Impact of a pharmaceutical care programme for patients with chronic disease initiated at the emergency department on drug-related negative outcomes: a randomised controlled trial.

BACKGROUND: The resolution of potential drug-related problems is a priority of pharmaceutical care programmes. OBJECTIVES: To assess the clinical impact on drug-related negative outcomes of a pharmaceutical care programme focusing on the resolution of potential drug-related problems, initiated in the emergency department for patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD). METHODS: Controlled trials, in which older adults (≥65 years) receiving four or more medications admitted to the emergency department for ≥12 hours for worsening of HF and/or COPD were randomised (1:1) to either a pharmaceutical care programme focusing on resolving potential drug-related problems initiated at the emergency department (intervention group (IG)) or standard care (control group). Comparisons between the groups were made for the proportion of patients with drug-related negative outcomes, number of drug-related negative outcomes per patient, mean stay, patients readmitted within 180 days and 180-day mortality. RESULTS: 118 patients were included, 59 in each group. Fewer patients in the IG had drug-related negative outcomes (37 (62.7%) vs 47 (79.7%) in the control group (p=0.042)). Fewer drug-related negative outcomes per patient occurred in the IG (56 (0.95 per patient) vs 85 (1.44 per patient) in the control group (p=0.01)). The mean stay was similar between groups (194.7 hours in the IG vs 242.5 hours in the control group (p=0.186)). No difference in revisits within 180 days was found (32 (54.24%) in the IG vs 22 (37.3%) in the control group (p=0.065)). 180-Day mortality was detected in 11 (18.6%) patients in the IG compared with 13 (22%) in the control group (p=0.647). CONCLUSION: A pharmaceutical care programme focusing on resolving potential drug-related problems initiated at the emergency department has a favourable clinical impact, as it reduces the number and prevalence of drug-related negative outcomes. No difference was found in other outcome variables.Trial registration number NCT02368548.

Negative clinical outcomes of medication resulting in emergency department visits.

PURPOSE: The results of analyses of patients' health problems related to medication use have been highly variable due to various factors, such as different study methodology, diverse variables determined, fields of study. The aim of our study was to determine the prevalence and preventability of negative clinical outcomes of medication (NCOMs). METHODS: This was a cross-sectional study performed in the emergency departments (EDs) of nine Spanish hospitals during a 3-month period. A two-stage probabilistic sampling method was used , and a systematic appraisal tool was used to identify the NCOMs based on information gathered through patient interview and review of the medical records. Case evaluations were conducted in two phases by pharmacists and physicians. The prevalence and preventability of NCOM were calculated. A homogeneity test was performed to assess potential differences in the prevalence for each hospital. RESULTS: A total of 4,611 patients were included in the study. The overall prevalence of NCOMs was 35.7 % [95 % confidence interval (CI) 33.3-38.1]. These NCOMs could be divided into three categories: ineffectiveness (18.2 %; 95 % CI 16.2-20.1), necessity (14.9 %; 95 % CI 13.4-16.6), and lack of safety (2.4 %; 95 % CI 1.9-2.8). About 81 % (95 % CI 80.1-82.3) of the NCOMs could have been prevented. CONCLUSIONS: NCOMs provoked approximately one-third of visits to the EDs, and a high percentage of these were preventable. Implementation of strategies for patient safety and pharmaceutical care could help to prevent these problems and optimize the use of medications.

Terms used in patient safety related to medication: a literature review.

PURPOSE: There is a lack of homogeneity in the terminology used in the context of patient safety related to medication. The aim of this review was to identify the terms and definitions used in patient safety related to medication within the scientific literature. METHODS: Original and review articles that were indexed between 1998 and 2008 in MEDLINE and EMBASE and contained terms used in patient safety related to medication were included. Terms and definitions were extracted and categorised according to whether its definition referred to the process of medication use, or to the clinical outcome of medication use, or both. RESULTS: Of 2564 articles, 147 were included. Sixty terms used in patient safety related to medication with 189 different definitions were identified. Among terms that referred only to the process of medication use (n = 23), medication error provided the greatest number of definitions (n = 29). Among terms that referred only to the clinical outcome of medication use (n = 31), adverse drug event provided the greatest number of definitions (n = 15). Finally, among terms that referred both to the process of use and to the clinical outcome of medication use (n = 13), drug-related problem provided the greatest number of definitions (n = 7). CONCLUSIONS: A multitude of terms and definitions are used in patient safety related to medication. This heterogeneity makes it difficult to compare the results among studies and to appreciate the true magnitude of the problem. Classifying and unifying the terminology is necessary to advance in patient safety strategies.

Autorreferencia de peso y talla y prevalencia de obesidad en pacientes con factores de riesgo o enfermedad cardiovascular / Self-reference of weight and height and prevalence of obesity in patients with cardiovascular risk factors or disease

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Problemas relacionados con los medicamentos en usuarios de un servicio de urgencias hospitalario: resultados de la validación de un cuestionario / Drug Related problems in hospital emergency service users: Results of the validation of a questionaire

Introducción: Los problemas relacionados con los medicamentos (PRM) son problemas de salud vinculados con el tratamiento farmacológico del paciente y que interfieren o pueden interferir con los resultados esperados de salud en ese paciente. Para llegar a identificar éstos, es necesario obtener la suficiente información acerca de los medicamentos que toma el paciente así como de sus problemas de salud. Este trabajo pretende conocer la prevalencia de PRM en las usuarios del servicio de urgencias del Hospital Universitario Virgen de las Nieves de Granada. Metodología: La entrevista con el paciente es el método que permite obtener la información de calidad necesaria para evaluar e identificar PRM por lo que se ha procedido a la validación de un cuestionario como instrumento para la evaluación y detección de PRM en los usuarios de dicho servicio de urgencias, con la finalidad de poder ser útil en nuevos estudios. Resultados: Tras la evaluación de la información se observo una prevalencia de PRM del 243%, de los cuales el 62, 7% fueron debidos a inefectividad del tratamiento farmacológico y el 618% de los mismos resultaron ser evitables. Conclusiones: Los PRM son an problema de salud de alta prevalencia y cerca de dos tercios son evitables (AU)

Introduction: Drug-related problems are health problems linked with patient's drug therapy and that interferes a may interfere with expected outcomes in that patient. in order to identify those DRP is necessary to obtain the information enough on drugs taken by the patient, and on his or her health problems. This study pretends to know the DRP prevalence in emergency room users at the University Hospital Virgen de las Nieves (Granada-Spain). Methods: The encounter with patient is the method that allows obtain the information of the required quality to assess and identify DRP, so as it has proceed to the validation of a questionnaire 5 a tool for the assessment and detection of DRP in the emergency room users, with the aim of been useful in other studies. Results: After the evaluation of the information a DRP prevalence of 24.3% was observed, being the 62.7% due to drug therapy ineffectiveness, and 67.8% being avoidable. Conclusions: DRP are a health problem of a high prevalence, and near two thirds are avoidable (AU)