125 A strategy for urinary incontinence treatment deprescription. (20th August 2018)

• Record Type: Journal Article
• Authors: Alzueta, Natalia; Fontela, Carmen; Celaya, Maria Concepción; Echeverria, Amaya; Leache, Leire; Sanz, Lorea; Acin, Teresa; Garjon, Javier; Agudo, Cristina
• Is Part Of: BMJ evidence-based medicine. Volume 23:Supplement 2(2018)
• Page Start: A59
• Page End: A59
• Publication Date: 2018-08-20
• Subjects: Evidence-based medicine -- Periodicals; 616.005
• DOI: 10.1136/bmjebm-2018-111070.125
• Languages: English
• ISSNs: 2515-446X

Abstract

Abstract : Objectives: To evaluate the impact of a strategy for the optimization of the urinary incontinence treatment in patients with diapers. In aged patients, the use of drugs for urinary incontinence contributes to increase the risk of suffering adverse effects such as delirium, tachycardia, atrial fibrillation, dry mouth, falls, eye dryness or constipation. According to the Priscus, Beers and STOPP criteria, these drugs are not recommended in this population group. The combination of these drugs and diapers is considered a therapeutic duplicity. Method: A retrospective health care evaluation of an intervention implemented in a northern region of Spain. Inclusion criteria: treatment with drugs for urinary incontinence (solifenacin, tolterodine, fesoterodine, oxybutynin, trospium or mirabegron) and all day use of diapers. Informative sessions were given in health care centers with the purpose of providing education and awareness. The list of patients included in the strategy was obtained from 'Observa' (Observatory of medication safety). This in-house developed software allows a communication linked to the electronic medication lists and medical records, between primary care pharmacists and GPs. Through this tool, proposals for discontinuation of those drugs were sent to each doctor whose patients met the inclusion criteria. The message also included information about the low benefit of these drugs in patients and the risk of suffering adverse events. If this message was accepted, the discontinuation of the treatment was immediately transferred to the electronic prescription. Results: A total of 392 patients were included in this intervention strategy. After 6 months, 81.6% of the sent proposals were evaluated by doctors, with an acceptance of 64.4%. Only 87 patients continued the treatment with the drug and diapers. The total amount of discontinued drugs was 206: solifenacin 27%, tolterodine 22%, mirabegron 19%, fesoterodine 18%, oxybutynin 11% and trospium 2%, which amounts to an annual saving of 130, 415€. Conclusions: The strategy led by primary care pharmacist aimed at promoting rational use of drugs for the urinary incontinence had a direct impact in patient`s quality of life, reducing the risk of adverse events. Observa allows intervening on the general population for the treatment optimization in a simple way and promoting medicines rational use. This strategy improves directly health care quality, while reducing costs. There was a great acceptance of the discontinuation proposal by GPs, reducing costs and improving the patients' safety.