[Assessment of pain in patients with rheumatic disease under biological therapy treatment].

BACKGROUND: To assess pain in patients with rheumatic disease under biological therapy treatment. METHODS: Observational retrospective study of patients with rheumatic disease under biological therapy treatment who visited the health care center as outpatients in February/August 2020. We collected demographic (sex and age), clinical (diagnosis, pain presence, intensity, and location), and pharmacological (biological therapy, concomitant treatment with traditional DMARDs, and analgesic treatment) variables from the electronic medical records and Farmatools Dominion®. RESULTS: We included 138 patients; mean age was 56 years and 71% were female. The most frequent diagnosis (47%) was ankylosing spondylitis. Anti-TNF-a was the most prescribed biological drug (64%); 60.1% of study patients received traditional drugs, particularly methotrexate and leflunomide (51.8 and 28.9%, respectively). Pain was reported in 81% of the cases, particularly in hands (73.2%) and knees (69.6%); mean pain intensity was 6.5 (VAS). Although 83.3% of the patients had been prescribed analgesics, pain persisted in 84.8% of the cases (VAS >4), being severe or very severe in 67.9%. Over half of the patients (52.2%) used more than one analgesic. The most frequently prescribed medications were non-steroidal anti-inflammatory drugs (NSAIDs) (60%), paracetamol (52.2%), and opioids (56.5%). NSAIDs controlled pain (14.5%) better than opioids (8.3%); there was no post-treatment improvement of pain in 29.6% of the patients. The number of prescribed drugs increased with pain intensity (rho= 0.264; p= 0.006). CONCLUSION: Almost 70% of study patients had uncontrolled severe rheumatic-related pain. This implies a challenge for esta­blishing effective treatments for this type of pain.

Evaluación del dolor en pacientes con patologías reumáticas entratamiento con terapias biológicas / Assessment of pain in patients with rheumatic disease under biological therapy treatment

Fundamento: El objetivo fue evaluar el dolor en pacientes con patologías reumáticas en tratamiento con terapias biológicas. Material y métodos: Estudio observacional, retrospectivo, de pacientes con enfermedad reumatológica tratada con terapias biológicas, atendidos en consulta externa en febrero/agosto de 2020. Se recogieron variables demográficas (sexo y edad), clínicas (diagnóstico, presencia de dolor, intensidad y localización) y farmacológicas (terapia biológica, tratamiento concomitante con FAME tradicionales, y tratamiento analgésico). Las fuentes de información utilizadas fueron la historia clínica electrónica y Farmatools Dominion®. Resultados: Se incluyeron 138 pacientes, con edad media 56 años, 71% mujeres. El diagnóstico más frecuente fue espondilitis anquilosante (47%). El fármaco biológico más utilizado fue anti TNF-α (64%) y el 60,1% recibían fármacos tradicionales, especialmente metotrexato y leflunomida (51,8 y 28,9%). El 81% de los pacientes presentaban dolor, especialmente en manos (73,2%) y rodillas (69,6%), de intensidad media 6,5 en la escala EVA. El 84,8% de los pacientes no tenía el dolor controlado (EVA >4) y era severo o muy severo en el 67,9% de los pacientes, a pesar de que el 83,3% tenían pautado tratamiento antiálgico, el 52,2% con más de un fármaco, con antiinflamatorios no esteroideos (AINE) (60%), paracetamol (52,2%) y opioides (56,5%). El dolor se controló mejor con AINE (14,5%) que con opioides (8,3%); en un 29,6% el dolor no mejoraba con el tratamiento. El número de fármacos aumentó con la intensidad del dolor (rho = 0,264; p = 0,006). Conclusiones: Más del 69% de los pacientes presentaba dolor no controlado y severo, reflejando el desafío que supone instaurar un tratamiento efectivo para el dolor.(AU)

Background: To assess pain in patients with rheumatic disease under biological therapy treatment. Methods. Observational retrospective study of patients with rheumatic disease under biological therapy treatment who visited the health care center as outpatients in February/August 2020. We collected demographic (sex and age), clinical (diagnosis, pain presence, intensity, and location), and pharmacological (biological therapy, concomitant treatment with traditional DMARDs, and analgesic treatment) variables from the electronic medical records and Farmatools Dominion®. Results: We included 138 patients; mean age was 56 years and 71% were female. The most frequent diagnosis (47%) was ankylosing spondylitis. Anti-TNF-α was the most prescribed biological drug (64%); 60.1% of study patients received traditional drugs, particularly methotrexate and leflunomide (51.8 and 28.9%, respectively). Pain was reported in 81% of the cases, particularly in hands (73.2%) and knees (69.6%); mean pain intensity was 6.5 (VAS). Although 83.3% of the patients had been prescribed analgesics, pain persisted in 84.8% of the cases (VAS >4), being severe or very severe in 67.9%. Over half of the patients (52.2%) used more than one analgesic. The most frequently prescribed medications were non-steroidal anti-inflammatory drugs (NSAIDs) (60%), paracetamol (52.2%), and opioids (56.5%). NSAIDs controlled pain (14.5%) better than opioids (8.3%); there was no post-treatment improvement of pain in 29.6% of the patients. The number of prescribed drugs increased with pain intensity (rho = 0.264; p = 0.006). Conclusion. Almost 70% of study patients had uncontrolled severe rheumatic-related pain. This implies a challenge for establishing effective treatments for this type of pain.(AU)

Conciliación terapéutica al ingreso hospitalario en el servicio de urgencias / Therapeutic Reconciliation on Admission to Hospital in the Emergency Department

Objetivos: Evaluar el proceso de conciliación de la medicación en el Servicio de Urgencias y analizar los problemas relacionados con la medicación identificados, su gravedad potencial y las intervenciones farmacéuticas realizadas durante este proceso. Métodos: Estudio observacional prospectivo, realizado en el Servicio de Urgencias de un hospital de tercer nivel. Se recogieron los datos correspondientes durante tres meses (abril-junio 2020). Se elaboraron criterios de priorización, para poder seleccionar a los pacientes con mayor riesgo de sufrir errores de conciliación. El proceso de conciliación se llevó a cabo mediante: Historia Clínica Electrónica, historial farmacoterapéutico de atención primaria y prescripción electrónica en el Servicio de Urgencias. Se consideraron errores de conciliación todas las discrepancias no justificadas por el médico y se valoraron su gravedad potencial según National Coordinating Council for Medication Error Reporting and Prevention. Resultados: Se incluyeron 23 pacientes, 13 fueron hombres. La edad media fue de 77,8 años (DE 11,2). Durante el proceso de conciliación se encontraron 116 discrepancias, de éstas 56 (48,3%) precisaron aclaración. Se detectaron 36 errores de conciliación, éstos fueron por: omisión medicamento (n=18; 50%), error de dosis (n=13; 36,1%) o error en la frecuencia de administración (n=5; 13,9%). La aceptación de estas intervenciones de conciliación fue del 92,6%. Además, se realizaron 22 intervenciones farmacéuticas con una aceptación del 100%.Conclusiones: La realización de un proceso de conciliación de la medicación en el Servicio de Urgencias ha evitado errores de medicación, la mayoría de ellos con relevancia clínica y ha mejorado la atención farmacoterapéutica de estos pacientes.(AU)

Objectives: To evaluate the medication reconcilia-tion procedure in the Emergency Department and to analyze the medication-related problems identi-fied, their potential severity and the pharmaceutical interventions made during this process.Methods: It was conducted a prospective and ob-servational study in the Emergency Department of a tertiary care hospital. Data were collected during three months (April-June 2020). Priority criteria were developed in order to select patients with a higher risk of suffering reconciliation errors. The reconciliation process was carried out by means of: Electronic Medical Record, primary care pharma-cotherapeutic history and electronic prescription in the Emergency Department. All discrepancies not justified by the physician were considered reconciliation errors and their potential severity was assessed according to the National Coordinating Council for Medication Error Reporting and Preven-tion.Results: 23 patients were included, 13 were men. The average age was 77.8 years (SD 11.2). During the reconciliation process 116 discrepancies were found, 56 (48.3%) of which required clarification. 36 reconciliation errors were detected, these were due to: medication omission (n = 18; 50%), dosage error (n = 13; 36.1%) or administration frequency error (n = 5; 13.9 %). The uptake of these reconciliation interventions was 92.6%. In addition, 22 pharma-ceutical interventions were performed with 100% acceptance.Conclusions: The implementation of a medication reconciliation process in the Emergency Depart-ment prevented medication errors, most of them with clinical relevance. Besides, it improved the pharmacotherapeutic care of these patients.(AU)

Enfoques complementarios en ancianos con polifarmacia: aproximación a sectores más vulnerables / Complementary approaches in the elderly on multiple medications: a look at the most vulnerable sectors

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Impact of hospitalization in an acute geriatric unit on polypharmacy and potentially inappropriate prescriptions: A retrospective study.

AIM: Polypharmacy is a highly prevalent geriatric syndrome, and hospitalizations can worsen it. The aim of the present study was to analyze the influence of hospitalization on polypharmacy and indicators of quality of prescribing, and their possible association with health outcomes. METHODS: A retrospective study of 200 patients discharged from an acute geriatric unit was carried out. Indicators of quality of prescription were registered at admission and discharge: polypharmacy defined as ≥5 medications, hyperpolypharmacy (≥10), potentially inappropriate prescribing by Beers and Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria, potentially prescribing omissions by Screening Tool to Alert doctors to the Right Treatment (START) criteria, drug interactions and anticholinergic burden measured with the Anticholinergic Risk Scale. Mortality, emergency room visits and hospital admissions occurring during 6 months after discharge were also registered. RESULTS: The total number of drugs increased at discharge (9.1 vs 10.1, P < 0.001), without increasing chronic medications (8.5 vs 8.3, P = 0.699). No significant variations were observed in the prevalence of polypharmacy (86.5% vs 82.2%), potentially inappropriate prescribing (68.5% vs 71.5%), potential prescribing omissions (58% vs 58%) or drug interactions (82.5% vs 83.5%). Patients with anticholinergic drugs tended to increase, not reaching statistical significance (39.5% vs 44.5%; P = 0.064). Polypharmacy was associated with emergency room visits (OR 2.62, 95% CI 1.07-6.40; P = 0.034), and hyperpolypharmacy with hospitalizations (OR 2.49, 95% CI 1.25-4.93; P = 0.009). CONCLUSIONS: After hospitalization in an acute geriatric unit, the prevalence of polypharmacy, potentially inappropriate prescribing, potential prescribing omissions, interactions or anticholinergic drugs is still very high. Polypharmacy is a risk factor for hospitalization and emergency room visits. Measuring indicators of quality of prescription might be useful to design interventions to optimize pharmacotherapy and improve health outcomes in elderly acute patients. Geriatr Gerontol Int 2017; 17: 2354-2361.