En los paı́ses desarrollados, las tasas de adherencia a los tratamientos en enfermedades crónicas se sitúan alrededor del 50%. Esta cifra es considerablemente menor en los paı́ses en vı́as de desarrollo, según un reciente informe de la Organización Mundial de la Salud (OMS), que califica la falta de adherencia como un )problema mundial de gran magnitud*. Es necesario entender la importancia del problema y poner en marcha estrategias adecuadas para solucionarlo. El presente artı́culo se centra fundamentalmente en analizar las consecuencias clı́nicas y económicas que produce el incumplimiento y los motivos por los que se origina este problema. Asimismo se identifican diferentes estrategias encaminadas a su mejora.

Adherencia y persistencia terapéutica: causas, consecuencias y estrategias de mejora

Background Adherence to the therapeutic plan is one of the most important health issues in terms of treatment efficacy, healthcare costs and patient safety. Unfortunately, homebound elderly patients are especially vulnerable to nonadherence because they have higher morbidity rates combined with cognitive and social problems that hinder their correct use of drugs. The level of therapeutic adherence in homebound elderly people has not been adequately studied.

Prevalence of adherence to treatment in homebound elderly people in primary health care: a descriptive, cross-sectional, multicentre study.

Introduction: Medication errors have been analyzed as a health professionals’ responsibility (due to mistakes in prescription, preparation or dispensing). However, sometimes, patients themselves (o...

A systematic review of patient medication error on self-administering medication at home.

In the current public health framework, the importance of medication as a determinant of citizens’ health has emerged as a factor warranting special attention. Most studies investigating the relationship between medication and quality of life do so from the perspective of adherence. However, other medication-related factors identified at home visits may be associated with health-related quality of life. Methods and design Objective: To describe the relationship between medication-related factors and the health-related quality of life in patients older than 65 years who use multiple medications (polypharmacy). Design: Cross-sectional descriptive study. Setting: Primary care. Participants: Patients older than 65 years who use multiple medications (n = 375). Measurements: The main outcome measure was health-related quality of life according to the EuroQol-5D instrument. Sociodemographic, clinical and medication-related variables were recorded during home interviews. Results Mean age was 74.72 ± 5.59 years, and 65.5% of our participants were women. The global level of health-related quality of life according to the EQ-5D visual analog scale was 59.25 ± 20.92. Of the five EuroQol dimensions, anxiety/depression and pain were the most frequently reported, while mobility and self-care were the dimensions with the greatest impact on self-reported quality of life. Multivariate analysis indicated that functional independence was the factor most strongly associated (β = 14.27 p < 0.001) with better health-related quality of life, while illiteracy (β = −13.58 p < 0.001), depression (β = −10.13 p < 0.001), social risk (β = −7.23 p = 0.004) and using more than 10 medicines (β = −4.85 p = 0.009) were strongly associated with a poorer health-related quality of life. Conclusions Factors inherent within the patient such as functional incapacity, cognitive impairment and social and emotional problems were the main constraints to quality of life in our study population. The number of medicines taken was negatively related with quality of life.

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Medication-related factors associated with health-related quality of life in patients older than 65 years with polypharmacy.

The growth of the aging population leads to the increase of chronic diseases, of the burden of multimorbility, and of the complexity polypharmacy. The prevalence of medication errors rises in patients with polypharmacy in primary care, and this is a major concern to healthcare systems. This study reviews the published literature on the inappropriate use of medicines in order to articulate recommendations on how to reduce it in chronic patients, particularly in those who are elderly, polymedicated, or multipathological. A systematic review of articles published from January 2000 to October 2015 was performed using MEDLINE, EMBASE, PsychInfo, Scopus, The Cochrane Library, and Index Medicus databases. We selected 80 studies in order to analyse the content that addressed the question under consideration. Our literature review found that half of patients know what their prescribed treatment is; that most of elderly people take five or more medications a day; that in elderly, polymedicated people, the probability of a medication error occurring is higher; that new tools have been recently developed to reduce errors; that elderly patients can understand written information but the presentation and format is an important factor; and that a high percentage of patients have remaining doubts after their visit. Thus, strategies based on the evidence should be applied in order to reduce medication errors.

https://www.mdpi.com/1660-4601/15/2/310/pdf

Inappropriate Use of Medication by Elderly, Polymedicated, or Multipathological Patients with Chronic Diseases.

http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=458414&TO=RVN&Eng=0

Errores de medicación e incumplimiento terapéutico en ancianos polimedicados

Resumen Objetivo Analizar el rendimiento del Palliative Prognostic Index (PPI) en los pacientes con enfermedades medicas en estadio avanzado, y recalibrarlo para adaptarlo al perfil de estos pacientes. Metodos Estudio prospectivo observacional multicentrico. Se incluyeron pacientes con una o mas enfermedades medicas avanzadas. Se analizo la calibracion (bondad de ajuste de Hosmer-Lemeshow) y el poder discriminativo (curva ROC y area bajo la curva [AUC]) del PPI en la prediccion de la mortalidad a los 180 dias. La recalibracion se llevo a cabo analizando las puntuaciones en el PPI de cada cuartil ascendente de probabilidad de fallecer. Se comparo la precision del PPI con la obtenida con el indice de Charlson. Resultados La mortalidad global de los 1.788 pacientes fue del 37,5%. La calibracion en la prediccion de mortalidad fue buena (bondad de ajuste con p = 0,21), oscilando la probabilidad pronosticada entre 0-0,25 en el primer cuartil de riesgo, y 0,48-0,8 en el ultimo cuartil. El poder discriminativo fue aceptable (AUC = 0,69; p  0 ,0001). En los grupos recalibrados, la mortalidad de los pacientes con 0/1-2/2,5-9,5 ≥ 10 puntos fue del 13, 23, 39 y 68%, respectivamente. La sensibilidad y el valor predictivo negativo del punto de corte de la escala por encima de 0 fueron 96 y 87%, respectivamente; la especificidad y el valor predictivo positivo del punto de corte de la escala por encima de 9,5 fueron del 95 y 68%. La calibracion del indice de Charslon fue buena (p = 0,2), y el poder discriminativo suboptimo (AUC = 0,52; p = 0,06). Conclusiones El PPI en los pacientes con enfermedades medicas en estadio avanzado puede ser de utilidad para el pronostico de supervivencia a 6 meses.

Recalibración del Palliative Prognostic Index en pacientes con enfermedades médicas avanzadas

Objective To analyze the accuracy of the Palliative Prognostic Index (PPI) in patients with advanced medical diseases and to recalibrate it in order to adapt it to the profile of these patients. Methods Multicenter, prospective, observational study that included patients with one or more advanced medical diseases. Calibration (Hosmer–Lemeshow goodness of fit) and discriminative power (ROC and area under the curve [AUC]) of PPI were analyzed in the prediction of mortality at 180 days. Recalibration was carried out by analyzing the scores on the PPI of each quartile upward of dying probability. Accuracy of PPI was compared with that obtained for the Charlson index. Results Overall mortality of the 1788 patients was 37.5%. Calibration in the prediction of mortality was good (goodness of fit with p = .21), the prognostic probabilities ranging from 0 to 0.25 in the first quartile of risk and from 0.48 to 0.8 in the last quartile. Discriminative power was acceptable (AUC = 69; p = .0001). In recalibrated groups, mortality of patients with 0/1–2/2.5–9.5/≥10 points was 13, 23, 39 and 68%, respectively. Sensitivity (S) and negative predicative value (NPF) of the cutoff point above 0 points were 96 and 87%, respectively, while specificity (sp) and positive predictive value (PPV) of the cutoff point above 9.5 points were 95 and 68%. Calibration of the Charlson index was good (p = .2), and its discriminative power (AUC = .52; p = .06) was suboptimal. Conclusions PPI can be a useful tool in predicting 6-month survival of patients with advanced medical conditions.

B. Barón Franco

Papers

Errores de medicación e incumplimiento terapéutico en ancianos polimedicados

Recalibración del Palliative Prognostic Index en pacientes con enfermedades médicas avanzadas

Adaptation of the Palliative Prognostic Index in patients with advanced medical conditions.

Consulta de orientación diagnóstica y terapéutica en Medicina Interna