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Your search keyword '"Juanes-Borrego, Ana"' showing total 3 results
Start Over Author "Juanes-Borrego, Ana" Topic frail elderly
3 results on '"Juanes-Borrego, Ana"'

1. Pharmaceutical services in nursing homes in Spain

Author

Fernández-Villalba, Elia María, Gil-Gómez, Isabel, Peris-Martí, Juan F, García-Mina Freire, María, Delgado-Silveira, Eva, and Juanes-Borrego, Ana

Subjects
Institucionalización, Atención farmacéutica, Prestación farmacéutica, Patient-centered care, Nursing homes, Institutionalization, Centro sociosanitario, Frail elderly, Pharmaceutical care, Encuestas y cuestionarios, Atención centrada en el paciente, Drug utilization review, Surveys and questionnaires, Revisión de tratamiento, Anciano frágil, Pharmaceutical services
Abstract

Objective: To describe the current situation regarding the specialized pharmaceutical service provision in nursing homes in Spain, from a health-care perspective reflecting activity, care and services provided. Method: Observational, cross-sectional, multicenter study conducted between February-June 2018 through a survey aimed at all Hospital Pharmacy Units in Spain. Once the initial version was assessed by twelve evaluators whose healthcare assistance work were related to nursing homes, an electronic form was designed, consisting on 10 dimensions and 66 questions. A piloting was carried out by six nursing homes pharmacists. The results were analyzed descriptively. Results: The overall response rate was 29.7% (113 out of 380). Out of all studied hospital pharmacy units, 46.0% (n = 52) served nursing homes (9 as Nursing Homes Pharmacy Department) whose characteristics defined a profile of pharmacy unit at hospital, public ownership, consolidation in this activity, with great variability in the number of centers and patients to be attended by service, and with the pharmacist's partial dedication. In 51.3% of cases, nursing homes professionals were represented at pharmacy and therapeutic committees, while 38.5% were from pharmacy services who participated in the selection of medical devices. Also, 67.4% performed an integral management of the therapy. The study has also shown that 34.6% counted on assisted electronic prescription, while 88.5% performed a pharmaceutical validation of the prescription prior to dispensing, which in 71.2% of cases consisted of individualized unit doses. It was found that 42.3% performed a third-level treatment comprehensive review, and 25.0% participated in the interdisciplinary nutritional assessment. It also showed that 34.6% actively participated in either comprehensive geriatric assessment, or clinical cases in interdisciplinary teams, and 46.2% counted on programs for the safe use of medicines. Conclusions: The specialized pharmaceutical care at nursing homes is a reality, although it presents important differences in essential aspects for the quality of the assistance provided. It is necessary to go in-depth on the care model to be developed, as well as having a greater involvement of pharmacy services to achieve a comprehensive and person-centered care. Resumen Objetivo: Describir la situación actual de la prestación farmacéutica especializada en centros sociosanitarios en España desde una perspectiva asistencial reflejando la actividad, la atención y los servicios prestados. Método: Estudio observacional, transversal, multicéntrico realizado entre febrero y junio de 2018 mediante encuesta dirigida a todos los servicios de farmacia hospitalaria de España. Una vez valorada la versión inicial por 12 evaluadores cuya labor asistencial estaba relacionada con centros sociosanitarios, se diseñó un formulario electrónico que constó de 10 dimensiones y 66 preguntas, y se realizó un pilotaje por seis farmacéuticos de centros sociosanitarios. Los resultados se analizaron de forma descriptiva. Resultados: La tasa de respuesta global fue del 29,7% (113 de 380). El 46,0% (n = 52) atendían centros sociosanitarios (9 como servicios de farmacia de centros sociosanitarios) cuyas características concretaron un perfil de servicio de farmacia de hospital, titularidad pública, consolidado en esta actividad, con gran variabilidad en número de centros y pacientes atendidos por servicio, y con dedicación parcial del farmacéutico. En el 51,3%, las comisiones de farmacia y terapéutica tenían representación de profesionales de los centros sociosanitarios, y el 38,5% de los servicios de farmacia participó en selección de productos sanitarios. El 67,4% realizó una gestión integral del tratamiento. El 34,6% disponía de prescripción electrónica asistida, el 88,5% realizó una validación farmacéutica de la prescripción previa a la dispensación que, en el 71,2% fue en dosis unitaria individualizada. El 42,3% llevó a cabo una revisión integral del tratamiento de nivel 3 y el 25,0% participó en la valoración nutricional interdisciplinar. El 34,6% participó activamente en la valoración geriátrica integral o de casos clínicos en los equipos interdisciplinares y el 46,2% disponía de programas para el uso seguro de los medicamentos. Conclusiones: La atención farmacéutica especializada en los centros sociosanitarios es una realidad, aunque presenta diferencias importantes en aspectos esenciales para la calidad de la asistencia prestada. Es necesario profundizar en el modelo asistencial a desarrollar y en una mayor implicación de los servicios de farmacia para lograr una atención integrada y centrada en la persona.

Published
2020

2. Factors associated with inappropriate intravenous antibiotic prescription in patients discharged from the emergency department.

Author

Medina‐Catalán, David, Ruiz‐Ramos, Jesus, Juanes‐Borrego, Ana, Herrera, Sergio A., Puig, Mireia, and Antonia Mangues‐Bafalluy, María

Subjects
ANTI-infective agents, ANTIBIOTICS, BLOOD, CELL culture, COMMUNICATION, DRUG utilization, DRUGS, DRUG prescribing, FRAIL elderly, HOSPITALS, HOSPITAL emergency services, OUTPATIENT services in hospitals, INTRAVENOUS therapy, MEDICAL records, MEDICAL referrals, MICROBIAL sensitivity tests, MULTIDRUG resistance, MULTIVARIATE analysis, SCIENTIFIC observation, STATISTICS, TIME, PHYSICIAN practice patterns, DISCHARGE planning, RETROSPECTIVE studies, PATIENT readmissions, DESCRIPTIVE statistics, INAPPROPRIATE prescribing (Medicine), ACQUISITION of data methodology, TERTIARY care, ODDS ratio
Abstract

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]

Published
2020
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3. Cefepime Dosing Requirements in Elderly Patients Attended in the Emergency Rooms.

Author

Ruiz-Ramos, Jesus, Herrera-Mateo, Sergio, López-Vinardell, Laia, Juanes-Borrego, Ana, Puig-Campmany, Mireia, and Mangues-Bafalluy, Maria Antonia

Subjects
*CEFEPIME, *HOSPITAL emergency services, *OLDER patients, *FRAIL elderly, *GRAM-negative bacteria, *ESCHERICHIA coli, *BACTEREMIA
Abstract

Objective: This study aimed to assess the probability of reaching an adequate pharmacokinetic/pharmacodynamic (pK/pD) index for different cefepime dosages in frail patients with bacteremia treated in the emergency room. Methods: Simulation study based on Gram-negative bacterial strains that cause bacteremia. The probability of reaching a time above the minimum inhibitory concentration (MIC) at 50% and 100% dosing intervals (fT > 50 and fT > 80% MIC) was assessed for two different renal clearance intervals. Results: One hundred twenty nine strains were collected, the predominant species being Escherichia coli (n = 83 [64.3%]). In patients with a ClCr of 30 mL/min, an fT > 50% MIC was reached in more than 90% of the simulations. However, a dose of at least 1 g every 12 h must be administered to reach an fT > 80% MIC. In patients with a ClCr of 30–60 mL/min, the probability of reaching an fT > 50% MIC was higher than 90% with doses of 1 g every 8 h or more, but this value was not reached in > 90% simulations for any of the doses tested in this study. Conclusions: Standard cefepime dosing can reach an adequate PK/PD index in frail patients. Nevertheless, a high dose or extended infusion is necessary to reach an fT > 80% MIC in patients with a ClCr > 60 mL/min. [ABSTRACT FROM AUTHOR]

Published
2022
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