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CP-106 Pharmaceutical care of chronically-ill patients in the hospital
  1. M Montero-Hernández1,
  2. MJ Fernández-Megía2,
  3. I Font-Noguera2,
  4. A Sánchez-Ramos2,
  5. JE Megías-Vericat2,
  6. JL Poveda-Andrés2
  1. 1Hospital Universitario y Politécnico La Fe, Pharmacy, Valencia, Spain
  2. 2Hospital Universitario y Politécnico La Fe, Pharmacy, Valencia, Spain


Background Patients can have several illnesses concurrently and regular medicines reviews have been recommended for those over 75. Pharmacists are a potential source of assistance in reviewing medicines.

Purpose To assess a pharmaceutical care programme based on monitoring of drug treatments in chronically hospitalised patients; to resolve drug-related problems (DRP) and thus reduce their associated cost.

Study design Retrospective observational study.

Population 43,089 hospitalised patients with 549,712 treatments in 2012.

Sample patients over the age of 80 years, polypharmacy and multiple diseases. DRP identified were recorded in the ATEFARM 2006.0.0.16 program. The IASER method (identification, act, monitoring, evaluate and results) was used as a tool to analyse the DRP.

Variables number and type of DRP, drugs, recommended actions, acceptance and cost savings.

Results 171 chronically-ill patients were selected with DRP. (4‰ of patients hospitalised). Conditions diagnosed per patient: 5.5(SD:2), common medicines: 8.4(SD:3.5) emergency visits: 9.8(SD:11.9) and hospital admissions: 4.1(SD:3.3) in the last 10 years. We recorded 194 DRP (1.1 problem/patient), identified by validation (67%) and analytical parameters (24%). 70% of DRP were detected and resolved before the patient received the drug, while 30% of DRP were resolved after the patient had received the drug. The main problems were the dosage (47%), wrong drug (34%) and duplication (10%). The DRP could alternatively be related to safety (51%), indication (31%) and effectiveness (18%).

The recommendations made included individualising drug dosage (46%), stopping the drug (19%) and suggesting an alternative treatment (14%). The therapeutic groups involved were: anti-ulcers (14%), antihypertensives (12%) and antibiotics (10%). 91% of the actions were accepted by physicians. 62% were relevant to improving patient care and 30% were clinically significant. The economic impact was 114,649 €/year saved.

Conclusions Chronic care management requires the involvement of all health professionals. A pharmaceutical care programme based on pharmacotherapeutic monitoring resolved DRPs in chronically-ill patients older than 80 years and improved the quality of treatment, at the same time saving money.

No conflict of interest.

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