Avoidable Adverse Events Related to Ignoring the Do-Not-Do Recommendations: A Retrospective Cohort Study Conducted in the Spanish Primary Care Setting

Mira, José Joaquín; Carrillo, Irene; Pérez-Pérez, Pastora; Astier-Peña, María Pilar; Mendivelso, Johanna Caro; Olivera, Guadalupe; Silvestre, Carmen; Nuín, Ma Angeles; Andrés, Jesús María Aranaz

doi:10.1097/pts.0000000000000830

Cited by 16 publications

(26 citation statements)

References 32 publications

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“…Multimorbidity, together with geriatric syndromes and frailty, frequently coexisting in the ageing process, increase clinical complexity and can lead to significant medicalization [ 9 ]. In these circumstances, there is an increased likelihood of low-value clinical practices, such as excessive polypharmacy and potentially inappropriate prescribing (PIP) [ 10 ]. These practices, in turn, may be determinant of certain adverse drug reactions (ADRs) or even mortality.…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Multimorbidity, Inappropriate Medication and Adverse Outcomes of Inpatient Care: MoPIM Cohort Study

Baré

Lleal

Sevilla-Sánchez

et al. 2023

IJERPH

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There is no published evidence on the possible differences in multimorbidity, inappropriate prescribing, and adverse outcomes of care, simultaneously, from a sex perspective in older patients. We aimed to identify those possible differences in patients hospitalized because of a chronic disease exacerbation. A multicenter, prospective cohort study of 740 older hospitalized patients (≥65 years) was designed, registering sociodemographic variables, frailty, Barthel index, chronic conditions (CCs), geriatric syndromes (GSs), polypharmacy, potentially inappropriate prescribing (PIP) according to STOPP/START criteria, and adverse drug reactions (ADRs). Outcomes were length of stay (LOS), discharge to nursing home, in-hospital mortality, cause of mortality, and existence of any ADR and its worst consequence. Bivariate analyses between sex and all variables were performed, and a network graph was created for each sex using CC and GS. A total of 740 patients were included (53.2% females, 53.5% ≥85 years old). Women presented higher prevalence of frailty, and more were living in a nursing home or alone, and had a higher percentage of PIP related to anxiolytics or pain management drugs. Moreover, they presented significant pairwise associations between CC, such as asthma, vertigo, thyroid diseases, osteoarticular diseases, and sleep disorders, and with GS, such as chronic pain, constipation, and anxiety/depression. No significant differences in immediate adverse outcomes of care were observed between men and women in the exacerbation episode.

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Section: Introductionmentioning

confidence: 99%

Sex Differences in Multimorbidity, Inappropriate Medication and Adverse Outcomes of Inpatient Care: MoPIM Cohort Study

Baré

Lleal

Sevilla-Sánchez

et al. 2023

IJERPH

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“…In absolute terms, this increase is higher in women (from 2.7% to 9.5%) than in men (from 2.3% to 8.5%). 12 In primary care, the SOBRINA study 13 showed that from 2018 to 2019, 55.1% of patients received at least one intervention classified as ‘Do Not Do’ related to benzodiazepines, Non-steroidal anti-inflammatory drugs (NSAIDs), lipid-lowering agents, antibiotics, paracetamol and ibuprofen. The percentage of medical records with more than one ‘Do Not Do’ was 18.5% in those over 29 years old.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological study on gender bias and low-value practices in primary care: a study protocol

Carrillo,

Lopez-Pineda,

Pérez-Jover

et al. 2023

BMJ Open

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IntroductionEvidence shows that gender has a substantial impact on health behaviours, access to and use of health systems and health system responses. This study aims to assess gender bias in patients subjected to low-value practices in the primary care setting and to develop recommendations for reducing adverse events that women experience for this reason.Methods and analysisA Delphi study will be performed to reach a consensus on the ‘Do Not Do’ recommendations with a possible gender bias. A retrospective cohort study in a random selection of medical records will then be carried out to identify the frequency of adverse events that occur when the selected ‘Do Not Do’ recommendations are ignored. Qualitative research techniques (consensus conference and nominal group) will be carried out to develop recommendations to address any gender bias detected, considering barriers and facilitators in clinical practice.Ethics and disseminationThe study was approved by the ethics committee of San Juan de Alicante Hospital (San Juan de Alicante, Spain) Reference N. 21/061. We will disseminate the research findings via peer-reviewed articles, presentations at national and international scientific forums and webinars.Trial registration numberThe study was registered at ClinicalTrials.gov (NCT05233852) on 10 February 2022.

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“…1 LVC causes preventable adverse events for patients and wastes limited resources. [2][3][4] It has been estimated that 10%-25% of healthcare spending in the USA is related to LVC. 5 6 Prevalence estimations of inappropriate diagnostic testing range from 0.09% to 97.5%, indicating that the prevalence, along with the costs, highly depends on the type of care.…”

Section: Introductionmentioning

confidence: 99%

“…Low-value care (LVC) is either care that is not beneficial for patients or care for which the value does not offset the risk or cost given the available alternatives 1. LVC causes preventable adverse events for patients and wastes limited resources 2–4. It has been estimated that 10%–25% of healthcare spending in the USA is related to LVC 5 6.…”

Section: Introductionmentioning

confidence: 99%

Development of the SPREAD framework to support the scaling of de-implementation strategies: a mixed-methods study

et al. 2022

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ObjectiveWe aimed to increase the understanding of the scaling of de-implementation strategies by identifying the determinants of the process and developing a determinant framework.Design and methodsThis study has a mixed-methods design. First, we performed an integrative review to build a literature-based framework describing the determinants of the scaling of healthcare innovations and interventions. PubMed and EMBASE were searched for relevant studies from 1995 to December 2020. We systematically extracted the determinants of the scaling of interventions and developed a literature-based framework. Subsequently, this framework was discussed in four focus groups with national and international de-implementation experts. The literature-based framework was complemented by the findings of the focus group meetings and adapted for the scaling of de-implementation strategies.ResultsThe literature search resulted in 42 articles that discussed the determinants of the scaling of innovations and interventions. No articles described determinants specifically for de-implementation strategies. During the focus groups, all participants agreed on the relevance of the extracted determinants for the scaling of de-implementation strategies. The experts emphasised that while the determinants are relevant for various countries, the implications differ due to different contexts, cultures and histories. The analyses of the focus groups resulted in additional topics and determinants, namely, medical training, professional networks, interests of stakeholders, clinical guidelines and patients’ perspectives. The results of the focus group meetings were combined with the literature framework, which together formed the supporting the scaling of de-implementation strategies (SPREAD) framework. The SPREAD framework includes determinants from four domains: (1) scaling plan, (2) external context, (3) de-implementation strategy and (4) adopters.ConclusionsThe SPREAD framework describes the determinants of the scaling of de-implementation strategies. These determinants are potential targets for various parties to facilitate the scaling of de-implementation strategies. Future research should validate these determinants of the scaling of de-implementation strategies.

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Avoidable Adverse Events Related to Ignoring the Do-Not-Do Recommendations: A Retrospective Cohort Study Conducted in the Spanish Primary Care Setting

Abstract: Supplemental digital content is available in the text.

Cited by 16 publications

References 32 publications

Sex Differences in Multimorbidity, Inappropriate Medication and Adverse Outcomes of Inpatient Care: MoPIM Cohort Study

Sex Differences in Multimorbidity, Inappropriate Medication and Adverse Outcomes of Inpatient Care: MoPIM Cohort Study

Epidemiological study on gender bias and low-value practices in primary care: a study protocol

Development of the SPREAD framework to support the scaling of de-implementation strategies: a mixed-methods study

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