Evaluation of high-alert medications in older residents in a long term care facility
Abstract
The identification of high-risk medications in polymedicated chronic patients as the elderly is a useful strategy to increase the safety of pharmacotherapy. To this end, the MARC list is applied in a population of 103 elderly people in a long term care facility linked to a community pharmacy. The identification is made at the dispensation act by electronic prescription, detecting simultaneously possible interactions of the patient‘s treatment. Moreover, the most usual medications with inadequate prescriptions, such as benzodiazepines, statins or PPIs, are specifically reviewed.
The study found that more than 90% of the population has more than one MARC prescribed and that the number of MARC prescribed and potential interactions increases when the patient is categorized as severe polymedicated (> 10 drugs). However, these variables do not vary according to the age or sex of the patient. The most prevalent MARC medications were Antiaggregants, benzodiazepines, NSAIDs and diuretics. These last two groups justify a large part of the interactions detected.
The strategy used in the study can be useful to introduce professional pharmaceutical services in this type of clinical environment.
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Barris Blundell D. Revisión de medicación según criterios STOPP/START en pacientes mayores del servicio de sistema personalizado de dosificación de medicamentos de una farmacia comunitaria. Farmacéuticos Comunitarios. 2015;7(2):31-36 - https://doi.org/10.5672/FC.2173-9218.(2015/Vol7).002.05
Casas Pérez P, Álvarez Schoendorff J, Herrerías Esteban G. Utilización del Listado MARC en la identificación de pacientes crónicos en tratamiento con medicamentos de alto riesgo en farmacia comunitaria. Farmacéuticos Comunitarios 2018;10 (Suplemento 1)
Delgado-Silveira E, Muñoz-García M, Montero-Errasquin B, Sánchez-Castellano C, Gallagher P, Cruz-Jentoft AJ. Prescripción inapropiada de medicamentos en los pacientes mayores: los criterios STOPP/START. Rev Esp Geriatr Gerontol. 2009;44(5):273-9. - https://doi.org/10.1016/j.regg.2009.03.017
Documento de Buenas Prácticas en Farmacia Comunitaria en España. Disponible en: http://www.portalfarma.com/Profesionales/Buenas-practicas-profesionales/Paginas/Buenas-practicas- Farmacia-Comunitaria.aspx
Domínguez Sánchez-Migallon P. Aplicación del listado Marc a pacientes polimedicados de un Centro de Salud. Rev Clin Med Fam 2017; 10(1): 5-11.
Galván Banqueri M, Alfaro Lara ER, Rincón Gómez M, Rivas Covas PC, Vega Coca MD, Nieto Martín MD. Factors related with the appropriateness of pharmacological treatment in polypathological patients. Farm Hosp. 2014;38(5):405-10.
Marín-Gorricho R, Casajus-Navasal A, Carrillo-Acevedo L, Serrano-Pérez A, Barajas-Santos MT, Hurtado-Gómez MF. Análisis de la prescripción potencialmente inadecuada según los criterios STOPP/START en un centro sociosanitario. Pharm Care Esp. 2017; 19(6): 499-520
Mud Castelló F, Mud Castelló S, Rodríguez Moncho MJ, Ivorra Insa MD, Ferrándiz
Manglano ML. Detección de prescripciones potencialmente inapropiadas en pacientes ancianos: estudio descriptivo en dos farmacias comunitarias. Farmacéuticos Comunitarios. 2014;6(2):20-26. - https://doi.org/10.5672/FC.2173-9218.(2014/Vol6).002.04
Nicieza-Garcia ML, Salgueiro-Vazquez ME, Jimeno-Demuth FJ, Manso G. Criterios de Beers versus STOPP en pacientes mayores, polimedicados y residentes en la comunidad. Farm Hosp 2016; 40(3):150-64
Proyecto MARC. Elaboración de una lista de medicamentos de alto riesgo para los pacientes crónicos. Madrid
Storms H, Marquet K, Aertgeerts B, Claes N. Prevalence of inappropriate medication use in residential long-term care facilities for the elderly: a systematic review. Eur J Gen Pract 2017; 23(1):69-77 - https://doi.org/10.1080/13814788.2017.1288211
Thomas MC. Diuretics, ACE inhibitors ans NSAIDs-the triple whammy. Med J Austr. 2000;172:184-5.
Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol. 2015; 71:1415-27. - https://doi.org/10.1007/s00228-015-1954-4
Ubeda M, Ferrandiz ML, Maicas N, Gomez C, Bonet M, Peris JE. Potentially inappropriate prescribing in institutionalised older patients in Spain: the STOPP-START criteria compared with the Beers criteria. Pharmacy Practice. 2012; 10(2): 83-91. - https://doi.org/10.4321/S1886-36552012000200004
Casas Pérez P, Álvarez Schoendorff J, Herrerías Esteban G. Utilización del Listado MARC en la identificación de pacientes crónicos en tratamiento con medicamentos de alto riesgo en farmacia comunitaria. Farmacéuticos Comunitarios 2018;10 (Suplemento 1)
Delgado-Silveira E, Muñoz-García M, Montero-Errasquin B, Sánchez-Castellano C, Gallagher P, Cruz-Jentoft AJ. Prescripción inapropiada de medicamentos en los pacientes mayores: los criterios STOPP/START. Rev Esp Geriatr Gerontol. 2009;44(5):273-9. - https://doi.org/10.1016/j.regg.2009.03.017
Documento de Buenas Prácticas en Farmacia Comunitaria en España. Disponible en: http://www.portalfarma.com/Profesionales/Buenas-practicas-profesionales/Paginas/Buenas-practicas- Farmacia-Comunitaria.aspx
Domínguez Sánchez-Migallon P. Aplicación del listado Marc a pacientes polimedicados de un Centro de Salud. Rev Clin Med Fam 2017; 10(1): 5-11.
Galván Banqueri M, Alfaro Lara ER, Rincón Gómez M, Rivas Covas PC, Vega Coca MD, Nieto Martín MD. Factors related with the appropriateness of pharmacological treatment in polypathological patients. Farm Hosp. 2014;38(5):405-10.
Marín-Gorricho R, Casajus-Navasal A, Carrillo-Acevedo L, Serrano-Pérez A, Barajas-Santos MT, Hurtado-Gómez MF. Análisis de la prescripción potencialmente inadecuada según los criterios STOPP/START en un centro sociosanitario. Pharm Care Esp. 2017; 19(6): 499-520
Mud Castelló F, Mud Castelló S, Rodríguez Moncho MJ, Ivorra Insa MD, Ferrándiz
Manglano ML. Detección de prescripciones potencialmente inapropiadas en pacientes ancianos: estudio descriptivo en dos farmacias comunitarias. Farmacéuticos Comunitarios. 2014;6(2):20-26. - https://doi.org/10.5672/FC.2173-9218.(2014/Vol6).002.04
Nicieza-Garcia ML, Salgueiro-Vazquez ME, Jimeno-Demuth FJ, Manso G. Criterios de Beers versus STOPP en pacientes mayores, polimedicados y residentes en la comunidad. Farm Hosp 2016; 40(3):150-64
Proyecto MARC. Elaboración de una lista de medicamentos de alto riesgo para los pacientes crónicos. Madrid
Storms H, Marquet K, Aertgeerts B, Claes N. Prevalence of inappropriate medication use in residential long-term care facilities for the elderly: a systematic review. Eur J Gen Pract 2017; 23(1):69-77 - https://doi.org/10.1080/13814788.2017.1288211
Thomas MC. Diuretics, ACE inhibitors ans NSAIDs-the triple whammy. Med J Austr. 2000;172:184-5.
Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol. 2015; 71:1415-27. - https://doi.org/10.1007/s00228-015-1954-4
Ubeda M, Ferrandiz ML, Maicas N, Gomez C, Bonet M, Peris JE. Potentially inappropriate prescribing in institutionalised older patients in Spain: the STOPP-START criteria compared with the Beers criteria. Pharmacy Practice. 2012; 10(2): 83-91. - https://doi.org/10.4321/S1886-36552012000200004
Maldonado Fernández De Gatta, P., & Fernández De Gatta Garcia, M. del M. (2019). Evaluation of high-alert medications in older residents in a long term care facility. FarmaJournal, 4(2), 31–40. https://doi.org/10.14201/fj2019423140
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