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).

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)

[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.

The role of the Pharmacist in the design, development and implementation of Medication Prescription Support Systems / Papel del farmacéutico en el diseño, desarrollo e implantación de sistemas de soporte a la prescripción de medicamentos

Clinical Decision Support Systems (CDSS) are computerized tools designed to help healthcare professionals to make clinical and therapeutic decisions, with the objective of improving patient care. Prescription-targeted CDSS have the highest impact in improving patient safety. Although there are different designs and functionalities, all these systems will combine clinical knowledge and patient information in a smart manner, in order to improve the prescription process. With the emergence of new technologies and advances in smart decision systems, the implementation of said systems can achieve an important improvement in terms of the prescription process and patient safety. The design and implementation of these systems should be performed by a multidisciplinary team of professionals, where Pharmacists will play an important role due to their technical knowledge about medications and the technologies associated to their use. This article aims to provide basic guidelines for the design and adequate implementation, monitoring and follow-up of Clinical Decision Support Systems within the setting of pharmacological prescription (AU)

Los sistemas de soporte a la decisión clínica son herramientas informáticas diseñadas para ayudar a los profesionales sanitarios en la toma de decisiones clínicas y terapéuticas, con la finalidad de mejorar la atención a los pacientes. Los sistemas dirigidos a la prescripción son los que mayor impacto tienen en la mejora de la seguridad de los pacientes. Aunque existen diferentes diseños y funcionalidades, estos sistemas coinciden en combinar de manera inteligente el conocimiento clínico y la información de los pacientes, para mejorar el proceso de prescripción. Con la aparición de las nuevas tecnologías y el avance de los sistemas inteligentes de decisión, la implantación de estos sistemas puede lograr una mejora importante en el proceso de prescripción y en la seguridad de los pacientes. El diseño e implantación de estos sistemas se debe llevar a cabo por un equipo multidisciplinar de profesionales, donde el farmacéutico tiene un papel destacado gracias a sus conocimientos técnicos sobre los medicamentos y sobre las tecnologías asociadas a la utilización de los mismos. Con este artículo se pretende aportar las directrices básicas para el diseño y la correcta implantación, monitorización y seguimientos de los Sistemas de Soporte a la Decisión Clínica en el ámbito de la prescripción farmacológica (AU)

The role of the Pharmacist in the design, development and implementation of Medication Prescription Support Systems.

Clinical Decision Support Systems (CDSS) are computerized tools designed to help healthcare professionals to make clinical and therapeutic decisions, with the objective of improving patient care. Prescription-targeted CDSS have the highest impact in improving patient safety. Although there are different designs and functionalities, all these systems will combine clinical knowledge and patient information in a smart manner, in order to improve the prescription process. With the emergence of new technologies and advances in smart decision systems, the implementation of said systems can achieve an important improvement in terms of the prescription process and patient safety. The design and implementation of these systems should be performed by a multidisciplinary team of professionals, where Pharmacists will play an important role due to their technical knowledge about medications and the technologies associated to their use. This article aims to provide basic guidelines for the design and adequate implementation, monitoring and follow-up of Clinical Decision Support Systems within the setting of pharmacological prescription.

Los sistemas de soporte a la decisión clínica son herramientas informáticas diseñadas para ayudar a los profesionales sanitarios en la toma de decisiones clínicas y terapéuticas, con la finalidad de mejorar la atención a los pacientes. Los sistemas dirigidos a la prescripción son los que mayor impacto tienen en la mejora de la seguridad de los pacientes. Aunque existen diferentes diseños y funcionalidades, estos sistemas coinciden en combinar de manera inteligente el conocimiento clínico y la información de los pacientes, para mejorar el proceso de prescripción. Con la aparición de las nuevas tecnologías y el avance de los sistemas inteligentes de decisión, la implantación de estos sistemas puede lograr una mejora importante en el proceso de prescripción y en la seguridad de los pacientes. El diseño e implantación de estos sistemas se debe llevar a cabo por un equipo multidisciplinar de profesionales, donde el farmacéutico tiene un papel destacado gracias a sus conocimientos técnicos sobre los medicamentos y sobre las tecnologías asociadas a la utilización de los mismos. Con este artículo se pretende aportar las directrices básicas para el diseño y la correcta implantación, monitorización y seguimientos de los Sistemas de Soporte a la Decisión Clínica en el ámbito de la prescripción farmacológica.