Abstract Objective: To analyse potentially inappropriate prescribing (PIP) in elderly polypathological patients (PP). Method: Multicentre observational, prospective study of 672 patients aged 75 years and older hospitalised in Internal Medicine between April 2011 and March 2012. The Beers, STOPP-START and ACOVE criteria were used to detect potentially inappropriate prescribing and the results of PP and non-PP patients were compared. Results: Of the 672 patients included, 419 (62%) were polypathological, of which 89.3% met PIP criteria versus 79.4% of non-polypathological patients (p <0.01). 40.3% of polypathological patients met at least one Beers criteria, 62.8% at least one STOPP criteria, 62.3% at least one START criteria and 65.6% at least one ACOVE criteria. The rate of potentially inappropriate prescribing was higher in polypathological patients regardless of the tool used. Conclusions: Given the high rate of potentially inappropriate prescribing in polypathological patients, strategies to improve prescribing adequacy must be developed.

Resumen Objetivo: Analizar el uso inadecuado de medicamentos en pacientes pluripatológicos de edad avanzada. Método: Estudio multicéntrico, observacional y prospectivo. Se reclutaron 672 pacientes mayores de 75 años hospitalizados en Medicina Interna entre abril de 2011 y marzo de 2012. Se utilizaron los criterios Beers, STOPP-START y ACOVE para detectar el uso inadecuado de medicamentos, y los resultados se compararon entre pacientes pluripatológicos y no pluripatológicos. Resultados: De 672 pacientes incluidos, 419 (62%) eran pluripatológicos y el 89,3% de ellos presentaban un uso inadecuado de medicamentos, frente al 79,4% de los no pluripatológicos (p <0,01). El 40,3% de los pacientes pluripatológicos cumplía criterios de Beers, el 62,8% criterios STOPP, el 62,3% criterios START y el 65,6% criterios ACOVE. El uso inadecuado de medicamentos fue mayor en los pacientes pluripatológicos con independencia de la herramienta utilizada. Conclusiones: La alta prevalencia de uso inadecuado de medicamentos en pacientes pluripatológicos hace necesario desarrollar estrategias para mejorar la adecuación farmacológica.

Abstract Objective: To analyse potentially inappropriate prescribing (PIP) in elderly polypathological patients (PP). Method: Multicentre observational, prospective study of 672 patients aged 75 years and older hospitalised in Internal Medicine between April 2011 and March 2012. The Beers, STOPP-START and ACOVE criteria were used to detect potentially inappropriate prescribing and the results of PP and non-PP patients were compared. Results: Of the 672 patients included, 419 (62%) were polypathological, of which 89.3% met PIP criteria versus 79.4% of non-polypathological patients (p <0.01). 40.3% of polypathological patients met at least one Beers criteria, 62.8% at least one STOPP criteria, 62.3% at least one START criteria and 65.6% at least one ACOVE criteria. The rate of potentially inappropriate prescribing was higher in polypathological patients regardless of the tool used. Conclusions: Given the high rate of potentially inappropriate prescribing in polypathological patients, strategies to improve prescribing adequacy must be developed.

Resumen Objetivo: Analizar el uso inadecuado de medicamentos en pacientes pluripatológicos de edad avanzada. Método: Estudio multicéntrico, observacional y prospectivo. Se reclutaron 672 pacientes mayores de 75 años hospitalizados en Medicina Interna entre abril de 2011 y marzo de 2012. Se utilizaron los criterios Beers, STOPP-START y ACOVE para detectar el uso inadecuado de medicamentos, y los resultados se compararon entre pacientes pluripatológicos y no pluripatológicos. Resultados: De 672 pacientes incluidos, 419 (62%) eran pluripatológicos y el 89,3% de ellos presentaban un uso inadecuado de medicamentos, frente al 79,4% de los no pluripatológicos (p <0,01). El 40,3% de los pacientes pluripatológicos cumplía criterios de Beers, el 62,8% criterios STOPP, el 62,3% criterios START y el 65,6% criterios ACOVE. El uso inadecuado de medicamentos fue mayor en los pacientes pluripatológicos con independencia de la herramienta utilizada. Conclusiones: La alta prevalencia de uso inadecuado de medicamentos en pacientes pluripatológicos hace necesario desarrollar estrategias para mejorar la adecuación farmacológica.

BACKGROUND: Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal. AIMS: Our goal was to describe the functioning of a Quick Diagnosis Unit in a Spanish public university hospital after evaluating 1,000 consecutive patients. We also aimed to ascertain the degree of satisfaction among Quick Diagnosis Unit patients and the costs of the model compared to conventional hospitalization practices. DESIGN: Observational, descriptive study. METHODS: Our sample comprised 1,000 patients evaluated between November 2008 and January 2010 in the Quick Diagnosis Unit of a tertiary university public hospital in Barcelona. Included patients were those who had potentially severe diseases and would normally require hospital admission for diagnosis but whose general condition allowed outpatient treatment. We analyzed several variables, including time to diagnosis, final diagnoses and hospitalizations avoided, and we also investigated the mean cost (as compared to conventional hospitalization) and the patients' satisfaction. RESULTS: In 88% of cases, the reasons for consultation were anemia, anorexia-cachexia syndrome, febrile syndrome, adenopathies, abdominal pain, chronic diarrhea and lung abnormalities. The most frequent diagnoses were cancer (18.8%; mainly colon cancer and lymphoma) and Iron-deficiency anemia (18%). The mean time to diagnosis was 9.2 days (range 1 to 19 days). An estimated 12.5 admissions/day in a one-year period (in the internal medicine department) were avoided. In a subgroup analysis, the mean cost per process (admission-discharge) for a conventional hospitalization was 3,416.13 Euros, while it was 735.65 Euros in the Quick Diagnosis Unit. Patients expressed a high degree of satisfaction with Quick Diagnosis Unit care. CONCLUSIONS: Quick Diagnosis Units represent a useful and cost-saving model for the diagnostic study of patients with potentially severe diseases. Future randomized study designs involving comparisons between controls and intervention groups would help elucidate the usefulness of Quick Diagnosis Units as an alternative to conventional hospitalization.