Background and Importance Dysphagia is usually associated to age and different conditions (neurodegenerative diseases such as Parkinson and amyotrophic lateral sclerosis (ALS), muscular dystrophy or respiratory diseases). Medication handling is very common and may affect to bioavailability, efficacy and toxicity profile of drugs, leading to administration errors.
Aim and Objectives To evaluate medication administration in patients with dysphagia by matching them to the best pharmaceutical form with recommendations on correct manipulation, after the request of reconciliation by the physician and the development of a pharmaceutical report. We also evaluated the recommendations acceptance.
Material and Methods Observational, retrospective study performed from January 2019 to August 2022. Collected data were: disease, number of drugs, suggested alternative suitable for dysphagia, drugs that cannot be handled due to their pharmaceutical form or because of being hazardous drugs, and most common active ingredients. Patients‘ clinical data were collected from our EHR.
Results We included 72 patients, median age was 73(IQR 66–84), 51% women. Among them, 46% were inpatients and 54% outpatients. Most prevalent diseases were: ALS 29 patients(40%) and stroke 17 patients(24%). The median of drugs for which manipulation was evaluated was 8(6–10) per patient. A dysphagia reconciliation report was performed in 52(72%) patients, a median of 3(1–4) alternatives to a more appropriate dosage form were proposed. Fifty drugs were found to be prescribed and should not be manipulated as hazardous drugs, soft capsules, extended-release or gastro-resistant tablets.
We analysed the drugs of 52/72 patients. Among the 379 active ingredients prescribed, most frequent therapeutic drug was group N (nervous system) 38,8%, group C (cardiovascular system) 20,1% and group A (alimentary tract and metabolism) 19,3%. The most prescribed active ingredients were paracetamol(26 patients), omeprazole(16), riluzole(11), and sertraline(11).
The suggested alternatives were mainly oral solutions(57%) and orodispersible dosage forms(36%).
Medical acceptance of recommendations about therapeutic alternatives adapted to swallowing disorders was 100%.
Conclusion and Relevance Dysphagia is a prevalent condition not only in elderly patients.
Medication reconciliation in patients with swallowing disorders is essential to ensure treatment efficacy.
Elaboration of pharmaceutical reports with treatment alternatives is very useful in hospital setting and during transitions of care.
Acceptance has been very positive by both physicians and patients.
References and/or Acknowledgements 1. Guide about medication administration in patients with swallowing disorders: https://www.sefh.es/bibliotecavirtual/guiadisfagia/Guia_disfagia2021_v4_interac_DEF.pdf?ts=20221117125904
Conflict of Interest No conflict of interest