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International Journal of Clinical Pharmacy

, Volume 39, Issue 5, pp 1018–1030 | Cite as

Potentially inappropriate medication at hospital admission in patients with palliative care needs

  • Daniel Sevilla-SánchezEmail author
  • Núria Molist-Brunet
  • Jordi Amblàs-Novellas
  • Joan Espaulella-Panicot
  • Carles Codina-Jané
Research Article

Abstract

Background Potentially inappropriate medications (PIMs) are common in older patients with polypharmacy, and are related to negative clinical results. Little information is available on the characteristics and consequences of PIMs in patients with advanced chronic conditions and palliative care needs. Objective To evaluate, for this population: (i) the prevalence of PIMs; (ii) the possible risk factors associated with its onset; and (iii) the related clinical consequences. Setting Acute-hospital care Geriatric Unit (AGU) in County of Osona, Spain. Method Ten-month prospective cross-sectional study. Patients with palliative care needs were identified according to the NECPAL CCOMS-ICO® test. Upon hospital admission, a multidisciplinary team consisting of a pharmacist and two AGU physicians determined the PIMs of the routine chronic medication of the patients. Sociodemographic and pharmacological data were collected with the objective of determining possible risk factors related to the existence of PIMs. Main outcome measure Prevalence and type of PIMs according to STOPP version 2 and MAI criteria at the time of hospital admission. Furthermore, days of hospital admission, destination at hospital discharge and survival analysis at 12 months related to PIMs were evaluated. Results Two hundred thirty-five patients (mean age 86.80, SD 5.37; 65.50% women) were recruited. According to the STOPP criteria, 88.50% of patients had ≥1 criterion (mainly ‘indication of medication’, followed by those that affect the nervous system and psychotropic drugs and risk drugs in people suffering from falls), and according to the MAI tool, 97.40% of the patients had some criterion related to inappropriate medication (mainly, duration of therapy). The following conditions were identified as risk factors for the existence of PIMs: insomnia, anxiety–depressive disorder, falls, pain, excessive polypharmacy and therapeutic complexity. There were no differences among patients in days of hospital stay, discharge’s destination or survival at 12 months, regardless of the tool used. Conclusion The presence of PIMs is high in patients requiring palliative care. Some potentially modifiable risk factors such as the pharmacological ones are associated with a greater presence of inappropriate medication. The presence of PIMs does not affect this population in terms of mortality.

Keywords

Chronic disease MAI Medication Appropriateness Index NECPAL Palliative care Polypharmacy Potentially inappropriate medication Spain STOPP criteria 

Notes

Acknowledgements

We thank all the nurses, patients and caregivers who have participated and collaborated in the study.

Funding

This study was partially supported by a Ph.D. Research Fellowship granted by “Consultori Bayes”. The funders had no role in the design, execution, analysis, interpretation or writing of the study.

Conflicts of interest

The authors declare that they have no conflict of interest with respect to the research, authorship and/or publication of this article.

Supplementary material

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Supplementary material 1 (DOCX 23 kb)
11096_2017_518_MOESM2_ESM.docx (20 kb)
Supplementary material 2 (DOCX 19 kb)
11096_2017_518_MOESM3_ESM.docx (15 kb)
Supplementary material 3 (DOCX 14 kb)

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Pharmacy DepartmentHospital Universitari de Vic, Hospital Universitari de la Santa Creu de VicVicSpain
  2. 2.Acute Geriatric UnitHospital Universitari de Vic, Hospital Universitari de la Santa Creu de VicVicSpain
  3. 3.Geriatric and Palliative Care Territorial UnitHospital Universitari de la Santa Creu de VicVicSpain
  4. 4.Pharmacy DepartmentHospital Clinic de BarcelonaVicSpain

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