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      Detección y resolución de problemas relacionados con medicamentos en un servicio de Atención Farmacéutica en Argentina Translated title: Detection and resolution of drug therapy problems in a Pharmaceutical Care service in Argentina

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          Abstract

          Resumen Introducción: La Atención Farmacéutica consiste en un proceso asistencial sistemático para detectar, resolver y prevenir Problemas Relacionados con Medicamentos. El objetivo del presente trabajo es describir el número y perfil de problemas detectados y resueltos en un conjunto de pacientes adultos atendidos en una Unidad de Optimización de la Farmacoterapia en Argentina, durante un seguimiento farmacoterapéutico promedio de un año. Método: Se realizó un estudio cuasi-experimental, abierto y prospectivo en 40 pacientes ambulatorios. Se registraron las características clínicas y medicamentos, así como su adherencia o no al servicio. Se empleó la clasificación de Problemas Relacionados con Medicamentos de Minnesota, registrando su dimensión, categoría, causa, patología o condición clínica asociada, medicamento asociado, estado de riesgo, estado final y método de resolución. Resultados: Los grupos farmacoterapéuticos mayormente utilizados fueron beta-bloqueantes, estatinas, vitaminas y minerales, analgésicos, inhibidores de la bomba de protones y benzodiacepinas. Los problemas de indicación, especialmente por necesidad de farmacoterapia adicional, prevalecieron como los más frecuentes, incluyendo la falta de farmacoterapia preventiva con vacunas. Se logró resolver el 73,6% de los problemas detectados, de los cuales el 60,3% se hizo a través de informes a los médicos tratantes. El resto se pudo abordar mediante la educación al paciente, especialmente los de adherencia. Conclusiones: La Atención Farmacéutica permitió una descripción sistemática del perfil de problemas farmacológicos detectados y resueltos en un conjunto de pacientes adultos mayores ambulatorios, principalmente de sexo femenino, en el contexto de una Unidad de Optimización de la Farmacoterapia montada en un hospital universitario de Argentina.

          Translated abstract

          Abstract Introduction: Pharmaceutical Care is a systematic process to detect, solve, and prevent Drug Related Problems. The aim of this study is to describe the number and profile of problems detected and solved in a group of adult patients interviewed in a Pharmacotherapy Optimization Unit in Argentina, during an average pharmacotherapeutic follow-up of one year. Method: A quasi-experimental, open-label, prospective study was carried out in 40 outpatients. The Clinical characteristics and medications were revealed, as well as their adherence to the service. The Minnesota classification of Drug Therapy Problems was used, recording dimension, category, cause, associated clinical condition, associated medication, risk status, final status, and resolution method. Results: The most widely used pharmacotherapeutic groups were beta-blockers, statins, vitamins and minerals, analgesics, proton pump inhibitors, and benzodiazepines. Indication problems, especially due to the need for additional pharmacotherapy, prevailed as the most frequent, including the lack of preventive vaccines. It was possible to solve 73.6% of the detected problems, of which 60.3% was done through reports to the treating physicians. The rest could be addressed through patient education, especially those related to adherence. Conclusions: Pharmaceutical Care allowed a systematic pharmacotherapy work-up of Drug Related Problems detected and solved in a group of elderly outpatients, mainly female, in the context of a Pharmacotherapy Optimization Unit set up in a university hospital in Argentina.

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          Most cited references35

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          Polypharmacy in elderly patients.

          Polypharmacy (ie, the use of multiple medications and/or the administration of more medications than are clinically indicated, representing unnecessary drug use) is common among the elderly. The goal of this research was to provide a description of observational studies examining the epidemiology of polypharmacy and to review randomized controlled studies that have been published in the past 2 decades designed to reduce polypharmacy in older adults. Materials for this review were gathered from a search of the MEDLINE database (1986-June 2007) and International Pharmaceutical Abstracts (1986-June 2007) to identify articles in people aged >65 years. We used a combination of the following search terms: polypharmacy, multiple medications, polymedicine, elderly, geriatric, and aged. A manual search of the reference lists from identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional articles. From these, the authors identified those studies that measured polypharmacy. The literature review found that polypharmacy continues to increase and is a known risk factor for important morbidity and mortality. There are few rigorously designed intervention studies that have been shown to reduce unnecessary polypharmacy in older adults. The literature review identified 5 articles, which are included here. All studies showed an improvement in polypharmacy. Many studies have found that various numbers of medications are associated with negative health outcomes, but more research is needed to further delineate the consequences associated with unnecessary drug use in elderly patients. Health care professionals should be aware of the risks and fully evaluate all medications at each patient visit to prevent polypharmacy from occurring.
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            Adverse drug events in ambulatory care.

            Adverse events related to drugs occur frequently among inpatients, and many of these events are preventable. However, few data are available on adverse drug events among outpatients. We conducted a study to determine the rates, types, severity, and preventability of such events among outpatients and to identify preventive strategies. We performed a prospective cohort study, including a survey of patients and a chart review, at four adult primary care practices in Boston (two hospital-based and two community-based), involving a total of 1202 outpatients who received at least one prescription during a four-week period. Prescriptions were computerized at two of the practices and handwritten at the other two. Of the 661 patients who responded to the survey (response rate, 55 percent), 162 had adverse drug events (25 percent; 95 percent confidence interval, 20 to 29 percent), with a total of 181 events (27 per 100 patients). Twenty-four of the events (13 percent) were serious, 51 (28 percent) were ameliorable, and 20 (11 percent) were preventable. Of the 51 ameliorable events, 32 (63 percent) were attributed to the physician's failure to respond to medication-related symptoms and 19 (37 percent) to the patient's failure to inform the physician of the symptoms. The medication classes most frequently involved in adverse drug events were selective serotonin-reuptake inhibitors (10 percent), beta-blockers (9 percent), angiotensin-converting-enzyme inhibitors (8 percent), and nonsteroidal antiinflammatory agents (8 percent). On multivariate analysis, only the number of medications taken was significantly associated with adverse events. Adverse events related to drugs are common in primary care, and many are preventable or ameliorable. Monitoring for and acting on symptoms are important. Improving communication between outpatients and providers may help prevent adverse events related to drugs. Copyright 2003 Massachusetts Medical Society
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              Prevalence, expenditures, and complications of multiple chronic conditions in the elderly.

              The prevalence, health care expenditures, and hospitalization experiences are important considerations among elderly populations with multiple chronic conditions. A cross-sectional analysis was conducted on a nationally random sample of 1 217 103 Medicare fee-for-service beneficiaries aged 65 and older living in the United States and enrolled in both Medicare Part A and Medicare Part B during 1999. Multiple logistic regression was used to analyze the influence of age, sex, and number of types of chronic conditions on the risk of incurring inpatient hospitalizations for ambulatory care sensitive conditions and hospitalizations with preventable complications among aged Medicare beneficiaries. In 1999, 82% of aged Medicare beneficiaries had 1 or more chronic conditions, and 65% had multiple chronic conditions. Inpatient admissions for ambulatory care sensitive conditions and hospitalizations with preventable complications increased with the number of chronic conditions. For example, Medicare beneficiaries with 4 or more chronic conditions were 99 times more likely than a beneficiary without any chronic conditions to have an admission for an ambulatory care sensitive condition (95% confidence interval, 86-113). Per capita Medicare expenditures increased with the number of types of chronic conditions from $211 among beneficiaries without a chronic condition to $13 973 among beneficiaries with 4 or more types of chronic conditions. The risk of an avoidable inpatient admission or a preventable complication in an inpatient setting increases dramatically with the number of chronic conditions. Better primary care, especially coordination of care, could reduce avoidable hospitalization rates, especially for individuals with multiple chronic conditions.
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                Author and article information

                Journal
                pharmcare
                Pharmaceutical Care España
                Pharm Care Esp.
                Fundación Pharmaceutical Care España (Barcelona, Barcelona, Spain )
                1139-6202
                2794-1140
                June 2023
                : 25
                : 3
                : 16-29
                Affiliations
                [1] Ciudad Autónoma de Buenos Aires orgnameUniversidad de Buenos Aires orgdiv1Facultad de Farmacia y Bioquímica orgdiv2Departamento de Farmacología Argentina
                [2] Ciudad Autónoma de Buenos Aires orgnameUniversidad de Buenos Aires orgdiv1Facultad de Medicina orgdiv2Hospital de Clínicas “José de San Martín” Argentina
                Article
                S2794-11402023000300003 S2794-1140(23)02500300003
                10.60103/phc.v25i3.803
                945a4fbb-dec9-4c0a-ac35-a5cacf4ce43c

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 16 January 2023
                : 04 June 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 36, Pages: 14
                Product

                SciELO Spain

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                servicios farmacéuticos,seguimiento farmacoterapéutico,drug therapy problems,pharmaceutical services,medication therapy management,problemas relacionados con medicamentos

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