Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias最新文献

Objective: To design a standardized methodology for documenting pharmaceutical interventions (PIs) in hospital emergency departments (EDs), to identify the clinical situations in which they are most frequently performed, and evaluate their economic impact.

Methods: We conducted a multicenter, observational, prospective study of PIs over a 2-month period (from April 12th through June 11th, 2021). A total of 36 types of PIs were identified and grouped into 5 categories: prevention of medication-related adverse events, resource utilization, individualized care, direct patient care, and administrative or support tasks. Clinical impact was evaluated using the GRADE system, based on the level of evidence and strength of recommendation for each intervention. Economic impact was calculated from the potential cost avoided by each PI.

Results: A total of 46 hospital pharmacists from 38 hospitals in Spain and Portugal participated, performing 5,667 PIs. Of these, 86.6% (4,907) were accepted and 95.3% (5,402) were proactive. By category, 36.5% (2,068) corresponded to administrative tasks, 35.9% (2,035) to individualized care, 22.4% (1,269) to adverse event prevention, 2.4% (135) to direct patient care, and 1.3% (75) to resource optimization; 1.5% (85) were not classifiable. Overall, 94.5% of PIs had a level of evidence III, 4.2% level IV, 1.2% level Ib, and 0.1% level IIa. The potential cost avoided amounted to €1,984,474.90.

Conclusions: The implementation of a standardized documentation methodology in EDs across Spain and Portugal highlights the value of clinical pharmacy in optimizing pharmacotherapy, supporting the care team, and reducing health care costs.

Objective: This study aims to identify the factors influencing low-acuity emergency department (ED) visits among older adults, focusing on chronic diseases, wealth, health care system access, and demographic characteristics.

Methods: Using longitudinal data from the Catalan public health system (2014-2020), we analyzed a cohort of individuals older than 65 years to analyze associations among sociodemographic characteristics, health care system access, and low-acuity ED visits. Low-acuity visits were defined by specific ICD-10 diagnoses selected based on aliterature review. Econometric models, including Poisson and Negative Binomial regressions were used to control for time-related factors (eg, holidays, weekends) and health care supply-side variables (eg, access to primary care).

Results: Chronic diseases were not significantly associated with higher rates of low-acuity ED visits, suggesting that older adults with chronic conditions don't necessarily rely on EDs for their care. Individuals with higher incomes were less likely to use EDs. Nationality (which may reflect cultural factors, among others) also influenced the number of ED visits, as did hospital complexity. More complex hospitals recorded higher rates of low-acuity visits, leading to increased costs. Periods of peak influx for low-acuity visits were identified, suggesting that extended primary care hours could reduce pressure on EDs.

Conclusions: The study highlights the role of health care access, income, and demographic factors in the use of lowacuity EDs among older adults. Strategies to optimize primary care access and redirect non-urgent cases to lower-cost centers could help reduce ED saturation and improve resource allocation, especially during periods of high demand.