Treatment adherence in patients older than 65 years who suffer early readmissions.

OBJECTIVE: Analyze the frequency of therapeutic noncompliance in patients who  suffer early readmissions, and identify the factors associated with it. METHOD: Observational, descriptive study of three months duration (March -  May 2014). All patients older than 65 years who readmitted in the 3-30 days  following the last hospital discharge were included. We excluded programmed  re-admissions and readmissions in the Intensive Care Unit. The variables  collected were: age, sex, medical service, major diagnostic category,  polypharmacy, number of days since the last hospital discharge, presence of  hypertension and/or diabetes. The therapeutic compliance and the difficulty in  the administration of medication were evaluated by means of the Morisky-Green  test and the Haynes-Sackett test respectively. A descriptive analysis of the  variables was carried out and they were related to the therapeutic adherence.  The variables with statistical significance were included in a multivariate logistic  regression model. RESULTS: Fifty seven percent of the patients presented lack of adherence to  pharmacological treatment. Twenty three percent had difficulty administering the medication. Eighty six percent had comorbidities  (hypertension and/or diabetes) and 79% had a caregiver. Eighty six percent of patients were polymedicated (≥ 5 drugs). There is a relationship between lack of adherence and difficulty in the administration of medications (p=0.021),  polypharmacy (p=0.002), and the presence of diabetes mellitus (p=0.018). CONCLUSIONS: Polymedication, the presence of diabetes mellitus and the existence of difficulty in the administration of medication are evidenced as prognostic factors of the lack of adherence to treatment in patients older than 65 years.

Objetivo: Analizar la frecuencia del incumplimiento terapéutico en pacientes que sufren reingresos hospitalarios precoces e identificar los factores asociados  al mismo.Método: Estudio observacional descriptivo de tres meses de duración (marzo­ mayo de 2014). Se incluyeron todos los pacientes mayores de 65 años que  reingresaron en los 3-30 días siguientes al alta hospitalaria. Fueron excluidos los reingresos programados y los reingresos en la Unidad de Cuidados Intensivos.  Las variables recogidas fueron: edad, sexo, servicio médico, categoría  diagnóstica mayor, polimedicación, número de días desde el alta, presencia de  hipertensión y/o diabetes. Se evaluó el cumplimiento terapéutico y la dificultad  en la administración de medicación mediante el test de Morisky-Green y el test  de Haynes-Sackett, respectivamente. Se realizó un análisis descriptivo de las  variables y se relacionaron estas con la adherencia terapéutica. Las variables  con significación estadística se incluyeron en un modelo de regresión logística multivariante.Resultados: El 57% de los pacientes presentaron falta de adherencia al tratamiento farmacológico. El 23% presentaba dificultad en la administración de la medicación. Un 86% presentaba comorbilidades  hipertensión y/o diabetes) y el 79% tenía cuidador. El 86% de los pacientes  estaban polimedicados (≥ 5 fármacos). Existe relación entre la falta de  adherencia y la dificultad en la administración de los medicamentos (p = 0,021), la polimedicación (p = 0,002) y la presencia de diabetes mellitus (p = 0,018).Conclusiones: La polimedicación, la presencia de diabetes mellitus y la  existencia de dificultad en la administración de la medicación se evidencian como factores pronósticos de la falta de adherencia al tratamiento en pacientes  mayores de 65 años.

Quality indicators for technologies applied to the hospital pharmacy.

The TECNO group of the Sociedad Española de Farmacia Hospitalaria (Spanish Society of Hospital Pharmacy) has addressed the definition of a catalogue of indicators for performance, quality and safety in the use of technologies applied to the logistic activity of Hospital Pharmacy Units.The project was developed with a methodology of qualitative techniques by consensus, with the members of the TECNO Group participating as experts. Once indicators had been defined, a validation phase was conducted, and standards were established based on the result of the sampling carried out in the hospitals of the group members.A total of 28 indicators were obtained, with their corresponding quality standards applied to the use of technologies in the processed for medication storage, dispensing and preparation.The definition of quality indicators and their standards for measuring technologies in the use of medication represents a step forward in the improvement of their safety.

El grupo TECNO de la Sociedad Española de Farmacia Hospitalaria ha abordado la definición de un catálogo de indicadores de funcionamiento, calidad y seguridad del uso de tecnologías aplicadas a la actividad logística de los Servicios de Farmacia Hospitalaria.El proyecto se desarrolló con una metodología de técnicas cualitativas de consenso participando como expertos los miembros del grupo TECNO. Una vez definidos los indicadores, se realizó una fase de validación y se establecieron estándares en base al resultado del muestreo realizado en los hospitales de los miembros del grupo.Se han obtenido un total de 28 indicadores con sus correspondientes estándares de calidad aplicados a la utilización de tecnologías en los procesos de almacenamiento, dispensación y elaboración de medicamentos.La definición de los indicadores de calidad y los estándares de medida de las tecnologías en el uso de los medicamentos es un paso adelante para mejorar su seguridad.

Potential drug-drug interactions in hospitalised haematological patients.

Background Frequently, haematological patients undergo highly complex and intensive treatment protocols, so a high risk of drug-drug interactions could be expected. Objectives To determine prevalence of clinically relevant drug-drug interactions, to identify the most frequent drug-drug interactions and associated risk factors. Methods A prospective, observational and descriptive study was carried out from November 2012 to February 2013. Twice a week, every patient's treatment sheet was collected. Each medication list was screened through two databases: Thomson MicromedexTM and Drug Interaction FactsTM. All identified potential drug-drug interactions with a moderate or higher severity rating were recorded. Summary statistics were used to describe patient and disease characteristics, most often prescribed drugs, and frequency, types and classification of drug-drug interactions. Multiple logistic regression models were used to identify risk factors associated with drug-drug interactions. Results A total of 2061 drug-drug interactions were detected in 317 treatment sheets from 58 patients. The prevalence of treatment sheets with drug-drug interactions by Micromedex and Drug Interaction Facts databases were 74.1% and 56.8%, respectively. Azole antifungals, immunosuppressive drugs, antiemetics, antidepressants, acid suppressants and corticosteroids were the most frequent involved drugs. In multivariate analysis, the main risk factor associated with increased odds for drug-drug interactions was a higher number of non-antineoplastic drugs. Conclusions The prevalence of drug-drug interactions was common, with immunosuppressant and azole antifungal agents being the most commonly involved drugs. The factor having the greatest influence on drug-drug interactions was a higher number of non-antineoplastic drugs.

Potential drug-drug interactions in oncological adult inpatients at a Spanish hospital: epidemiology and risk factors.

BACKGROUND: Oncological patients are at high risk for drug-drug interactions (DDIs), which may contribute to therapeutic failure or lead to serious adverse events. OBJECTIVE: To determine the prevalence of potential DDIs in medication lists, to describe the most frequent DDIs and to investigate the possible risk factors associated with them. A prospective cohort study was performed at the Oncology Department of a tertiary hospital over a 12-week period. Twice a week, every inpatient's treatment sheet was collected and screened through two databases: Micromedex™ and Drug Interaction Facts™. All identified potential DDIs with a moderate or higher severity rating were recorded. Multivariate analysis was used to identify risk factors associated with DDIs. RESULT: A total of 1956 DDIs were detected in 699 treatment sheets. The prevalence of treatment sheets with DDIs was 81.0 % and 32.6 % by Micromedex™ and Drug Interaction Facts™, respectively. Central nervous depressant agents and antiemetics were the most commonly involved groups in DDIs. A higher number of non-antineoplastic drugs was related with potential DDIs [adjusted-OR 1.398 and 1.613 by Micromedex™ and Drug Interaction Facts™, respectively]. CONCLUSION The prevalence of potential DDIs was widely variable among databases. The main risk factor associated with DDIs was a higher number of non-antineoplastic medicines.