Evaluation of Polypharmacy in Home Care and Ambulatory ...
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Projeto Gráfico: Seção de Edição Técnico-Científica / DIETC / CEDC / INCA DISCUSSION CONCLUSION RESULTS METHOD INTRODUCTION OBJECTIVES SUMMARY REFERENCES Evaluation of Polypharmacy in Home Care and Ambulatory Section in a Palliative Care Unit Introduction: The main challenge of health professionals in relation to patients in Palliative Care is the control of symptoms that reduce their quality of life. It often requires the use of polypharmacy for this control, and has been associated with adverse reactions to drugs, medication errors, unable to adhere to therapy proposal and increased risk of hospitalization and can be aggravated by age, presence of other comorbidities, in addition to the cancer amending the kinetics of drugs. Objective: To evaluate the indicators of polypharmacy and indicators of clinical symptoms of patients referred to the home care service and ambulatory service of palliative care unit. Method: Analysis of data collected from medical prescriptions, from January to May of 2008 of home care and ambulatory service, counting the number of prescribed items and identifying the prescription with higher and lower number of items. Results: There was observed an average was 4.6 per prescription at home care and 6.6 in ambulatory. Regarding the number of prescribed items, it was observed that prescription with greater number of items was 20 and the lowest was 1 in the home care and in the ambulatory was 17 and 1 respectively. In patients who complained of pain there was a percentage of 34% for the home care and 50.6% for the ambulatory. Discussion and Conclusion: Achieving the control of symptoms in palliative therapy often requires the use of medicines and involves polypharmacy. The control of pain recommended by WHO as the analgesic ladder with the use of associations such as: non-opioid analgesics, opioids and adjuvant, ranging from joint pain (antidepressants, anticonvulsants, neuroleptics) to support medication (anti-ulcer and laxative), which makes prescription long, justifying the polypharmacy at ambulatory, where there was a higher percentage of patients with pain. (Keywords: Polypharmacy, palliative care) 1 1 2 2 1 Trombini, L.R.B., Barbosa, M.F, Nogueira, T.A. , Pereira, L.C. & Lima, S.G.G. 1 National Cancer Institute – Cancer Hospital IV e-mail: [email protected] 2 Pharmacy College - Federal Fluminense University - Specialization Course for Training in Healthcare Services Hospital for pharmacists, in the mold of Residence e-mail: [email protected] The main challenge of health professionals for patients in palliative care is control of symptoms that reduce their quality of life. It often requires the use of polypharmacy for this control, and has been associated with adverse drug reactions (ADRs), medication errors, difficulty in joining the proposed therapeutic and increased risk of hospitalization and may be exacerbated by age, presence of other co morbidities, besides neoplasy amending the drugs kinetics. The polypharmacy is defined as the administration of multiple drugs in the same user, most commonly seen in elderly. The pharmacist for his technical knowledge is able to contribute to the safe and rational use of drugs and to optimize patient care as a member of the multidisciplinary team of palliative care. To evaluate indicators of polypharmacy and indicators of clinical symptoms of patients referred to the Home Care and Ambulatory of Cancer Hospital IV. Analysis of data collected from medical prescriptions in the period January to May of 2008 for Ambulatory Section and Home Care Section, counting the number of prescribed items and identifying the prescription with higher and lower number of items and analysis of indicators of clinical symptoms of patients referred for unit Cancer Hospital IV. There was evaluated on the requirements that the average of items per prescription was 4.6 in Home Care Section and 6.6 at Division of Ambulatory (Figure 1). Regarding the number of items prescribed was observed that the prescription with the largest number of items in Home Care Section was 20 and the lowest was 1 and Ambulatory Sector was 17 and 1 respectively. The analysis of the clinical indicators of sectors involved in the study presented is an average age of 67 years to 59 years for Home Care and Ambulatory respectively. And the profile of symptoms among patients referred to the unit was observed: fatigue, xerostomy, anorexia, constipation and pain were more common. And in patients who complained of pain there was a percentage of 34% for the Home Care Section and 50.6% for Ambulatory Section. Achieving the control of symptoms in palliative therapy often requires the use of medicines and involves polypharmacy. The control of pain recommended by the WHO analgesic ladder with regards the use of associations as non-opioid analgesics, opioids and adjuvants, ranging from co-analgesics (antidepressants, anticonvulsants, neuroleptics) to support medication (anti-ulcers and laxatives), which makes prescription long, hence the polypharmacy in the Ambulatory Section where there was a greater percentage of patients with pain (Figure 2). The methods of care to patients under study showed a different profile of prescription. In Home Care Section therapeutic support to patients, performed more frequently, had a lower incidence of polypharmacy. Another differential is given by the presence of the pharmacist managing the supply of Home Care Section drugs for this patient, producing pharmaceutical guidelines, provided to caregivers in order to facilitate the understanding of requirements, as this sector shows a greater number of elderly patients. Thus the attention of the pharmacist and their joint action the team helps to provide better quality of life and minimize polypharmacy and provide a pharmacological treatment. Figure 1: Comparative Profile of polypharmacy between Ambulatory and Home Care Section 0 20 40 60 0 a 6 7 a 10 > 10 Items Quantity of prescription (%) Ambulatory Home Care Comparative Profile of polypharmacy between Ambulatory and Home Care Sections Figure 2: Porcentage of patients with pain for referred to the Home Care and Ambulatory Section Percentage of patients with pain referred to the Home Care and Ambulatory Sections 32 18 40 45 35 50 52 57 55 39 0 10 20 30 40 50 60 Jan Feb Mar Apr May Home Care Ambulatory 1- Fulton, M.M, Allen, E.R.A, Polypharmacy in the elderly: a literature review, Journal of The American Academy of Nurse pratitioners, v.17 (4) 123-132 april 2005 2- Leite, S.N, Vasconcellos, M.P.C, Adesão à terapêutica medicamentosa: elementos para a discussão de conceitos e pressupostos adotados na literatura, Ciência & Saúde Coletiva, 8 (3) 775-782, 2003 3- Currow et AL, Prescribing in Palliative care as death approaches, Journal compilation The American Geriatrics Society, v. 55(4) 590-595 april 2007 4- Koh, N.Y, Koo, W.H. Polypharmacy in Palliative Care : Can it be reduced? Singapore Med J., v 43(6) 279-283, 2002 5- Goh, C.R Minimising Polypharmacy – a Challenge in Palliative Care Singapore Med J. v. 43 (6) 273-275, 2002 6- Carter BL, Zillich AJ, Elliot WJ. How pharmacists can assist physicians with controlling blood pressure. J Clin Hypertens 2003 March; 1(5):31-7 Area of Knowledge: Palliative Care.
Transcript of Evaluation of Polypharmacy in Home Care and Ambulatory ...
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INCA
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Evaluation of Polypharmacy in Home Care and Ambulatory Section in a Palliative Care Unit
Introduction: The main challenge of health professionals in relation to patients in Palliative Care is the control of symptoms that reduce their quality of life. It often requires the use of polypharmacy for this control, and has been associated with adverse reactions to drugs, medication errors, unable to adhere to therapy proposal and increased risk of hospitalization and can be aggravated by age, presence of other comorbidities, in addition to the cancer amending the kinetics of drugs. Objective: To evaluate the indicators of polypharmacy and indicators of clinical symptoms of patients referred to the home care service and ambulatory service of palliative care unit. Method: Analysis of data collected from medical prescriptions, from January to May of 2008 of home care and ambulatory service, counting the number of prescribed items and identifying the prescription with higher and lower number of items. Results: There was observed an average was 4.6 per prescription at home care and 6.6 in ambulatory. Regarding the number of prescribed items, it was observed that prescription with greater number of items was 20 and the lowest was 1 in the home care and in the ambulatory was 17 and 1 respectively. In patients who complained of pain there was a percentage of 34% for the home care and 50.6% for the ambulatory. Discussion and Conclusion: Achieving the control of symptoms in palliative therapy often requires the use of medicines and involves polypharmacy. The control of pain recommended by WHO as the analgesic ladder with the use of associations such as: non-opioid analgesics, opioids and adjuvant, ranging from joint pain (antidepressants, anticonvulsants, neuroleptics) to support medication (anti-ulcer and laxative), which makes prescription long, justifying the polypharmacy at ambulatory, where there was a higher percentage of patients with pain.
(Keywords: Polypharmacy, palliative care)
1 1 2 2 1Trombini, L.R.B. , Barbosa, M.F , Nogueira, T.A. , Pereira, L.C. & Lima, S.G.G.
1National Cancer Institute – Cancer Hospital IV
e-mail: [email protected] Pharmacy College - Federal Fluminense University - Specialization Course for Training in Healthcare Services Hospital for pharmacists, in the mold of Residence
e-mail: [email protected]
The main challenge of health professionals for patients in palliative care is control of symptoms that reduce their quality of life. It often requires the use of polypharmacy for this control, and has been associated with adverse drug reactions (ADRs), medication errors, difficulty in joining the proposed therapeutic and increased risk of hospitalization and may be exacerbated by age, presence of other co morbidities, besides neoplasy amending the drugs kinetics. The polypharmacy is defined as the administration of multiple drugs in the same user, most commonly seen in elderly. The pharmacist for his technical knowledge is able to contribute to the safe and rational use of drugs and to optimize patient care as a member of the multidisciplinary team of palliative care.
To evaluate indicators of polypharmacy and indicators of clinical symptoms of patients referred to the Home Care and Ambulatory of Cancer Hospital IV.
Analysis of data collected from medical prescriptions in the period January to May of 2008 for Ambulatory Section and Home Care Section, counting the number of prescribed items and identifying the prescription with higher and lower number of items and analysis of indicators of clinical symptoms of patients referred for unit Cancer Hospital IV.
There was evaluated on the requirements that the average of items per prescription was 4.6 in Home Care Section and 6.6 at Division of Ambulatory (Figure 1). Regarding the number of items prescribed was observed that the prescription with the largest number of items in Home Care Section was 20 and the lowest was 1 and Ambulatory Sector was 17 and 1 respectively. The analysis of the clinical indicators of sectors involved in the study presented is an average age of 67 years to 59 years for Home Care and Ambulatory respectively. And the profile of symptoms among patients referred to the unit was observed: fatigue, xerostomy, anorexia, constipation and pain were more common. And in patients who complained of pain there was a percentage of 34% for the Home Care Section and 50.6% for Ambulatory Section.
Achieving the control of symptoms in palliative therapy often requires the use of medicines and involves polypharmacy. The control of pain recommended by the WHO analgesic ladder with regards the use of associations as non-opioid analgesics, opioids and adjuvants, ranging from co-analgesics (antidepressants, anticonvulsants, neuroleptics) to support medication (anti-ulcers and laxatives), which makes prescription long, hence the polypharmacy in the Ambulatory Section where there was a greater percentage of patients with pain (Figure 2). The methods of care to patients under study showed a different profile of prescription. In Home Care Section therapeutic support to patients, performed more frequently, had a lower incidence of polypharmacy. Another differential is given by the presence of the pharmacist managing the supply of Home Care Section drugs for this patient, producing pharmaceutical guidelines, provided to caregivers in order to facilitate the understanding of requirements, as this sector shows a greater number of elderly patients.
Thus the attention of the pharmacist and their joint action the team helps to provide better quality of life and minimize polypharmacy and provide a pharmacological treatment.
Figure 1: Comparative Profile of polypharmacy between Ambulatory and Home Care Section
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Comparative Profile of polypharmacy between Ambulatory and Home
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1- Fulton, M.M, Allen, E.R.A, Polypharmacy in the elderly: a literature review, Journal of The American Academy of Nurse pratitioners, v.17 (4) 123-132 april 2005 2- Leite, S.N, Vasconcellos, M.P.C, Adesão à terapêutica medicamentosa: elementos para a discussão de conceitos e pressupostos adotados na literatura, Ciência & Saúde Coletiva, 8 (3) 775-782, 20033- Currow et AL, Prescribing in Palliative care as death approaches, Journal compilation The American Geriatrics Society, v. 55(4) 590-595 april 20074- Koh, N.Y, Koo, W.H. Polypharmacy in Palliative Care : Can it be reduced? Singapore Med J., v 43(6) 279-283, 20025- Goh, C.R Minimising Polypharmacy – a Challenge in Palliative Care Singapore Med J. v. 43 (6) 273-275, 20026- Carter BL, Zillich AJ, Elliot WJ. How pharmacists can assist physicians with controlling blood pressure. J Clin Hypertens 2003 March; 1(5):31-7
Area of Knowledge: Palliative Care.
