Time filter

Source Type

Castillo-Paramo A.,Vigo Primary Care Region | Claveria A.,Quality and Research Unit | Verdejo Gonzalez A.,Vigo Primary Care Region | Rey Gomez-Serranillos I.,Vigo Primary Care Region | And 3 more authors.
European Journal of General Practice | Year: 2014

Background: STOPP (screening tool of older persons' prescriptions)/START (screening tool to alert doctors to right treatment) criteria aim to identify potentially inappropriate medication (PIM) due to mis-, over-And under-prescription in older patients. Initially developed by Irish experts, their applicability has been demonstrated in primary health care (PHC). Objective: To quantify and identify the most frequent PIM at PHC level using STOPP/START criteria. To identify factors that may modulate the onset of PIM. Methods: Audit of a random sample of 272 electronic health records (including prescription, diagnosis and laboratory results) of patients ≥ 65 years old, with at least one prescription in the last three months, from a PHC setting in the Vigo Health Authority (Spain). Original STOPP/START criteria were used, as well as a version adapted to Spanish PHC. Descriptive statistics and generalized linear models were applied. Results: The median number of medicines per patient was 5 (inter-quartile range: 3-7). The prevalence of PIM identified by the STOPP criteria was 37.5% and 50.7%, with the original criteria and the Spanish version, respectively. Using both versions of the START tool, the prevalence of under-prescription was 45.9% and 43.0%, respectively. A significant correlation was found between the number of STOPP PIM and number of prescriptions, and between the number of START PIM with Charlson comorbidity index and number of prescriptions. Of 87 criteria, 20 accounted for 80% of PIM. Conclusion: According to STOPP/START criteria, there is a high level of PIM in PHC setting. To prevent PIM occurring, action must be taken. © 2014 Informa Healthcare.

Duran-Parrondo C.,Fontias Primary Care Center | Vazquez-Lago J.M.,University of Santiago de Compostela | Campos-Lopez A.M.,Lerez Primary Care Center | Figueiras A.,University of Santiago de Compostela | Figueiras A.,Consortium for Biomedical Research in Epidemiology and Public Health
Drug Safety | Year: 2011

Background: In patients undergoing oral anticoagulation treatment, correct control of the international normalized ratio (INR) is necessary. This study sought to assess the effectiveness of a pharmacotherapeutic follow-up programme (PTP) on achieving an optimal INR range, reducing the need for rescue medications and for monitoring the development of possible adverse events associated with poor oral anticoagulation therapy control (haemorrhagic events and thromboembolic disease). Objective: The aim of this study was to evaluate the effectiveness of a PTP targeted at the anticoagulated patient to ensure proper self-control of anticoagulation. Methods: This was a prospective, controlled, multicentre cohort study conducted at four primary care centres in Galicia (northwest Spain), covering a group of patients receiving anticoagulation treatment exposed to pharmacotherapeutic follow-up by a primary care pharmacist (n = 272), and a concurrent control group (n = 460). The intervention consisted of a patient health-education programme plus activities involving collaboration with the physician. The educational intervention exposure period was 12 months (starting from February 2006 and finishing in February 2007), during which time a minimum of one INR determination per month was performed. To assess the quality of haematological control, the British Committee for Standards in Haematology criteria were used, namely (i) 50% or more determinations per patient within a range of 0.5 units above or below the target INR; and (ii) 80% or more determinations per patient within a range of 0.75 units above or below the target INR. As an indicator of correct control of coagulation, we also assessed the occurrence of oral anticoagulation therapy-related adverse events, such as active bleeding, haematomas (jointly referred to as haemorrhagic events) and thromboembolic events. Depending on the type of response variable, negative binomial regression or Cox proportional risks models were fitted. Results: Compared with the control group, the PTP managed to improve correct INR ranges by (i) 25% (relative risk [RR] = 0.75; 95% CI 0.69, 0.82) in terms of the number of patients who had their determinations within ±0.5 units of the target range; and (ii) 26% (RR = 0.74; 95% CI 0.67, 0.81) in terms of the number of patients who had their determinations within ±0.75 units of the target range. Patients belonging to the intervention group registered a 75% reduction in bleeding (hazard ratio [HR] = 0.25; 95% CI 0.18, 0.36). For every 3.27 patients exposed to the PTP, one event would be prevented (number needed to treat = 3.27; 95% CI 2.73, 4.07). Conclusions: Including patients receiving oral anticoagulant treatment in a PTP enhances INR control, efficacy and safety of treatment, and efficiency of primary healthcare services. © 2011 Adis Data Information BV. All rights reserved.

Teixeira Rodrigues A.,University of Aveiro | Teixeira Rodrigues A.,University of Coimbra | Roque F.,University of Aveiro | Roque F.,Polytechnic Institute of Guarda | And 7 more authors.
International Journal of Antimicrobial Agents | Year: 2013

Inappropriate prescription has been associated with mounting rates of antibiotic resistance worldwide, demanding more detailed studies into physicians' decision-making process. Accordingly, this study sought to explore physicians' perceptions of factors influencing antibiotic prescribing. A systematic search was performed for qualitative studies focused on understanding physicians' perceptions of the factors, attitudes and knowledge influencing antibiotic prescription. Of the total of 35 papers selected for review purposes, 18 solely included physicians and the remaining 17 also included patients and/or other healthcare providers. Data collection was based mainly on interviews, followed by questionnaires and focus groups, and the methodologies mainly used for data analysis were grounded theory and thematic analysis. Factors cited by physicians as having an impact on antibiotic prescribing were grouped into those that were intrinsic (group 1) and those that were extrinsic (group 2) to the healthcare professional. Among the former, physicians' attitudes, such as complacency or fear, were rated as being most influential on antibiotic prescribing, whilst patient-related factors (e.g. signs and symptoms) or healthcare system-related factors (e.g. time pressure and policies/guidelines implemented) were the most commonly reported extrinsic factors. These findings revealed that: (i) antibiotic prescribing is a complex process influenced by factors affecting all the actors involved, including physicians, other healthcare providers, healthcare system, patients and the general public; and (ii) such factors are mutually dependent. Hence, by shedding new light on the process, these findings will hopefully contribute to generating new and more effective strategies for improving antibiotic prescribing and allaying global concern about antibiotic resistance. © 2012 Elsevier B.V. and the International Society of Chemotherapy.

Lopez-Vazquez P.,Galician Ministry of Health | Lopez-Vazquez P.,University of Santiago de Compostela | Vazquez-Lago J.M.,University of Santiago de Compostela | Figueiras A.,University of Santiago de Compostela | Figueiras A.,Consortium for Biomedical Research in Epidemiology and Public Health
Journal of Evaluation in Clinical Practice | Year: 2012

Background Antibiotic resistance is one of the principal public health problems worldwide. Currently, inappropriate use of antibiotics is regarded as the principal determinant of resistance, with most of these drugs being prescribed outside a hospital setting. This systematic review sought to identify the factors, attitudes and knowledge linked to misprescription of antibiotics. Methods A systematic review was conducted using the MEDLINE-PubMed and EMBASE databases. The selection criteria required that papers: (1) be published in English or Spanish; (2) designate their objective as that of addressing attitudes/knowledge or other factors related with the prescribing of antibiotics; and (3) use quality and/or quantity indicators to define misprescription. The following were excluded: any paper that used qualitative methodology and any paper that included descriptive analysis only. Results A total of 46 papers that met the inclusion criteria were included in the review. They were very heterogeneous and displayed major methodological limitations. Doctors' socio-demographic and personal factors did not appear to exert much influence. Complacency (fulfilling what professionals perceived as being patients'/parents' expectations) and, to a lesser extent, fear (fear of possible complications in the patient) were the attitudes associated with misprescription of antibiotics. Conclusions Before designing interventions aimed at improving the prescription and use of antibiotics, studies are needed to identify precisely which factors influence prescribing. © 2011 Blackwell Publishing Ltd.

Herdeiro M.T.,University of Porto | Herdeiro M.T.,Center for Health Technology and Information Systems Research | Herdeiro M.T.,University of Aveiro | Ribeiro-Vaz I.,University of Porto | And 6 more authors.
Drug Safety | Year: 2012

Background: Spontaneous reporting of adverse drug reactions (ADRs) is the method most widely used by pharmacovigilance systems, with the principal limitation being the physician's underreporting. Objective: This study sought to evaluate the results of workshop and telephone-interview interventions designed to improve the quantity and relevance of ADR reporting by physicians. Methods: A cluster-randomized controlled trial was conducted on 6579 physicians in northern Portugal in 2008. Following randomization, we allocated 1034 physicians to a telephone-interview intervention, 438 to a workshop intervention and the remaining 5107 to the control group. At the workshop, a real clinical case was presented and participants were then asked to report on it by completing the relevant form. In the telephone intervention, participants were asked (i) whether they had ever had any suspicion of ADRs; (ii) whether they had experienced any difficulties in reporting; (iii) whether they remembered the different methods that could be used for reporting purposes; and (iv) whether they attached importance to the individual physician's role in reporting. We followed up physicians to assess ADR reporting rates to the Northern Pharmacovigilance Centre. In terms of relevance, adverse reactions were classified as serious or unexpected. Statistical analysis was performed on an intention-to-treat basis, and generalized linear mixed models were applied using the penalized quasi-likelihood method. The physicians studied were followed up over a period of 20 months. Results: Two hundred physicians underwent the educational intervention. Comparison with the control group showed that the workshop intervention increased the spontaneous ADR reporting rate by an average of 4-fold (relative risk [RR] 3.97; 95% CI 3.86, 4.08; p < 0.001) across the 20 months postintervention. Telephone interviews, in contrast, proved less efficient since they led to no significant difference (p = 0.052) vis-à-vis the control group in ADR reporting (RR 1.02; 95% CI 1.00, 1.04). The effects of the interventions on the reporting rate of serious and high-causality ADRs indicated that the RRs associated with workshops were 6.84 (95% CI 6.69, 6.98; p < 0.001) for serious ADRs and 3.58 (95% CI 3.51, 3.66; p < 0.001) for high-causality ADRs. Conclusions: Whereas telephone interventions only increased spontaneous reporting in the first 4 months of follow-up, workshops significantly increased both the quantity and relevance of spontaneous ADR reporting for more than 1 year. © 2012 Springer International Publishing AG. All rights reserved.

Discover hidden collaborations