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Purpose: In the last decades, different criteria have been developed for detecting inappropriate prescription in older patients. In Spain, translations and adaptations of international lists are available but it would be necessary a national list which could cope with the peculiarities of our health system, existing pharmaceutical market, and prescription habits. We propose in this project the creation of a Spanish potentially inappropriate drugs list which could be applicable in our clinical scenario., Methods: We use a Delphi method involving 25 experts from different backgrounds (Clinical Pharmacology, Geriatrics, Rational Use of Drugs and Pharmacy, Primary Care and Pharmacoepidemiology, and Pharmacovigilance) that were asked to participate in two-round questionnaires. For analysis, current recommendations of Worth and Pigni were applied, and every statement was classified into one of three groups: strong, moderate, or low agreement. Statements with strong agreement were accepted to be part of the inadequate prescription list. Moderate agreement statements were selected to enter the second questionnaire, and statements with low agreement were further analyzed to determine if it was due to heterogeneity or due to dispersion in the answers., Results: The first questionnaire consisted of 160 proposed sentences, of which 106 reached a high agreement, 32 a moderate agreement, and 22 a low agreement. All sentences proposed in the second questionnaire reached a strong agreement. The total accepted sentences were 138., Conclusions: We offer a list of inadequate prescription in older patients adapted to the Spanish pharmacopeia and according to the prescription habits in our environment.

Objective: To identify the consumption pathway and strategies of coping with antidepressants use from the patients perspective., Design: Qualitative research., Setting: Tenerife., Sampling: Theoretical sampling until saturation., Method: A total of 17 open interviews with patients who consumed antidepressants whether combined with tranquilisers or not. The age range was between 35-85 years, and there were 13 women. Ten lived in a more urban setting and the rest in rural areas. Interviews were audio-recorded, transcribed verbatim and analysed using a modified Grounded Theory supported by the software program ATLAS.ti., Results: The process identified as coping with antidepressants, was called "struggling internally and externally." It consisted of the individual assessment of the benefits and risks of medication use (internal struggle), addressing stigma and social pressure (external struggle). The outcome of the assessment made by patients may lead to different strategies for adjusting to drug treatment: "unconditional acceptance", "resigned acceptance" or "forced acceptance"., Conclusions: Understanding the evaluation process that the patient needs to go through, given the internal and external struggle in which they are immersed, can be useful to develop interventions that improve medication use. In fact, physicians have an important role, although not always explicitly sought in resolving the dilemma posed by patients using antidepressant drugs and, therefore, reducing the length of patient suffering., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Objective: To examine the advantages and disadvantages of two different Health Care Systems from the perspective of Primary Care (PC) physicians., Design: Qualitative research based on the analysis of documents written as diaries for the study., Setting: Primary Care in the Canary Islands (Spain) and Alberta (Canada) CONTEXT AND PARTICIPANTS: Intentional sample to identify different profiles of physicians., Method: Participants were asked to write a document describing their work activities, including the impact of the organisational system and on their personal life. Two representatives of the health care system were asked to write a detailed description about how PC is organised in their country. Nine diaries were collected (5 from the Canary Islands and 4 from Alberta). Ritchie & Spencer framework was used for the analysis., Results: In Alberta, physicians have access to more complementary tests; they can offer hospital care; they have to sort out administrative work; they can choose were to work; and can specialise in different types of health care services. In the Canary Islands physicians can have paid holidays and the administrative issues do not depend on them, patients have a physician assigned and seem to have more institutional support., Conclusions: The results of this study allow us to constructively analyse the role of PC physicians, assess the advantages and re-think the disadvantages related to how we work in order to learn from other health care systems., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Introduction: Psychiatric disorders, either due to their psychopathology or the drug treatments required, may lead to changes in perception, information processing and integration, and psychomotor activity which may disturb and/or interfere with the ability to drive safely., Method: This study assesses competence to drive in a sample of psychiatric outpatients, with a driver's license, who drove regularly. This ability was assessed with the accredited LNDETER 100 battery, an electronic assessment unit measurement, in different clinical situations., Results: Only 24 of the 120 patients passed the four tests required to obtain or renew a driver's license, and 80% failed in at least one of the required tests. None of the patients studied had notified the traffic authorities or the examination centers that they had a psychiatric condition that could affect safe driving. No patient stopped driving, although 10% of them admitted that their ability to drive was somewhat deteriorated., Conclusions: Psychiatric patients with altered psychomotor performance should be a concern for psychiatrists and general practitioners regarding their competence to drive vehicles. Clinical, ethical and legal aspects of our findings are discussed.

Background: Adverse Drug Reactions (ADR) and Drug-Related Problems (DRP's) are a frequency cause of hospital emergency room visits and require better assessment., Method: An analysis was made of 1097 consecutive admission to the emergency room at the Nuestra Senora de los Volcanes, Hospital (currently the General Hospital of Lanzarote) in Arrecife de Lanzarote (Canary Islands) over a three-month period in order to detect any possible DAR or any other drug-related problems., Results: Nineteen (19) of the 1097 admissions were due to Adverse Drug Reactions (ADR) (1.73%; 95% IC:0.96%-2.5%). Some of the most outstanding of the other "Drug-Related Problems" (DRP's) were medication overdose, which was diagnosed in 5 (0.45%) of the patients; the worsening of the symptoms due to ceasing to take the medication was involved in 8 (0.72%), and incorrect treatments which involved medical care at the emergency room totaled 11 (1.0%). The number of drug-related problems (DRP's) in the sample totaled 43 (3.9%). The drug-related problems (DRP's) led to hospitalization in 1.9% of the cases seen in the emergency room and led to hospitalization in 9.6% of all of hospital admission through the emergency room for the period of time under study. The ADR led to 4.1% of the hospital admissions., Conclusions: Drug-related problems are a frequent, major problem which has not been well-analyzed in the emergency rooms. Additionally, emergency rooms can function as the first point of detection of a ADR among an outpatient population.