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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]

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]

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.

Objectives: To draft a list of actions and quality indicators for pharmacist care in hospital emergency departments, based on consensus among a panel of experts regarding which actions to prioritize in this setting., Material and Methods: A panel of experts from the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Emergency Medicine (SEMES) evaluated a preliminary list of potential actions and quality of care indicators. The experts used a questionnaire to assess the proposals on the basis of available evidence. In the first round, each expert individually assessed the importance of each proposed action based on 4 dimensions: evidence base, impact on clinical response and patient safety, ease of implementation, and priority. In the second round the experts attended a virtual meeting to reach consensus on a revised list of proposals; suggestions and comments that had been made anonymously in the first round were included. The group then prioritized each action as basic, intermediate, or advanced., Results: The experts evaluated a total of 26 potential actions and associated quality indicators. No items were eliminated in the analysis of scores and comments from the first round. After the second round, 25 actions survived. Nine were considered basic, 10 intermediate, and 6 advanced., Conclusion: The expert panel's list of pharmacist actions and care quality indicators provides a basis for developing a pharmacist care program in Spanish emergency departments on 3 levels of priority. The list can serve as a guide to pharmacists, managers, physicians, and nurses involved in the effort to improve drug therapy in this hospital setting.

Objective: Deprescribing is considered one of the main strategies available for  preparing an individualized therapeutic plan in patients with multiple pathologies or complex chronic conditions. However, despite the practice has been in place for some years, there is a need for studies that support the achievement of satisfactory health outcomes, as well as tools that help implement deprescribing in routine clinical practice. The  bjective of this project is to analyze the impact of reducing polypharmacy,  through the LESS-CHRON deprescribing tool, on a population  of elderly polymedicated patients with multiple conditions., Method: This will be a quasi-experimental, pre-and-post intervention multicenter cohort study. The variables to be analyzed will be  divided into two large groups: those related to pharmacology and those related to health outcomes. They will be collected at baseline, at 3 and at 6-12  months. A first screening phase will be carried out to recruit candidate patients  and obtain information about the identified deprescribing  opportunities. The second phase will constitute the intervention phase, where  the LESS-CHRON tool will be applied and the actual deprescribing of the drugs  will be carried out., Discussion: LESS-CHRON has been proclaimed as a suitable deprescribing tool in clinical practice. Validation of LESS-CHRON will seek to show the results that can be achieved following the deprescribing of drugs,  in addition to demonstrating that the tool can reliably be used by clinicians in  their routine practice. On the other hand, the results of this project may  provide information leading to improving or adapting the tool itself, giving rise  to a second generation of more efficient version., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Objectives: To evaluate the anticholinergic burden on discharge of patients treated for constipation in an emergency department (ED) and to assess the effect on emergency revisiting within 30 days., Material and Methods: Observational retrospective cohort study. We collected cases with a discharge diagnosis of constipation after ED treatment between September 2018 and June 2019 and recorded information on all drugs taken and the anticholinergic burden of treatment. A revisit to the ED within 30 days was the primary outcome., Results: We included 104 patients. A high anticholinergic burden of treatment was identified in 47 (56.6%), an intermediate burden in 30 (36.1%), and a low burden in 6 (7.2%). Twenty-nine (27.9%) patients revisited the ED within 30 days of discharge. An intermediate anticholinergic burden (23 patients [31.1%] vs 4 [13.3%]; P = .061) and high burden (19 [40.4%] vs 8 [14.1%]; P = .002] was associated with revisiting within 30 days in the univariate analysis. On multivariate analysis, a high anticholinergic burden was independently associated with a higher rate of revisiting than a low burden: adjusted odds ratio (aOR), 4.21; 95% CI, 1.07-16.5; P = .039. An intermediate load was not associated with more revisits, however: aOR, 1.27; 95% CI, 0.25-6.41; P = .776. Prescription of long-term treatment with laxatives on discharge did not reduce revisiting withing 30-days in the group with a high anticholinergic load (OR, 0.86; 95% CI, 0.48-3.27; P = .526), but it did have an effect in patients an intermediate burden (OR, 0.13; 95% CI, 0.02-0.99; P = .049)., Conclusion: The prescription of drugs leading to a high anticholinergic burden was a factor associated with ED revisits within 30 days in patients treated for constipation.

Objective: To describe the current situation regarding the specialized pharmaceutical service provision in nursing homes in Spain,  from a healthcare 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., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)