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Vol. 156. Issue 6.
Pages 263-269 (March 2021)
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Vol. 156. Issue 6.
Pages 263-269 (March 2021)
Original
Integrated health intervention on polypharmacy and inappropriate prescribing in elderly people with multimorbidity: Results at the end of the intervention and at 6 months after the intervention
Intervención sanitaria integrada en polifarmacia y prescripción inapropiada en personas de edad avanzada con multimorbilidad. Resultados al finalizar la intervención y a los 6 meses
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Antonio San-Joséa,
Corresponding author
asanjose@vhebron.net

Corresponding author. Internal Medicine Service, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, Barcelona 08035, Phone 34-934894105; Fax: +34-934894109..
, Carmen Pérez-Bocanegraa, Antonia Agustíb,c, Helena Laordend, Jordi Gostd, Xavier Vidalb,c, Vanessa Oropezaa, Rosa Romerod
a Geriatric Unit. Internal Medicine Service, Vall d’Hebron University Hospital, Barcelona, Spain
b Clinical Pharmacology Service, Vall d’Hebron University Hospital , Barcelona, Spain
c Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain
d Primary Care Centre Casernes. Catalan Institut of Health, Barcelona, Spain
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Tables (5)
Table 1. Baseline characteristics of the patients.
Table 2. Number of medicines and STOPP / START criteria at the end of the intervention and at 6 months compared with the values before the intervention.
Table 3. Factors associated with a decrease in the STOPP / START criteria at the end of the intervention and at 6 months.
Table 4. Results at 6 months in patients with a decrease in the STOPP / START criteria at the end of the intervention.
Table 5. Main changes in the STOPP / START criteria at the beginning, the end and at 6 months after the intervention.
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Abstract
Background and objective

To analyse the impact of an integrated health intervention focused on polypharmacy and inappropriate prescribing (IP) in elderly people with multimorbidity.

Material and methods

Patients were referred for assessment and intervention from primary care or hospital to an interdisciplinary team composed of primary and hospital medical staff and nurses. Pharmacological assessment was centred on polypharmacy and IP using the STOPP/START criteria. Changes in polypharmacy and in IP were analysed at the end of the intervention and at 6 months.

Results

One hundred consecutive patients (mean (SD) age 81.5(8.0) years, 54(54%) male) were analysed. Mean prescribed medicines at baseline was > 10. There were no significant changes at the end of the intervention and at 6 months. The proportion of patients with two or more STOPP criteria reduced from 37% at the beginning of the intervention to 18% at the end (p< .001), and the proportion of those with START criteria from 13% to 6% (p = .004). These differences persisted at 6 months. The number of STOPP and START criteria before the intervention was associated with a decrease in the STOPP and START criteria at the end of the intervention and at 6 months. A reduction in polypharmacy (p= .041) and in falls (p= .034) was observed at 6 months in those with a decrease in the STOPP criteria at the end of the intervention.

Conclusions

An integrated health intervention centred on polypharmacy and IP in elderly people improves inappropriate prescribing that persists beyond the intervention.

Keywords:
Frail elderly people
Multimorbidity
Polypharmacy
Inappropriate prescribing
Integrated health care
Resumen
Fundamento y objetivo

Analizar el impacto de una intervención sanitaria integrada centrada en la polifarmacia y la prescripción inapropiada (PI) en pacientes de edad avanzada con multimorbilidad.

Material y métodos

Los pacientes fueron remitidos desde la atención primaria o el hospital a un equipo interdisciplinar compuesto por médicos y enfermeras de atención primaria y del hospital para la valoración e intervención. La valoración farmacológica se centró en la polifarmacia y en la PI utilizando los criterios STOPP/START. Se analizaron cambios en la polifarmacia y en la PI al final de la intervención y a los 6 meses.

Resultados

Se analizaron 100 pacientes consecutivos con una edad media de 81,5 (8,0) años de los cuales el 54% fueron varones. La media de medicamentos basales fue >10. No hubo diferencias significativas al finalizar la intervención ni a los 6 meses. La proporción de pacientes con 2 o más criterios STOPP se redujo del 37% al comienzo de la intervención al 18% al final (p<0,001), y la proporción de aquellos con criterios START del 13 al 6% (p=0,004). Estos resultados se mantuvieron a los 6 meses. El número de criterios STOPP y START antes de la intervención se asoció a un descenso de los criterios STOPP y START, al final de la intervención y a los 6 meses. En aquellos con una disminución de los criterios STOPP al finalizar la intervención, se observó a los 6 meses una disminución en la polifarmacia (p=0,041) y en las caídas (p=0,034).

Conclusiones

Una intervención sanitaria integrada centrada en la polifarmacia y en la PI en pacientes de edad avanzada mejora la prescripción inapropiada, y dichas mejoras persisten después de la intervención.

Palabras clave:
Persona mayor frágil
Multimorbilidad
Polifarmacia
Prescripción inapropiada
Sistemas de salud integrados

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