Detección de la prescripción inadecuada en personas mayores. Papel de la enfermera

  1. Silvia González Reguera 1
  2. Mª Nélida Fernández Martínez 2
  3. Ana Mª Sahagún Prieto 2
  4. José Manuel Rodríguez Lago 2
  5. Cristina López Cadenas 2
  6. Raquel Díez Láiz 2
  7. Salvador Postigo Mota coord. 3
  1. 1 Unidad de Endoscopia del Servicio de Aparato Digestivo del Hospital Universitario Marqués de Valdecilla, Santander.
  2. 2 Área de Farmacología. Departamento de Ciencias Biomédicas. Universidad de León.
  3. 3 Facultad de Medicina y Ciencias de la Salud. Universidad de Extremadura.
Journal:
Revista ROL de enfermería

ISSN: 0210-5020

Year of publication: 2022

Volume: 45

Issue: 9

Pages: 44-51

Type: Article

More publications in: Revista ROL de enfermería

Abstract

In the last decades there have been a series of changes at the health and pharmacological level that have increased the life expectancy of society, leading to a notable increase in the number of seniors. Progressive aging with associated comorbidities, translates into a patient profile susceptible to polymedication and therefore, phenomena such as inappropriate prescription, adverse drug reactions or drug interactions. This situation generates the majority of hospital admissions in people over 65 years, which leads to an increase in the use of healthcare resources and an increase in pharmaceutical spending. In order to optimize prescriptions in multipathological senior patients, reducing potentially inappropriate prescription and adverse drug reactions, there are various tools worldwide. These can be grouped into two large groups, on the one hand, the implicit methods that are based on critical judgments, and on the other hand, the explicit methods in which defined criteria based on scientific data and created by groups of experts through consensus-building methods, usually the Delphi. The STOPP / START criteria represent the most appropriate explicit method for the detection of potentially inappropriate prescription compared to the rest of the available tools, although research continues with the aim of optimization. Regarding the nursing role, this is increasingly valued due to its intervention in the process of therapeutic adequacy of drugs, which increases the quality of care provided to geriatric patients. The nurse is a very important support within the multidisciplinary team with which it is intended to treat the profile of a polymedicated patient susceptible to suffering inappropriate prescription and/or the factors related to said prescription.

Bibliographic References

  • INE. Instituto Nacional de Estadística [Internet]. Available from: https://www.ine.es/
  • UN. World Population Prospects 2019 [Internet]. Department of Economic and Social Affairs. World Population Prospects 2019. 2019; 49-78p. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12283219
  • Mud Castelló M, Mud Castelló S, Rodriguez Moncho Mj, Ivorra Insa MD, Ferrándiz Manglano ML. Herramientas para evaluar la adecuación de la prescripción en ancianos. Farm Comunitarios. 2013;5(4):147–51.
  • Hernández‐Rodríguez MÁ, Sempere‐Verdú E, Vicens‐Caldentey C, González‐Rubio F, Miguel‐García F, Palop‐Larrea V, et al. Evolution of polypharmacy in a spanish population (2005‐2015): A database study. Pharmacoepidemiol Drug Saf [Internet]. 2020;29(4):433-443. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/pds.4956
  • Martin-Pérez M, López de Andrés A, Hernández-Barrera V, JiménezGarcía R, Jiménez-Trujillo I, Palacios-Ceña D, et al. Prevalencia de polifarmacia en la población mayor de 65 años en España: análisis de las Encuestas Nacionales de Salud 2006 y 2011/12. Rev Esp Geriatr Gerontol. 2017;52(1):2–8.
  • Gutiérrez-Valencia M, Aldaz Herce P, Lacalle-Fabo E, Contreras Escámez B, Cedeno-Veloz B, Martínez-Velilla N. Prevalence of polypharmacy and associated factors in older adults in Spain: Data from the National Health Survey 2017. Med Clínica. 2019;153(4):141–50.
  • Onder G, Liperoti R, Fialova D, Topinkova E, Tosato M, Danese P, et al. Polypharmacy in nursing home in Europe: results from the SHELTER study. J Gerontol A Biol Sci Med Sci [Internet]. 2012;67(6):698–704. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22219520
  • Gnjidic D, Hilmer SH, Blyth FM, Naganathan V, Waite L SM et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. Journal of clinical epidemiology [Internet]. 2012;989–995. Available from: https://pubmed.ncbi.nlm.nih.gov/22742913/
  • Villafaina Barroso A, Gavilán Moral E, et. al. Pacientes polimedicados frágiles, un reto para el sistema sanitario. Inf Ter Sist Nac Salud. 2011;35(4):114–23. Available from: https://www.mscbs.gob.es/biblioPublic/publicaciones/recursos_propios/infMedic/docs/PolimedicadosVol35n4.pdf
  • OMS. Uso racional de los medicamentos. [Internet]. Medicina clínica. Ginebra. 1990. Vol.94; p. 628–32. Available from: https://apps.who.int/iris/handle/10665/37403
  • Delgado Silveira E, Muñoz García M, Montero Errasquin B, Sánchez Castellano C, Gallagher PF, Cruz-Jentoft AJ. Prescripción inapropiada de medicamentos en los pacientes mayores: los criterios STOPP/START. Rev Esp Geriatr Gerontol. 2009;44(5):273–9.
  • Esteban Jiménez Ó, Arroyo Aniés MP, Vicens Caldentey C, González Rubio F, Hernández Rodríguez MÁ, Sempere Manuel M. Deprescribing to increase people health or when deprescribing could be the best pill. Aten Primaria [Internet]. 2018; 50: 70-9p. Available from: https://doi.org/10.1016/j.aprim.2018.09.0001
  • Galván-Banqueri M, Santos-Ramos B, Vega-Coca MD, Alfaro-Lara ER, Nieto-Martín MD, Pérez-Guerrero C. Adecuación del tratamiento farmacológico en pacientes pluripatológicos. Aten Primaria [Internet]. 2013;45(1):6–18. Available from: https://www.sciencedirect.com/science/article/pii/S0212656712001618
  • Reeve E, Gnjidic D, Long J, Hilmer S. A systematic review of the emerging definition of “deprescribing” with network analysis: Implications for future research and clinical practice. Br J Clin Pharmacol [Internet]. 2015;80(6):1254–68. Available from: https://pubmed.ncbi.nlm.nih.gov/27006985/
  • Lesende IM, Iturbe AG, Pavón JG, Cortés JJB, Soler PA. The frail elderly. Detection and management in Primary Care. Aten Primaria. 2010;42(7):388–93.
  • Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370(9582):173–84.
  • Hanlon JT, Schmader KE. The medication appropriateness index at 20: Where it started, where it has been, and where it may be going. Drugs Aging. 2013;30(11): 893–900. Avaible from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3831621/
  • Sinvani L, Kozikowski A, Smilios C, Patel V, Qiu G, Akerman M, et al. Implementing ACOVE quality indicators as an intervention checklist to improve care for hospitalized older adults. J Hosp Med [Internet]. 2017;12(7):517–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28699939
  • Rognstad S, Brekke M, Fetveit A, Spigset O, Wyller TB, Straand J. The norwegian general practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients. Scand J Prim Health Care [Internet]. 2009;27(3):153–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19462339
  • Laroche ML, Charmes JP, Merle L. Potentially inappropriate medications in the elderly: A French consensus panel list. Eur J Clin Pharmacol [Internet]. 2007;63(8):725–31. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17554532
  • O’Mahony D, Gallagher PF. Inappropriate prescribing in the older population: need for new criteria. Age Ageing [Internet]. 2008;37(2):138–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18349010
  • Chang C Bin, Chan DC. Comparison of published explicit criteria for potentially inappropriate medications in older adults [Internet]. Drugs Aging. 2010; 27(12):947-57. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21087065
  • Fick DM, Semla TP, Steinman M, Beizer J, Brandt N, Dombrowski R, et al. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674–94.
  • Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72–83.
  • Gallo C, Vilosio J. Actualización de los criterios STOPP/START. Evid Act Pract Ambul 2015;18(4):124-129.
  • Kendall M, Enright D. Provision of medicines information: The example of the British National Formulary [Internet]. British Journal of Clinical Pharmacology. 2012;73(6): 934–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22360536
  • Walley T, Webb DJ. Developing a core curriculum in clinical pharmacology and therapeutics: a Delphi study. Br J Clin Pharmacol. 1997;44(2):167–70.
  • O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing [Internet]. 2015;44(2):213–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25324330
  • Blanco-Reina E, Valdellós J, Aguilar-Cano L, García-Merino MR, OcañaRiola R, Ariza-Zafra G, et al. 2015 Beers Criteria and STOPP v2 for detecting potentially inappropriate medication in community-dwelling older people: prevalence, profile, and risk factors. Eur J Clin Pharmacol. 2019;75(10):1459–66. Available from: https://pubmed.ncbi.nlm.nih.gov/31338540/
  • Mucalo I, Hadžiabdić MO, Brajković A, Lukić S, Marić P, Marinović I, et al. Potentially inappropriate medicines in elderly hospitalised patients according to the EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol. Eur J Clin Pharmacol. 2017;73(8):991–9. Available from: https://link.springer.com/article/10.1007/s00228-017-2246-y.
  • Lavan AH, O’Mahony D, Gallagher P, Fordham R, Flanagan E, Dahly D, et al. The effect of SENATOR (Software ENgine for the Assessment and optimisation of drug and non-drug Therapy in Older peRsons) on incident adverse drug reactions (ADRs) in an older hospital cohort – Trial Protocol. BMC Geriatr. 2019;13:19(1).
  • Crowley EK, Sallevelt BTGM, Huibers CJA, Murphy KD, Spruit M, Shen Z, et al. Intervention protocol: OPtimising thERapy to prevent avoidable hospital Admission in the Multi-morbid elderly (OPERAM): A structured medication review with support of a computerised decision support system. BMC Health Serv Res. 2020;17:20(1).
  • Sevilla-Sánchez D, Molist-Brunet N, Espaulella-Panicot J, GonzálezBueno J, Solà-Bonada N, Amblàs-Novellas J, et al. Potentially inappropriate medication in palliative care patients according to STOPP-Frail criteria. Eur Geriatr Med [Internet]. 2018;9(4):543–50. Available from: https://doi.org/10.1007/s41999-018-0073-z
  • Ramirez Pérez MC, Ramírez L, Lorente M. Revisión desde el personal de enfermería sobre los efectos de la polimedicación en ancianos. Early Hum Dev [Internet]. 2013;83(1):1–11.
  • Montero-Suárez M, Souto-Pereira M, Vazquez-Lago JM, Portela-Romero M. Analysis of drug-related problems in polymedicated patients over the age of 64 in primary care. A cross-sectional descriptive study. Enferm Clin. 2020; 17; S1130-8621(20)30011-5. Available from: https://pubmed.ncbi.nlm.nih.gov/32081574/