Complejidad del régimen de medicación en pacientes pluripatológicos / Complexity of the medication regimen for polypathological patients

Objetivo: Determinar la complejidad del régimen terapéutico en pacientes pluripatológicos hospitalizados en servicios de medicina interna. Métodos: En un estudio observacional multicéntrico se incluyeron pacientes pluripatológicos hospitalizados en servicios de medicina interna. Se excluyeron los reingresos y los fallecidos. Se recogieron datos de edad, sexo, residencia, patología, índices de Charlson, Barthel y Lawton-Brody, cuestionario de Pfeiffer, escala de Gijón, número de ingresos en el año previo, delirium, necesidad y disponibilidad de cuidador y puntuación en el índice PROFUND. Se calculó la complejidad terapéutica con el Medication Regimen Complexity Index (MRCI). Se consideró un régimen terapéutico complejo cuando la puntuación en el MRCI estaba en el cuarto cuartil. Para determinar los factores asociados con la complejidad se construyó un modelo de regresión logística. Resultados: Se incluyeron 233 pacientes pluripatológicos; el 52,9%, mujeres; edad media (desviación estándar): 79,8 (8,6) años. El consumo medio de fármacos fue 8,4 (3,3). La puntuación media (desviación estándar) en el MRCI fue 30 (15,2). La puntuación por cuartiles del MRCI fue 0-20, 20,5-30, 30,5-42, 42,5-80. Las enfermedades respiratorias (OR: 4,185; IC95%: 2,015-8,693; p<0,001) se asociaron de forma independiente con mayor complejidad terapéutica, y las enfermedades neurológicas con déficit mental permanente (OR; 0,265; IC95%: 0,085-0,828; p=0,022) se asocian con menor complejidad. Conclusiones: Los pacientes pluripatológicos están polimedicados y tienen regímenes terapéuticos de medicación complejos. Las enfermedades respiratorias determinan una mayor complejidad, y el deterioro cognitivo, una menor complejidad terapéutica

Objective: To determine the complexity of the therapeutic regimen for polypathological patients hospitalised in internal medicine departments. Methods: A multicentre observational study included polypathological patients hospitalised in internal medicine departments. Patients who were readmitted or died were excluded. Data were collected on age, sex, residence, disease, Charlson, Barthel and Lawton-Brody indices, Pfeiffer questionnaire, Gijón scale, number of hospitalisations in the previous year, delirium, need for and availability of caregivers and the PROFUND index score. We calculated the therapeutic complexity with the Medication Regimen Complexity Index (MRCI). We considered a therapeutic regimen complex when the MRCI score was in the fourth quartile. To determine the factors associated with complexity, we constructed a logistic regression model. Results: We included 233 polypathological patients, 52.9% of whom were women, with a mean age of 79.8 (SD: 8.6) years. The mean number of drugs consumed was 8.4 (SD: 3.3). The mean MRCI score was 30 (SD: 15.2). The MRCI score by quartiles was 0-20, 20.5-30, 30.5-42, 42.5-80. The respiratory diseases (OR: 4.185; 95%CI: 2.015-8.693; P<.001) were independently associated with increased therapeutic complexity, and the neurological diseases with permanent mental deficiency (OR: 0.265; 95%CI: 0.085-0.828; P=.022) were associated with less complexity. Conclusions: Patients with comorbidities are polymedicated and have complex therapeutic drug regimens. Respiratory diseases determine greater therapeutic complexity, while cognitive impairment determines a lower therapeutic complexity

Complexity of the medication regimen for polypathological patients. / Complejidad del régimen de medicación en pacientes pluripatológicos.

OBJECTIVE: To determine the complexity of the therapeutic regimen for polypathological patients hospitalised in internal medicine departments. METHODS: A multicentre observational study included polypathological patients hospitalised in internal medicine departments. Patients who were readmitted or died were excluded. Data were collected on age, sex, residence, disease, Charlson, Barthel and Lawton-Brody indices, Pfeiffer questionnaire, Gijón scale, number of hospitalisations in the previous year, delirium, need for and availability of caregivers and the PROFUND index score. We calculated the therapeutic complexity with the Medication Regimen Complexity Index (MRCI). We considered a therapeutic regimen complex when the MRCI score was in the fourth quartile. To determine the factors associated with complexity, we constructed a logistic regression model. RESULTS: We included 233 polypathological patients, 52.9% of whom were women, with a mean age of 79.8 (SD: 8.6) years. The mean number of drugs consumed was 8.4 (SD: 3.3). The mean MRCI score was 30 (SD: 15.2). The MRCI score by quartiles was 0-20, 20.5-30, 30.5-42, 42.5-80. The respiratory diseases (OR: 4.185; 95%CI: 2.015-8.693; P<.001) were independently associated with increased therapeutic complexity, and the neurological diseases with permanent mental deficiency (OR: 0.265; 95%CI: 0.085-0.828; P=.022) were associated with less complexity. CONCLUSIONS: Patients with comorbidities are polymedicated and have complex therapeutic drug regimens. Respiratory diseases determine greater therapeutic complexity, while cognitive impairment determines a lower therapeutic complexity.

Pluripatología, polifarmacia, complejidad terapéutica y uso adecuado de la medicación / Polypathology, polypharmacy, medication regimen complexity and drug therapy appropriateness

Los pacientes pluripatológicos suelen ser ancianos y consumen muchos fármacos. La polifarmacia afecta a un 85% de los mismos y no se asocia con mayor supervivencia. Al contrario, los expone a más efectos adversos, como pérdida de peso, caídas, deterioro funcional y cognitivo, y hospitalizaciones. La complejidad del régimen medicamentoso incluye más aspectos que el simple número de medicamentos consumidos. La forma galénica, la frecuencia de las dosis, o la forma de preparar la medicación pueden complicar la comprensión y el seguimiento de las prescripciones. Tanto la polifarmacia como la complejidad terapéutica se asocian con una peor adherencia de los pacientes. Para evitar la polifarmacia, la complejidad y mejorar la adherencia es necesario un uso adecuado de la medicación. Prescribir bien consiste en seleccionar aquellos medicamentos de los que hay claras evidencias para su empleo en la indicación, que son adecuados a las circunstancias del paciente, bien tolerados, coste-efectivos y en los que los beneficios de su uso superan a los riesgos. Para mejorar la prescripción de medicamentos es necesario llevar a cabo de forma periódica revisiones de la medicación, especialmente cuando el paciente cambia de médico y en las transiciones asistenciales. Los criterios de Beers y los STOPP/START (Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) son herramientas eficaces para ello. La desprescripción en los pacientes pluripatológicos polimedicados atendiendo a sus circunstancias clínicas, pronóstico y preferencias puede contribuir a un uso más adecuado de la medicación (AU)

Polypathological patients are usually elderly and take numerous drugs. Polypharmacy affects 85% of these individuals and is not associated with greater survival. On the contrary, polypharmacy exposes these individuals to more adverse effects, such as weight loss, falls, functional and cognitive impairment and hospitalisations. The complexity of a drug regimen covers more aspects than the simple number of drugs consumed. The galenic form, the dosage and the method for preparing the drug can impede the understanding of and compliance with prescriptions. Both polypharmacy and therapeutic complexity are associated with poorer adherence by patients. To prevent polypharmacy, reduce complexity and improve adherence, the appropriate use of drugs is needed. Proper prescribing consists of selecting drugs that have clear evidence for their use in the indication, which are appropriate for the patient's circumstances, are well tolerated and cost-effective and whose benefits outweigh the risks. To improve the drug prescription, periodic reviews of the drugs need to be conducted, especially when the patient changes doctor and during healthcare transitions. The Beers and STOPP/START (Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria are effective tools for this improvement. Deprescription for polymedicated polypathological patients that considers their clinical circumstances, prognosis and preferences can contribute to a more appropriate use of drugs (AU)

Polypathology, polypharmacy, medication regimen complexity and drug therapy appropriateness. / Pluripatología, polifarmacia, complejidad terapéutica y uso adecuado de la medicación.

Polypathological patients are usually elderly and take numerous drugs. Polypharmacy affects 85% of these individuals and is not associated with greater survival. On the contrary, polypharmacy exposes these individuals to more adverse effects, such as weight loss, falls, functional and cognitive impairment and hospitalisations. The complexity of a drug regimen covers more aspects than the simple number of drugs consumed. The galenic form, the dosage and the method for preparing the drug can impede the understanding of and compliance with prescriptions. Both polypharmacy and therapeutic complexity are associated with poorer adherence by patients. To prevent polypharmacy, reduce complexity and improve adherence, the appropriate use of drugs is needed. Proper prescribing consists of selecting drugs that have clear evidence for their use in the indication, which are appropriate for the patient's circumstances, are well tolerated and cost-effective and whose benefits outweigh the risks. To improve the drug prescription, periodic reviews of the drugs need to be conducted, especially when the patient changes doctor and during healthcare transitions. The Beers and STOPP/START (Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria are effective tools for this improvement. Deprescription for polymedicated polypathological patients that considers their clinical circumstances, prognosis and preferences can contribute to a more appropriate use of drugs.