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Inicio Medicina Clínica (English Edition) Simplified medication regimen and survival in polypathological patients
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Vol. 154. Issue 7.
Pages 248-253 (April 2020)
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Vol. 154. Issue 7.
Pages 248-253 (April 2020)
Original article
Simplified medication regimen and survival in polypathological patients
Simplicidad del régimen de medicación y supervivencia en pacientes pluripatológicos
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Jesús Díez-Manglanoa,b,c,
Corresponding author
jdiez@aragon.es

Corresponding author.
, Lorena Bellostas Muñozd
a Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain
b Grupo de Investigación en Comorbilidad y Pluripatología en Aragón, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
c Grupo EpiChron, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
d Servicio de Traumatología, Hospital Universitario La Paz, Madrid, Spain
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Table 1. Baseline characteristics of the patients according to the scoring quartiles in the MRCI.
Table 2. Factors associated with mortality at 4 years.
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Abstract
Objective

To determine if a more simplified medication regimen is associated with survival in polypathological patients.

Methods

Multicentre cohort study. We included polypathological patients admitted to internal medicine wards between March 1st and June 30rd, 2011. Patients that died during admission and readmissions were excluded. Data were collected about age, gender, home, comorbidity, Charlson, Barthel and Lawton-Brody indexes, Short Portable Mental State Questionnaire, socio-familial Gijón scale, admissions in the previous year, delirium, need of a caregiver and PROFUND index. The therapy complexity was measured with the Medication Regimen Complexity Index (MRCI). The follow-up lasted 4-years. To determine the factors associated with mortality we performed a Cox proportional regression model.

Results

Overall 223 polypathological patients were included, with a mean age of 79.8 (8.6) years. Mean score in MRCI was 32.0 (15.2). After 4 years, 161 (72.2%) patients died, 36 with a more simplified medication regimen. Age, (HR 1.060 95%CI 1.032–1.089; p<.001), neoplasms (HR 2.477 95%CI 1.564–3.923; p<.001), and the number of admissions in the previous year (HR 1.251 95%CI 1.100–1.423; p=.001) were independently associated with 4-year mortality, and Barthel index score (HR .991 95%CI .983–0.998; p<.001) and a more simplified medication regimen (HR 0.634 95%CI 0.414–.970; p=.036) with lower mortality.

Conclusions

In polypathological patients, the more simplified medication regimens are associated with a lower mortality.

Keywords:
Polypathological patient
Therapeutic complexity
Medication regimen complexity index
Survival
Resumen
Objetivo

Determinar si un régimen medicamentoso más simple en pacientes pluripatológicos se asocia con la supervivencia.

Métodos

En un estudio de cohortes multicéntrico se incluyeron pacientes pluripatológicos hospitalizados en servicios de medicina interna entre el 1 de marzo y el 30 de junio de 2011. Se excluyeron los reingresos y los fallecidos. Se recogieron datos de edad, sexo, residencia, patología, índices de Charlson, Barthel y Lawton-Brody, Short Portable Mental State Questionnaire, escala de Gijón, número de ingresos en el año previo, delirium, necesidad de cuidador e índice PROFUND. Se calculó la complejidad terapéutica con el Medication Regimen Complexity Index (MRCI). Se hizo un seguimiento de 4 años. Para determinar los factores asociados con la mortalidad por todas las causas se construyó un modelo de regresión de Cox.

Resultados

Se incluyeron 233 pacientes pluripatológicos con una edad media de 79,8 (8,6) años. La puntuación media en el MRCI fue 32,0 (15,2). A los 4 años fallecieron 161 (72,2 %) pacientes, 36 con régimen de medicación más simple. La edad HR 1,060 IC95% 1,032–1,089; p<0,001, las neoplasias HR 2,477 IC95% 1,564–3,923; p<0,001, y el número de ingresos en el año previo HR 1,251 IC95% 1,100–1,423; p=0,001 se asociaron de forma independiente con la mortalidad, y la puntuación del índice de Barthel HR 0,991 IC95% 0,983–0,998; p<0,001 y la simplicidad del régimen de medicación HR 0,634 IC95% 0,414–0,970; p=0,036 con menor mortalidad.

Conclusiones

En los pacientes pluripatológicos los regímenes de medicación más simples se asocian con una menor mortalidad.

Palabras clave:
Paciente pluripatológico
Complejidad terapéutica
Medication regimen complexity index
Supervivencia

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