5PSQ-105 Evaluation of a chronic medication adequacy programme at hospital discharge for frail patients admitted to the emergency short-stay unit of a tertiary hospital
Year: 2025
Type: conference-paper
Abstract: Background and Importance Elderly’s frailty and multimorbidity make them vulnerable to polypharmacy and inappropriate use of medications. This leads to the development of drug related problems (DRP), putting their health at risk. Different strategies have been proposed to optimise polipharmacy in older adults. Aim and Objectives To adequate the chronic medication of frail patients discharged from the emergency short-stay unit, according to the evidence and individualised to their comorbidities. To analyse the performed interventions according to physician’s acceptance and clinical benefit obtained. Material and Methods Multidisciplinary project on the adequacy of chronic medication at hospital discharge developed in a tertiary-level hospital. Prospective medication plan review of patients expected to be discharged and who met frailty criteria (adjusted morbidity grade=4 and readmission risk ≥10%) was performed. Recommendations were made for patients with inadequate medication, of which those made between February-May 2024 were analysed. Collected data from electronic health record: demographics, comorbidities, intervention acceptance, medication plan and reconsultations to the health system in the next 3 months. Clinical benefit was evaluated as efficiency for the non-occurrence of a potential DRP for primary prevention interventions (PPI) and for the DRP-resolution for secondary prevention interventions (SPI), and safety as the non-occurrence of damage related intervention. Two groups were compared according to acceptance (A) or non-acceptance (N-A). Qualitative variables expressed as absolute values and relative frequencies and quantitative variables as medians (interquartile range). Results Sixty-six interventions (55(83.3%) PPI, 11(16.67%) SPI) were made in sixty patients(61.6% women, 85.7(5.75) years, 11.3(7) drugs/patient). Baseline characteristics were balanced between groups. Main intervened drugs: benzodiazepines(53.0%), antidepressants(13.6%); proton pump inhibitors(6.1%), inhalation therapy(4.6%), antiplatelet agents(4.6%) and others(18.1%). Reasons for inadequacy: inappropriate drug(65.2%), adverse effect(13.5%), better alternative available (10.6%), inappropriate dose (6.1%) and additional treatment required (4.6%). A group: 30(45.5%) of which 22 PPI(73.3%) and 8 SPI(26.7%). Efficacy and safety: PPI (18(81.8%) and 21(95.45%)) and SPI (8(100.0%) and 8(100.0%)). Medical reconsultations (A vs N-A): for any reason (70.37%vs72.73%), DRP-related (7.4%vs21.21%). DRP-resolution (A vs N-A): 100% (8/8) vs 0% (0/3). Conclusion and Relevance The interventions performed were mostly effective and safe. Although a longer follow-up time would be necessary to confirm a clinical impact, DRP-reconsultations were lower in the intervention-accepted group. The acceptance rate should be improved by involving primary care physicians. References and/or Acknowledgements Conflict of Interest No conflict of interest
Authors: M Canedo Castelo, A Suárez-Lledó, JR Pérez Mas, F Llopis Roca, P Malchair, MB Badia Tahull, J Martínez-Casanova
Institution: Bellvitge University Hospital
Language: English
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4408376405