[Prospective observational study of the impact of problems accessing treatment such as risk factors for adherence and persistence. Pilot study]. / Estudio observacional prospectivo del impacto de los problemas de acceso al tratamiento como factores de riesgo de la adherencia y persistencia. Estudio piloto.

Introduction: Some preliminary studies that reveal the onset of risk factors not investigated previously in regard to the health system were performed. They can reduce adherence and/or persistence of pharmacological treatments. Knowledge about them can lead to possible solutions. Aim: To estimate the incidence of risk factors in regard to the health system that can reduce adherence/persistence with treatments associated with problems accessing these in the community pharmacy. Method: Transversal, randomized, prospective study in community pharmacies in Asturias and Aragón regions. The primary endpoint was the incidence of new risk factors that means that the prescription is inadequate for its dispensing. Different subgroups were analyzed according to type of risk factor, population and prescription. Results: The typical patient is a vulnerable person according to his age (65.4 years), multipathology and polypharmacy (6.8 drugs). After the evaluation of 138,697 cases of dispensing in 98 community pharmacies a total of 2009 patients were detected with 2221 cases of dispensing with risk factors in terms of adherence and/or persistence (1.6% of the total dispensing). The type of incidence most commonly observed was expiry of the prescription (54.7%; 95%CI=52.6-56.8), followed by no prescription record (18.7%; 95%CI: 17.1-20.3). For its part supply problems stood at 10.2% (95%CI= 10.6%-10.9%). The most compromised therapeutic groups were groups N Nervous System (27.6%), C Cardiovascular System (20.3%) and A Gastrointestinal System (15.3%). Conclusions: The results obtained suggest that the current incidence of risk factors in regard to the health system in terms of adherence and/or persistence may comprise a health problem with a clinical, quality of life and financial impact. As these risk factors are modifiable, a greater capacity for community pharmaceutical action by means of exceptional dispensing to authorize the treatment's continuity would be an acceptable solution.

[Project on exceptional dispensation in the Principality of Asturias]. / Proyecto sobre dispensación excepcional en el Principado de Asturias.

Community pharmacy (CF) is daily confronted with situations that prevent the proper dispensing of medication, putting at risk the continuity of treatment by patients, which causes medication-related problems (DRPs). In this pilot study, carried out in the Principality of Asturias, the aim was to quantify the number of incidents of this type related to those aspects of the prescription that could be easily corrected by the community pharmacist through simple interventions at the time of dispensing. It was carried out in ten pharmacies in this autonomous community during normal opening hours over fifteen working days. The sample included a total of 32,331 containers dispensed. A total of 406 incidences of exceptional dispensing were recorded. The total incidence rate reached 1.26% of the dispensations, which extrapolating to the total number of dispensations made in Asturias during the month of October 2020 would give us a figure of 27,030 total dispensations susceptible to exceptional dispensing.The total incidence rate was lower in urban pharmacies (1.03%) compared to semi-urban and rural pharmacies (1.37% and 1.39%). Most of the cases (59.4 %) involved patients with an individual contribution to the Health System corresponding to 10 % (TSI2) and the mean age of the patient was 60.8 years. Regarding the level of care, 79% of the cases corresponded to Primary Care (PC) prescriptions. The most common type of incidence is "potential interruption due to prescription not active at the time of dispensing (exceeding the 10-day margin)" with an incidence rate of 0.61 % of the dispensations, which would mean a total of 13,181 prescriptions susceptible to exceptional dispensing due to this type of incidence.In terms of economic savings, it was found that 63 of the 406 cases would have necessarily required a medical consultation and 30% of them would have been for active patients. Therefore, the remaining 343 cases, which could be resolved through exceptional dispensing by the community pharmacist, would mean a saving of more than 4,000 consultations and nearly 200,000 euros in direct and indirect costs if the pharmacist were allowed to intervene.

[Impact of the pandemic on primary care. SESPAS Report 2022]. / Impacto de la pandemia en la atención primaria. Informe SESPAS 2022.

The COVID-19 pandemic, which last 2 years and still goes on, has pushed the primary health care (PC) to a current worrying situation of saturation and exhaustion. It is a community infectious disease, with a great amount of cases (around 10 million declared in January 2022) due to that, PC has made an extraordinary effort to pay attention on mild cases and on PC and to detect potentially serious cases early. Unfortunately, up to now, a global evaluation of the actions has not been carried out, in order to allow us to learn from this new experience. This article describes the different phases of the pandemic and its impact on PC. Finally, solutions are proposed to reinforce the central criteria that allow PC to be maintained as the foundation of the welfare state, longitudinality, resolution, accessibility, and care coordination and continuity, thanks to the contribution of resources and skills given to the PC. In conclusion, PC must still being the basis of the health system and it is mandatory to recover and claim those competencies and resources that should always have been a part of PC.