Summary of the good practice:
The practice includes management of polypharmacy in multimorbid elderly or frail people. The main objective is to improve the appropriateness and safety in prescribing the Integrated Care Organisation Donostialdea. The specific objectives are: to know the prevalence of inappropriate prescribing (IP) and security issues of medicines, designing interventions aimed at improving safety in prescribing and assess their impact. It is a planned strategy of progressive implementation.
The components are:
- Training aimed at medical and nursing professionals with the following modules: general training in polypharmacy and conservative prescribing, medication reconciliation, review of mediation (tools and case studies); Medication review in specific areas related to each project to be implemented (excessive polypharmacy, renal failure, STOPP- START criteria, osteoporosis, medicine safety signals, etc.).”
- Methodology: training “cascade” interactive. The promoter group, led from Primary Care Pharmacy and of multidisciplinary composition, prepares materials and provides “training of trainers” (a reference-forming in each primary care unit).”
- Consensus between primary care and specialist-care”
- Identification of multimorbid patients through the tool “Osakidetza Business Intelligence (OBI)””
- Medication Review by the primary care physician”
- Evaluation and feedback to professionals
- Transferable key aspects: training methodology, automation of consults, local consensus process, medication review methodology, evaluation.
Challenge addressed by the good practice
- High prevalence of polypharmacy in our environment and exponential upward trend.
- High prevalence of inappropriate prescribing and safety problems associated with drugs in our environment.
- Coordination problems between primary care and specialized in managing medication in complex patient care.
- Difficulty to implement changes related to improving the appropriateness of prescribing. It is necessary to design, pilot, evaluate and implement effective interventions tailored to the context..
Key innovative elements of the good practice
- The practice systematizes the process of reviewing medication, by promoting the use of tools with implicit and explicit criteria.
- The cascade training through the training of trainers allows in a reduced time, the deployment to all primary care units (UAP) of the Integrated care organisation (20, 250 family physicians). The involvement of trainers is high and the methodology is participatory. Its reception has been very good (above average scores 8.5 out of 10 in all educational activities), attended> 70% of recipients.
- The electronic identification of populations at risk and inappropriate prescriptions allows acting on large patient populations, and to automatize and monitor the consults.
- Promotes consensus between primary care and specialized care, through meetings with heads and service leaders, focused on issues of specific, measurable and assessable security, promoting mutual understanding and agreemen
Full Scirocco information on the good practice
Publications and reports on the good practice
Documented evidence. Evidence is based on systematic qualitative and quantitative studies.
Security Alerts: in 2014-2015 have reported five security alerts involving 2,000 patients. – Deprescription of bisphosphonate: 44.6% (1212/2717) of the active treatments were discontinued. shifts to another group of drugs for osteoporosis only in 5.9% of cases were observed discontinued. The estimated drug saving was € 251,232 compared initial cost of 697,019 €. – Polymedicated over 80 years with 10 or more drugs: A reduction was observed in the number of drugs of -0.88 (95% CI. 0.72 to -1.04, p <0.0001, representing a reduction of 7.4% of all prescriptions are he observed a reduction of 27.1% of potential security problems. – Renal failure and diabetes: A decrease was observed in the prevalence of inappropriate prescriptions of 56% (64/114) in the unit in which was implemented (Zumaia-Zestoa- Getaria). – Collaboration primary care-specialized care in polypharmacy. On going:. 7 hospital services have been implicated. Inappropriate prescriptions affect to the following number of patients per service: cardiology (3926), digestive (3384), rheumatology- traumatology (4817), gynaecology (429), mental health (530), respiratory (142).
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