Sistemas de gestión para la renovación de recetas médicas: estrategia para optimizar su utilización

ResumenObjetivoMejorar el cumplimiento de los pacientes con el sistema de medicación repetida. Evaluar los motivos de impuntualidad en la recogida de las recetas y su relación con el incumplimiento terapéutico declarado por el mismo paciente.DiseñoEstudio de intervención cuasiexperimental antes-después con grupo control.EmplazamientoCentro de atención primaria que atiende a una población de 62.981 habitantes.ParticipantesPacientes con enfermedades crónicas incluidos en el sistema de gestión de medicación repetida (100 en el grupo control y 100 en el grupo intervención) que son impuntuales al recoger las recetas.IntervencionesSesión informativa-educativa consistente en una breve entrevista con la farmacéutica del centro de atención primaria, en la que se educaba al usuario en el cumplimiento del sistema de medicación repetida y del tratamiento, se identificaban los motivos de impuntualidad y se realizaba el test de Morisky-Green.Mediciones principalesPuntualidad de los pacientes en las recogidas de recetas posteriores a la intervención. Motivo de impuntualidad en la recogida de reclutamiento. Cumplimiento terapéutico según el test de Morisky-Green.ResultadosGlobalmente se obtuvo una mejora absoluta de la puntualidad del 17% en el grupo intervención (el 60% de los pacientes del grupo intervención y el 43% del grupo control fueron puntuales tanto en la primera como en la segunda recogida de seguimiento). Las mujeres del grupo intervención fueron más puntuales. No se observaron diferencias por edad, número de medicamentos o motivo de impuntualidad.ConclusionesEs posible mejorar el cumplimiento de los pacientes con el sistema de medicación repetida mediante una sencilla intervención informativa-educativa.AbstractObjectiveTo improve patient compliance with a repeat prescription system. To evaluate the reasons for not being punctual in collecting prescriptions and the non-compliance declared by the patients themselves.DesignQuasi-experimental study before and after intervention including a control group.SettingPrimary health care centre which serves a population of 62,981 inhabitants.ParticipantsPatients with chronic diseases included in the repeat prescription management system (100 in the control group and 100 in the intervention group) who were unpunctual in collecting their prescriptions.InterventionsAn informative-educational session consisting of a short interview with the pharmacist from Primary Health Care Centre, in which the patient was educated on compliance of the repeat prescription system and treatment. The reasons for the unpunctuality were identified and the Moriskey-Green test was performed.Main measurementsPunctuality of the patients in collecting their prescriptions after the intervention. Reasons for unpunctuality recorded at recruitment. Therapeutic compliance according to the Moriskey-Green test.ResultsThere was an overall absolute improvement of 17% in punctuality in the intervention group (60% of the patients in the intervention group and 43% in the control group were punctual in the first as well as in the second follow up. Women were more punctual in the intervention group. There were no differences seen due to age, number of medications or reason for unpunctuality.ConclusionsIt is possible to improve patient compliance with the prescription renewal system using a simple informative-educational intervention

Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People

Background: SARS-CoV-2 has caused a high mortality in institutionalised individuals. There are very few studies on the involvement and the real impact of COVID-19 in nursing homes. This study analysed factors related to morbidity and mortality of COVID-19 in institutionalised elderly people. Methods: This cohort study included 842 individuals from 12 nursing homes in Sant Cugat del Vallès (Spain) from 15 March to 15 May 2020. We evaluated individual factors (demographic, dependence, clinical, and therapeutic) and those related to the nursing homes (size and staff) associated with infection and mortality by SARS-CoV-2. Infection was diagnosed by molecular biology test. Results: Of the 842 residents included in the analysis, 784 underwent a Polymerase Chain Reaction (PCR) test; 74.2% were women, the mean age was 87.1 years, and 11.1% died. The PCR test was positive in 44%. A total of 33.4% of the residents presented symptoms compatible with COVID-19 and of these, 80.9% were PCR-positive for SARS-CoV-2. Infection by SARS-CoV-2 among residents was associated with the rate of staff infected in the homes. Mortality by SARS-CoV-2 was related to male sex and a greater grade of dependence measured with the Barthel index. Conclusions: SARS-Cov-2 infection in institutionalised people is associated with the infection rate in nursing home workers and mortality by SARS-Cov-2 with sex and greater dependency according to the Barthel index. Adequate management of nursing home staff and special attention to measures of infection control, especially of individuals with greater dependence, are keys for successful management of future pandemic situations. Keywords: COVID-19; comorbidity; frail elderly; frailty; long-term care; nursing homes