5PSQ-076 Comprehensive assessment of pharmacotherapy in the complex chronic patient as a security strategy

<h3>Background and Importance</h3> Complex chronic patients (CCP) have changing needs that require continuous reassessment. Care transition makes parmacotherapeutic review and reconciliation fundamental to find discrepancies and ensure the safety of these patients. <h3>Aim and Objectives</h3> To analyse a comprehensive pharmacotherapy assessment program (CPAP) impact in the number of discrepancies and high-risk discrepancies at discharge between groups, intervention patients and control patients, who had medication list in the discharge report in order to compare with the electronic prescription. <h3>Material and Methods</h3> Prospective intervention study in the emergency department of a tertiary hospital between 01/09/2023–11/30/2023. <b>Inclusion criteria</b>: Complex chronic patients who consulted emergency department and were not institutionalised or palliative. CPAP was performed in &lt;24 h/48h in the emergency department that included: conciliation, review of pharmacotherapy and issue of a pharmacotherapeutic recommendations report. <b>Variables</b>: age, sex, Charlson index, polypharmacy, hyperpolypharmacy, number of patients with discrepancies and high-risk discrepancies, number of discrepancies and high-risk discrepancies and most related high-risk discrepancy drugs. <h3>Results</h3> No statistically significant differences have been found between intervention patients and control patients in the following variables (N=151). Intervention patients vs control patients: Age: 82.9 vs 81.5. Sex: 79 male (52.3%) vs 59 male (39%). Charlson index:7 vs 7. Polypharmacy:142 (94%) vs 140 (92.7%). Hyperpolypharmacy: 81(57.4%) vs 88 (58.3%). Of the patients who were discharged and had a medication list in the discharge report: <b>Intervention patients</b> (96): 74 (77.8%) patients had 256 discrepancies (3.46 discrepancies/patient). 41 (55.4%) patients had 53 high-risk discrepancies (1.29 high-risk discrepancies/patient). <b>Control patients</b> (82): 70 (85.4%) patients had 326 discrepancies (4.66 discrepancies/patient). 47 (55.4%) patients had 78 high-risk discrepancies (1.66 high-risk discrepancies/patient). If both groups are compared, there are statistically significant differences in the number of discrepancies between groups (p=0,02) and the number of high-risk discrepancies (p=0,005). Pharmacologic groups/drugs with the highest number of high-risk discrepancies were: insulin, analgesics (tramadol), antipsychotic (quetiapine) and benzodiazepines (lorazepam). <h3>Conclusion and Relevance</h3> In more than half of the patients there are discrepancies between treatment described in the discharge report and their electronic prescription, which is a safety problem. There are statistically significant differences between groups showing that CPAP can reduce the number of patients with discrepancies and high-risk discrepancies. Most drugs with the highest number of high-risk discrepancies were nervous system related. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest