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4CPS-166 Comprehensive assessment of pharmacotherapy in the complex chronic patient: collaboration between different levels of care
  1. M Muñoz-García1,
  2. C Acosta-Cano1,
  3. E Delgado1,
  4. E Gomez-Bayona1,
  5. MD Molina-Mendoza1,
  6. L Quesada-Muñoz1,
  7. MJ Zamorano-Serrano2,
  8. EC López-Díaz3,
  9. V Greciano-Greciano3,
  10. A Álvarez-Díaz1
  1. 1Hospital Universitario Ramon Y Cajal, Pharmacy Department, Madrid, Spain
  2. 2Hospital Universitario Ramon Y Cajal, Emergency Department, Madrid, Spain
  3. 3Dirección Asistencial Este, Pharmacy Department, Madrid, Spain


Background and Importance Complex chronic patients (CCP) have changing needs that require continuous reassessment and effective coordination of different levels of care.

Aim and Objectives To analyse a comprehensive pharmacotherapy assessment programme (CPAP) in the CCP regarding health resources utilisation, optimisation of pharmacotherapy, pharmacotherapeutic and patient satisfaction.

Material and Methods Prospective intervention study in a tertiary hospital´s emergency department (ED) between 9 January 2023 to 31 August 2023. Inclusion criteria: CCP who consulted the ED, signed informed consent, and were not seriously ill or institutionalised.

A CPAP in <24 h/48h in the ED included: conciliation, review of pharmacotherapy and prescriptions and issue of a pharmacotherapeutic recommendations report. The report was sent to primary care (PC) professionals at discharge. To assess patient’s satisfaction, a follow-up phone call was made 30 days after discharge (score 0–10).

Collected variables were age, sex, Charlson index, admission service, length of stay, 30-day post-discharge ED visits, mortality, number of drugs, number of recommendations issued and accepted.

Results One hundred and ten CCPs were included in the ED, 56 males (50.9%), median age 86(35–101), median Charlson Index: 7(2–14).

103 (94%) patients were polymedicated and 74(67.3%) hyperpolymedicated. Median number of chronic drugs per patient was 11 (3–21).

Eighty-five (77.3%) were admitted, mean stay 8 days, at Internal Medicine 37 (43.5%).

Seventy-six (83.6%) completed the follow-up period, of which 17 (15.8%) returned to the ED and 6 (7.9%) were readmitted. Losses: Exitus:18; Palliative:8 ; Other: 8.

In the ED, 376 recommendations were made (mean 3.4/patients) and 91(24.2%) were accepted. At discharge 168 (mean 2.2/patient) and 54 (32.1%) were accepted. 95 errors were detected between the electronic prescription and the discharge report, 55 (57.9%) in the first evaluation.

Patient satisfaction with the project was 9.4 (7–10).

Conclusion and Relevance A high percentage of CCPs attending the ED were admitted. A quarter of the CCPs were readmitted or returned to the ED during the month of follow-up.

There is a decrease in the number of recommendations issued after the CCP’s stay in the hospital, but there is greater acceptance of the discharge recommendations.

In more than half of the patients there are discrepancies between the treatment described in the discharge report and their electronic prescription, which is a safety problem.

Patients reported a high satisfaction level with the project.

Conflict of Interest No conflict of interest.

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