Impacto del COVID-19 en personas mayores en España: Algunos resultados y reflexiones

El COVID19 se informa desde China (Wuan) a finales de diciembre de 2019 y se extiende por Taiwán, Corea, Singapur y Hong Kong. En enero llega a Francia y el 31 de ese mes es diagnosticado el primer caso de COVID-19 en España, un “turista alemán”, en la isla canaria de La Gomera. No obstante, no es hasta el 24 febrero cuando son detectados, simultáneamente, casos en Madrid, Cataluña y Valencia, llegando el 9 de marzo un cierto descontrol que lleva al Gobierno a establecer medidas drásticas de cuarentena y confinamiento. Este escueto, y no completo, recorrido geográfico e histórico, corre en paralelo a declaraciones de la OMS (2015, 2018). Así, el 5 y 10 de enero de 2020 la OMS publica alarmas de referencia para la comunidad mundial de investigación y salud pública y un amplio conjunto de descripción sintomática y orientaciones técnicas con recomendaciones para todos los países sobre el modo de detectar casos, realizar pruebas de laboratorio y gestionar los posibles casos y el establecimiento como primer grupo “de población de riesgo a los mayores de 70 años”. Finalmente, el 30 de enero, el director general de la OMS declara que el brote está causado por un nuevo coronavirus, 2019-nCov, constituyendo una “emergencia de salud pública de importancia internacional” y finalmente el 12 de marzo el COVID-19 se declara como una pandemia, es decir, una “emergencia de salud pública mundial”

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe