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Aim: Benzodiazepine prescription is a growing phenomenon among the elderly population. However, information related to the frequency of these drugs among the elderly population attending in emergency departments (ED) and its impact over prognosis is scarce. The aim of this study is to assess the prevalence of benzodiazepine prescription and to analyze its association with short‐term prognosis in elderly patients attended in ED. Methods: A retrospective analysis of the EDEN (Emergency Department Elderly in Need) cohort was conducted. This registry included all elderly patients attending in 52 Spanish EDs for any condition, between April 1st and 7th in 2019. Socio‐demographic data, comorbidities, and medication were recorded by consulting the patient's electronic health records. The assessed outcomes consisted on new ED visit, hospitalization, and mortality at 30 days after the first ED visit, associated with the use of benzodiazepines at baseline in comparison with no prescription of benzodiazepines. Crude and adjusted logistic regression analyses including patient's comorbidities were performed. Two sensitivity analyses were performed considering concomitant prescription of other central nervous system depressants as well as direct discharge from the ED. Results: 25 557 patients were evaluated (mean age 78 [IQR: 71–84]). 7865 (30.8%) patients were taken benzodiazepines at admission. After adjustment for comorbidities and other central nervous system drugs, benzodiazepine prescription was associated with ED revisit [OR: 1.10 (95%CI: 1.03–1.18)]. Similar results were found in the sensitivity analysis, eliminating patients with central nervous depressors [OR: 1.11 (1.03–1.25)] and patients discharged to home [OR: 1.13 (1.04–1.23)]. No association was found between the use of these drugs and new hospitalizations [OR: 0.90 (0.77–1.05)] or mortality 30 days after discharge [OR: 1.01 (0.88–1.18)]. The results held for all three outcomes in the sensitivity analyses. Conclusion: The use of benzodiazepines is a frequent phenomenon among the elderly population attended in the ED, being associated with an increased risk of new visits to the emergency room, but not with an increased risk of 30‐day hospitalization or mortality. [ABSTRACT FROM AUTHOR]

The progressive aging and comorbidities of the population have led to an increase in the number of patients with polypharmacy attended to in the emergency department. Drug-related problems (DRPs) have become a major cause of admission to these units, as well as a high rate of short-term readmissions. Anticoagulants, antibiotics, antidiabetics, and opioids have been shown to be the most common drugs involved in this issue. Inappropriate polypharmacy has been pointed out as one of the major causes of these emergency visits. Different ways of conducting chronic medication reviews at discharge, primary care coordination, and phone contact with patients at discharge have been shown to reduce new hospitalizations and new emergency room visits due to DRPs, and they are key elements for improving the quality of care provided by emergency services. [ABSTRACT FROM AUTHOR]

Objective To evaluate the cost-effectiveness of a secondary prevention programme in patients admitted to the emergency department due to drug-related problems (DRPs). Methods A decision model compared costs and outcomes of patients with DRPs admitted to the emergency department. Model variables and costs, along with their distributions, were obtained from the trial results and literature. The study was performed from the perspective of the National Health System including only direct costs. Key findings The implementation of a secondary prevention programme for DRPs reduces costs associated with emergency department revisits, with an annual net benefit of €87 639. Considering a mortality rate attributable to readmission of 4.7%, the cost per life-years gained (LYG) with the implementation of this programme was €2205. In the short term, the reduction in the number of revisits following the programme implementation was the variable that most affected the model, with the benefit threshold value corresponding to a relative reduction of 12.4% of the number of revisits of patients with DRPs to obtain benefits. Conclusions Implementing a secondary prevention programme is cost-effective for patients with DRPs admitted to the emergency department. Implementation costs will be exceeded by reducing revisits to the emergency department. [ABSTRACT FROM AUTHOR]

Background: Metformin-associated lactic acidosis (MALA) is a widely documented adverse event of metformin. Despite being considered one of the main causes of metabolic acidosis, the association between an anion gap and MALA diagnosis is still uncertain.Case Presentation: Cases involving six Caucasian patients with suspected MALA who were admitted to the emergency department were analysed. All these patients presented with pH values < 7.35, lactate levels > 2 mmol/L, and estimated glomerular filtration < 30 mL/min. Metformin plasma concentrations were > 2.5 mg/L in all the patients. The highest metformin concentrations were not found in the patients with the highest lactate levels. The anion gap values ranged from 12.3 to 39.3, with only two patients exhibiting values > 14.Conclusions: In patients with MALA, there is a significant variability in the anion gap values, which is not related to the level of metformin accumulation, and therefore, it is doubtful whether measuring anion gaps is useful as an approach for MALA diagnosis. [ABSTRACT FROM AUTHOR]

What is known and Objective: Since 2011, a collaborative territorial network for urgent care has been deployed in Hospital de la Santa Creu i Sant Pau area, which allows direct and early transfer of patients with frailty from the hospital emergency department (ED) to other healthcare settings according to the destination's adequacy. This study aimed to identify factors associated with inappropriate intravenous antibiotic treatment prescribed on referral of patients with frailty based on microbiological culture and analyse the effect of inappropriate prescription on ED reconsultations for any cause 30 days after hospital discharge. Methods: This observational, retrospective study was performed at a tertiary hospital between March 2018 and February 2019 and included 264 patients. A multivariate analysis, including variables with a P‐value <.2 in the previous univariate analysis, was conducted. The variables included in the analysis were age, sex, patient comorbidities (COPD, diabetes and chronic kidney disease), antibiotic treatment in the last 30 days and patient referral (nursing home or family home). Results and Discussion: Multidrug‐resistant bacteria were isolated from 85 patients (51.5% of the isolates). In total, 159 patients received carbapenem, of whom 87 (54.7%) had non–drug‐resistant bacteria. The antibiotic was considered inappropriate in 33 patients (12.5%) according to an antibiogram. Only 71 (26.8%) patients had a definitive culture on discharge. Moreover, 73 (28.3%) patients were readmitted after 30 days. Patients with an inappropriate antibiotic treatment had more reconsultations within 30 days than those with adequate treatment (59.3% vs 24.5%; P <.001). In a multivariate analysis, an inappropriate prescription was significantly associated with a higher number of reconsultations at 30 days (OR, 3.22 [1.37‐7.57]). What is new and Conclusion: In patients discharged from the ED with intravenous antibiotics, the empirical prescription of an inappropriate drug according to the final culture is a frequent problem and is related to a higher number of reconsultations. This highlights the need to implement early communication strategies with outpatient units to optimize antibiotic therapy once microbiological results are known. [ABSTRACT FROM AUTHOR]

Background Nowadays, it is difficult to establish a specific method of intervention by the pharmacist and its clinical repercussions. Our aim was to identify interventions by pharmacists integrated within an interdisciplinary team for chronic complex patients (CCPs) and determine which of them produce the best results. Methods A systematic review (SR) was performed based on PICO(d) question (2008–18): (Population): CCPs; (Intervention): carried out by health system pharmacists in collaboration with an interdisciplinary team; (Comparator): any; (Outcome): clinical and health resources usage outcomes; (Design): meta-analysis, SR and randomized clinical trials. Results Nine articles were included: one SR and eight randomized clinical trials. The interventions consisted mainly in putting in order the pharmacotherapy and the review of the medication adequacy, medication reconciliation in transition of care and educational intervention for health professionals. Only one showed significant improvements in mortality (27.9% vs. 38.5%; HR = 1.49; P  = 0.026), two in health-related quality of life [according to EQ-5D (European Quality of Life—5 Dimensions) and EQ-VAS (European Quality of Life—Visual Analog Scale) tests] and four in other health-related results (subjective self-assessment scales, falls or episodes of delirium and negative health outcomes associated with medication). Significant differences between groups were found in hospital stay and frequency of visits to the emergency department. No better results were observed in hospitalization rate. Otherwise, one study measured cost utility and found a cost of €45 987 per quality-adjusted life year gained due to the intervention. Conclusions It was not possible to determine with certainty which interventions produce the best results in CCPs. The clinical heterogeneity of the studies and the short follow-up of most studies probably contributed to this uncertainty. [ABSTRACT FROM AUTHOR]