The Barriers to Deprescription in Older Patients: A Survey of Spanish Clinicians.

BACKGROUND AND OBJECTIVE: There are barriers to deprescription that hinder its implementation in clinical practice. The objective of this study was to analyse the main barriers and limitations of the deprescription process perceived by physicians who care for multipathological patients. MATERIALS AND METHODS: The "deprescription questionnaire of elderly patients" was adapted to an online format and sent to physicians in geriatrics. Question 1 is a reference to establish agreement or disagreement with this practice. The influence of different aspects of deprescription was analysed via the demographic characteristics of the clinicians and perceptions of the various barriers (questions 2-9) by means of bivariate analysis. Based on the latter, a multivariate model was carried out to demonstrate the relationship between barriers and the degree of deprescription agreement among respondents. RESULTS: Of the 72 respondents, 72.2% were in favour of deprescribing. Regarding the analyses, the demographic characteristics did not influence rankings. The deprescription of preventive drugs and consensus with patients were associated with a positive attitude towards deprescribing, while withdrawing drugs prescribed by other professionals, time constraints and patient reluctance emerged as possible barriers. The only factor independently associated with deprescribing was lack of time. CONCLUSIONS: Time was found to be the main barrier to deprescription. Training, the creation of multidisciplinary teams and integrated health systems are key facilitators.

Feasibility of the Implementation of LESS-CHRON in Clinical Practice: A Pilot Intervention Study in Older Patients With Multimorbidity.

Background and Objectives: Potentially inappropriate medication refers to the prescription of drugs whose risks outweigh the benefits. There are different pharmacotherapeutic optimization strategies to detect and avoid potentially inappropriate medications (PIMs), namely deprescription. The List of Evidence-Based Deprescribing for Chronic Patients (LESS-CHRON) criteria were designed as a tool to systematize the deprescribing process. LESS-CHRON has established itself as one of the most suitable to be applied in older (≥65 years) multimorbid patients. However, it has not been applied to these patients, to measure the impact on their treatment. For this reason, a pilot study was conducted to analyze the feasibility of implementing this tool in a care pathway. Research Design and Methods: A pre-post quasi-experimental study was conducted. Older outpatients with multimorbidity from the Internal Medicine Unit of a benchmark Hospital were included. The main variable was feasibility in clinical practice, understood as the likelihood that the deprescribing intervention recommended by the pharmacist would be applied to the patient. Success rate, therapeutic, and anticholinergic burden, and other variables related to health care utilization were analyzed. Results: A total of 95 deprescribing reports were prepared. Forty-three were evaluated by the physician who assessed the recommendations made by pharmacists. This translates into an implementation feasibility of 45.3%. The application of LESS-CHRON identified 92 PIMs. The acceptance rate was 76.7% and after 3 months 82.7% of the stopped drugs remained deprescribed. A reduction in anticholinergic burden and enhanced adherence was achieved. However, no improvement was found in clinical or health care utilization variables. Discussion and Implications: The implementation of the tool in a care pathway is feasible. The intervention has achieved great acceptance and deprescribing has been successful in a not insignificant percentage. Future studies with a larger sample size are necessary to obtain more robust results in clinical and health care utilization variables.

Three double-dose reinforced hepatitis B revaccination scheme for patients with cirrhosis unresponsive to the standard regimen: an open-label randomised clinical trial.

OBJECTIVE: We aimed to compare the response rates between two different hepatitis B virus vaccination schedules for cirrhotic subjects who were non-responders to the first three 40 µg doses (month 0-1-2), and identify factors associated with the final response. DESIGN: A total of 120 cirrhotic patients (72.5% decompensated) were randomised at a 1:1 ratio to receive a single 40 µg booster vaccination at month 6 (classical arm) versus an additional round of three new 40 µg doses administered at monthly intervals (experimental arm). The main outcome was the rate of postvaccinal anti-hepatitis B surface antibodies levels ≥10 mIU/mL. RESULTS: Efficacy by ITT analysis was higher in the experimental arm (46.7%) than in the classical one (25%); OR 2.63, p=0.013. The experimental arm increased response rates compared with the classical one from 31% to 68% (OR 4.72; p=0.007), from 24.4% to 50% (OR 3.09; p=0.012) and from 24.4% to 53.8% (OR 3.62; p=0.007), in Child A, Model for End-Stage Liver Disease (MELD) <15 and MELD-Na<15 patients, respectively. Patients with more advanced liver disease did not benefit from the reinforced scheme. Both regimens showed similar safety profiles. Multivariable analysis showed that the experimental treatment was independently response associated when adjusted across three logistic regression models indicating equivalent cirrhosis severity. CONCLUSION: For cirrhotic patients, the revaccination of non-responders to the first three dose cycle, with three additional 40 µg doses, achieved significantly better response rates to those obtained with an isolated 40 µg booster dose. TRIAL REGISTRATION NUMBER: NCT01884415.

Prevalence of Potentially Inappropriate Medications in Patients With Multimorbidity According to LESS-CHRON and STOPPFrail Criteria.

OBJECTIVE: LESS-CHRON (List of Evidence-Based Deprescribing for Chronic Patients) and STOPPFrail (Screening Tool of Older Persons' Prescriptions in Frail adults with limited life expectancy) are criterion-based deprescribing tools. This study aimed to identify the prevalence of potentially inappropriate medications (PIMs) with these tools in an outpatient, polymedicated, older population with multimorbidity. DESIGN: Single-center cross-sectional observational study. SETTING AND PARTICIPANTS: PIMs and criteria subject to deprescribing identified by each tool were collected in patients who were being followed up on outpatient internal medicine consultation. METHODS: PIMs were identified by STOPPFrail and LESS-CHRON criteria reviewing medical histories and pharmacologic treatments of the patients in the electronic health card system. Sociodemographic, clinical, and pharmacologic variables were recorded. A correlation analysis between treatment tools and clinical values was performed using the nonparametric Spearman rho correlation. RESULTS: Eighty-three patients with a median of 14.4 (interquartile range 12-17) prescribed drugs were included. The total number of PIMs identified with LESS-CHRON was 158 vs 127 with STOPPFrail. Eight of the 27 criteria (29.6%) for LESS-CHRON and 15 of the 25 for STOPPFrail were found to be not applicable. A significant correlation was obtained for both tools with the number of prescribed drugs at the time of inclusion. The Profund, Barthel, and Frail-VIG index only showed a significant correlation with LESS-CHRON. CONCLUSION AND IMPLICATIONS: Both tools have shown the capacity to identify PIMs that can be deprescribed in the population studied. However, LESS-CHRON appears to have a greater detection potential in the subgroup of patients analyzed. STOPPFrail brings a certain complementarity in other areas of therapy not covered by LESS-CHRON.

Adaptación transcultural y validación al español del cuestionario de desprescripción en el paciente de edad avanzada / Cross-cultural adaptation and validation into Spanish of the deprescription questionnaire in the elderly patient

Antecedentes y objetivo: En 2017 se desarrolló un cuestionario en italiano que tenía como objetivo determinar las percepciones de los clínicos ante la desprescripción en población de edad avanzada.El objetivo fue traducir y adaptar transculturalmente al español este cuestionario de desprescripción.MétodosTraducción directa y retrotraducción, seguidas de una síntesis y adaptación por un tercer traductor. Desarrollo de un panel de expertos para evaluar la adecuación de la traducción, comprensibilidad de la pregunta traducida y utilidad de cada cuestión. Se realizó un análisis de comprensibilidad a médicos familiarizados con la desprescripción.ResultadosSe obtuvo la versión española del cuestionario, donde el grado de dificultad medio en la traducción directa e inversa fue baja/moderada. En la primera fase del panel de expertos 4 preguntas tuvieron apartados considerados «indeterminados» y una fue «dudosa». Tras la segunda fase, todas las cuestiones fueron «adecuadas» a excepción de una.ConclusionesSe trata de la primera adaptación transcultural al español de este cuestionario, lo que permitirá disponer de una herramienta para valorar la percepción de los clínicos y establecer mejoras en la realización de esta práctica. (AU)

Background and objective: In 2017, a questionnaire was developed in Italian with the aim of determining clinicians’ perceptions of deprescription in the elderly population.The objective was to translate and cross-culturally adapt this deprescription questionnaire to Spanish.MethodsForward and blind-back translations, followed by a synthesis and adaptation by a third translator. Development of an expert panel to evaluate the adequacy of the translation, the understandability of the translated question and the usefulness of each question. A comprehensibility analysis was carried out on physicians familiar with deprescription.ResultsThe Spanish version of the questionnaire was obtained, where the average degree of difficulty in the direct and the back-translation was low/moderate. In the first phase of the panel of experts, 4 questions had sections considered “indeterminate” and one question was “doubtful”. After the second phase, all the questions were considered “adequate” except for one.ConclusionsThis is the first cross-cultural adaptation to Spanish of this questionnaire, which will provide a tool to assess clinicians’ perception of this practice and establish improvements to carry out this activity. (AU)

Validation protocol of the LESS-CHRON deprescription tool in multimorbidity patients. LESS-CHRON-VALIDATION Project.

OBJECTIVE: Deprescribing is considered one of the main strategies available for  preparing an individualized therapeutic plan in patients with multiple pathologies or complex chronic conditions. However, despite the practice has been in place for some years, there is a need for studies that support the achievement of satisfactory health outcomes, as well as tools that help implement deprescribing in routine clinical practice. The  bjective of this project is to analyze the impact of reducing polypharmacy,  through the LESS-CHRON deprescribing tool, on a population  of elderly polymedicated patients with multiple conditions. METHOD: This will be a quasi-experimental, pre-and-post intervention multicenter cohort study. The variables to be analyzed will be  divided into two large groups: those related to pharmacology and those related to health outcomes. They will be collected at baseline, at 3 and at 6-12  months. A first screening phase will be carried out to recruit candidate patients  and obtain information about the identified deprescribing  opportunities. The second phase will constitute the intervention phase, where  the LESS-CHRON tool will be applied and the actual deprescribing of the drugs  will be carried out. DISCUSSION: LESS-CHRON has been proclaimed as a suitable deprescribing tool in clinical practice. Validation of LESS-CHRON will seek to show the results that can be achieved following the deprescribing of drugs,  in addition to demonstrating that the tool can reliably be used by clinicians in  their routine practice. On the other hand, the results of this project may  provide information leading to improving or adapting the tool itself, giving rise  to a second generation of more efficient version.

OBJETIVO: La desprescripción se considera una de las principales estrategias disponibles para el abordaje del plan terapéutico individualizado en  pacientes pluripatológicos o crónicos complejos. Sin embargo, a pesar de ser una práctica ya instaurada desde hace algunos años, se reclama la necesidad de estudios que avalen la obtención de buenos resultados en salud, además de herramientas que ayuden a su desarrollo en la práctica clínica habitual. El objetivo de este proyecto es analizar el impacto en  la disminución de la farmacoterapia mediante la desprescripción de fármacos, aplicando la herramienta LESS-CHRON, en una población de  pacientes de edad avanzada, polimedicada y con múltiples patologías.Método: Estudio cuasiexperimental, pre-post, multicéntrico. Las variables a analizar se dividirán en dos grandes grupos: referidas a la esfera  farmacológica y referidas a resultados en salud. Se recogerán en el momento  basal, a los 3 y a los 6-12 meses. Se realizará una primera fase de screening  para localizar a los pacientes candidatos, que permitirá obtener la información relativa a las oportunidades de desprescripción identificadas. La  segunda constituirá la fase de intervención, en la que se aplicará la  herramienta LESS-CHRON y se llevará a cabo la desprescripción real de los  fármacos.Discusión: LESS­CHRON se ha proclamado como una herramienta adecuada para llevar a cabo la desprescripción de fármacos en la práctica clínica. La validación de la herramienta LESS-CHRON tratará de poner  de manifiesto los resultados que se logran tras efectuar la desprescripción,  además de demostrar su fiabilidad como herramienta, de modo que los clínicos puedan usarla como parte de su actividad asistencial con total  confianza. Por otro lado, los resultados de este proyecto podrán arrojar  información para la mejora o adaptación de la propia herramienta, dando lugar  a una segunda generación o futuras versiones mejoradas y más  eficientes.

Traducción y adaptación transcultural al español de la escala MULTIPleS en pacientes de edad avanzada con multimorbilidad / Cross-cultural adaptation into Spanish of the MULTIPleS scale in elderly patients with multimorbidity

Antecedentes y objetivo: La escala Multimorbidity Illness Perceptions Scale (MULTIPleS) analiza si padecer dos o más enfermedades crónicas repercute en la calidad de vida, coste y resultados clínicos de los pacientes. El objetivo fue traducir y adaptar transculturalmente al español la escala MULTIPleS.MétodosTraducción directa y retrotraducción seguidas de síntesis y adaptación por un tercer traductor y un panel de expertos para garantizar la equivalencia conceptual, semántica y de contenido entre ambas versiones. Posteriormente, se realizó un análisis de comprensibilidad en una muestra de pacientes.ResultadosSe obtuvo la versión española de la escala MULTIPleS. El grado de dificultad medio en la traducción directa y la retrotraducción del título y de las preguntas demostró una dificultad baja. En la fase de síntesis y adaptación, se resolvieron 6 discrepancias. El análisis de comprensibilidad se realizó en 10 pacientes, lográndose el requisito establecido (> 80%) para todos los ítems.ConclusionesSe trata de la primera adaptación transcultural al español de la escala MULTIPleS. Disponer de esta escala retrotraducida permitirá analizar la percepción de los pacientes ante la enfermedad y aplicar así mejoras en su asistencia sanitaria. (AU)

Background and objective: The Multimorbidity Illness Perceptions Scale (MULTIPleS) analyzes whether suffering from two or more chronic diseases affects the quality of life, cost and clinical results of patients. The objective was to translate and cross-culturally adapt the MULTIPleS scale into Spanish.MethodsDirect translation and back translation followed by synthesis and adaptation by a third translator and a panel of experts to guarantee the conceptual, semantic and content equivalence between both versions. Subsequently, a comprehensibility analysis was performed on a sample of patients.ResultsThe Spanish version of the MULTIPleS scale was obtained. The medium degree of difficulty in the direct translation and the back translation of the title and the questions showed a low difficulty. In the synthesis and adaptation phase, 6 discrepancies were resolved. The comprehensibility analysis was performed in 10 patients, achieving the established requirement (> 80%) for all items.ConclusionsThis is the first cross-cultural adaptation to Spanish of the MULTIPleS scale. Having this back-translated scale will make it possible to analyze patients’ perception of the disease and thus apply improvements in their healthcare. (AU)

Protocolo de validación de la herramientade desprescripción LESS-CHRON en pacientespluripatológicos. Proyecto LESS-CHRON-VALIDATION / Validation protocol of the LESS-CHRON deprescription tool in multimorbidity patients. LESS-CHRON-VALIDATION Project

Objetivo: La desprescripción se considera una de las principales estrategias disponibles para el abordaje del plan terapéutico individualizado enpacientes pluripatológicos o crónicos complejos. Sin embargo, a pesar deser una práctica ya instaurada desde hace algunos años, se reclama lanecesidad de estudios que avalen la obtención de buenos resultados ensalud, además de herramientas que ayuden a su desarrollo en la prácticaclínica habitual. El objetivo de este proyecto es analizar el impacto en ladisminución de la farmacoterapia mediante la desprescripción de fármacos,aplicando la herramienta LESS-CHRON, en una población de pacientes deedad avanzada, polimedicada y con múltiples patologías.Método: Estudio cuasiexperimental, pre-post, multicéntrico. Las variables aanalizar se dividirán en dos grandes grupos: referidas a la esfera farmacológica y referidas a resultados en salud. Se recogerán en el momento basal,a los 3 y a los 6-12 meses. Se realizará una primera fase de screening paralocalizar a los pacientes candidatos, que permitirá obtener la informaciónrelativa a las oportunidades de desprescripción identificadas. La segundaconstituirá la fase de intervención, en la que se aplicará la herramientaLESS-CHRON y se llevará a cabo la desprescripción real de los fármacos.(AU)

Objective: Deprescribing is considered one of the main strategies available for preparing an individualized therapeutic plan in patients withmultiple pathologies or complex chronic conditions. However, despite thepractice has been in place for some years, there is a need for studies thatsupport the achievement of satisfactory health outcomes, as well as toolsthat help implement deprescribing in routine clinical practice. The objective of this project is to analyze the impact of reducing polypharmacy,through the LESS-CHRON deprescribing tool, on a population of elderlypolymedicated patients with multiple conditions.Method: This will be a quasi-experimental, pre-and-post interventionmulticenter cohort study. The variables to be analyzed will be dividedinto two large groups: those related to pharmacology and those related to health outcomes. They will be collected at baseline, at 3 and at6-12 months. A first screening phase will be carried out to recruit candidate patients and obtain information about the identified deprescribingopportunities. The second phase will constitute the intervention phase,where the LESS-CHRON tool will be applied and the actual deprescribingof the drugs will be carried out. (AU)

[Cross-cultural adaptation and validation into Spanish of the deprescription questionnaire in the elderly patient]. / Adaptación transcultural y validación al español del cuestionario de desprescripción en el paciente de edad avanzada.

BACKGROUND AND OBJECTIVE: In 2017, a questionnaire was developed in Italian with the aim of determining clinicians' perceptions of deprescription in the elderly population. The objective was to translate and cross-culturally adapt this deprescription questionnaire to Spanish. METHODS: Forward and blind-back translations, followed by a synthesis and adaptation by a third translator. Development of an expert panel to evaluate the adequacy of the translation, the understandability of the translated question and the usefulness of each question. A comprehensibility analysis was carried out on physicians familiar with deprescription. RESULTS: The Spanish version of the questionnaire was obtained, where the average degree of difficulty in the direct and the back-translation was low/moderate. In the first phase of the panel of experts, 4 questions had sections considered "indeterminate" and one question was "doubtful". After the second phase, all the questions were considered "adequate" except for one. CONCLUSIONS: This is the first cross-cultural adaptation to Spanish of this questionnaire, which will provide a tool to assess clinicians' perception of this practice and establish improvements to carry out this activity.

Cross-cultural adaptation into Spanish of the MULTIPleS scale in elderly patients with multimorbidity. / Traducción y adaptación transcultural al español de la escala MULTIPleS en pacientes de edad avanzada con multimorbilidad.

BACKGROUND AND OBJECTIVE: The Multimorbidity Illness Perceptions Scale (MULTIPleS) analyzes whether suffering from two or more chronic diseases affects the quality of life, cost and clinical results of patients. The objective was to translate and cross-culturally adapt the MULTIPleS scale into Spanish. METHODS: Direct translation and back translation followed by synthesis and adaptation by a third translator and a panel of experts to guarantee the conceptual, semantic and content equivalence between both versions. Subsequently, a comprehensibility analysis was performed on a sample of patients. RESULTS: The Spanish version of the MULTIPleS scale was obtained. The medium degree of difficulty in the direct translation and the back translation of the title and the questions showed a low difficulty. In the synthesis and adaptation phase, 6 discrepancies were resolved. The comprehensibility analysis was performed in 10 patients, achieving the established requirement (> 80%) for all items. CONCLUSIONS: This is the first cross-cultural adaptation to Spanish of the MULTIPleS scale. Having this back-translated scale will make it possible to analyze patients' perception of the disease and thus apply improvements in their healthcare.

Identification and characterisation of deprescribing tools for older patients: A scoping review.

BACKGROUND: Deprescription is the revision of the therapeutic plan with the aim of simplifying it, taking into account patient preferences, prognosis and environment. This strategy is particularly relevant in older patients, mostly polymedicated individuals, since they are exposed to numerous adverse effects and interactions and tend to have less adherence to treatments. OBJECTIVE: To identify the deprescribing tools for older patients available in the scientific literature, classify them according to their design and describe their main features and potential applicability in clinical practice. METHODS: A search was conducted in PubMed and EMBASE for relevant literature published before July 2021. The PRISMA-ScR method was applied, extracting variables related to study and tool characteristics as well as potential clinical applicability. The main inclusion criteria were studies focused on designing or developing deprescribing tools for older patients and those that indicated the features of the deprescribing tool used in detail. RESULTS: Fourteen of 723 papers met the inclusion criteria, and 12 tools were identified: 6 "algorithm-based tools" and 6 "criterion-based tools". Though all tools are aimed at older patients, there are certain peculiarities regarding their design, population, application setting and variables included. Of the 6 criterion-based tools found, 4 used the Delphi method for their design and development. Furthermore, most of them agree on the pharmacological groups that are likely to be deprescribed. CONCLUSIONS: Taking into account the importance of the clinical situation and priorities in the care plan in the deprescribing process, the authors believe that tools which help to evaluate these aspects are the most suitable for application in clinical practice. However, it is necessary to continue studying applicability in real-life clinical scenarios and to obtain health results.

Chronic-pharma: New Platform for Chronic Patients Pharmacotherapy Optimization.

We describe the technological development of a web platform named CHRONIC-PHARMA that integrates three prescription support tools for patients with chronic diseases: Anticholinergic Burden Calculator (ABC), LESS-CHRON criteria and TRIGGER-CHRON. They focus on the optimization and evaluation of pharmacotherapy in patients with chronic diseases, resulting in a useful, single platform that can facilitate the review of pharmacotherapy and improve the safety of chronically ill patients. This is achieved by estimating and reducing the anticholinergic risk (ABC), detecting opportunities for deprescribing drugs and monitoring its success (LESS-CHRON criteria), as well as calculating the risk of adverse drug events (TRIGGER-CHRON). The platform is freely accessible online ( https://chronic-pharma.com/ ) as well as through a mobile application, and therefore easily accessible among the healthcare community.

[Transcultural translation and adaptation into spanish of the questionnaire "Healthcare task difficulty (hctd) among older-adults with multimorbidity".] / Traducción y adaptación transcultural al español del cuestionario "Healthcare task difficulty (HCTD) among older-adults with multimorbidity".

OBJECTIVE: The increase in chronic diseases as a consequence of the rising life expectancy calls for tools that allow us to analyze the difficulty that patients with multimorbidity present when performing healthcare-related tasks. To this end, we carried out a cross-cultural translation and adaptation into Spanish of the questionnaire "Healthcare Task Difficulty (HCTD) among Older Adults with Multimorbidity." METHODS: Direct translation and back translation were made, followed by a synthesis and adaptation by a third translator and a panel of experts in order to guarantee the conceptual, semantic, and content equivalence between the original questionnaire and the Spanish version. Additionally, an evaluation of the comprehension of the questionnaire in Spanish was carried out in a sample of elderly patients with multimorbidity. RESULTS: The Spanish version of the HCTD questionnaire (HCTD-E) was obtained. The overall difficulty of the translators to find an equivalent expression between both languages was low. In the synthesis and adaptation part, four discrepancies were resolved (two of them were adapted in order to use a terminology closer to our health system and the other two were completed with different examples). The comprehensibility analysis was conducted in a sample of ten elderly patients with multimorbidity, and they showed an excellent comprehensibility. CONCLUSIONS: This is the first cross-cultural adaptation to Spanish of the HCTD questionnaire. The methodology used through direct translation, back-translation and adaptation by a third translator and a panel of experts demonstrated a high level of comprehensibility of the HCTD-E, which was measured with cognitive interviews in a sample of patients.

OBJETIVO: El incremento de las enfermedades crónicas como consecuencia del aumento en la esperanza de vida, hace necesario disponer de herramientas que permitan analizar la dificultad que presentan los pacientes con multimorbilidad, a la hora de realizar tareas relacionadas con la asistencia sanitaria. Con este fin, se llevó a cabo una traducción y adaptación transcultural al español del cuestionario "Healthcare Task Difficulty (HCTD) among Older Adults with Multimorbidity". METODOS: Traducción directa y retrotraducción llevadas a cabo por dos traductores, seguidas de una síntesis y adaptación por parte de un tercer traductor. Posterior creación de un panel de expertos con el fin de garantizar la equivalencia conceptual, semántica y de contenido entre la versión original y la española. A continuación, se realizó una evaluación de la comprensión del cuestionario en español en una muestra de pacientes de edad avanzada con múltiples patologías. RESULTADOS: Se obtuvo la versión española del cuestionario HCTD (HCTD-E). La dificultad global encontrada por los traductores para hallar una expresión equivalente entre ambos idiomas fue baja. En la fase de síntesis y adaptación, se resolvieron 4 discrepancias con el fin de utilizar una terminología más cercana a nuestro sistema sanitario. El análisis de comprensibilidad se efectuó sobre una muestra de 10 pacientes, mayores y con multimorbilidad en seguimiento por Medicina Interna, el cual demostró una comprensibilidad excelente. CONCLUSIONES: Se trata de la primera adaptación transcultural al español del cuestionario HCTD. La metodología utilizada mediante traducción directa, retrotraducción y adaptación por parte de un tercer traductor y un panel de expertos, ha demostrado un alto nivel de comprensibilidad de la herramienta HCTD-E medida a través de entrevistas cognitivas realizadas en una muestra de pacientes.

Validation of the LESS-CHRON criteria: reliability study of a tool for deprescribing in patients with multimorbidity.

OBJECTIVE: The 'LESS-CHRON criteria' (List of Evidence-Based Deprescribing for Chronic Patients criteria) is a newly created tool with 27 criteria to guide deprescribing. It was developed using a Delphi methodology. Each criterion consists of drugs and their indications, conditions under which deprescribing would be considered, a health variable to be monitored after deprescribing and a follow-up period. The aim of our study was to evaluate the reliability of the LESS-CHRON criteria in a population of patients with multimorbidity to determine the possible usefulness of this tool in clinical practice. METHODS: We selected chronic patients with multimorbidity from an internal medicine unit who were older than 80 years old and were alive at the time of the study. To determine interobserver reliability, each professional (internist or hospital pharmacy specialist) applied the questionnaire under the same conditions and with the same resources. To determine intraobserver reliability, each health professional applied the tool at baseline and 2 months later. We measured interobserver and intraobserver reliability using the kappa coefficient. The proportion of overall agreement was also determined. RESULTS: We obtained a moderate overall kappa (ĸ=0.46, 95% CI 0.36 to 0.55) for interobserver reliability, and good (ĸ=0.65, 95% CI 0.57 to 0.78) and moderate (ĸ=0.59, 95% CI 0.49 to 0.74) values for intraobserver reliability for the internist and pharmacist, respectively. The proportion of overall agreement was very high: 92% (range: 62%-100%) for the interobserver, and 94% (80%-100%) and 93% (63%-100%) for the internist and pharmacist, respectively. CONCLUSIONS: The LESS-CHRON criteria shows early promise as a reliable method to help guide deprescribing in patients with multimorbidity. Further, more complete testing with a larger sample of prescribers is needed.

Association Between Drug Burden Index and Functional and Cognitive Function in Patients with Multimorbidity.

BACKGROUND: Anticholinergic and sedative drugs are associated with adverse events such as cognitive and functional impairment in elderly. The Drug Burden Index (DBI) is a measure of an individual's total exposure to anticholinergic and sedative drugs. Objetive: The study aimed to evaluate the association between the total DBI and cognitive and functional impairment in patients with multimorbidity. SETTING: Patients with multimorbidity enrolled in the IMPACTO project. METHODS: Cross-sectional observational study. MAIN OUTCOME MEASURE: The anticholinergic and sedative exposure was calculated using DBI. The Pfeiffer Test (PT) was used for cognitive status and the Barthel Index (BI) for functional status. RESULTS: 336 patients were included (mean age 77.6 ± 8.7 years, 54.2% men and a mean of 11.5 ± 3.7 prescribed drugs). 180 patients (53.6%) exposed to anticholinergic and/or sedative drugs were identified. The median score obtained in PT was slightly higher in exposed patients (1 (IQR 0-2) and 2 (IQR 0-4), p = 0.082 in "non-exposed" and "exposed", respectively). The bivariate analysis showed an association [0.544 (95% CI 0.044-1.063, p = 0.03)]. The median obtained in the BI analysis was 85.0 (IQR 30.0) and 75.5 (IQR 42.5) p = 0.002, in "nonexposed" and "exposed", respectively. After the adjusted analysis, a relationship was obtained between both the variables [-9,558 (95% CI-15,794; -3,321, p = 0.03)]. CONCLUSION: Higher DBI is associated with the impairment of functional status and, slightly to the deterioration of cognitive function in patients with multimorbidity. DBI should be considered in patients with multimorbidity to optimize the pharmacological treatment of a group of special interest due to its vulnerability.

Desprescripción: guiando su definición / Deprescribing: guiding its definition

No disponible

Novel tool for deprescribing in chronic patients with multimorbidity: List of Evidence-Based Deprescribing for Chronic Patients criteria.

AIM: To create a tool to identify drugs and clinical situations that offers an opportunity of deprescribing in patients with multimorbidity. METHODS: A literature review completed with electronic brainstorming, and subsequently, a panel of experts using the Delphi methodology were applied. The experts assessed the criteria identified in the literature and brainstorming as possible situations for deprescribing. They were also asked to assess the influence of life prognosis in each criterion. A tool was composed of the most appropriate criteria according to the strength of their evidence, usefulness in patients with multimorbidity and applicability in clinical practice. RESULTS: Out of a total of 100, 27 criteria were selected to be included in the final list. It was named the LESS-CHRON criteria (List of Evidence-baSed depreScribing for CHRONic patients), and was organized by the anatomical group of the Anatomical, Therapeutic, Chemical (ATC) classification system of the drug to be deprescribed. Each criterion contains: drug indication for which it is prescribed, clinical situation that offers an opportunity to deprescribe, clinical variable to be monitored and the minimum time to follow up the patient after deprescribing. CONCLUSIONS: The "LESS-CHRON criteria" are the result of a comprehensive and standardized methodology to identify clinical situations for deprescribing drugs in chronic patients with multimorbidity. Geriatr Gerontol Int 2017; 17: 2200-2207.

Intervenciones para la mejora de la adherencia al tratamiento en pacientes pluripatológicos: resumen de revisiones sistemáticas / Interventions for improving adherence to treatment in patients with multiple pathologies: overview of systematic reviews

Objetivo: Evaluar la evidencia disponible respecto a la eficacia de intervenciones destinadas a mejorar la adherencia al tratamiento que sean aplicables a pacientes pluripatológicos (PP). Diseño: Revisión de revisiones sistemáticas. Fuentes de datos: Se consultaron (septiembre de 2013): Pubmed, EMBASE, the Cochrane Library, CRD y WoS para detectar intervenciones para la mejora de la adherencia en PP, o en su defecto, pacientes con patologías definitorias de pluripatología o polimedicados. Selección de estudios: Se incluyeron revisiones sistemáticas de ensayos clínicos con PP o de características similares. Estas debían comparar la eficacia de cualquier intervención destinada a mejorar el cumplimiento del tratamiento autoadministrado prescrito con la práctica habitual u otra intervención. Extracción de datos: Se extrajo información sobre la población en estudio, la intervención ensayada y la eficacia de la misma en términos de mejora de la adherencia. Resultados: Se recuperaron 566 artículos de los que se seleccionaron 9 revisiones sistemáticas. Ninguna se centraba específicamente en PP. Sí consideraban pacientes con múltiples patologías crónicas, patologías definitorias de pluripatología o polimedicados. La eficacia global de las intervenciones fue modesta, no observándose diferencias relevantes entre las intervenciones de carácter conductual, educativo o combinado. Algunos componentes de estas intervenciones como son el asesoramiento al paciente o las estrategias de simplificación posológica parecen ser herramientas eficaces en la mejora de la adherencia en este grupo poblacional. Conclusiones: Existe una gran heterogeneidad de intervenciones orientadas a la mejora de la adherencia de eficacia modesta, no habiendo sido diseñadas para una población de PP (AU)

Objective: To assess the available scientific evidence regarding the efficacy of interventions aimed to enhance medication adherence in patients with multiple chronic conditions (PMCC). Design: Overview of systematic reviews. Data sources: The following databases were consulted (September 2013): Pubmed, EMBASE, the Cochrane Library, CRD and WoS to identify interventions aimed to enhance medication adherence in PMCC, or otherwise, patients with chronic diseases common in the PMCC, or polypharmacy. Study selection: Systematic reviews of clinical trials focused on PMCC or similar were included. They should compare the efficacy of any intervention aimed to improve compliance to prescribed and self-administered medications with clinical practice or other interventions. Data extraction: Information about the study population, nature of intervention and efficacy in terms of improved adherence was extracted. Results: 566 articles were retrieved of which 9 systematic reviews were included. None was specifically focused on PMCC but considered patients with chronic diseases common in the PMCC, patients with more than one chronic disease and polypharmacy. The overall effectiveness of interventions was modest without relevant differences between behavioural, educational and combined interventions. Some components of these interventions including patient counselling and regimen simplification appear to be effective tools in improving adherence in this population group. Conclusion: There is a large heterogeneity of interventions aimed to improve adherence with modest efficacy, none in PMCC (AU)