Background and importance The aging of the population implies a growing prevalence of chronic diseases and polypharmacy as well as drug related problems (DRP). Elderly patients have complex care needs that are difficult to carry out in the emergency department (ED) which may entail an increase in potentially inappropriate medications (PIM).
Aim and objectives To detect PIM in chronic complex patients (CCP) and in patients with advanced chronic disease (ACD) after a stay in the ED.
Material and methods A retrospective observational study was conducted in November 2018 in an ED of a second level hospital. Variables recorded were demographic data, cause of admission, CCP/ACD and treatment before/after the stay in the ED. STOPP-START criteria and the criteria of Chronicity Prevention and Care Programme (PPAC) of the Department of Health of Catalonia were used.
Results One hundred patients (50.9% men) were included with a mean age of 80.6±11.3 years: 84.7% were CCP and 15.3% had ACD. The main reasons for admission to the ED were acute bronchitis and low back pain. The average number of drugs prescribed per patient was 9.6 (3–18).
In this study, 242 PIM were detected in 90 patients (83.9% in CCP; 16.1% in ACD), an average of 2.7±1.4 per patient. Three quarters of PIM were because of chronic treatment. Sixty-three PIM were detected with the PPAC criteria, the most prevalent was ‘09: benzodiazepines and other hypnotics for ≥6 months’; 51 were START criteria (the most frequent being ‘SA 6: ACEI in well documented heart failure’) and 128 STOPP criterial (the main criterion being ‘SD 5: Benzodiazepines for ≥4 weeks’).
The PIM of 14 patients may have been related to the cause of admission to the ED, in particular due to falls and fractures. All had drug related falls prescribed in their chronic treatment.
Conclusion and relevance The study population had a very advanced age with a high degree of polypharmacy and a high prevalence of PIM. The most frequent drugs involved were nervous system drugs, specially the benzodiazepines. The pharmacist’s contribution to review chronic treatment and to detect PIM can improve the safety of patients in the ED.
References and/or acknowledgements No conflict of interest.
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