Background Reconciliation of discrepancies in the patient's treatment may improve the quality of healthcare in a population susceptible to drug errors. Purpose To analyse differences detected in home treatment after hospital discharge for polymedicated patients (typically ≥6 drugs in their treatment) over 64 years of age. Materials and methods Cross-sectional study of patients undergoing treatment, over 64 years of age, admitted to the internal medicine ward in the period March to July of 2011. The authors reviewed the medicines documented in the electronic medical records prior to admission, on discharge as well as on the day of home visits (at least 3 weeks after discharge). During the visits, the patient, family and/or carer were interviewed in order to find out the patient's current medicines and to detect possible discrepancies. Discrepancies were considered to be present when there were unexplained differences between the medicines documented in the electronic medical record and those actually taken by the patient. Results A total of 52 patients were included in this study and our findings showed that the 92.3% displayed at least one discrepancy in their usual chronic medicines between what was prescribed and taken. The different types of discrepancies detected were as follows: 49.2% of the patients were noted as not taking a drug they had previously been taking (omission), 53.6% were still taking a drug that had been suspended (commission), 73.0% had a difference in dose, route and/or frequency of administration, in 28.9% no substitution had been performed and 11.8% had duplication. Conclusions Discrepancies between what is prescribed and taken in the chronic treatment of polymedicated patients over 64 years old are a common event, especially those relating to dose, route and/or frequency of administration.
Introduction Due to their impact on healthcare systems, the sustainability and optimization of high-cost drugs is an issue of concern for several countries. Different strategies have been implemented such as centralized purchasing to optimize budgetary resources. However, there is still a need for a mechanism to optimize these drugs further. Methods We conducted this prospective multicenter intervention study in five hospitals in the Andalusian Public Health System of Cádiz (Spain) between July 2019 and September 2021. We developed an online website (Farmastock) and implemented it to determine the availability of high-cost, low-use, and near-expiry medicines in each hospital. We used a simple analysis using operational variables to assess the project intervention's savings impact on managing these high-cost drugs. ResultsThe implementation of Farmastock in Cádiz resulted in savings of 675,757.52 € for the Andalusian Public Health System, with 238 medicines transferred out of the 373 available. Of these medicines offered, the most considerable percentage were medicines used for pathologies with high clinical instability and accounted for nearly 80% of the medicines optimized by the tool. Conclusions Farmastock allowed the Andalusian Public Health System to make substantial financial savings by not making new purchases of high-cost drugs available in other centers of this health network that were not being used. Therefore, this tool is a very efficient measure to contribute to the sustainability of the APHS and could be implemented in more hospitals soon.
Background The accumulation of drugs can cause errors in taking the medicines and an unnecessary increase in health expenditure. Purpose To quantify the accumulation of drugs in the home medicines cabinets of polymedicated patients aged over 64 and to assess the associated factors. Materials and methods Cross-sectional study of polymedicated patients (≥6 medicines in their usual treatment) over the age of 64 admitted to the internal medicine ward in the period from March to July 2011. The authors reviewed the electronic medical record prior to admission, hospital discharge reports and active treatment. Furthermore, The authors interviewed the patient, family and/or care giver to confirm their chronic treatment as well as reviewing the contents of the medicines cabinet in a home visit. The authors considered the patient was accumulating medicines when The authors found either more than one container of at least 3 different drugs or more than 3 containers of the same drug. Results Of the 52 patients enrolled in the current study, 48.1% accumulated medicines in the home medicines cabinet. Of these, 28.0% accumulated between 3 and 6 drugs, 8.0% between 7 and 9 drugs, 36.0% between 10 and 14 drugs and 28.0% were stockpiling over 14 drugs. In a deeper analysis of the factors that could affect drug accumulation, it was observed that 53.8% of women stockpiled medicines at home compared to 42.3% of men. Distribution by age of those who stockpiled medicines was 30% of 65–70 year-olds, 50.0% of 71–75 year-olds, 41.7% of 76–80 year-olds, 81.8% of 81–85 year-olds and 20.0% in the population aged over 85. Conclusions Almost half of the polymedicated patients together accumulated over 64 medicines in their home medicines cabinets. Females had a greater tendency to do this. There was a trend to patients stockpiling drugs in line with their age. However, accumulation peaked at 81–85 years old.
Background The use of calcium and magnesium reduces both the incidence and time of development of peripheral sensory neurotoxicity, oxaliplatin-limiting toxicity. Purpose To determine the effectiveness of calcium gluconate and magnesium sulphate in preventing sensory neurotoxicity associated with the use of oxaliplatin. Materials and methods Retrospective observational study of patients diagnosed with colorectal cancer treated with oxaliplatin + 5-fluorouracil (5-FU) and calcium folinate or capecitabine plus oxaliplatin for the years 2009-2010, with oxaliplatin treatments of 85 mg/m2 every 14 days or 130 mg/m2 every 21 days, respectively. All received 1 gram of calcium gluconate and 1.5 grams of magnesium sulphate of 15% diluted in 250 ml glucose 5% before and after oxaliplatin administration. In all cases, the oxaliplatin infusion time was 2 h. Symptoms of chronic or cumulative sensory neurotoxicity (SNT), graduated according to the scale of the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE v3). The primary end point was the percentage of patients with grade 2 or higher SNT at any time during or after oxaliplatin-based therapy. Results The authors included 48 patients. The mean age was 63.62 years (50% men and 50% women). The primary tumour was colon in 70.8% of cases (33.3% adjuvant and 37.5% metastatic) and rectum in 29.1% (16.7% adjuvant and 12.5% metastatic). A total of 33 patients received oxaliplatin regimens of 85 mg/m2 every 14 days, while 15 patients received oxaliplatin regimens of 130 mg/m2 every 21 days. 12.5% patients (6/26) presented SNT=2 (none grade > 2), with a mean cumulative dose (±SD) of 878.33±205.88 (mg/m2) and an average of 10.33±2.42 cycles received. In 83.3% (5/6) of cases was necessary to reduce the dose of oxaliplatin administered. Conclusions The low incidence of SNT=2 or higher (6 patients and none, respectively) of our study support the neuroprotective activity of the Ca/Mg.
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