[Prescription of acetylcholinesterase inhibitors and memantine in the Canary Islands, comparison with the Spanish population.] / Prescripción de inhibidores de acetilcolinesterasa y memantina en Canarias: comparación con la población española.

OBJECTIVE: In the Canary Islands the prescriptions billed to the National Health System are registered in a database (FarmaCanarias). The main objective was to estimate the consumption of Acetylcholinesterase inhibitors (IACE) and Memantine in Canary Islands and to compare with a Spanish sample from Pharmacoepidemiological Research Base in Primary Care (PRBPC) which is national in scope. As secondary we determined the percentage in treatment in the Spanish sample. METHODS: The prescriptions of IACE and / or memantine in 2017 were calculated as Defined Daily Doses per 100 habitants (DHD) in FarmaCanarias and PRBPC. The prescriptions in FarmaCanarias were disclosed by island and age groups were also compared. The percentage of cases in treatment was calculated in PRBPC from records with diagnosis of "dementia". All the comparations were made by Pearson's χ2. RESULTS: The prescription of IACE and Memantine was: 3.042% (95% CI; 3.039-3.045) and 1.584% (95% CI; 1.582-1.587) in The Canary islands, respectively and 2.545% (95% CI; 2.518-2.572) and 0.922% (95% CI; 0.906-0.938), in PRBPC (p<0.001). DHDs between islands were different, except in two (p<0.001) The distribution by age group between FarmaCanarias and PRBPC was hetereogeneous (p<0.001). The percentage of dementia cases in treatment in PRBPC was 45.51% (95% CI; 45.186-45.838). CONCLUSIONS: The prescription of IACE and Memantine was higher in the Canary Islands, which added to the difference by age group, suggests epidemiological differences in dementia compared to the mainland. There is heterogeneity between islands that could be due to epidemiological factors, provider or the Public Health Service.

OBJETIVO: En Canarias las recetas facturadas al Sistema Nacional de Salud están registradas en una base de datos (FarmaCanarias). El objetivo principal de este estudio fue calcular el consumo de inhibidores de la acetilcolinesterasa (IACE) y memantina en Canarias y compararlo con una muestra representativa de la población española procedente de la Base de Investigación Farmacoepidemiológica en Atención Primaria (BIFAP). Como objetivo secundario determinamos el porcentaje de casos tratados en la muestra española. METODOS: Las prescripciones de IACE y/o memantina se calcularon como Dosis Diarias Definidas por 100 habitantes (DHD) en FarmaCanarias y en BIFAP. Se calcularon los resultados por isla y también se compararon por grupos de edad. Los casos tratados se calcularon como porcentaje sobre los casos con demencia totales en BIFAP. Todas las comparaciones fueron efectuadas con la χ2 de Pearson. RESULTADOS: El consumo de IACE y Memantina fue de 3,042% (IC 95%; 3,039-3,045) y 1,584% (IC 95%; 1,582-1,587) en Canarias, respectivamente y de 2,545% (IC 95%; 2,518-2,572) y 0,922% (IC 95%; 0,906-0,938), en BIFAP (p<0,001). Las DHD entre islas fueron diferentes, salvo en dos (p<0,001). La distribución por grupos de edad entre FarmaCanarias y BIFAP fue heterogénea (p<0,001). El porcentaje de casos tratados en BIFAP fue: 45,51% (IC 95%; 45,186-45,838). CONCLUSIONES: La prescripción de IACE y Memantina fue mayor en Canarias lo que, añadido a la diferencia por grupos de edad, sugiere diferencias epidemiológicas en demencia frente al resto de España. Existe heterogeneidad entre islas que podría deberse a factores epidemiológicos, de proveedor o del Servicio Público de Salud.

Spanish list of potentially inappropriate drugs in the elderly (ES-PIA project).

PURPOSE: In the last decades, different criteria have been developed for detecting inappropriate prescription in older patients. In Spain, translations and adaptations of international lists are available but it would be necessary a national list which could cope with the peculiarities of our health system, existing pharmaceutical market, and prescription habits. We propose in this project the creation of a Spanish potentially inappropriate drugs list which could be applicable in our clinical scenario. METHODS: We use a Delphi method involving 25 experts from different backgrounds (Clinical Pharmacology, Geriatrics, Rational Use of Drugs and Pharmacy, Primary Care and Pharmacoepidemiology, and Pharmacovigilance) that were asked to participate in two-round questionnaires. For analysis, current recommendations of Worth and Pigni were applied, and every statement was classified into one of three groups: strong, moderate, or low agreement. Statements with strong agreement were accepted to be part of the inadequate prescription list. Moderate agreement statements were selected to enter the second questionnaire, and statements with low agreement were further analyzed to determine if it was due to heterogeneity or due to dispersion in the answers. RESULTS: The first questionnaire consisted of 160 proposed sentences, of which 106 reached a high agreement, 32 a moderate agreement, and 22 a low agreement. All sentences proposed in the second questionnaire reached a strong agreement. The total accepted sentences were 138. CONCLUSIONS: We offer a list of inadequate prescription in older patients adapted to the Spanish pharmacopeia and according to the prescription habits in our environment.