BackgroundDiabetes mellitus type 2 (DM2) is a chronic disease with major impact on morbidity and mortality and the use of health resources.PurposeTo analyse the evolution of consumption of antidiabetic drugs from 2001 to 2014. To study the variations in admissions due to lower extremity amputations from 2007 to 2013.Material and methodsDescriptive study of the use of antidiabetic drugs between 2001 and 2014. Field of study: two tertiary hospitals and their reference areas, the target population consisting of 675 000 people. Prescriptions under the National Health System coverage were studied. The unit of measure was defined daily doses (DDD) per 1000 inhabitants per day (DHD), using the anatomical therapeutic chemical (ATC)/DDD classification (2006). Hospitalisation data were collected from the hospital dat base. For statistical comparisons, the Student’s t test was used.ResultsDuring the study period, consumption of insulins was maintained from 17.9 DHD to 18.3 DHD but oral agents increased from 41.3 DHD to 52.7 DHD. Consumption of sulfonylureas was gradually reduced from 30.1 DHD to 16.4 DHD but metformin (alone) usage increased from 4.3 DHD to 23.7 DHD, being the most consumed agent in 2014 (45% of consumption). Oral combinations were introduced in 2004 (0.1 DHD) and were the third most consumed group in 2014 (6.5 DHD). Consumption of dipeptidyl peptidase-4 inhibitors (since 2008) and ‘other hypoglycaemic agents’ increased from 0.3 DHD (2008) to 3.8 DHD and from 1.4 DHD to 2 DHD, respectively. On the other hand, the use of thiazolidinediones (since 2004) and alpha-glucosidase inhibitors was reduced from 0.7 DHD (2004) to 0.1 DHD and from 4.5 DHD to 0.2 DHD, respectively. The number of admissions due to lower extremity amputations from 2007 to 2013 was 94, 111, 145, 140, 125, 66 and 72, respectively. The number of amputations decreased significantly from 2008 to 2011 vs. 2013 (p < 0.05).ConclusionMetformin (alone) remains the drug of choice in treating DM2.Increased consumption of oral combinations could reflect more patients in more advanced stages of disease who do not respond to monotherapy.To associate the decrease in admissions due to lower extremity amputations with a higher consumption of oral antidiabetic drugs, more studies are needed.No conflict of interest.
Background and Importance The COVID-19 disease, declared a pandemic in March 2020, radically changed people's way of life. The health risk, the measures of the state of alarm and its impact at social and economic level have exposed the population to a threat to their psychological well-being. Aim and Objectives To analyse the relationship between COVID-19 and changes in the trend of psychotropic drug consumption. Material and Methods Descriptive drug utilisation study which included 665,222 inhabitants. This population is distributed in an urban (UA) (275,990 inhabitants) and rural, peri-urban (RA) (389,232 inhabitants) area. The study period was January 2018 to December 2021. Data were obtained from the database of dispensed and billed prescriptions. The unit used was the Defined Daily Dose (DDD) and the main variable was the DDD per 1000 inhabitants and day (DHD). The therapeutic groups studied were benzodiazepines (N05BA, N05CA, N05CF) and antidepressants (N06AB, N06AX), according to the Anatomical Therapeutic Chemical Classification System (ATC). Mann-Whitney test was used for statistical analysis. ResultsThe group of drugs with the greatest increase in consumption was benzodiazepines, followed by antidepressants, the latter being higher in the 2nd and 4th quarter of 2020, coinciding with the first and second wave and higher in rural areas. In antipsychotic dispensations, a slight increase was only observed in the metropolitan area (p<0,05). During the year 2021, the rates of benzodiazepines were decreasing, ending the year at values similar to pre-pandemic rates. In contrast, the increase in antidepressant use was sustained during 2021.
prescription and dose of idarucizumab; response to treatment (normalisation of aPTT and clinical evolution). Results Fifty-four patients prescribed idarucizumab were identified. One patient was excluded because active treatment was declined (n=53). Median age was 82 years (RIQ: 75-88.5), 58.5% male and 41.5% female. The indication for dabigatran was stroke prevention and systemic embolism due to non-valvular atrial fibrillation in 52 patients and stroke in 1 patient. The doses of dabigatran reported in the medical records were: 150 mg/12 h in 16 patients, 110 mg/12 in 34 patients and 75 mg/12 in 1 patient (no data in 2 patients). Thirty-six patients received idarucizumab for major bleeding, 12 for urgent surgery, 3 for urgent invasive procedure and 2 for supratherapeutic levels of dabigatran. In all cases the indication was established by the haematology department. Median aPTT before antidote administration was 46.95 seconds (RIQ: 35.2-52.5) (n=52); 1 patient had supratherapeutic levels of dabigatran, showing incoagulable. Median aPTT after idarucizumab administration was 27.4 seconds (RIQ: 25-29.8) (no post-administration aPTT values in 6 patients). The dose of idarucizumab was 5 g in all cases. Four patients died. In 49 patients treatment was effective with no episodes of rebleeding or thromboembolism. Conclusion and RelevanceIdarucizumab was mostly used in major bleeding. Treatment was effective in 92% of the study population.
BackgroundIn some regions, the pharmaceutical services at nursing homes are held by pharmacists from hospitals in the public network.PurposeTo determine the impact of medicines reconciliation on the prevalence of potentially inappropriate medicines (PIMs) in institutionalised elderly patients and to analyse the most frequently PIMs prescribed.Material and methodsRetrospective non-experimental study conducted between December 2014 and February 2015 at four nursing homes: two in which medicines reconciliation was performed and two others where it was not.The prevalence of PIMs prescribed at the residences in which reconciliation was carried out was compared with the prescription at residences in which it was not. PIM frequency was analysed according to the list of drugs to be avoided in older adults (65 years old or older) included in the 2012 Beers criteria.ResultsA total of 521 patients with a mean age of 83 years were included, 224 at nursing homes where reconciliation was conducted and 297 at residences in which it was not. In the first group of residences, there were 142 (63.4%) patients with inappropriate prescriptions compared with 203 (68.3%) in the other group. At homes where medicines reconciliation was carried out, the total number of prescriptions was 2182, and 239 (10.9%) were PIMs. In the other group of patients, the total number of prescriptions was 2849, and 12.8% (365) were inadequate (p < 0.05 vs reconciliation). The total number of different prescribed specialties which were inadequate for patients was 59 for patients in the medicines reconciliation group and 83 in the other group. For comparison of independent proportions, Epidat software version 3.1 was used.The most frequently prescribed PIMs in the reconciliation group were lorazepam, bromazepam, alprazolam, zolpidem and quetiapine, and in the other group of patients, lorazepam, zolpidem, haloperidol, alprazolam and clorazepate dipotassium.ConclusionThe results of this study show a high prevalence of PIMs in institutionalised elderly patients, although residences with a medicines reconciliation programme had a lower percentage of elderly patients with PIMs and fewer inappropriate prescriptions. The total number of different inadequate specialties was also lower.Regarding PIMs, lorazepam, zolpidem and alprazolam were among the five most commonly prescribed in both groups.References and/or AcknowledgementsBeers Criteria UpdateNo conflict of interest.
BackgroundAtrial fibrillation (AF) is a common clinical problem, particularly in the elderly. Dabigatran is indicated for the prevention of stroke and systemic embolism, and the reduction of vascular mortality for patients with non-valvular atrial AF. The recommended daily dose of dabigatran is 150 mg every 12 hours. However, in patients aged 80 or older the recommended dose is 110 mg every 12 hours due to a high bleeding risk.PurposeTo study how dabigatran is prescribed in patients aged 80 or older and determine the number of older patients with non-recommended dosages of dabigatran.Material and methodsObservational descriptive study. Field of study: two tertiary hospitals and their reference areas. The target population consisted of 6 75 000 people. From January 2017 to July 2017, patients with a dabigatran prescription under the national health system coverage were studied. For statistical comparisons, the Student’s t test was used.ResultsThe number of patients with dabigatran prescriptions in our region were 992. The average age of patients was 75.4 years and 51.4% were females. Prescriptions were divided into 150 mg (460 patients, average age 68.2 years and 56.5% were males) 110 mg (512 patients, average age 81.6 years, p<001 vs. 150 mg, and 58.2% were females) and 75 mg (20 patients, average age 81.3 years and 55% were females).Four hundred and nineteen patients aged 80 or older had dabigatran prescriptions. Doses prescribed were 150 mg (n=40, 9.5%), 110 mg (n=366; 87.4%) and 75 mg (n=13; 3.1%).ConclusionOur data shows that most of the patients aged 80 or older in our region consume lower doses of dabigatran. The average age of patients is significantly higher in 110 mg prescriptions versus 150 mg. However, 9.5% of older patients receive non-recommended dosages of dabigatran. Interventions to improve prescriptions in older people are required.No conflict of interest
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