Multi-medication: clinical value of chronically prescribed drugs in a primary care centre.

Casafont A, Casellas J, Gallart A, Guinart E, Lladó A, Llens A, Llopart B, Moret A, Olivé E, Parejo Ll, Planas A, Taberner L, Viñas V. Old Salt Health Centre. Girona. Catalonia. Objective: To study the clinical value of the chronically prescribed drugs in multi-medicated patients. Methods: Descriptive transversal study of a population of 12021 patients. Multi-medication was defined as the presence of 10 or more drugs in the treatment plan for at least 12 months at the time of the study. Drugs were reviewed one by one according to the clinical context of each patient by six groups of two primary care physicians and qualified as: A: indicated and without better alternative, B: indicated but with better alternative (by efficacy, safety or cost), C: unknown indication and D: not indicated at all. Dosage and frequency were equally valued, as well as if the adequate controls were carried out when they were needed. The pharmacological evaluation was based on the best scientific evidence obtained in the reference databases. Results: 313 patients were detected as multi-medicated with a global intake of 5005 drugs. Drugs were evaluated as A: 1200, B: 1500, C: 300 i D: 2005. Dosage and frequency were adequate in 50% and controls needed were carried out in 45%. Conclusions: Multi-medication should be taken into account, as this increases the risk of drug interactions, drug-related morbidity and mistakes in dosage or frequency, especially in aged patients. We consider that the regular revision of treatments and the withdrawal of drugs not strictly indicated is an essential measure in the follow-up of our patients. Definitely, the prescription of drugs lacking of the necessary clinical value, should be certainly considered close to the negligence.