Palamós, Spain
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Turro-Garriga O.,Girona Biomedical Research Institute IDIBGI | Calvo-Perxas L.,Girona Biomedical Research Institute IDIBGI | Albaladejo R.,Hospital Of Figueres | Alsina E.,Dementia Unit | And 14 more authors.
Archives of Gerontology and Geriatrics | Year: 2015

Objective: Drug spending increases exponentially from the age of 65-70 years, and dementia is one of the diseases significantly contributing to this increase. Our aim was to describe pharmaceutical consumption and cost in patients with dementia, using the Anatomical Therapeutic Chemical (ATC) classification system. We also assessed the evolution of costs and consumption, and the variables associated to this evolution during three years. Methods: Three years prospective cohort study using data from the ReDeGi and the Health Region of Girona (HRG) Pharmacy Unit database from the Public Catalan Healthcare Service (PCHS). Frequency of consumption and costs of ATC categories of drugs were calculated. Results: Sample of 869 patients with dementia, most of them with a diagnosis of degenerative dementia (72.6%), and in a mild stage of the disease (68.2%). Central nervous system (CNS) drugs had the highest consumption rate (97.2%), followed by metabolic system drugs (80.1%), and cardiovascular system drugs (75.4%). Total pharmaceutical cost was of 2124.8 € per patient/year (standard deviation (SD). =. 1018.5 €), and spending on CNS drugs was 55.5% of the total cost. After 36 months, pharmaceutical cost increased in 694.9 € (SD. =. 1741.9), which was associated with dementia severity and institutionalization at baseline. Conclusions: Pharmaceutical consumption and costs are high in patients with dementia, and they increase with time, showing an association with baseline dementia severity and institutionalization. CNS drugs are the pharmaceuticals with highest prescription rates and associated costs. © 2015 Elsevier Ireland Ltd.


Calvo-Perxas L.,Institute of Biomedical Investigation of Girona IdIBGi | Turro-Garriga O.,Institute of Biomedical Investigation of Girona IdIBGi | Aguirregomozcorta M.,Hospital Of Figueres | Bisbe J.,Hospital dOlot | And 14 more authors.
Journal of the American Medical Directors Association | Year: 2014

Objectives: Psychotropic drugs are usually prescribed to deal with behavioral and psychological symptoms of dementia, especially when nonpharmacologic approaches are not available or have limited efficacy. Poor outcomes and serious adverse events of the drugs used must be addressed, and risk-benefit ratios need to be considered. The aim of this longitudinal study was to describe the evolution of dispensation of psychotropic drugs in patients with Alzheimer's disease (AD) and to identify the associated demographic and clinical variables. Methods: Longitudinal study using 698 cases with AD included in the Registry of Dementias of Girona in 2007 and 2008 and followed up during 3 years. Drugs were categorized according to the Anatomical Therapeutic Chemical classification. Binary logistic regression analyses were used to detect the variables associated with the use of antipsychotics, selective serotonin reuptake inhibitors (SSRIs), anxiolytics, and hypnotics. Results: Of the patients, 51.2% consumed antipsychotics at least once during the three years of the study, whereas 73.3% and 58.2% consumed SSRIs and anxiolytics, respectively; 32.8% used hypnotics. Antipsychotic use was associated with a diagnosis of AD with delusions) [odds ratio (OR)= 5.7] and with increased behavior disorders (OR= 1.2). Patients with AD with depressed mood were more likely to be treated with SSRIs (OR= 3.1), while being a woman was associated with increased dispensation of anxiolytics (OR= 1.9) and SSRIs (OR= 2.2). Conclusions: Consumption of psychotropic drugs by the patients with AD registered in the Registry of Dementias of Girona is very high. Despite all the described adverse effects and recommendations of caution in their use, antipsychotics still are extensively used. © 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine.


Detweiler M.B.,Psychiatry Service | Detweiler M.B.,Geriatric Research Group | Detweiler M.B.,Virginia Polytechnic Institute and State University | Khachiyants N.,Carilion Clinic Geriatric Psychiatry Fellowship Program | And 5 more authors.
Consultant Pharmacist | Year: 2011

OBJECTIVE: To report the response to low-dose risperidone in individuals with combat-related post-traumatic stress disorder (PTSD) combat nightmares. DESIGN: Case series. SETTING: Veterans Affairs Medical Center Mental Health Clinic and collaborative VA-U.S. Army Fort Bragg Warrior Transition Telepsychiatry Clinic. PRACTICE DESCRIPTION: Veterans at the VA; soldiers that have severe medical and mental health problems in the Warrior Transition Telepsychiatry Clinic. MAIN OUTCOME MEASURE(S): No response: no change in frequency and/or severity of nightmares; partial response: decrease in frequency and/or severity of nightmares; full response: total cessation of recall of nightmares. RESULTS: The four individuals included one active duty soldier and three veterans, ranging from 40 to 76 years of age. All served in the infantry, each in a different combat theater. Two participants had a reduction in the frequency and severity of nightmares at risperidone 1 mg at night. One veteran with blood alcohol levels greater than 300 mg/mL had a partial response with risperidone 3 mg at night. Without active substance abuse, the four individuals had a total cessation of nightmares the first night at a risperidone dose of 2 mg at night. The total cessation of nightmares with risperidone continued despite changes in concurrent antidepressants, anxiolytics, and hypnotics. No medication side effects were reported. CONCLUSION: The use of low-dose risperidone (1-3 mg) at night can reduce the severity and frequency or stop the recall of PTSD combat nightmares in some veterans and active duty soldiers. Risperidone may be an effective medication for combat nightmares of PTSD and merits additional exploration. © 2011 American Society of Consultant Pharmacists, Inc. All rights reserved.


PubMed | Hospital Of Blanes, Hospital Universitari Dr Josep Trueta, Dementia Unit, University of Girona and 6 more.
Type: Journal Article | Journal: Archives of gerontology and geriatrics | Year: 2015

Drug spending increases exponentially from the age of 65-70 years, and dementia is one of the diseases significantly contributing to this increase. Our aim was to describe pharmaceutical consumption and cost in patients with dementia, using the Anatomical Therapeutic Chemical (ATC) classification system. We also assessed the evolution of costs and consumption, and the variables associated to this evolution during three years.Three years prospective cohort study using data from the ReDeGi and the Health Region of Girona (HRG) Pharmacy Unit database from the Public Catalan Healthcare Service (PCHS). Frequency of consumption and costs of ATC categories of drugs were calculated.Sample of 869 patients with dementia, most of them with a diagnosis of degenerative dementia (72.6%), and in a mild stage of the disease (68.2%). Central nervous system (CNS) drugs had the highest consumption rate (97.2%), followed by metabolic system drugs (80.1%), and cardiovascular system drugs (75.4%). Total pharmaceutical cost was of 2124.8 per patient/year (standard deviation (SD)=1018.5 ), and spending on CNS drugs was 55.5% of the total cost. After 36 months, pharmaceutical cost increased in 694.9 (SD=1741.9), which was associated with dementia severity and institutionalization at baseline.Pharmaceutical consumption and costs are high in patients with dementia, and they increase with time, showing an association with baseline dementia severity and institutionalization. CNS drugs are the pharmaceuticals with highest prescription rates and associated costs.

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