• Mercedes Galván-Banqueri, Ana Isabel González-Méndez, Eva Rocío Alfaro-Lara, María Dolores Nieto-Martín, Concepción Pérez-Guerrero, and Bernardo Santos-Ramos.
• Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España. mercedes.galvan.sspa@juntadeandalucia.es
• Aten Primaria. 2013 May 1; 45 (5): 235-43.

Objective[corrected] To analyze the appropriateness of pharmacotherapy and, if necessary, carry out interventions for its improvement in a cohort of patients with multiple chronic conditions.DesignDescriptive, prospective study of 21 months duration.LocationHospital Universitario Virgen del Rocío.ParticipantsPatients with multiple chronic conditions included in a project for integrated healthcare.MethodsThe primary endpoint was the number of inappropriate treatments. To evaluate the appropriateness of pharmacotherapy, the specialist in hospital pharmacy followed a standardized procedure consisting of the Medication Appropriateness Index (MAI) questionnaire, modified as an implicit method, and the list of criteria of the Screening Tool of Older Person's Potentially Inappropriate Prescription/Screening Tool to Alert doctors to the Right (STOPP-START) as an explicit method.ResultsA total of 244 patients were included, with a mean age of 76 ± 8 (± SD) years. Half (50%) of the patients were men. The mean number of diagnoses per patient was 8 ± 3 (± SD) and 12 ± 4 drugs (± SD). A total of 840 inappropriate treatments were detected, most of them being due to the presence of interactions. The STOPP criteria most not complied with, were duplicate drug class, and prolonged use of benzodiazepines with long half-life or long-acting metabolites, and START for ACE inhibitors in chronic heart failure and statins and antiplatelets in diabetes mellitus, if one or more coexisting risk factors.ConclusionsWe detected a large number of inappropriate treatments. This highlights the importance of evaluating the appropriateness of drug treatment in patients with multiple conditions. It is advisable to use a combined pharmacist intervention strategy that includes both an implicit method and an explicit method.Copyright © 2012 Elsevier España, S.L. All rights reserved.

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