Study of medications use of elderly admitted to acute care hospital

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: The prevalence of diseases increases with age and so does use of medications. Thus illness related to medications use does also become more prevalent. This study aims at evaluating medications of elderly people admitted to an acute care hospital, and demonstrate adverse reactions and quality indicators. Material and methods: This is a study of patients 75 years of age and older admitted acutely to internalmedicine at the Reykjavik Hospital over a three month period in the spring of 1995. All medications and diagnoses were registered and the medical records reviewed. The contribution of adverse medication effects to the admission was assessed. Quality of treatment was evaluated according to evidence based medicine for the diagnoses chosen. The study included 208 individuals, 133 women and 75 men with the mean age of 82.4 years. Results: Mean length of stay for women was 19.9 days and men 15.2 days. Number of drugs on admission and discharge ranged from 0 to 18. The mean number of drugs were for women 5.8 and 6.9 and men 6.6 and 7.7 on admission and discharge, respectively. In 16 cases or 7.7% it was judged that there was a high likelihood of the admission being due to an adverse effect. Potential drug interactions according to a computer software package were not judged to be of clinical importance in any case. Conclusions: Treatment for coronary heart disease, heart failure, osteoporosis, insomnia and long term prednisolon treatment is not completely optimal according to evidence based medicine. The results of this study indicate that treatment could be improved for example with use of clinical guidelines.Tilgangur: Með hækkandi aldri vex algengi sjúkdóma og jafnframt lyfjanotkun. Veikindi sem tengjast lyfjanotkun verða því tíðari meðal aldraðra. Rannsóknin lýsir lyfjanotkun aldraðra á bráðasjúkrahúsi, aukaverkunum og gæðavísum. Efniviður og aðferðir: Þessi rannsókn tekur til allra aldraðra, 75 ára og eldri, sem lögðust inn brátt á lyflækningadeildir Borgarspítalans á þriggja mánaða tímabili vorið 1995. Öll lyf og allar sjúkdómsgreiningar voru skráð og sjúkraskrár yfirfarnar. Lagt var mat á það hvort lyfjanotkun ætti þátt í innlögn. Gæði lyfjameðferðar voru metin meðal annars með tilliti til fyrri og núverandi sjúkdómsgreininga. Niðurstöður: Könnunin náði til 208 einstaklinga, 133 kvenna og 75 karla á aldrinum 75 til 98 ára, meðalaldur 82,4 ár. Meðallegudagar kvennanna voru 19,9 dagar og karlanna 15,2 dagar. Skráður fjöldi lyfja við innskrift var á bilinu 0 til 18 lyf og við útskrift mest 18. Meðalfjöldi lyfja hjá konum við innskrift var 5,8 lyf og við útskrift 6,9. Karlar höfðu 6,6 lyf við innskrift að meðaltali og 7,7 við útskrift. Í 16 tilvikum eða 7,7% voru taldar miklar líkur á að sjúklingur hefði lagst inn vegna aukaverkana lyfja. Engin vísbending um milliverkun samkvæmt tölvuútskrift reyndist hafa klíníska þýðingu að mati höfunda. Ályktanir: Aldraðir sem leggjast inn á bráðasjúkrahús eru á fjölda lyfja og eiga aukaverkanir lyfja nokkurn þátt í innlögnum. Hvað varðar meðferð á kransæðasjúkdómi, hjartabilun, beinþynningu, svefntruflunum og langtímameðferð með sykursterum kom fram að all nokkuð vantar upp á að bestu meðferð, samkvæmt niðurstöðum rannsókna, sé beitt. Niðurstöður rannsóknarinnar, ásamt þeim grófu gæðavísum sem beitt var, benda til að gera megi betur til dæmis með klínískum leiðbeiningum

Quality control of antimicrobial usage in Reykjavik Hospital in 1994 - 1998: economic impact

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenAims: To investigate the effect of guidelines and supervision of the prescription of antimicrobial agents at Reykjavik Hospital on the cost and the amount used of these agents. Material and methods: The investigation was conducted from 1994 to 1997. Guidelines were issued for the prescription of antimicrobial agents in empirical treatment and for prophylactics in surgery. The availability of these agents was reduced and the physicians had to order these drugs by filling out a special application form. These forms were later on used for the supervision by a pharmacist and an infectious disease physician of the use of antmicrobial agents and to monitor any change in the prescription of the agents. If needed the supervisors gave advice to the clinicians responsible for the patients care. The supervision took place at eight of the wards of the hospital and started at different times during May 1995 to March 1996. Results: The cost of the usage of antimicrobial agents was reduced after the introduction of the supervision. However, as time passed from the implementation of the supervision the cost tended to increase again. The greatest cost reduction was achieved at the departments of surgery or 8.5 million Icelandic crowns. At the departments of medicine the cost reduction was 2.3 million crowns. By correcting for the cost of supervisory staff the real cost decrease was approximately 6 million crowns. The total amount of prescribed antimicrobial agents measured by the Standardised Daily Dosage was reduced in all the concerned wards by 3-14%. Conclusions: The real cost decreases after the implementation of supervision of the prescription of antimicrobial agents was approximately six million Icelandic crowns during 1994 to 1997. Also, the proportion of antimicrobial agents in the total cost of drugs was reduced after the supervision started in spite of increasing mean cost per Standardised Daily Dosage increased at the departments during the study period. The goal of reducing the amount of antimicrobial agents prescribed was also achieved.Markmið: Að kanna áhrif leiðbeininga og eftirlits með gjöf sýklalyfja á Sjúkrahúsi Reykjavíkur á kostnað og magn gefinna sýklalyfja. Með markvissri notkun sýklalyfja er stefnt að því að bæta meðferð sjúklinga, koma í veg fyrir ónauðsynlega sýklalyfjameðferð, fækka legudögum, draga úr umhverfisspjöllum og óþarfa kostnaði við lækningar