care Geriatric Unit. Patients with advanced chronic conditions were identified by the NECPAL test. Medication complexity was established using the Medication Regimen Complexity Index (MRCI) tool. Demographic, pharmacological and clinical patient data were collected with the objective of determining risk factors related to high medication complexity. Measured clinical outcomes were hospital length of stay, destination on hospital discharge, in-hospital mortality and 2-year survival. RESULTS: Two hundred and thirty-five patients (mean age 86.8, SD 5.37; 65.5% female) were recruited. MRCI's mean score was 38 points (SD 16.54, rank: 2.00-98.50), with 57.9% of patients with high medication complexity (MRCI >35 points).

Modelo de Prescripción Centrado en la Persona para mejorar la adherencia terapéutica en pacientes con multimorbilidad / Patient-Centered Prescription Model to improve therapeutic adherence in patients with multimorbidity

Según los estudios disponibles, la eficacia de las intervenciones para mejorar la adherencia terapéutica en pacientes con multimorbilidad es limitada e inconsistente; por ello, debemos definir nuevos modelos de intervención que incorporen como elementos clave la atención centrada en la persona, el abordaje interdisciplinar y la orientación a la mejora de la adecuación terapéutica. En este sentido, el Modelo de Prescripción Centrado en la Persona ha demostrado su capacidad para adecuar la prescripción a las necesidades de pacientes con complejidad clínica. Para ello, incorpora cuatro etapas consecutivas: 1) valoración centrada en el paciente; 2) valoración centrada en el diagnóstico; 3) valoración centrada en el fármaco, y 4) propuesta de plan terapéutico. Proponemos, a través de un caso práctico, una adaptación del Modelo de Prescripción Centrado en la Persona como estrategia para mejorar la adherencia terapéutica. Para ello, en la primera etapa del modelo hemos incorporado una herramienta para la valoración multidimensional de la adherencia adaptada transculturalmente al español. Posteriormente, proponemos un conjunto de intervenciones a aplicar en las tres etapas restantes del modelo. Dichas intervenciones han sido identificadas en un resumen de revisiones sistemáticas y posteriormente seleccionadas mediante la metodología Delphi. Todos estos elementos han sido considerados adecuados en pacientes con multimorbilidad por la solidez de su evidencia, su utilidad potencial en la población diana y la factibilidad de su aplicación en la práctica clínica. La aproximación propuesta pretende sentar las bases de un modelo de cambio respecto al abordaje de la adherencia en el paciente con multimorbilidad

To date, interventions to improve medication adherence in patients with multimorbidity have shown modest and inconsistent efficacy among available studies. Thereby, we should define new approaches aimed at improving medication adherence tailored to effective prescribing, with a multidisciplinary approach and patient-centered. In this regard, the Patient-Centered Prescription Model has shown its usefulness on improving appropriateness of drug treatments in patients with clinical complexity. For that, this strategy addresses the following four steps: 1) Patient-Centered assessment; 2) Diagnosis-Centered assessment; 3) Medication-Centered assessment; and 4) Therapeutic Plan. We propose through a clinical case an adaptation of the Patient-Centered Prescription Model to enhance both appropriateness and medication adherence in patients with multimorbidity. To this end, we have included on its first step the Spanish version of a cross-culturally adapted scale for the multidimensional assessment of medication adherence. Furthermore, we suggest a set of interventions to be applied in the three remaining steps of the model. These interventions were firstly identified by an overview of systematic reviews and then selected by a panel of experts based on Delphi methodology. All of these elements have been considered appropriate in patients with multimorbidity according to three criteria: strength of their supporting evidence, usefulness in the target population and feasibility of implementation in clinical practice. The proposed approach intends to lay the foundations for an innovative way in tackling medication adherence in patients with multimorbidity

Patient-Centered Prescription Model to improve therapeutic adherence in patients with multimorbidity.

To date, interventions to improve medication adherence in patients with multimorbidity have shown modest and inconsistent efficacy among  available studies. Thereby, we should define new approaches aimed at improving medication adherence tailored to effective prescribing, with a multidisciplinary approach and patient-centered.In this regard, the Patient-Centered Prescription Model has shown its usefulness on improving appropriateness of drug treatments in patients with clinical complexity. For that, this strategy addresses the following four steps: 1) Patient-Centered assessment; 2) Diagnosis-Centered assessment; 3) Medication-Centered assessment; and 4) Therapeutic Plan.We propose through a clinical case an adaptation of the Patient-Centered Prescription Model to enhance both appropriateness and medication adherence in patients with multimorbidity. To this end, we have  included on its first step the Spanish version of a cross-culturally adapted scale  for the multidimensional assessment of medication adherence. Furthermore, we suggest a set of interventions to be applied in the three remaining steps of  the model. These interventions were firstly identified by an overview of systematic reviews and then selected by a panel of experts based on Delphi methodology.All of these elements have been considered appropriate in patients with multimorbidity according to three criteria: strength of their supporting  evidence, usefulness in the target population and feasibility of implementation in clinical practice.The proposed approach intends to lay the foundations for an innovative way in  tackling medication adherence in patients with multimorbidity.

Según los estudios disponibles, la eficacia de las intervenciones para mejorar la  adherencia terapéutica en pacientes con multimorbilidad es limitada e  inconsistente; por ello, debemos definir nuevos modelos de intervención que  incorporen como elementos clave la atención centrada en la persona, el abordaje interdisciplinar y la orientación a la mejora de la adecuación terapéutica.En este sentido, el Modelo de Prescripción Centrado en la Persona ha  demostrado su capacidad para adecuar la prescripción a las necesidades de  pacientes con complejidad clínica. Para ello, incorpora cuatro etapas consecutivas: 1) valoración centrada en el paciente; 2) valoración  centrada en el diagnóstico; 3) valoración centrada en el fármaco, y 4) propuesta de plan terapéutico.Proponemos, a través de un caso práctico, una adaptación del Modelo de Prescripción Centrado en la Persona como estrategia para mejorar la  adherencia terapéutica. Para ello, en la primera etapa del modelo hemos  incorporado una herramienta para la valoración multidimensional de la  adherencia adaptada transculturalmente al español. Posteriormente,  proponemos un conjunto de intervenciones a aplicar en las tres etapas restantes del modelo. Dichas intervenciones han sido identificadas en un resumen de  revisiones sistemáticas y posteriormente seleccionadas mediante la metodología  Delphi. Todos estos elementos han sido considerados adecuados en pacientes  con multimorbilidad por la solidez de su evidencia, su utilidad potencial en la población diana y la factibilidad de su aplicación en la práctica clínica. La  aproximación propuesta pretende sentar las bases de un modelo de cambio respecto al abordaje de la adherencia en el paciente con multimorbilidad.

Prevalence, risk factors and adverse outcomes of anticholinergic burden in patients with advanced chronic conditions at hospital admission.

AIM: To evaluate the anticholinergic burden (ACB), the risk factors associated with its onset and the clinical consequences for patients with advanced chronic conditions. METHODS: A 10-month cross-sectional study was carried out in an acute hospital care geriatric unit. Patients with advanced chronic conditions were identified by the NECessity of PALliative care (NECPAL) test. The ACB was established using the Anticholinergic Drug Scale and Drug Burden Index (DBI) tools. Demographic, pharmacological and clinical patient data were collected with the objective of determining risk factors related to ACB. Measured clinical outcomes were the presence of acute confusional state, bone fractures, length of stay, mortality and 12-month survival rate. RESULTS: A total of 235 patients were recruited (mean age 86.80 years, SD 5.37 years; 65.50% women), and 82.10% (DBI) and 93.6% (Anticholinergic Drug Scale) of the patients were treated with anticholinergic medications. Excessive polypharmacy (≥10 drugs) was identified as a risk factor for the presence of anticholinergic medication (Anticholinergic Drug Scale: OR 6.26, 95% CI 1.38-28.42; DBI: OR 3.44, 95% CI 1.60-7.38). High anticholinergic burden (by DBI >2 points) was an independent risk factor for the presence of acute confusional state on hospital admission (OR 2.98, 95% CI 1.04-8.50). However, ACB was not related to bone fractures on admission, length of stay, mortality or survival. CONCLUSIONS: Patients with advanced chronic conditions are frequently treated with anticholinergic drugs, with excessive polypharmacy as a risk factor. Anticholinergic drugs are a risk factor for the presence of acute confusional state on hospital admission, but have no other effect in terms of morbimortality. Geriatr Gerontol Int 2018; 18: 1159-1165.

Potentially inappropriate medication in palliative care patients according to STOPP-Frail criteria.

BACKGROUND: Potentially inappropriate medications (PIMs) are common in palliative care patients, but no specific tools have been used to determine these PIMs. OBJECTIVE: To evaluate the prevalence of PIMs according to specific tool 'STOPP-Frail', related factors with its existence and clinical consequences. METHODS: This is a post hoc analysis from a 10-month prospective cross-sectional study. Upon hospital admission in an acute geriatric unit (AGU), demographic and pharmacological data were collected to determine related associated factors. The main outcome was prevalence and type of PIMs (by STOPP-Frail criteria). Measured clinical outcomes were adverse drug events, length of stay, location upon discharge, in-hospital mortality and 1-year survival. RESULTS: Two hundred thirty-five patients (mean age 86.80; 65.50% women) were recruited. Overall, 67.2% of patients had ≥ 1 criterion (mainly 'drugs without clinical indication' due to alimentary tract and metabolism drugs). Related factors associated with PIMs according to STOPP-Frail criteria were moderate polypharmacy (OR 7.16 CI 95% 2.27-22.52) and excessive polypharmacy (OR 7.30 CI 95% 2.34-22.73), but not advanced age (OR 0.26 CI 95% 0.12-0.53) or previous hospitalisations (OR 0.61 CI 95% 0.48-0.79). There were no differences in clinical outcomes. CONCLUSION: PIMs according to STOPP-Frail are often used in palliative care patients. PIMs were associated with polypharmacy, but no related morbidity or mortality effects have been observed.

Modelo de prescripción centrado en la persona para mejorar la adecuación y adherencia terapéutica en los pacientes con multimorbilidad / Patient-centred prescription model to improve adequate prescription and therapeutic adherence in patients with multiple disorders

Las personas con multimorbilidad y polifarmacia se asocian con frecuencia a la complejidad clínica, entendida como aquella situación de incertidumbre condicionada por las dificultades en establecer un diagnóstico situacional y la toma de decisiones. En este grupo poblacional, la atención centrada en la persona se propone como uno de los mejores enfoques terapéuticos. En este contexto, el elemento práctico más relevante es la elaboración de un plan terapéutico individualizado, donde el plan farmacológico mantiene un rol relevante. En estos últimos años se ha observado un incremento importante del conocimiento en el ámbito de la adecuación de la prescripción y de la adherencia. Dadas estas circunstancias, es necesario encontrar un modelo que facilite a los profesionales la incorporación de este conocimiento a la práctica clínica. La prescripción centrada en la persona es un modelo de revisión de la medicación que engloba diferentes estrategias en una misma intervención. Se realiza por un equipo multidisciplinar y permite adecuar el plan farmacológico de pacientes con complejidad clínica (AU)

Patients with multiple disorders and on multiple medication are often associated with clinical complexity, defined as a situation of uncertainty conditioned by difficulties in establishing a situational diagnosis and decision-making. The patient-centred care approach in this population group seems to be one of the best therapeutic options. In this context, the preparation of an individualised therapeutic plan is the most relevant practical element, where the pharmacological plan maintains an important role. There has recently been a significant increase in knowledge in the area of adequacy of prescription and adherence. In this context, we must find a model must be found that incorporates this knowledge into clinical practice by the professionals. Person-centred prescription is a medication review model that includes different strategies in a single intervention. It is performed by a multidisciplinary team, and allows them to adapt the pharmacological plan of patients with clinical complexity (AU)

Traducción y adaptación transcultural al español del cuestionario ARMS para la medida de la adherencia en pacientes pluripatológicos / Spanish translation and cross-cultural adaptation of the ARMS-scale for measuring medication adherence in polypathological patients

Objetivo: Traducir y adaptar transculturalmente el cuestionario ARMS al español para medir la adherencia en pacientes pluripatológicos. Diseño: Traducción, adaptación transcultural y análisis de la comprensibilidad mediante entrevistas cognitivas. Emplazamiento: Hospital de segundo nivel. Mediciones: 1) Traducción directa e inversa seguidas de una síntesis y adaptación transcultural mediante metodología cualitativa para garantizar la equivalencia conceptual, semántica y de contenido entre el cuestionario original y su versión española. 2) Análisis de la comprensibilidad de la versión española del cuestionario mediante entrevistas cognitivas en una muestra de pacientes pluripatológicos no institucionalizados. Resultados: Se obtuvo la versión española del cuestionario ARMS (ARMS-e). La dificultad global de los traductores responsables de la traducción directa e inversa para encontrar una expresión conceptualmente equivalente entre los dos idiomas fue baja. El análisis de la comprensibilidad, realizado en una muestra aleatoria de 40 pacientes pluripatológicos no institucionalizados ingresados en un servicio de medicina interna de un hospital de segundo nivel, mostró una excelente comprensibilidad. Conclusiones: El cuestionario ARMS-e es una versión adaptada al español del cuestionario ARMS que es adecuada para la medida de la adherencia en pacientes pluripatológicos. Su estructura facilita un abordaje multidimensional de la falta de adherencia permitiendo individualizar posibles intervenciones en función de las barreras detectadas en cada paciente (AU)

Aim: Translate the ARMS scale into Spanish ensuring cross-cultural equivalence for measuring medication adherence in polypathological patients. Design: Translation, cross-cultural adaptation and pilot testing. Location: Secondary hospital. Measurements: (i) Forward and blind-back translations followed by cross-cultural adaptation through qualitative methodology to ensure conceptual, semantic and content equivalence between the original scale and the Spanish version. (ii) Pilot testing in non-institutionalized polypathological patients to assess the instrument for clarity. Results: The Spanish version of the ARMS scale has been obtained. Overall scores from translators involved in forward and blind-back translations were consistent with a low difficulty for assuring conceptual equivalence between both languages. Pilot testing (cognitive debriefing) in a sample of 40 non-institutionalized polypathological patients admitted to an internal medicine department of a secondary hospital showed an excellent clarity. Conclusions: The ARMS-e scale is a Spanish-adapted version of the ARMS scale, suitable for measuring adherence in polypathological patients. Its structure enables a multidimensional approach of the lack of adherence allowing the implementation of individualized interventions guided by the barriers detected in every patient (AU)

Potentially inappropriate medication at hospital admission in patients with palliative care needs.

Background Potentially inappropriate medications (PIMs) are common in older patients with polypharmacy, and are related to negative clinical results. Little information is available on the characteristics and consequences of PIMs in patients with advanced chronic conditions and palliative care needs. Objective To evaluate, for this population: (i) the prevalence of PIMs; (ii) the possible risk factors associated with its onset; and (iii) the related clinical consequences. Setting Acute-hospital care Geriatric Unit (AGU) in County of Osona, Spain. Method Ten-month prospective cross-sectional study. Patients with palliative care needs were identified according to the NECPAL CCOMS-ICO® test. Upon hospital admission, a multidisciplinary team consisting of a pharmacist and two AGU physicians determined the PIMs of the routine chronic medication of the patients. Sociodemographic and pharmacological data were collected with the objective of determining possible risk factors related to the existence of PIMs. Main outcome measure Prevalence and type of PIMs according to STOPP version 2 and MAI criteria at the time of hospital admission. Furthermore, days of hospital admission, destination at hospital discharge and survival analysis at 12 months related to PIMs were evaluated. Results Two hundred thirty-five patients (mean age 86.80, SD 5.37; 65.50% women) were recruited. According to the STOPP criteria, 88.50% of patients had ≥1 criterion (mainly 'indication of medication', followed by those that affect the nervous system and psychotropic drugs and risk drugs in people suffering from falls), and according to the MAI tool, 97.40% of the patients had some criterion related to inappropriate medication (mainly, duration of therapy). The following conditions were identified as risk factors for the existence of PIMs: insomnia, anxiety-depressive disorder, falls, pain, excessive polypharmacy and therapeutic complexity. There were no differences among patients in days of hospital stay, discharge's destination or survival at 12 months, regardless of the tool used. Conclusion The presence of PIMs is high in patients requiring palliative care. Some potentially modifiable risk factors such as the pharmacological ones are associated with a greater presence of inappropriate medication. The presence of PIMs does not affect this population in terms of mortality.

An Interactive Mobile Phone-Website Platform to Facilitate Real-Time Management of Medication in Chronically ill Patients.

Poor adherence to medication is a prevalent issue that affects 50-60% of chronically ill patients. We present Medplan, a platform for patients/caregivers and healthcare professionals (HCPs) that aims to enhance adherence, increase patient medication knowledge, and facilitate communication between patients and HCPs. The Medplan platform was designed and developed by a multidisciplinary team composed of primary care and hospital physicians, pharmacists, patients, and developers. We questioned 62 patients in order to know their opinion about the different functions the app would incorporate and other possible features that should be taken into consideration. Medplan comprises a website for HCPs and an application (app) that is installed on the patient's phone. The app is available in Spanish, Catalan, and English. The patient's medication plan was introduced by the HCP and interfaced with the app. Each medicine is represented by an icon showing the indication of the treatment, the trade name, active ingredients, dose, and route of administration. Information about special requirements (e.g., need to take medication on an empty stomach), side effects, or lifestyle recommendations can also be provided. Additional functions include a medication reminder alarm system, by which patients can confirm whether or not they have taken the drug. Patients can self-track their adherence, and all data collected are sent automatically to the website for analysis by the HCP. Weekly motivation messages are sent to encourage adherence. A tool enabling interactive communication between patients and HCPs (primary care or hospital care) is also included. The app contains a feature enabling the HCP to verify the suitability of over-the-counter drugs. Medplan has the potential to significantly improve management of medication in chronically ill patients. A pilot study is being conducted to test whether Medplan is useful and effective.

[Patient-centred prescription model to improve adequate prescription and therapeutic adherence in patients with multiple disorders]. / Modelo de prescripción centrado en la persona para mejorar la adecuación y adherencia terapéutica en los pacientes con multimorbilidad.

Patients with multiple disorders and on multiple medication are often associated with clinical complexity, defined as a situation of uncertainty conditioned by difficulties in establishing a situational diagnosis and decision-making. The patient-centred care approach in this population group seems to be one of the best therapeutic options. In this context, the preparation of an individualised therapeutic plan is the most relevant practical element, where the pharmacological plan maintains an important role. There has recently been a significant increase in knowledge in the area of adequacy of prescription and adherence. In this context, we must find a model must be found that incorporates this knowledge into clinical practice by the professionals. Person-centred prescription is a medication review model that includes different strategies in a single intervention. It is performed by a multidisciplinary team, and allows them to adapt the pharmacological plan of patients with clinical complexity.

[Spanish translation and cross-cultural adaptation of the ARMS-scale for measuring medication adherence in polypathological patients]. / Traducción y adaptación transcultural al español del cuestionario ARMS para la medida de la adherencia en pacientes pluripatológicos.

AIM: Translate the ARMS scale into Spanish ensuring cross-cultural equivalence for measuring medication adherence in polypathological patients. DESIGN: Translation, cross-cultural adaptation and pilot testing. LOCATION: Secondary hospital. MEASUREMENTS: (i)Forward and blind-back translations followed by cross-cultural adaptation through qualitative methodology to ensure conceptual, semantic and content equivalence between the original scale and the Spanish version. (ii)Pilot testing in non-institutionalized polypathological patients to assess the instrument for clarity. RESULTS: The Spanish version of the ARMS scale has been obtained. Overall scores from translators involved in forward and blind-back translations were consistent with a low difficulty for assuring conceptual equivalence between both languages. Pilot testing (cognitive debriefing) in a sample of 40 non-institutionalized polypathological patients admitted to an internal medicine department of a secondary hospital showed an excellent clarity. CONCLUSIONS: The ARMS-e scale is a Spanish-adapted version of the ARMS scale, suitable for measuring adherence in polypathological patients. Its structure enables a multidimensional approach of the lack of adherence allowing the implementation of individualized interventions guided by the barriers detected in every patient.

Adverse drug events in patients with advanced chronic conditions who have a prognosis of limited life expectancy at hospital admission.

PURPOSE: Adverse drug events (ADEs) lead to adverse clinical outcomes such as hospitalization. There is little information about the characteristics of ADEs in patients with advanced chronic conditions and have a prognosis of limited life expectancy. This study aimed to evaluate (i) the prevalence of ADEs at the time of admission to hospital, (ii) the causality, severity, and preventability of the ADEs, and (iii) the clinical and pharmacological characteristics associated with the ADEs. METHODS: This is a prospective cross-sectional study (county of Osona, Catalonia, Spain). We included patients who required palliative care as identified by the NECPAL CCOMS-ICO tool who were hospitalized in an acute geriatric unit (AGU). A system of alerts (trigger tool) was used together with a multidisciplinary review for the detection of the ADEs. RESULTS: Over the course of 10 months, 235 patients were recruited. Seventy-six ADEs affecting 24.68 % of the sample were identified, and of these, 23 (30.26 % of the ADEs; 8.51 % of the sample) were directly related to hospitalization. The multivariate logistic regression analysis identified the following risk factors: presence of extreme polypharmacy (≥10 medications) (OR = 3.02; 95 % CI = 1.48-6.19), anticholinergic burden according to the Anticholinergic Drug Scale (ADS) (OR = 2.32; 95 % CI = 1.13-4.78), and treatment complexity according to the Medication Regimen Complexity Index (MRCI) scale (OR = 2.90; 95 % CI = 1.44-5.83). The vast majority (94.45 %) of the ADEs were considered to be preventable. There were no differences in the survival of the patients. CONCLUSIONS: ADEs are common, largely preventable, and implicated in the hospitalization of patients who require palliative care.

mHealth intervention to improve medication management in chronically ill patients: analysis of the recruitment process.

OBJECTIVES: Mobile phones have been rapidly adopted by the general population and are now a promising technology with considerable potential in health care. However, refusal rates of 24%-75% have been reported in telemedicine studies. We aimed to report the challenges faced when recruiting patients to use Android and iOS smartphone applications aimed at improving medication management and communication between patients and healthcare professionals. METHODS: The patients invited to participate had heart failure and/or hypertension and/or dyslipidemia. After reaching the number of participants required for inclusion, the recruitment process was analyzed, and the study team determined the reasons for refusal. RESULTS: Of the 448 potential participants who were invited to participate, 210 responded. Of these, 37.1% did not use a smartphone, 2.9% owned a mobile phone that was neither iOS nor Android, and 28.6% were smartphone users who refused to participate. In this case, the most common motive was that patients considered their routine healthcare sufficient and had no trouble remembering to take their medicines (81.7%). The final study sample comprised 48 patients. The mean age of the patients enrolled was significantly lower than that of participants who were not included (59.9 ± 10.6 vs. 66.8 ± 11.4 years, respectively; p=0.00). CONCLUSION: We found age to be an important barrier to smartphone use in healthcare. Among smartphone users, good adherence and sufficient routine healthcare were the most common reasons for refusal to participate. Thus, this type of intervention could enhance participation for poor adherers or caregivers. Implementing educational initiatives could play a key role in improving patient perceptions of technology.

Feasibility and Preliminary Outcomes of a Web and Smartphone-Based Medication Self-Management Platform for Chronically Ill Patients.

OBJECTIVE: The aim of this study was to assess the feasibility and preliminary outcomes of a medication self-management platform for chronically ill patients, Medplan. METHODS: We performed a 6-month single-arm prospective pre-post intervention study of patients receiving treatment for hypertension and/or dyslipidemia and/or heart failure and/or human immunodeficiency virus infection. During the pre-intervention phase, participants were followed according to their usual care; during the intervention phase, they used Medplan. We evaluated adherence, health outcomes, healthcare resources and measured the satisfaction of patients and health care professionals. RESULTS: The study population comprised 42 patients. No differences were found in adherence to medication measured by proportion of days covered with medication (PDC). However, when adherence was measured using the SMAQ, the percentage of adherent patients improved during the intervention phase (p < 0.05), and the number of days with missed doses decreased (p < 0.05). Adherence measured using the Medplan app showed poor concordance with PDC. No differences were found in health outcomes or in the use of health care resources during the study period. The mean satisfaction score for Medplan was 7.2 ± 2.7 out of 10 among patients and 7.3 ± 1.7 among health care professionals. In fact, 71.4 % of participants said they would recommend the app to a friend, and 88.1 % wanted to continue using it. CONCLUSION: The Medplan platform proved to be feasible and was well accepted by its users. However, its impact on adherence differed depending on the assessment method. The lack of effect on PDC is mainly because patients were already good adherers at baseline. The study enabled us to validate the platform in real patients using many different mobile devices and to identify potential barriers to scaling up the platform.

Adecuación de la historia farmacoterapéutica y errores de conciliación en un servicio de urgencias / Accuracy in the medication history and reconciliation errors in the emergency department

Fundamento y objetivo: Evaluar la calidad de la historia farmacoterapéutica registrada en un servicio de urgencias hospitalario (SUH) de un hospital de tercer nivel. Determinar la prevalencia de errores de conciliación (EC). Material y método: Estudio unicéntrico, prospectivo y de intervención. Se comparó la lista de medicación habitual obtenida por un farmacéutico frente a la registrada por el médico para identificar discrepancias. Posteriormente, se comparó la medicación habitual con la prescripción activa (SUH). Todas las discrepancias no justificadas se comentaron con el médico para determinar si se trataba de un EC. Se realizó un análisis univariante para identificar factores asociados con la aparición de EC. Resultados: El farmacéutico identificó un mayor número de fármacos habituales por paciente respecto al médico (6,89 frente a 5,70; p < 0,05). Únicamente el 39% de los fármacos identificados por el médico se registraron correctamente en la historia clínica. La principal causa de discrepancia fue la omisión de información a nivel de fármaco (39%) o de posología (33%). Se detectaron 157 EC que afectaron a 85 pacientes (43%), mayoritariamente por omisión (62%). Los principales factores asociados a EC fueron la edad y la polimedicación. La presencia de un cuidador/familiar responsable de la medicación fue un factor protector. No se encontró asociación entre discrepancias en el registro y EC. Conclusiones: La recogida de la historia farmacoterapéutica es un proceso susceptible de mejora. El farmacéutico puede ayudar a obtener una anamnesis de calidad e incrementar la seguridad del paciente interceptando EC. Es necesario mejorar los sistemas de información para evitar este tipo de incidentes (AU)

Background and objective: To assess the accuracy of pharmaceutical anamnesis obtained at the Emergency Department (ED) of a tertiary referral hospital and to determine the prevalence of medication reconciliation errors (RE). Material and method: This was a single-center, prospective, interventional study. The home medication list obtained by a pharmacist was compared with the one recorded by a doctor to identify inaccuracies. Subsequently, the home medication list was compared with the active prescription at the ED. All unexplained discrepancies were checked with the doctor in charge to evaluate if a RE has occurred. An univariate analysis was performed to identify factors associated with RE. Results: The pharmacist identified a higher number of drugs than doctors (6.89 versus 5.70; P < 0.05). Only 39% of the drugs obtained by doctors were properly written down in the patient's record. The main cause of discrepancy was omission of information regarding the name of the drug (39%) or its dosage (33%). One hundred and fifty-seven RE were identified and they affected 85 patients (43%), mainly related to information omission (62%). Age and polymedication were identified as main risk factors of RE. The presence of a caregiver or relative in the ED was judged to be a protective factor. No relationship was found between inaccuracies in the registries and RE. Conclusions: The process of obtaining a proper pharmaceutical anamnesis still needs improvement. The pharmacist may play a role in the process of obtaining a good quality anamnesis and increase patient safety by detecting RE. Better information systems are needed to avoid this type of incidents (AU)

[Accuracy in the medication history and reconciliation errors in the emergency department]. / Adecuación de la historia farmacoterapéutica y errores de conciliación en un servicio de urgencias.

BACKGROUND AND OBJECTIVE: To assess the accuracy of pharmaceutical anamnesis obtained at the Emergency Department (ED) of a tertiary referral hospital and to determine the prevalence of medication reconciliation errors (RE). MATERIAL AND METHOD: This was a single-center, prospective, interventional study. The home medication list obtained by a pharmacist was compared with the one recorded by a doctor to identify inaccuracies. Subsequently, the home medication list was compared with the active prescription at the ED. All unexplained discrepancies were checked with the doctor in charge to evaluate if a RE has occurred. An univariate analysis was performed to identify factors associated with RE. RESULTS: The pharmacist identified a higher number of drugs than doctors (6.89 versus 5.70; P<0.05). Only 39% of the drugs obtained by doctors were properly written down in the patient's record. The main cause of discrepancy was omission of information regarding the name of the drug (39%) or its dosage (33%). One hundred and fifty-seven RE were identified and they affected 85 patients (43%), mainly related to information omission (62%). Age and polymedication were identified as main risk factors of RE. The presence of a caregiver or relative in the ED was judged to be a protective factor. No relationship was found between inaccuracies in the registries and RE. CONCLUSIONS: The process of obtaining a proper pharmaceutical anamnesis still needs improvement. The pharmacist may play a role in the process of obtaining a good quality anamnesis and increase patient safety by detecting RE. Better information systems are needed to avoid this type of incidents.

Dosing of chemotherapy in obese and cachectic patients: results of a national survey.

BACKGROUND: It is not unusual to find obese and cachectic patients in the hematology oncology setting. However, information on dosage in these groups is scarce. OBJECTIVE: The objectives of our study were to explore the dosing strategies applied in the treatment of obese and cachectic cancer patients and to determine whether these strategies are applied in clinical trials. SETTING: Members of the Spanish Group for the Development of Hematology-Oncology Pharmacy (GEDEFO). METHODS: We invited all cancer hospital pharmacists to participate in a survey. MAIN OUTCOME MEASURE: Descriptive statistics of the dosing strategies approaches. RESULTS: We invited 159 eligible hospitals to participate, and 38 responded to the survey. A total of 50 surveys were received: different strategies were applied by different physicians from the same hospital and by hematology and oncology departments. Body mass index was used to define obesity and cachexia in 40 and 30 % of the cases, respectively. Capping the body surface area (BSA) was the approach most commonly followed (64.1 %) in obese patients, whereas no specific approach was adopted in cachectic patients. In hematology patients, the BSA calculation was based on ideal body weight or adjusted body weight in 16.0 % of cases (n = 2) and 50.0 % of cases (n = 6), respectively; in oncology patients, use of adjusted or ideal body weight was negligible. Actual body weight was the main approach in obese patients (35 surveys) and cachectic patients (48 surveys). Creatinine clearance was assessed mainly using the Cockcroft and Gault equation (around 76.0 % of responses). As for clinical trials, 64.1 % of the respondents (n = 25 hospitals) considered the criteria from each clinical trial individually. CONCLUSIONS: Dose adjustments are more frequent in obese patients than in cachectic patients. In cancer oncology patients, dose is adjusted mainly by hematology and hematopoietic cell transplant teams. Capping BSA is the most frequent strategy, followed by calculating actual body weight.