ABSTRACT
INTRODUCTION: Integrase inhibitors and especially dolutegravir (DTG) are placed as a first-line antiretroviral treatment for their efficacy and safety. Although in the pivotal trials the rate of adverse effects (AEs) was low (2-3%), in real-life studies it appears to be higher, especially neuropsychiatric AEs. The objective is to determine the percentage of AEs and discontinuation of DTG in our site and the relationship with the psychiatric background. METHODS: Retrospective descriptive study of patients starting DTG from 2015 to 2017. Discontinuation of treatment, AEs and previous psychiatric pathology were recorded. Follow-up is carried out since the beginning of the treatment, and hospitalizations and emergency room and primary care visits were registered. The study was authorized by the Ethics Committee for Clinical Research of Aragon. RESULTS: Two hundred and eighty-three patients were included, between 11 and 87 years old, 70% male. 21% were naive. 24% of the patients discontinued treatment with DTG, 10% due to AEs. Neuropsychiatric AEs were detected in 5%. This group of patients had a more frequent previous psychiatric history (62 vs. 41%; P=.002) than the ongoing treatment group and they needed more visits to primary care (18.8 vs. 8.4%; P=.016) and emergency room (8,7 vs. 3.3%; P=.061). CONCLUSION: Patients who discontinued treatment with DTG had more psychiatric history. Although more studies are required, it is necessary to assess this background before starting treatment with integrase inhibitors. Symptoms such as anxiety, insomnia or depression can be DTG AEs more frequently than expected. Being identified by primary care and emergency physicians could avoid the unnecessary prescription of other medications.
Subject(s)
HIV Infections , HIV-1 , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , HIV Infections/drug therapy , Heterocyclic Compounds, 3-Ring , Humans , Male , Middle Aged , Oxazines , Piperazines , Pyridones , Retrospective Studies , Young AdultABSTRACT
Objetivo: el objetivo principal de este trabajo es describir las actividades realizadas para la implan-tación del programa de atención farmacéutica a la primera residencia sociosanitaria privada vinculada a nuestro servicio de farmacia y detallar los recur-sos empleados. La iniciativa surgió de la necesidad de cumplimiento del Decreto 92/2019, del Gobierno de Aragón, por el que se regula la atención farma-céutica en los centros sociales de Aragón. El obje-tivo secundario es analizar el impacto económico y de actividad tras la implantación.Método: el proceso de implantación se realizó en-tre junio y diciembre de 2020 en tres fases: análisis de la situación previa, preimplantación e implanta-ción. Los recursos materiales y humanos utilizados fueron mínimos. El proceso farmacoterapéutico implantado contempla la prescripción en un módu-lo de la historia clínica electrónica que se sincroniza con el módulo de unidosis de Farmatools® del servicio de farmacia, validación farmacéutica y dispensación en dosis unitarias por paciente.Resultado: el ahorro medio mensual en costes directos de medicamentos frente al modelo ante-rior fue de 4.080,81 (48,97%). La aplicación del programa supone un incremento importante de la actividad del servicio (tiempo de validación, pre-paración y revisión de tratamientos, recepción de pedidos y reenvasado).Conclusión: la implantación de programas de atención farmacéutica a centros sociosanitarios desde los servicios de farmacia consigue reducir costes directos en medicamentos. Sin embargo, los proyectos deben ir acompañados de presupuesto en personal y material para poder desarrollar una atención farmacéutica de calidad (AU)
Objetive: the main objective is to describe the activities performed for the implementation of a pharmaceutical care program in the first private nursing home dependent on our pharmacy depart-ment, and to detail the resources used for it. This initiative was motivated by the need to comply with the Decree 92/2019, of the Government of Aragon, which regulates pharmaceutical care in the nursing homes of Aragon. The secondary objective is to analyse the economic and activity impact after the implementation.Method: the implantation process was carried out between June and December 2020 in three phases: analysis of the previous situation, pre-implementa-tion and implementation. The program needed very little equipment and human resources to be carried out. The pharmacotherapeutic process contem-plates the prescription in a section of the electronic medical record, that synchronises with the prescrib-ing software of the Pharmacy Department (Farma-tools®). Furthermore, it includes pharmaceutical validation and unit-dose dispensation per patient.Result: the average monthly savings in direct drug costs compared to the previous system were 4.080,81 (48.97%). The application of the program represented a significant increase in the activity of the Pharmacy Department (treatment validation, drug conciliation and preparation and checking of the medication).Conclusion: the implementation of pharmaceuti-cal care programs in nursing homes from hospital pharmacy departments gets to reduce direct costs in drugs. However, these actions must be accom-panied by a budget for equipment and human resources in order to develop quality pharmaceuti-cal care (AU)