title: [Pharmaceutical intervention to reduce the iatrogenic risk associated with the triple whammy combination].
abstract: OBJECTIVE
  To analyze the effect of an intervention to reduce the iatrogenic risk associated with concomitant treatment with angiotensin converting enzyme inhibitors (ACEi) and/or angiotensin-II receptor blockers (ARB) with diuretics and nonsteroidal anti-inflamatory drugs (NSAID), combination known as triple whammy (TW).
  
  
  METHODS
  Uncontrolled before-after intervention study.
  
  
  METHODS
  15 health centers from a health area (reference population of 292.746 habitants).
  
  
  METHODS
  260 patients ≥18 years old with chronic and concomitant prescriptions of drugs from the therapeutic groups (ATC code): diuretics (C03), ACEi/ARBs (C09) and NSAID (M01) during the month of January 2015 INTERVENTIONS: A double intervention was conducted during February and March 2015: an educational part, which consisted of an informative session, and an individualized part, in which recommendations to general practitioner were assessed after reviewing medical records.
  
  
  METHODS
  The number of patients in whom at least one intervention was accepted and the number of patients who continued on TW combination in June 2015, were analyzed. Results were analyzed using descriptive statistics and the prevalence of TW was compared with the one in June 2015 using the Newcombe-Wilson's hybrid method.
  
  
  RESULTS
  260 patients were included in the study. Recommendations were made in 165 patients (63.5%) and at least one was accepted in 97 (58.8%) patients. In June 2015, 184 patients continued with the TW combination. The TW prevalence decreased by 0.19/1,000 patients (IC 95%: 0.04/1,000 to 0.34/1,000; P=0.017) after the intervention.
  
  
  CONCLUSIONS
  The intervention improved the prescription and reduced the number of patients on TW combination.
authors.affiliation: Hospital Universitario Son Espases, Palma de Mallorca, España. Electronic address: gemmaarrufat@gmail.com.
authors.forename: Gemma
authors.initials: G
authors.lastname: Arrufat-Goterris
authors.affiliation: Hospital Universitario Son Espases, Palma de Mallorca, España.
authors.forename: Fernando
authors.initials: F
authors.lastname: do Pazo-Oubiña
authors.affiliation: Complejo Asistencial Universitario de Salamanca, Salamanca, España.
authors.forename: María
authors.initials: M
authors.lastname: Malpartida-Flores
authors.affiliation: Hospital Universitario Son Espases, Palma de Mallorca, España.
authors.forename: Raquel María
authors.initials: RM
authors.lastname: Rodríguez-Rincón
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects*; D004232:Diuretics / Q000008:administration & dosage* / Q000009:adverse effects*; D004347:Drug Interactions; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D008297:Male; D008875:Middle Aged
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004232:Diuretics
keywords: Acute kidney injury; Agentes antihipertensivos; Agentes antiinflamatorios no esteroideos; Anti-inflammatory agents, non-steroidal; Antihypertensive agents; Drug interactions; Interacciones farmacológicas; Lesión renal aguda