Consumption of Inappropriate Psychotropic Drugs in Residential Homes for the Elderly: Comparative Study Between 2001 and 2006

Sicras-Mainar, Antoni; Peláez-de-Loño, Jordi; Castellá-Rosales, Amparo; Rodríguez-Darriba, Merçé

doi:10.1016/S2173-5085(08)70033-9

Farmacia Hospitalaria

ISSN: 1130-6343

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Web of Science, Scopus, Scimago Journal and Country Rank (SJR), Índice H: 18, CINHAL, EMBASE Excerpta Medica, Índice Bibliográfico Español en Ciencias de la Salud (IBECS), Índice Español de Ciencia Y Tecnología (ICyT), Índice Médico Español (IME), International Pharmaceutical Abstracts (IPA), MEDLINE, DOAJ, Dialnet, Latindex, Medes, Scientific Electronic Library Online (SciELO), REDIB.

Before-after study, that includes ambulatory prescriptions (CatSalut) made in the nursing homes centers of a Sanitary Region during year 2001 (reference, 107 centers) and 2006 (comparison, 152 centers) respectively. PI was considered (Beers Criteria), 15/72 active principles pertaining to the subgroup-therapeutic ones: antidepressants, neuroleptics, sedatives-hypnotics, and tranquilizers. The measurement of the consumption was made by means of the establishment of quantitative indicators in defined daily dose (DDD), packages, and cost. Statistical meaning, P<.05.

Results

Studied patients: 4795 and 6350 (years, 2001–2006, respectively), the global use of psichodrugs in DDD was of 1 508 061 and 2 286 347. The PI use was of 19.0% (confidence intervals of 95% [CI], 17.9–20.1) as opposed to 12.5% (95% CI, 11.5–13.5). Increases of DDD/resident in some PI are observed: perfenazine (22.6%), halazepam (28.6%), amitriptyline (15.9%), clobazam (16.6%), and diazepam (6.6%), P<.001.

Conclusions

A tendency in diminishing the consumption of PI in institutionalized patients is observed, although its use continues being elevated. An excessive drug use exists with anticholinergic and sedative properties, reason why specific interventions would be due to make, with the purpose of improving the rational use of the drugs in this sensible group of patients.

Key words:

Inappropriate psichodrugs

Nursing homes

Drugs use

Resumen

Objetivo

Evaluar la comparación del consumo de psicofármacos inadecuados (PI) en población institucionalizada.

Método

Estudio antes-después, que incluye las recetas ambulatorias (CatSalut) realizadas en los centros residenciales geriátricos de una Región Sanitaria durante el año 2001 (referencia: 107 centros) y 2006 (comparación: 152 centros), respectivamente. Se consideraron PI (Criterios Beers) 15/72 principios activos pertenecientes a los subgrupos-terapéuticos: antidepresivos, neurolépticos, sedanteshipnóticos y tranquilizantes. La medición del consumo se realizó mediante el establecimiento de indicadores cuantitativos en dosis diaria definida (DDD), envases y gasto. Significación estadística, p<0,05.

Resultados

Pacientes estudiados: 4.795 y 6.350 (años: 2001 y 2006, respectivamente), la utilización global de psicofármacos en DDD fue de 1.508.061 y 2.286.347. El uso de PI fue del 19% (intervalos de confianza del 95% [IC]: 17,9–20,1) frente al 12,5% (IC del 95%, 11,5–13,5). Se observan incrementos de DDD/residente en algunos PI: perfenazina (22,6%), halazepam (28,6%), amitriptilina (15,9%), clobazam (16,6%) y diazepam (6,6%), p<0,001.

Conclusiones

Se observa una tendencia en disminuir el consumo de PI en pacientes institucionalizados, aunque su uso sigue siendo elevado. Existe una excesiva utilización de fármacos con propiedades anticolinérgicas y sedativas, por lo que se deberían realizar intervenciones específicas, con la finalidad de mejorar el uso racional del medicamento en este sensible colectivo de pacientes.

Palabras clave:

Psicofármacos inadecuados

Residencias geriátricas

Uso de medicamentos

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