4CPS-250 Optimisation of pharmacotherapy in institutionalised patients in a socio-health centre

Abstract

BackgroundThe pharmaceutical care model proposed in socio-health centres (SHC) aims to provide efficient and coordinated pharmaceutical services between different levels of care. The integration of the hospital pharmacist into the multidisciplinary team improves the socio-healthcare of institutionalised elderly patients.PurposeOptimise drug therapy of institutionalised patients (residents) in a SHC through pharmaceutical intervention (PI).Material and methodsProspective and quasi-experimental pilot study without control group, which includes the residents of a SHC Exclusion criteria: patients assigned to health centres (HC) and patients without drug treatment. Residents’ pharmacotherapy were reviewed with proposals for pharmaceutical treatment modification (PI), evaluation and multidisciplinary consensus. PI types: adequate adherence to the Pharmacotherapy Guide of SHC (PGSHC) in a Health Management Area with replacement for Specialties with Better Geriatric Profile (SBGP) and the implementation of the Therapeutic Equivalents Program; dose adjustment according to recommendations in geriatric patients (chronic kidney disease, psychoactive drugs); and deprescribing (duplicates, Non-Elevated Intrinsic Value Drugs (NEIVD) and Stopp criteria (safety issues or poor prognosis). Suggestions for improvement.ResultsNumber of residents, 104. Excluded: six (three assigned to HC, three without pharmacological treatment). Of the 97 patients included, 78.4%(n=76) were assisted and 21.6% (n=21) were valid residents. Mean age: 79.5 years (range 49–99, SD: 10.3); 54.6% (n=53) were males. Pharmacological profile: number prescription drugs/chronic patients: mean: 5.3 (range 1–12, SD: 2.93); prevalence of polypharmacy (≥5 drugs): 59.8%( n=58). Total PI performed: 61; average PI/resident: 0.6; therapeutic equivalent alternative: 40.9% (n=25). Adequacy to PGSHC: 36% (n=22) with adaptation to presentations included (24.5%, n=15) and SBGP (11.4%, n=7); dose adjustment: 8.1% (n=5); deprescribing: 14.75% (n=9) with five cases of duplicity, three safety issues and one NEIVD. Substitution of drugs prescribed by equivalent alternatives of the PGSHC supposes a significant cost saving. Improvement proposals: continuous re-evaluation of patients, so the design and implementation of a Pharmacotherapy Review Programme in institutionalised elderly patients is proposed, with a personalised action plan integrated into the Comprehensive Geriatric Assessment and quantification of the economic impact.ConclusionInstitutionalised patients are chronic patients with high complexity, so it is essential to review pharmacotherapeutic practices through an attention and care shared multidisciplinary team. The incorporation of the pharmacist into the multidisciplinary team allows optimisation of the treatments with a rational use of these.No conflict of interest