5PSQ-076 Comprehensive assessment of pharmacotherapy in the complex chronic patient as a security strategy
Year: 2025
Type: conference-paper
Abstract: Background and Importance Complex chronic patients (CCP) have changing needs that require continuous reassessment. Care transition makes parmacotherapeutic review and reconciliation fundamental to find discrepancies and ensure the safety of these patients. Aim and Objectives To analyse a comprehensive pharmacotherapy assessment program (CPAP) impact in the number of discrepancies and high-risk discrepancies at discharge between groups, intervention patients and control patients, who had medication list in the discharge report in order to compare with the electronic prescription. Material and Methods Prospective intervention study in the emergency department of a tertiary hospital between 01/09/2023–11/30/2023. Inclusion criteria: Complex chronic patients who consulted emergency department and were not institutionalised or palliative. CPAP was performed in <24 h/48h in the emergency department that included: conciliation, review of pharmacotherapy and issue of a pharmacotherapeutic recommendations report. Variables: age, sex, Charlson index, polypharmacy, hyperpolypharmacy, number of patients with discrepancies and high-risk discrepancies, number of discrepancies and high-risk discrepancies and most related high-risk discrepancy drugs. Results No statistically significant differences have been found between intervention patients and control patients in the following variables (N=151). Intervention patients vs control patients: Age: 82.9 vs 81.5. Sex: 79 male (52.3%) vs 59 male (39%). Charlson index:7 vs 7. Polypharmacy:142 (94%) vs 140 (92.7%). Hyperpolypharmacy: 81(57.4%) vs 88 (58.3%). Of the patients who were discharged and had a medication list in the discharge report: Intervention patients (96): 74 (77.8%) patients had 256 discrepancies (3.46 discrepancies/patient). 41 (55.4%) patients had 53 high-risk discrepancies (1.29 high-risk discrepancies/patient). Control patients (82): 70 (85.4%) patients had 326 discrepancies (4.66 discrepancies/patient). 47 (55.4%) patients had 78 high-risk discrepancies (1.66 high-risk discrepancies/patient). If both groups are compared, there are statistically significant differences in the number of discrepancies between groups (p=0,02) and the number of high-risk discrepancies (p=0,005). Pharmacologic groups/drugs with the highest number of high-risk discrepancies were: insulin, analgesics (tramadol), antipsychotic (quetiapine) and benzodiazepines (lorazepam). Conclusion and Relevance In more than half of the patients there are discrepancies between treatment described in the discharge report and their electronic prescription, which is a safety problem. There are statistically significant differences between groups showing that CPAP can reduce the number of patients with discrepancies and high-risk discrepancies. Most drugs with the highest number of high-risk discrepancies were nervous system related. References and/or Acknowledgements Conflict of Interest No conflict of interest
Authors: C Acosta Cano, M Muñoz García, E Delgado Silveira, MD Molina Mendoza, MJ Zamorano Serrano, EC López Diaz, V Greciano Greciano, AM Alvarez Diaz
Institution: Hospital Universitario Ramón y Cajal
Language: English
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4408376277