Diseño y validación de la escala para valorar la fragilidad de los pacientes crónicos / Design and validation of the scale to assess the fragility of chronic patients

Objetivo: Crear una escala y herramienta que nos permita medir la fragilidad del paciente crónico. Diseño: Estudio observacional sobre crónicos del área. Emplazamiento: Se ha realizado entre enero de 2011 a diciembre 2015, una población de 2.108 individuos. Los datos se recogieron de la historia clínica y aplicación expresa para el registro de los pacientes frágiles, sobre hoja estructurada de recogida de datos. Participantes: Sujetos frágiles del área Sanitaria Norte de Málaga. Intervención: Diseño y validación de una escala. Mediciones principales: Variable principal de resultado: escala de fragilidad Antequera (EPADI) constituida por seis criterios/factores valorables: edad, Pfeiffer, Barthell, Charlson, sociofamiliar y pluripatológico. Las variables de resultados en accesibilidad se utilizaron como variables de predicción. Las variables cuantitativas se describen mediante la media y desviación estándar. Las variables cualitativas las presentamos en frecuencias junto con sus porcentajes. Para obtener un modelo de predicción de la utilización de recursos la muestra se dividió en dos sub-muestras de igual tamaño. Resultados: A partir de las variables de interés por expertos, se identificaron predictores univariantes en la utilización de recursos en la muestra M_EPADI1, para construir un modelo de regresión logística multivariante que permita predecir la utilización de recursos. Para la validación de la escala se utilizó la muestra M_EPADI2. Conclusiones: Se ha podido comprobar que los criterios utilizados en nuestra escala son adecuados para definir la fragilidad, por lo tanto la escala EPADI valora perfectamente el grado de fragilidad de los usuarios crónicos en base a los recursos consumidos

Objective: To create a scale and tool that allows us to measure the fragility of the chronic patient. Design: Observational study on the area's chronicles. Location: Between January 2011 and December 2015, a population of 2108 individuals. Data were collected from the medical history and expressed application for the registration of fragile patients, on structured data collection sheet. Participants: Fragile subjects of the North Sanitary Area of Malaga. Intervention: Design and validation of a scale. Main measurements: Study variables. Main outcome variable: Antequera Fragility Scale (EPADI) consisting of five criteria / factors: age, Pfeiffer, Barthell, Charlson, sociofamiliar and pluripatological. Accessibility outcome variables were used as prediction variables. Quantitative variables are described by mean and standard deviation. The qualitative variables are presented in frequencies along with their percentages. To obtain a predictive model of resource utilization the sample was divided into two subsamples of equal size. Results: From the variables of interest by experts, univariate predictors were identified in the use of resources in the sample M_EPADI1, to construct a model of multivariate logistic regression that allows to predict the resource utilization. For the validation of the scale, the sample M_EPADI2 was used. Conclusions: It was verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly values the degree of fragility of chronic users based on the resources consumed. Conclusions: It has been verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly evaluates the degree of fragility of chronic users based on the resources consumed

Evaluation of Inappropriate Prescribing in Patients Older than 65 Years in Primary Health Care.

To asses inappropriate prescribing and its predisposing factors in polymedicated patients over the age of 65 in primary health care. DESIGN: cross-sectional study. SETTING: Primary care centres in the Costa del Sol Health District and Northern Health Area of Malaga in southern Spain. PARTICIPANTS: Patients older than 65 years who use multiple medications. Data collection was conducted during 1 year in a population of 425 individuals who comprised a stratified randomized sample of the population of health care users in the study area. The data were collected by interview on a structured data collection form. STUDY VARIABLES: Dependent variable: Potentially inappropriate prescribing (PIP) (STOPP/START criteria). Predictor variables: Sociodemographic characteristics, clinical characteristics and medication use. A descriptive analysis of the variables was performed. Statistical inference was based on bivariate analysis (Student's t or Mann-Whitney U test and chi-squared test) and multivariate analysis was used to control for confounding factors. 73.6% of participants met one or more STOPP/START criteria. According to information about prescribed treatments, 48.5% of participants met at least one STOPP criterion and 43.30% of them met at least one START criterion. The largest percentage of inappropriate prescriptions was associated with cardiovascular treatments. More than three-quarters of the participants had one or more inappropriate prescriptions for medicines in primary care, according to STOPP/START criteria. In addition, PIP was directly related to the number of prescribed medications, gender and specific pathologies (diabetes).

[Design and validation of the scale to assess the fragility of chronic patients]. / Diseño y validación de la escala para valorar la fragilidad de los pacientes crónicos.

OBJECTIVE: To create a scale and tool that allows us to measure the fragility of the chronic patient. DESIGN: Observational study on the area's chronicles. LOCATION: Between January 2011 and December 2015, a population of 2108 individuals. Data were collected from the medical history and expressed application for the registration of fragile patients, on structured data collection sheet. PARTICIPANTS: Fragile subjects of the North Sanitary Area of Malaga. INTERVENTION: Design and validation of a scale. MAIN MEASUREMENTS: Study variables. MAIN OUTCOME VARIABLE: Antequera Fragility Scale (EPADI) consisting of five criteria / factors: age, Pfeiffer, Barthell, Charlson, sociofamiliar and pluripatological. Accessibility outcome variables were used as prediction variables. Quantitative variables are described by mean and standard deviation. The qualitative variables are presented in frequencies along with their percentages. To obtain a predictive model of resource utilization the sample was divided into two subsamples of equal size. RESULTS: From the variables of interest by experts, univariate predictors were identified in the use of resources in the sample M_EPADI1, to construct a model of multivariate logistic regression that allows to predict the resource utilization. For the validation of the scale, the sample M_EPADI2 was used. CONCLUSIONS: It was verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly values the degree of fragility of chronic users based on the resources consumed. CONCLUSIONS: It has been verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly evaluates the degree of fragility of chronic users based on the resources consumed.

Prevalence and Related Factors of Ineffective Self-Health Management in Polymedicated Patients Over the Age of 65 Years.

PURPOSE: To determine the prevalence of Ineffective Self-Health Management (ISHM) (00078) and its related factors in polymedicated patients over the age of 65 years. METHODS: A cross-sectional, descriptive design was used. A home interview was conducted with each participant (N = 375) for data collection. FINDINGS: The prevalence of ISHM was 37.3%. The risk factors associated were social risk, depression, noncompliance, medication errors, and confusion with medications. CONCLUSIONS: Among polymedicated elderly patients, the prevalence of ISHM is high. The diagnosis is closely connected to the compliance and complexity of the treatment regimen, in addition to those relating strictly to social and emotional factors. IMPLICATIONS: Nursing methodology encompasses instruments that allow nurses in clinical practice to evaluate the issue of compliance.

Medication-related factors associated with health-related quality of life in patients older than 65 years with polypharmacy.

METHODS AND DESIGN: Objective: To describe the relationship between medication-related factors and the health-related quality of life in patients older than 65 years who use multiple medications (polypharmacy). Design: Cross-sectional descriptive study. Setting: Primary care. Participants: Patients older than 65 years who use multiple medications (n = 375). Measurements: The main outcome measure was health-related quality of life according to the EuroQol-5D instrument. Sociodemographic, clinical and medication-related variables were recorded during home interviews. RESULTS: Mean age was 74.72 ± 5.59 years, and 65.5% of our participants were women. The global level of health-related quality of life according to the EQ-5D visual analog scale was 59.25 ± 20.92. Of the five EuroQol dimensions, anxiety/depression and pain were the most frequently reported, while mobility and self-care were the dimensions with the greatest impact on self-reported quality of life. Multivariate analysis indicated that functional independence was the factor most strongly associated (ß = 14.27 p < 0.001) with better health-related quality of life, while illiteracy (ß = -13.58 p < 0.001), depression (ß = -10.13 p < 0.001), social risk (ß = -7.23 p = 0.004) and using more than 10 medicines (ß = -4.85 p = 0.009) were strongly associated with a poorer health-related quality of life. CONCLUSIONS: Factors inherent within the patient such as functional incapacity, cognitive impairment and social and emotional problems were the main constraints to quality of life in our study population. The number of medicines taken was negatively related with quality of life.

Adherencia al tratamiento en pacientes polimedicados mayores de 65 años con prescripción por principio activo / Adherence to treatment, by active ingredient, in patients over 65 years on multiple medication

OBJETIVO: Valorar el nivel de adherencia al tratamiento y los factores relacionados en polimedicados mayores de 65 con prescripción por principio activo. DISEÑO: Estudio observacional, descriptivo, transversal, sobre polimedicados mayores de 65 años adscritos a los centros de atención primaria del Distrito Sanitario Costa del Sol y del Área Sanitaria Norte de Málaga. Se ha realizado entre enero del 2011 y septiembre del 2012, sobre una población de 375 individuos obtenida mediante muestreo aleatorio simple a partir de las listas de pacientes proporcionadas por cada centro. Los datos se recogieron mediante entrevista, sobre hoja estructurada de recogida de datos y previa firma del consentimiento informado. Variables del estudio: Variable principal de resultado: adherencia al tratamiento (test de Morisky-Green). Variables predictoras: Prescripción por principio activo, variables sociodemográficas, clínicas y relacionadas con la medicación. Se efectuó un análisis descriptivo de las variables. La inferencia estadística se realizó mediante análisis bivariante (test de la t de Student o U de Mann Whitney y chi al cuadrado), controlándose los factores de confusión mediante análisis multivariante (regresión lineal y logística). RESULTADOS: El cumplimiento terapéutico se sitúa en el 51,7%, no apreciándose diferencias estadísticamente significativas con respecto al sexo o la edad. Encontramos relación con residir en zona de interior (p = 0,001), vivir acompañados (p < 0,05) y no presentar riesgo de ansiedad (p = 0,046). CONCLUSIONES: La adherencia es similar a los estudios realizados, independientemente de si la prescripción es por principio activo. El incumplimiento fue mayor en individuos que viven solos, en población costera y con riesgo de ansiedad

AIM: To assess the level of adherence, by active ingredient, to treatment and associated factors in polymedicated patients over 65 years-old. DESIGN: Observational, descriptive and cross-sectional study over polymedicated patients over 65 years of the Costa del Sol Health District and the North Malaga Health Area. The study was performed between January 2011 and September 2012 on 375 subjects obtained by simple random sampling from lists provided by each health centre. Data was collected by means of an interview with structured questions. Informed consent was given and signed by all patients before interview. Study variables: Main results variable adherence to treatment (Morisky-Green's test).Predictable variables: Prescription by active ingredient, socio-demographic variables, healthcare centre variables, and treatment associated variables. A descriptive analysis of variables was performed. Statistical inference was determined using univariate analysis (t test of Student or Mann-Whitney U, and Chi-squared), and controlling for confounding factors by multivariate analysis (linear and logistic regression). RESULTS: The result for therapeutic compliance was 51.7%. No statistically significant differences were observed as regards sex and age. A relationship was found in those who resided in rural areas (p = 0.001), lived with family (p < 0.05), and were not at risk of suffering from anxiety (p = 0.046). CONCLUSIONS: We found similar patient adherence to treatment despite the prescribing generic drugs. Failure to therapeutic compliance was greater in those patients who lived by themselves, in a city close to the coast, or in those patients who were at risk of suffering from anxiety

[Adherence to treatment, by active ingredient, in patients over 65 years on multiple medication]. / Adherencia al tratamiento en pacientes polimedicados mayores de 65 años con prescripción por principio activo.

AIM: To assess the level of adherence, by active ingredient, to treatment and associated factors in polymedicated patients over 65 years-old. DESIGN: Observational, descriptive and cross-sectional study over polymedicated patients over 65 years of the Costa del Sol Health District and the North Malaga Health Area. The study was performed between January 2011 and September 2012 on 375 subjects obtained by simple random sampling from lists provided by each health centre. Data was collected by means of an interview with structured questions. Informed consent was given and signed by all patients before interview. STUDY VARIABLES: Main results variable adherence to treatment (Morisky-Green's test). PREDICTABLE VARIABLES: Prescription by active ingredient, socio-demographic variables, health care centre variables, and treatment associated variables. A descriptive analysis of variables was performed. Statistical inference was determined using univariate analysis (t test of Student or Mann-Whitney U, and Chi-squared), and controlling for confounding factors by multivariate analysis (linear and logistic regression). RESULTS: The result for therapeutic compliance was 51.7%. No statistically significant differences were observed as regards sex and age. A relationship was found in those who resided in rural areas (P=.001), lived with family (P<.05), and were not at risk of suffering from anxiety (P=.046). CONCLUSIONS: We found similar patient adherence to treatment despite the prescribing generic drugs. Failure to therapeutic compliance was greater in those patients who lived by themselves, in a city close to the coast, or in those patients who were at risk of suffering from anxiety.