Background Patient safety by improving the use of chronic medications requires coordination between levels of care. New anticoagulants (NACOS) are high risk drugs that require systematic processes that allow review of their adequacy and safety.
Purpose Creation of one group for inter-level coordination (GILC) to improve the appropriateness of prescribing and safe use of these treatments based of an initial evaluation according to the recommendations of the Spanish Agency for Medication and Healthcare Products ‘Agencia Española del Medicamento y Productos Sanitarios’ (AEMPS).
Material and methods The GILC is joined by potential prescribers of NACOS: haematology, cardiology, internal medicine, family physician, emergency doctor and clinical pharmacist as a dynamic and inter-level agent.
The starting point was assessed by an observational and retrospective study that included patients treated with NACOS from January 2014 to December 2014. The variables: age, gender, indication, doses, renal function (RF) and liver function (LF) were obtained from medical records considering if the recommendations of AEMPS were followed.
Results 54 patients were included in the study (70 (±12) years old, 64.8% men). 46.2% of patients had no indication as AEMPS. Before starting treatment, RF was not assesed in 16.7% and LF in 35.2% of patients. Doses were not adjusted for RF in 7.4% of patients and 3.7% had contraindications of LF. 32 patients were untreated over 1 year and 25% of these did not receive controls. 9.4% required dose adjustment and 6.3% had adverse reactions.
Conclusion A high percentage of prescriptions did not meet the recommendations given by AEMPS.
GILC reached general consensus on the use of AEMPS criteria and added the risk of falling and cognitive ability. Furthermore, it has allowed the set up of channels of communication to facilitate adaptation and security of NACOS.
During the monitoring process it was pointed out that the family physician is responsible for the integral and continuous patient care, and for periodic monitoring of RF and LF, and adherence to treatment. The clinical pharmacist was designated as the reviewer of the consensus.
No conflict of interest.
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