[What do primary care physicians think about deprescription?] / ¿Qué opinan los médicos de atención primaria sobre la deprescripción?

INTRODUCTION: To learn about the perceptions and attitudes of family doctors regarding deprescription. MATERIAL AND METHODS: This is a cross-sectional study conducted at the Organización Sanitaria Integrada Bidasoa, Osakidetza. In November 2018, sessions were held at health centres on deprescribing for family doctors, following which the PACPD-12 questionnaire was handed out, translated into Spanish and adapted. The responses to the questionnaire were collected, together with the socio-demographic variables. RESULTS: Forty-two of the 58 doctors who received the survey responded (72%). One hundred percent considered deprescription beneficial in the current scenario. The drug groups that they most frequently considered deprescribing were the benzodiazepines, bisphosphonates and proton pump inhibitors. The main reasons they gave for deprescribing were to reduce harm from adverse effects and that the medication was of minimal benefit in the patient's circumstances, and they indicated that specific training in deprescribing and pharmacist alerts in the clinical history would facilitate deprescription. Barriers highlighted were lack of time, prescribing by other professionals, or resistance on the part of the patient or their family. CONCLUSIONS: Knowing what doctors think about deprescribing and its barriers and facilitators are necessary to plan a strategy to facilitate the practice. Although all the respondents indicated that they consider deprescription beneficial, they found barriers in their daily practice to their being able to implement it.

Impacto de la pandemia SARS-CoV-2 en el inicio de las prescripciones / Impact of the SARS-CoV-2 pandemic on the start of prescriptions

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Conciliación de la medicación en atención primaria tras el alta hospitalaria / Medication reconciliation in primary care after hospital discharge

Objetivos: El objetivo primario de este estudio es comprobar si la información de los cambios propuestos en el tratamiento habitual de los pacientes al alta hospitalaria se traslada a su hoja de tratamiento activo cuando acuden a atención primaria. Se plantean objetivos secundarios como analizar la media de medicamentos por paciente al ingreso y al alta; identificar otros factores que pudieran influir en la modificación del tratamiento durante el ingreso (edad del paciente o número de fármacos previamente indicados, entre otros). También se analiza la relación entre el centro de salud al que pertenece el paciente y la probabilidad de que se concilie su medicación cuando acude a atención primaria. Material y métodos: Se trata de un estudio transversal observacional, desarrollado en la Organización Sanitaria Integrada Bidasoa. Se incluyó a todos los pacientes mayores de 65 años polimedicados (que tomaban 5 o más fármacos) de la organización, dados de alta en el Hospital Bidasoa entre el 15 de octubre y el 11 de noviembre de 2012. Las altas producidas en este periodo se enviaron desde el hospital a cada responsable de seguridad del paciente de los centros de atención primaria, y a través de la revisión de la historia clínica de cada paciente se obtuvo información relativa a si habían acudido a su centro en los 15 días posteriores al alta, así como de si se efectuó alguna modificación en la hoja de tratamiento activo. Resultados: Doscientos sesenta y un pacientes (n = 261) fueron dados de alta en el periodo de estudio, de los cuales 80 cumplían los criterios de inclusión. El informe de alta de 39 de ellos (49%) proponía algún cambio en su hoja de tratamiento activo. De ellos, 35 (90%) se pusieron en contacto con atención primaria, y en 24 pacientes los cambios fueron incluidos en su hoja de tratamiento activo, lo que supone el 68% de los que contactaron con atención primaria y el 61% de los que hubieran requerido cambios. Conclusiones: Los resultados observados en este estudio nos llevan a pensar en la necesidad de establecer un programa de conciliación de la medicación para los pacientes polimedicados al alta hospitalaria. Además, consideramos interesante ahondar en los motivos por los cuales los pacientes que a pesar de haber acudido a atención primaria tras el alta hospitalaria, no vieron trasladados los cambios de la medicación a su hoja de tratamiento activo (AU)

Objectives: The primary objective of this study was to determine if changes prescribed in the usual treatment of patients at discharge from the hospital were updated in their active treatment sheet when they came to the Primary Care clinic. The secondary objectives included, determining whether the drug average varies between the admission and discharge, as well as, identifying other factors related to the modification of treatment during hospital admission including, among others, patient age or the number of drugs previously indicated. Finally, the relationship between the Primary Care Unit to which the patient belonged and the probability that the medication was reconciled was also examined. Material and methods: This is an observational cross-sectional study conducted in the Bidasoa Integrated Healthcare Organization. The study included every patient over 65 years old with multiple medication (taking 5 or more drugs) belonging to this organization, and discharged from Bidasoa Hospital between 15th October and 11th November 2012. The information on hospital discharges during this period was sent from the hospital to those responsible for patient safety in the Primary Health Care Centers. Each patient clinical history was reviewed in order to confirm if a visit (at least once in the first two weeks after discharge) had been made to their Primary Care Unit, and whether there had been a change in their active treatment sheet. Results: Two hundred sixty-one patients (n = 261) were discharged from Bidasoa Hospital in the study period, and 80 met the inclusion criteria. The discharge report proposed a change in the active treatment in 39 of them (49%). Of these, 35 (90%) attended a Primary Care clinic, and the changes were included in their active treatment sheet in 24 patients, representing 68% of those who contacted Primary Care, and 61% of those who would have required changes. Conclusions: The results demonstrate the need to establish a reconciliation medication program for patients on multiple medications after hospital discharge. Moreover, further studies are needed to investigate what may be the reasons why the changes to active treatment sheets are not taking place for some patients, despite these having visited Primary Care after having been discharged from hospital

[Medication reconciliation in primary care after hospital discharge]. / Conciliación de la medicación en atención primaria tras el alta hospitalaria.

OBJECTIVES: The primary objective of this study was to determine if changes prescribed in the usual treatment of patients at discharge from the hospital were updated in their active treatment sheet when they came to the Primary Care clinic. The secondary objectives included, determining whether the drug average varies between the admission and discharge, as well as, identifying other factors related to the modification of treatment during hospital admission including, among others, patient age or the number of drugs previously indicated. Finally, the relationship between the Primary Care Unit to which the patient belonged and the probability that the medication was reconciled was also examined. MATERIAL AND METHODS: This is an observational cross-sectional study conducted in the Bidasoa Integrated Healthcare Organization. The study included every patient over 65 years old with multiple medication (taking 5 or more drugs) belonging to this organization, and discharged from Bidasoa Hospital between 15th October and 11th November 2012. The information on hospital discharges during this period was sent from the hospital to those responsible for patient safety in the Primary Health Care Centers. Each patient clinical history was reviewed in order to confirm if a visit (at least once in the first two weeks after discharge) had been made to their Primary Care Unit, and whether there had been a change in their active treatment sheet. RESULTS: Two hundred sixty-one patients (n=261) were discharged from Bidasoa Hospital in the study period, and 80 met the inclusion criteria. The discharge report proposed a change in the active treatment in 39 of them (49%). Of these, 35 (90%) attended a Primary Care clinic, and the changes were included in their active treatment sheet in 24 patients, representing 68% of those who contacted Primary Care, and 61% of those who would have required changes. CONCLUSIONS: The results demonstrate the need to establish a reconciliation medication program for patients on multiple medications after hospital discharge. Moreover, further studies are needed to investigate what may be the reasons why the changes to active treatment sheets are not taking place for some patients, despite these having visited Primary Care after having been discharged from hospital.

Prescripción de especialidades farmacéuticas genéricas (EFG) en atención primaria / Prescription of Generic Medicines in Primary Care

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[Suitability of antibiotic prescription in primary care in the Basque Autonomous Community]. / Idoneidad de la prescripción antibiótica en atención primaria en la Comunidad Autónoma Vasca.

OBJECTIVE: To study the variability and suitability of antibiotic prescription in primary care in the Basque Country. DESIGN: Prospective, descriptive study. SETTING: Basque Country health care centres both within and not in the reformed network. MEASUREMENTS AND MAIN RESULTS: 3182 infections from consultations for infectious disease were studied through sampling stratified by health area during February, March and April 1998. The appropriateness of antibiotics (ATB) prescription was compared with some standards after an extensive bibliographic review. 68.6% of consultations were infections not needing ATB (infections of respiratory airways, acute bronchitis, flu and gastro-enteritis). ATB were used in 28.5% of these cases (CI: 26.6-30.5), especially in acute bronchitis (90.7%) (CI: 87.3-93.4). Unnecessary prescription supposes 39.7% of total antibiotic prescription (CI: 37.2-42.1%), which means unnecessary annual expenditure of 1155 million pesetas. In 31.4% of the infections that require ATB treatment, in 23.7% inappropriate treatment was chosen (CI: 21-26.7%). Overall appropriateness of treatment was 72.2% (CI: 70.6-73.8). Working in the reformed system was linked to better prescription in all cases. Paediatricians prescribed better in the case of infections not susceptible to ATB treatment. CONCLUSIONS: ATB prescription is not consistent with the available scientific evidence. Incorrect treatments occur especially in benign and self-limiting processes. A local policy of ATB use that includes multi-disciplinary collaboration and effective ongoing training is necessary.

Idoneidad de la prescripción antibiótica en atención primaria en la Comunidad Autónoma Vasca / The suitability of antibiotic prescription in primary care in the basque autonomous community

Objetivo. Estudiar la variabilidad e idoneidad de la prescripción antibiótica en atención primaria en la Comunidad Autónoma Vasca (CAV).Diseño. Estudio descriptivo, prospectivo. Emplazamiento. Centros de atención primaria de la red reformada y no reformada de la CAV. Mediciones y resultados principales. Se estudiaron 3.182 infecciones obtenidas de consultas sobre enfermedad infecciosa mediante muestreo estratificado por área sanitaria durante febrero, marzo y abril de 1998. La idoneidad de la prescripción de antibióticos (ATB) se comparó con unos patrones elaborados tras una extensa revisión bibliográfica. Un 68,6 por ciento de las consultas son infecciones que no requieren ATB (catarro de vías altas [IRA], bronquitis aguda, gripe y gastroenteritis). Se utilizan ATB en un 28,5 por ciento de estos casos (IC, 26,6-30,5). Destaca la bronquitis aguda, con un 90,7 por ciento (IC, 87,3-93,4). La prescripción innecesaria supone un 39,7 por ciento de la prescripción total antibiótica (IC, 37,2-42,1 por ciento), suponiendo un gasto anual innecesario de 1.155 millones de pesetas. En el 31,4 por ciento de las infecciones que requieren tratamiento con ATB, se opta por uno no adecuado en un 23,7 por ciento (IC, 21-26,7 por ciento). En total, la idoneidad del tratamiento global fue del 72,2 por ciento (IC, 70,6-73,8). El hecho de trabajar en la red reformada se asoció a una mejor prescripción en todos los casos. Los pediatras prescriben mejor en el caso de las infecciones no susceptibles de tratamiento con ATB. Conclusiones. La prescripción de ATB no se realiza conforme a la evidencia científica disponible. Los tratamientos incorrectos tienen lugar sobre todo en procesos benignos y autolimitados. Es necesaria una política local de uso de ATB que incluya colaboración multidisciplinaria y formación continuada efectiva (AU)