Complex Chronic Patients Research Articles

The relationship between HbA1c and the activities of daily living in complex chronic patients with and without intracerebral hemorrhage

BackgroundAssociations between HbA1c and adverse outcomes in ischemic and hemorrhagic stroke have been confirmed. It is still unclear whether HbA1c is related to the activities of daily living (ADL) score in complex chronic patients (CCP) with and without intracerebral hemorrhage (ICH).AimThe associations between HbA1c and ADL (Barthel score) in CCP with ICH and without ICH were evaluated, respectively.MethodsWe have analyzed data from a previous cohort study involving in 3594 CCPs without a ICH history at baseline, who were followed up for 5 years to assess ICH episode.ResultsOne hundred sixty-one ICH case were detected in a total of 3594 patients during the period of follow up for 5 years. Our nonlinear analysis suggested positive trends on the association between HBA1c and Barthel score in ICH and non-ICH patients, respectively. The multivariate linear regression analysis showed that elevated HbA1c was positively associated with a higher Barthel score among all study population (β = 1.25, 95% CI: 0.92, 1.59; P < 0.0001) with adjusted age and sex. Among non-ICH patients, increased HbA1c was still positively associated with an increased Barthel score (β = 1.24, 95% CI: 0.90, 1.58; P < 0.001). However, HbA1c appeared to have no any relationship with Barthel score in ICH patients (β = 1.87, 95% CI: -0.07, 3.82; P = 0.0613) after adjustment for age and sex. By additionally using sensitivity analysis, we still observed that the strong relationship was still existed in non-ICH patients (β = 0.90, 95% CI: 0.56, 1.24; P < 0.001) but not in ICH patients (β = 1.88, 95% CI: -0.10, 3.86; P = 0.0649).ConclusionWe observed for the first time that elevated HbA1c is associated with better ADL in CCPs without ICH but not in those with ICH. This interesting discovery contradicts the traditional adverse effects of elevated HbA1c.

Age has an independent association with total cost of care in adults admitted to pediatric hospitals.

Previous studies in adults admitted to pediatric hospitals primarily investigated associations between complex chronic condition characteristics and patient outcomes. Our study explored the association of age with length of stay (LOS) and total cost in these adults, accounting for other patient factors. Using the Pediatric Health Information System, we included 1,215,736 patient encounters from 2021 to 2022. Unadjusted and adjusted analyses were performed using bivariable and multivariable log-linear regression. There was a significant positive association between age and total cost, with adults 18-20 years having 13% higher total cost (95% confidence interval [CI]: 12%-15%), 21-25 years with 25% higher total cost (95% CI: 22%-29%), and 25-99 years having 72% higher total cost (95% CI: 66%-79%) than 1-17 years. Our findings suggest expanding upon the existing status quo to identify the most appropriate environment to care for this unique and growing population, especially given the anticipated reduction in pediatric beds and subspecialty expertise.

Community Care Needs of Highly Complex Chronic Patients: An Epidemiological Study in a Healthcare Area.

One of the priorities in family and community care is the epidemiological surveillance of the care needs and dysfunctionality present in populations of highly complex chronic patients (HCCPs) using standardised nursing languages. The aim of this study is to establish the prevalence of care needs and dysfunctionality among HCCPs in a specific health area by municipalities and geographical areas (metropolitan, north, and south) while verifying correlations with sociodemographic, financial, and health characteristics. This is an epidemiological, observational, descriptive, cross-sectional study carried out with a sample of 51,374 HCCPs, whose data were grouped into 31 municipalities. Data were collected on the following variables: sociodemographic, financial, health, functional status (health patterns), and care needs (nursing diagnoses). The mean age of the HCCPs was 73.41 (1.45) years, of which 56.18 (2.86)% were women. The municipalities in the northern area have a significantly higher proportion of older patients, HCCPs, lower incomes, and higher unemployment rates. The southern area had higher proportions of non-Spanish nationals and professionals in the hotel and catering industry, and the metropolitan area had a higher proportion of employed individuals and higher levels of education. Northern municipalities had a higher prevalence of illnesses and anxiolytic and anti-psychotic treatments. Dysfunctionality frequencies did not differ significantly by area. However, a higher prevalence of 13 nursing diagnoses was observed in the north. A high number of correlations were observed between population characteristics, dysfunctionality, and prevalent diagnoses. Finally, the frequencies of dysfunctionality in the population and the most common care needs were mapped by municipality. This research sought to ascertain whether there was an unequal distribution of these two aspects among HCCPs in order to gain a deeper epidemiological understanding of them from a family and community perspective using standardised nursing languages. This study was not registered.

Virtual Consultation in Dermatology: Access Inequalities According to Socioeconomic Characteristics and the Place of Residence.

Virtual consultation has been implemented as a tool to improve the cooperation and coordination between primary care and other specialties. However, in its use in dermatology, inequities have been described. The aim of this study was to identify individual and geographical factors affecting the likelihood of accessing this resource. We conducted a cross-sectional study. The study population was individuals living in Aragón, a region in the north-east of Spain, who were users of the Aragon Health Service in 2021. To explore the differences in individual and area characteristics, between patients with virtual and non-virtual dermatology consultation, we performed bivariate analyses. To analyse the use of virtual consultation in dermatology, a multilevel methodology stratified by sex was developed. We analysed 39,174 dermatology visits, with 16,910 being virtual (43.17%). The rates of virtual consultation were higher in urban areas and the most affluent areas, for older persons, chronic complex patients and people with more advantageous socioeconomic positions. The best multilevel model conducted showed inequalities by socioeconomic position and area of residence. There are individual and area inequalities in the use of teledermatology. As this tool should improve equity of access, teledermatology interventions must address and adapt to the needs of the local patient population.

Nursing interventions to promote dyspnea self-management of complex chronic patients: An integrated review

ObjectivesChronic dyspnea, a distressing symptom in patients with complex chronic conditions, is linked to higher risks of mortality. This study aimed to identify nursing interventions that could improve self-management for complex chronic patients, thereby enhancing control over chronic dyspnea. The findings intend to guide nursing care strategies that promote self-management among this population. MethodsWe searched the databases Medline, Scopus, Web of Science, CINAHL, Cochrane Database of Systematic Reviews (CDSR), and Joanna Briggs Institute (JBI) databases were searched in December 2023. We included adult patients with complex chronic conditions with chronic dyspnoea. The team screened articles collaboratively, using Rayyan software. A qualitative appraisal was performed according to JBI Critical Appraisal Checklist tools. The review protocol is registered under the number CRD42023456021. ResultsOur review included 18 studies that explored a variety of interventions for chronic dyspnea. We identified pharmacological interventions (such as oxygen therapy and inhalation treatments) and non-pharmacological approaches (including educational programs, breathing exercises, fluid intake management, body awareness techniques, peer support, emotional intelligence training, and the use of web applications). Those interventions empower patients, improve their ability to fulfill life roles, mitigate emotional distress, and improve overall quality of life. Nursing care can be crucial in enabling individuals to achieve independence and autonomy in self-care. ConclusionsPromoting self-management for chronic dyspnea in complex chronic patients requires a holistic approach, encompassing multidisciplinary interventions, individualized self-care education, peer engagement, and technological support. Current research on self-management inadequately addresses interventions targeting patient behaviour change. It highlights the need to delve deeper into the self-management process. Further research is needed to expand the evidence base and refine these interventions.

Toward Sustainable Adoption of Integrated Care for Prevention of Unplanned Hospitalizations: A Qualitative Analysis.

Complex chronic patients are prone to unplanned hospitalizations leading to a high burden on healthcare systems. To date, interventions to prevent unplanned admissions show inconclusive results. We report a qualitative analysis performed into the EU initiative JADECARE (2020-2023) to design a digitally enabled integrated care program aiming at preventing unplanned hospitalizations. A two-phase process with four design thinking (DT) sessions was conducted to analyse the management of complex chronic patients in the region of Catalonia (ES). In Phase I, Discovery, two DT sessions, October 2021 and February 2022, were done using as background information: i) the results of twenty structured interviews (five patients and fifteen professionals), ii) two governmental documents on regional deployment of integrated care and on the Catalan digital health strategy, respectively, and iii) the results of a cluster analysis of 761 hospitalizations. In Phase II, Confirmation, we examined the 30- and 90-day post-discharge periods of 49,604 hospitalizations as input for two additional DT sessions conducted in November and December 2022. The qualitative analysis identified poor personalization of the interventions, the need for organizational changes, immature digitalization, and suboptimal services evaluation as main explanatory factors of the observed efficacy-effectiveness gap. Additionally, a program for prevention of unplanned hospitalizations, to be evaluated during the period 2024-2025, was generated. A digitally enabled adaptive case management approach to foster collaborative work and personalization of care, as well as organizational re-engineering, are endorsed for value-based prevention of unplanned hospitalizations.

Drug-Related Problems Detected in Complex Chronic Patients by Community Pharmacists of Catalonia: Perception of the Person-Centred Approach Necessity.

Community pharmacies are healthcare settings in which pharmacists are in an ideal position to carry out pharmaceutical care. The aim of this study was to analyse the number, type and groups of drugs that caused drug-related problems (DRPs) detected in complex chronic patients who are outpatients, the interventions and actions of community pharmacists and their impact on patient medication adherence. The study was designed as a secondary analysis of a multicentre study in the field of primary healthcare and community pharmacies in Catalonia (Spain). The patients who took part were divided into two groups by the primary care physician depending on whether or not they were considered likely to receive their medication through a monitored dosage system (MDS) based on pre-established criteria. Patients underwent 12 months of follow-up by community pharmacists. The prevalence of DRPs among the studied complex chronic patients was high (n = 689). The most identified DRP was nonadherence (31.20%). In the MDS group, results showed a statistically significant increase of 21% in the number of adherent patients with respect to the baseline visit (p-value = 0.0008). Community pharmacists can have an important role in addressing DRPs and optimizing the safety and effectiveness of medications for these patients and in involving them in their own health conditions.

Características de los pacientes traqueostomizados en seguimiento por un Servicio de Atención Paliativa y de Paciente Crónico Complejo (SAPPCC)

Introduction and objectivesIn recent years, there has been an increase in the number of children with tracheostomies. The objective was to describe the characteristics of paediatric patients with a tracheostomy followed up by the palliative care and complex chronic patient service (PCCCPS) of a tertiary care hospital. MethodsSingle-centre retrospective observational study in patients aged less than 18years with a tracheostomy manage by the PCCCPS of a tertiary care hospital (November 2020-June 2022). We analysed epidemiological, clinical, microbiological and social data by reviewing the health records. ResultsThe sample included 44 tracheostomized patients. The most frequent underlying disease was acquired upper airway disease (20.5%). The most common indication for tracheostomy was upper airway obstruction (66%). Bacterial isolates were detected in 84% of the tracheal aspirates, among which Pseudomonas aeruginosa was most frequent (56.8%). The most frequently prescribed antibiotic was ciprofloxacin (84%). In addition, 18.1% of the patients received at least one course of intravenous antibiotherapy and 29.5% received more than three systemic antibiotic regimens in the past 20months. Fifty-nine percent of the children were schooled: 38.6% attended a regular school, 15.9% a special needs school and 4.5% were home-schooled. We identified social difficulties in 53.7%. Also, 22.7% of the families received financial support to care for a child with severe illness. ConclusionsBecause of the complexity of caring for tracheostomized children, integral and coordinated management is essential. Schooling is possible and safe if caregivers are trained.

Improving healthcare at home for complex chronic patients (CCPs) in Andalusia (JADECARE pilot)

Introduction: A Complex Chronic Disease is a condition involving multiple morbidities that requires the attention of multiple health care providers and, therefore, a holistic approach. &#x0D; The Andalusian Public Health System is responsible for the provision of healthcare and public health services to the Andalusian population (8.5 million inhabitants), where around 200000 complex chronic patients (CCPs), with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) have been identified and prioritized. Healthcare at home for CCPs is considered a key element that facilitates patient follow-up, can avoid emergency episodes, promoting patient empowerment.&#x0D; The Andalusian participation in the EU Joint Action JADECARE “joint action on implementation of digitally enabled integrated person-centered care” (GA 951442) focuses on improving healthcare at home for CCPs with CHF and COPD. The development, implementation and testing of a Centralised System for Proactive Follow-up (SCSP) of chronic patients is being monitored, as well as the tele-referral service which is being expanded. The SCSP is supported by National funds as well (Servicio para la implantación de una solución corporativa para el seguimiento proactivode pacientes crónicos en el sistema sanitario público de Andalucía (Expdte. 039/21-SP.).&#x0D; The aim of the JADECARE Andalusian pilot is to improve health status and quality of life of CCPs by enhancing home healthcare proactive follow-up and its evaluation.&#x0D; Method: The development, implementation and testing of the Centralised System for Proactive Follow-up of chronic patients within Andalusian Public Health System includes several steps, from tendering, SCSP design and development, to training and assessment.&#x0D; The SCSP will allow to gather information from home healthcare of CCPs integrated in the corporate IT system and EHR (Diraya). The platform will be a key element for healthcare professionals in the proactive and remote monitoring of chronic patients, allowing early identification of warning signs/signals, adaptation of prescriptions, anticipation of health problems, providing support to caregivers and avoiding unplanned inpatient episodes. This SCSP will be monitored as well as the tele-referral system for CCPs.&#x0D; &#x0D; Results, Conclusions and Lessons learned: Results of this pilot will be presented during the conference. Process, outcomes, patients’ satisfaction and technology acceptance model indicators will be measured.&#x0D; The SCSP is expected to facilitate patients’ follow-up, improving continuity of care by healthcare professionals and patients’ quality of life.&#x0D; Discussions: The Andalusian JADECARE pilot is aligned with the Andalusian Comprehensive Healthcare Plan for Patients with Chronic Diseases and the Andalusian Comprehensive Care Plan, and takes into account the experience of the “Digital roadmap towards an integrated health care sector”, from the Region of Southern Denmark.&#x0D; An integrated healthcare system linked to a solid corporate IT system allow the development of a Centralised System for Proactive Follow-up of chronic patients that leads to an improvement of patient care and quality of life while public healthcare resources are optimized.&#x0D; Limitations: Health outcomes assessment in the timeframe of the project.&#x0D; Suggestions for future research: Home healthcare monitoring assessment.

Validez predictiva del Clinical Risk Groups en pacientes crónicos en el ambito de la atencion primaria

ObjectiveTo analyse a prediction model for admissions and hospital emergencies based on Clinical Risk Groups, in a population of complex chronic patients demanding primary care. DesignA multicentric retrospective observational study, of a cohort of chronic patients with comorbidity, from January until December 2013. PlaceThe study population was assigned to the Santa Pola and Raval health centres from the Health Department of Elche. ParticipantsCohort of chronic patients with comorbidity, from January to December 2013. InterventionsData about the number of admissions, reasons and complexity level associated with the admission were collected by the review of medical records. Main measuresTo determine the level of complexity, the classification included in the chronicity strategy of the Valencian Community based on Clinical Risk Groups was used. ResultsFive hundred and four patients were recruited with a high complexity degree (N3) and 272 with moderate/low complexity (N1–N2). A higher comorbidity was observed in N3 patients with high complexity [Charlson 2.9 (DE 1.8) vs. 1.9 (DE 1.3); P<.001], and higher dependence degree for basic diary activities [Barthel 16.1 (n=81) vs. 7.3 (n=20); P<.001].Association between the number of admissions [0.4 (DE 0.8) vs. 0.1 (DE 0.5); P<.001] and emergency visits [0.8 (DE 1.5) vs. 0.3 (DE 0.8), P<.001] was significatively higher in patients from N3 group than N1-N2 groups. ConclusionsThe predictive capacity of CRG grouper showed high sensibility for the patient classification with a high degree of complexity. Its specificity and positive predictive value were lower for the association of the N3 complexity stratum.

Treatment of Patient with Cutaneous Lupus Erythematosus with Roflumilast Cream 0.3%

Introduction: Cutaneous lupus erythematosus (CLE) is the cutaneous form of a common autoimmune disease, lupus erythematosus, driven by a dysfunction within the adaptive and innate immune system. CLE is subcategorized further into acute, subacute and chronic disease. Here we report a case of a patient with systemic and refractory cutaneous disease with improvement in manifestations demonstrating efficacy following treatment with roflumilast cream 0.3% in a complex chronic CLE patient with uncontrolled disease, intense pruritus and scarring. Case Report: A 48-year-old Asian female with history of smoking, chronic refractory SLE since 2008 with a new onset of pruritic rash. Previous therapies including thalidomide, hydroxychloroquine, methotrexate, mycophenolate mofetil, numerous research trials, oral and intramuscular steroids that failed to control her systemic LE. A Rheumatology colleague referred the patient for new onset cutaneous manifestations. Initial presentation revealed lesions involving 2% of the occipital scalp. Pathology confirmed the diagnosis of discoid lupus. Intralesional triamcinolone , plus topical betamethasone dipropionate 0.05% twice daily (BID) and timolol 0.5% OP solution for wound healing were initiated. Fifteen months later the patient had disease progression of her CLE on to her scalp, face, legs and arms, with the chief complaint of persistent pruritus despite oral prednisone, hydroxychloroquine and thalidomide. The patient’s rheumatologist requested alternative treatment for cutaneous disease without use of long term topical high potency steroids. A second series of intralesional triamcinolone injections plus betamethasone dipropionate 0.05% BID for 3-4 weeks and titrate down to 2-3 applications per week, and addition of roflumilast cream 0.3% was initiated once daily to her face, scalp, and lower legs. On the third office visit, four weeks later, the patient reported pruritus and cutaneous manifestations in lower legs controlled and scalp and face have marked improvement. After 8 weeks on this regimen, the patient return reported that scalp and face continued to improve and disease on the legs continue to be controlled despite not using topical treatment for four weeks. Roflumilast cream 0.3% once daily was continued as monotherapy. Two months later, the patient reported that her skin was fully controlled was starting to repigment with monotherapy. Conclusions: This case report of a 48-year-old female with refractory treatment resistant chronic SLE and CLE treated with roflumilast cream 0.3%, a phosphodiesterase-4 (PDE-4) inhibitor, resulted in disease control, the symptom improvement of improved pruritus as well as repigmentation of the skin. The results observed in this patient suggest this topical intervention, if implemented at the beginning of treatment for cutaneous onset of disease, may have the potential to halt the progression of cutaneous involvement. This case report serves to highlight a promising intervention that may lead to better cutaneous control without long term side effects of topical steroid use.

Effectiveness of a home health monitoring and education program for complex chronic patients, led by primary care nurses.

The challenge of chronicity has led developed countries to design strategies to respond to the new needs of complex chronic patients (CCP). There is evidence supporting better beneficial effects and more efficient care for CCP when home-base care programs are provided by Primary Health Care professionals. The main objective of the present study was to assess the effectiveness of a nursing intervention program of home visits for CCP analyzing the use of health services in terms of hospital admissions, emergency care unit visits, and mortality rate. A quasi-experimental study was designed to retrospectively evaluate the effectiveness of a 3-year proactive, individualized nursing intervention in improving health outcomes measured by health service utilization (hospitalization, emergency care, and nursing home visits) in these patients. Of the 344 complex chronic patients participating in the study, 93 were assigned to the intervention group (IG) and 251 to the control group (CG). Along the period of study, the number of home visits in the IG almost tripled in relation to the CG (14.29 ± 4.49 vs. 4.17 ± 2.68, p < 0.001). Admissions in the first and second year of the study period were lower in the intervention group p = 0.002 and p < 0.001 respectively. All the participants in the control group were admitted at least once during the study period. In contrast, 29.0% of the participants in the intervention group never had a hospital admission during the 3-years study period. The number of ED visits to the emergency department was significantly lower in the IG during the 3 years of the study periods. The cumulative number of emergency visits in the IG was half that in the CG (5.66 ± 4. vs. 11.11 ± 4.45, p < 0.001, Cohen'd,1.53). A total of 35.5% of the participants in the intervention group visited the emergency department on three or fewer occasions compared to 98% of the subjects in the control group who visited the emergency department on more than six occasions (p < 0.001). The 3-year overall mortality rate was 23.5% in the control group and 21.6% in the nursing home visit program. These differences were not statistically significant. The program demonstrated its effectiveness in reduction of hospital admissions and visits to the emergency department. The program had no impact on mortality rate. This program of home visits reinforces the role of primary care nurses in advanced competencies in chronicity.

Prevalence of medication-related problems in complex chronic patients and opportunities for improvement

ObjectiveTo estimate the prevalence of medication-related problems in patients treated in continuous care units and to identify the therapeutic areas in which these problems were more concentrated. MethodObservational descriptive prospective study. Review of clinical histories and outpatient treatment by a hospital pharmacist. Communicating medication-related problems detected to the responsible doctor. Analysis of the therapeutic areas in which the problems were most concentrated. Results85 patients were reviewed, and 368 potential medication-related problems were identified. The areas with the most prevalent medication-related problems were the long-term use of hypnotics, sub-optimal analgesia, optimizable antidepressant treatment, statins in patients older than 75 years in primary prevention and in those with high-intensity doses in secondary prevention, patients with heart failure without angiotensin-converting enzyme inhibitors, and proton-pump inhibitors without indication. ConclusionsTraining interventions should be implemented and computer assistance should be developed to help avoid the most prevalent medication-related problems.

Innovative Health and Social Integrated Care Model Effectiveness to Improve Quality Care for Chronic Patients: A Single Group Assignment Clinical Trial.

Patients with chronic disease have become one of the major challenges for health and social protection systems in developed countries. Integrated care models (ICM) have demonstrably improved the quality of care of chronic patients. However, new models of integration need further evaluation of its effectiveness and outcomes. The ICM studied promoted coordination between the health and social sectors during a 6-month period, through an ad hoc developed application (app) that enabled a constant flow of communication between professionals from both sectors. Patients' quality of life, treatment adherence, chronic patient experience and caregiver overload were assessed by questionnaires at baseline, at the end of the intervention and 6 months post-intervention. The implementation of the new health and social ICM permitted new case detection and medical and social services offered to chronic patients. Furthermore, the quality of life and treatment adherence of patients and caregiver overload were significantly improved. These positive effects lasted at least 6 months after the intervention. Integrated care may facilitate access to care services, increase perceived patient quality of life and treatment adherence. Enhanced access to medical and social services from complex chronic patients may have important implications for caregivers and the care systems who are struggling to adapt to an expanding demand.

Translated article] Medication reconciliation in pediatric hemato-oncologic patients: A multicenter study

ObjectiveTo determine the prevalence of reconciliation errors on admission to hospital in the pediatric onco-hematological population in order to check whether they are similarly susceptible to these reconciliation errors as adults and to describe the characteristics of the patients who suffer them. MethodsA 12-month prospective, multicentre study of medication reconciliation on admission in the pediatric onco-hematological population to assess the incidence of reconciliation errors and to describe the characteristics of the patients. ResultsMedication reconciliation was performed in 157 patients. At least a medication discrepancy was detected in 96 patients. Of the discrepancies detected, 52.1% were related to patient's new clinical situation or by the physician, while 48.9% were determined to be reconciliation errors. The most frequent type of reconciliation error was the “omission of a medication”, followed by “a different dose, frequency or route of administration”. A total of 77 pharmaceutical interventions were carried out, 94.2% of which were accepted. In the group of patients with a number equal to or greater than 4 drugs in home treatment, there was a 2.1-fold increase in the probability of suffering a reconciliation error. ConclusionsIn order to avoid or reduce errors in one of the critical safety points such as transitions of care, there are measures such as medication reconciliation. In the case of complex chronic pediatric patients, such as onco-hematological patients, the number of drugs as part of home treatment is the variable that has been associated with the presence of medication reconciliation errors on admission to hospital, and the omission of some medication was the main cause of these errors.

Intervention of pharmacist included in multidisciplinary team to reduce adverse drug event: a qualitative systematic review

BackgroundPreventable harm in healthcare is a growing public health challenge. In addition to the economic costs of safety failures, adverse drug events (ADE) may lead to complication or even death. Multidisciplinary care team involving a pharmacist appears to be an adequate response to prevention of adverse drug event. This qualitative systematic review aims to identify and describe multidisciplinary planned team-based care involving at least one pharmacist to limit or prevent adverse drug events in the adult patients.MethodsTo determine the type of interprofessional collaboration to prevent adverse drug event in which a pharmacist was involved, we conducted a qualitative systematic review of the literature of randomized controlled trials. Two independent reviewers screened trials in three databases: Medline, Web of Science, ScienceDirect. Prospective studies of at least three different health professionals’ interventions, one of whom was a pharmacist in the last five years were included. Two reviewers performed data extraction and quality appraisal independently. We used TIDieR checklist to appraise articles quality.ResultsIn total 803 citations were retrieved, 34 were analysed and 16 full-text articles were reviewed. Only 3 studies published an implementation evaluation. More than half of the interventions (62%) targeted elderly patients including 6 whom lived in nursing homes. Studies outcomes were heterogeneous, and we did not perform a statistical analysis of the impact of these interventions. Most teams are composed of a physician/pharmacist/nurse trio (94%; 100%; 88%). Half of the teams were composed of the primary care physician. Other professionals were included such as physical therapists (25%), social worker (19%), occupational therapists (12%), and community health educator (6%). Multidisciplinary medication review was the most common intervention and was generally structured in four steps: data collection and baseline assessment, appraisal report by health professionals, a multidisciplinary medication review meeting and a patient follow-up.ConclusionsThe most common multidisciplinary intervention to prevent ADE in the adult population is the multidisciplinary drug review meeting at least the physician/pharmacist/nurse trio. Interventions target mostly elderly people in nursing homes, although complex chronic patients could benefit from this type of assessment.Trial registrationPROSPERO registration: CRD42022334685.

Estudio multicéntrico de conciliación de la medicación en onco-hematología pediátrica

ObjectiveTo determine the prevalence of reconciliation errors (RE) on admission to hospital in the paediatric onco-haematological population in order to check whether they are similarly susceptible to these RE as adults and to describe the characteristics of the patients who suffer them. MethodsA 12-month prospective, multicentre study of medication reconciliation on admission in the paediatric onco-haematological population to assess the incidence of RE and describe the characteristics of the patients in whom they occur. ResultsMedication reconciliation was performed in 157 patients. At least 1 medication discrepancy was detected in 96 patients. Of the discrepancies detected, 52.1% were justified by the patient's new clinical situation or by the physician, while 48.9% were determined to be RE. The most frequent type of RE was the "omission of a medication", followed by "a different dose, frequency or route of administration". A total of 77 pharmaceutical interventions were carried out, 94.2% of which were accepted. In the group of patients with a number equal to or greater than 4 drugs in home treatment, there was a 2.1-fold increase in the probability of suffering a RE. ConclusionsIn order to avoid or reduce errors in one of the critical safety points such as transitions of care, there are measures such as medication reconciliation. In the case of complex chronic paediatric patients, such as onco-haematological patients, the number of drugs as part of home treatment is the variable that has been associated with the presence of medication RE on admission to hospital, with the omission of some medication being the main cause of these errors.

Síndromes geriátricos en recursos de atención intermedia: cribado, prevalencia y mortalidad intrahospitalaria. Estudio prospectivo multicéntrico

ObjectiveTo determine the prevalence of geriatric syndromes (GS) in the geriatric population of the different intermediate care resources, as well as its relationship with intrahospital mortality. Material and methodsA prospective observational descriptive study, carried out in intermediate care resources in the Vic area (Barcelona) between July 2018 and September 2019. All people aged ≥65 years and/or criteria of complex chronic patient and/or advanced chronic disease, who were assessed for the presence of GS using the trigger questions of the Frail VIG-Index (IF-VIG), administered at baseline, on admission, on discharge and 30 days after discharge. ResultsFour hundred and forty-two participants were included, of which 55.4% were women, with a mean age of 83.48 years. There are significant differences (P<.05) between frailty, age and number of GS in relation to the intermediate care resource at the time of admission. There were significant differences in the prevalence of GS between the group of patients who died during the hospitalization (24.7% of the sample) in relation to the survivors: both in a situation baseline (malnutrition, dysphagia, delirium, loss of autonomy, pressure ulcers, and insomnia), as well as in the admission assessment (falls, malnutrition, dysphagia, cognitive impairment, delirium, loss of autonomy, and insomnia). ConclusionsThere is a close relationship between the prevalence of GS and in-hospital mortality in intermediate care resources. In the absence of more studies, the use of the IF-VIG as a screening checklist for GS could be useful for its detection.

Artículo traducido] Atención farmacéutica al paciente ingresado en una unidad multidisciplinar de paciente crónico complejo

ObjectiveTo assess the pharmacist’s contributions by analysing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital. MethodObservational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019 - June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and PRISCUS criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22. ResultsWe reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons.Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases).Moreover, statistically significant differences were observed in the number of drugs at admission between patients included in the complex chronic programme and those not included (p = 0.001), and in the number of drugs at discharge (p = 0.006). ConclusionsThe integration of the pharmacist in the multidisciplinary team of the complex chronic patient unit improves patient safety and quality of care. The selected criteria were useful for detecting inappropriate drugs in this population and favoured deprescription.

The Utilization of Stellate Ganglion Block in the Treatment of Long-COVID: A Case Series

BACKGROUND: With the recent COVID-19 pandemic, chronic pain physicians undoubtedly face the challenge of treating long-COVID within the already complex chronic pain patient population. Sympathetic blockade of the stellate ganglion has historically been utilized as a diagnostic and therapeutic tool in confirming and targeting the sympathetically mediated component of many chronic pain conditions, but its role in treating long-COVID symptoms has yet to be thoroughly studied or elucidated. CASE SERIES: We present a unique case series where the utilization of stellate ganglion blockade in one case and use of stellate ganglion blockade followed by rhizotomy in another were successful in sustained and near-complete relief of all initial long-COVID symptoms during a 3-month follow-up period. CONCLUSIONS: Our case series presents promising results on the role of stellate ganglion blockade in the sustained and near-complete relief of multiple long-COVID symptoms during the longest known follow-up period to date. KEY WORDS: COVID-19, dysautonomia, long-COVID, rhizotomy, stellate ganglion block