La seguridad del medicamento en Atención Primaria

La práctica sanitaria conlleva riesgos para los pacientes y profesionales que les atienden. El estudio APEAS (Estudio sobre Seguridad de los Pacientes en Atención Primaria) puso de manifiesto el papel de los medicamentos tanto en el origen como en la consecuencia de los efectos adversos (en el 48,2% de los efectos adversos los factores causales estaban relacionados con la medicación). La utilización de los medicamentos constituye un sistema complejo que incluye los procesos de selección, prescripción, dispensación, administración y seguimiento. Esta complejidad conlleva un mayor riesgo de que se produzcan errores. En el ámbito de la atención primaria, desde comienzos de los años noventa, se ha estado trabajando con los profesionales en el desarrollo de un programa de uso racional del medicamento (URM). El uso seguro de la medicación es un pilar fundamental del programa de URM. En este trabajo se revisan los aspectos del URM en relación con la prevención de de riesgos en el uso de la medicación y en particular, los aspectos relacionados con la prescripción y los pacientes más vulnerables, los crónicos polimedicados

Patients receiving a high burden of antibiotics in the community in Spain: a cross-sectional study.

Some patients in the community receive a high burden of antibiotics. We aimed at describing the characteristics of these patients, antibiotics used, and conditions for which they received antibiotics. We carried out a cross-sectional study. Setting: Thirty Health Primary Care Areas from 12 regions in Spain, covering 5,960,191 inhabitants. Patients having at least 30 packages of antibacterials for systemic use dispensed in 2017 were considered. Main outcome measures: Prevalence of antibiotic use, conditions for which antibiotics were prescribed, clinical characteristics of patients, comorbidities, concomitant treatments, and microbiological isolates. Patient's average age was 70 years; 52% were men; 60% smokers/ex-smokers; 54% obese. Overall, 93% of patients had, at least, one chronic condition, and four comorbidities on average. Most common comorbidities were cardiovascular and/or hypertension (67%), respiratory diseases (62%), neurological/mental conditions (32%), diabetes (23%), and urological diseases (21%); 29% were immunosuppressed, 10% were dead at the time of data collection. Patients received three antibiotic treatments per year, mainly fluoroquinolones (28%), macrolides (21%), penicillins (19%), or cephalosporins (12%). Most frequently treated conditions were lower respiratory tract (infections or prophylaxis) (48%), urinary (27%), and skin/soft tissue infections (11%). Thirty-five percent have been guided by a microbiological diagnosis, being Pseudomonas aeruginosa (30%) and Escherichia coli (16%) the most frequent isolates. In conclusion, high antibiotic consumers in the community were basically elder, with multimorbidity and polymedication. They frequently received broad-spectrum antibiotics for long periods of time. The approach to infections in high consumers should be differentiated from healthy patients receiving antibiotics occasionally

La seguridad del medicamento en Atención Primaria

La práctica sanitaria conlleva riesgos para los pacientes y profesionales que les atienden. El estudio APEAS (Estudio sobre Seguridad de los Pacientes en Atención Primaria) puso de manifiesto el papel de los medicamentos tanto en el origen como en la consecuencia de los efectos adversos (en el 48,2% de los efectos adversos los factores causales estaban relacionados con la medicación). La utilización de los medicamentos constituye un sistema complejo que incluye los procesos de selección, prescripción, dispensación, administración y seguimiento. Esta complejidad conlleva un mayor riesgo de que se produzcan errores. En el ámbito de la atención primaria, desde comienzos de los años noventa, se ha estado trabajando con los profesionales en el desarrollo de un programa de uso racional del medicamento (URM). El uso seguro de la medicación es un pilar fundamental del programa de URM. En este trabajo se revisan los aspectos del URM en relación con la prevención de de riesgos en el uso de la medicación y en particular, los aspectos relacionados con la prescripción y los pacientes más vulnerables, los crónicos polimedicados

Sars-Cov-2 Infection in Patients on Long-Term Treatment with Macrolides in Spain: A National Cross-Sectional Study

The aim of this study was to know the prevalence and severity of COVID-19 in patients treated with long-term macrolides and to describe the factors associated with worse outcomes. A cross-sectional study was conducted in Primary Care setting. Patients with macrolides dispensed continuously from 1 October 2019 to 31 March 2020, were considered. Main outcome: diagnosis of coronavirus disease-19 (COVID-19). Secondary outcomes: symptoms, severity, characteristics of patients, comorbidities, concomitant treatments. A total of 3057 patients met the inclusion criteria. Median age: 73 (64–81) years; 55% were men; 62% smokers/ex-smokers; 56% obese/overweight. Overall, 95% of patients had chronic respiratory diseases and four comorbidities as a median. Prevalence of COVID-19: 4.8%. This was in accordance with official data during the first wave of the pandemic. The most common symptoms were respiratory: shortness of breath, cough, and pneumonia. Additionally, 53% percent of patients had mild/moderate symptoms, 28% required hospital admission, and 19% died with COVID-19. The percentage of patients hospitalized and deaths were 2.6 and 5.8 times higher, respectively, in the COVID-19 group (p < 0.001). There was no evidence of a beneficial effect of long-term courses of macrolides in preventing SARS-CoV-2 infection or the progression to worse outcomes in old patients with underlying chronic respiratory diseases and a high burden of comorbidity