Impact of patients' perception of COPD and treatment on adherence and health-related quality of life in real-world: Study in 53 community pharmacies.

BACKGROUND: Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimize disease management. We aimed to assess the impact of patients' perception of their treatment and disease on adherence and Health-Related Quality of Life (HRQL) in patients attending a community pharmacy, where usually subjects have a better condition than those in clinical settings. METHODS: We performed a cross-sectional study of 318 patients with COPD in treatment with inhalers in the last 3 months from 53 community pharmacies. We assessed HRQL with St George's Respiratory Questionnaire (SGRQ). Persistence was assessed from the three previous refills and adherence through the Test of Adherence to Inhalers test. RESULTS: Persistence was achieved by 78.6% of the patients and 58.5% had good adherence. Patients having a multidose DPI and those with MDI showed a 2.8-fold and 4.1-fold increased association, respectively, with intermediate/poor adherence in comparison with those having a single dose DPI. Those patients who did not have knowledge about COPD (aOR 2.106, p = 0.006) and those who thought that the inhaler effectiveness was fair/poor (aOR 2.361, p = 0.006) were more likely to have intermediate/poor adherence. Overall SGRQ score was significantly worse in patients with intermediate/poor adherence (p = 0.036) and in those who thought the inhaler's effectiveness was fair/poor (p < 0.001). CONCLUSIONS: The type of inhaler and patients' knowledge and perceptions of their disease and treatment were associated with good adherence and higher HRQL. Clinicians should promote shared-decision making in the choice of inhaler depending on patients' individual abilities and beliefs.

Impact of changes in pill appearance in the adherence to angiotensin receptor blockers and in the blood pressure levels: a retrospective cohort study.

OBJECTIVE: To assess the level of adherence to angiotensin receptor blockers (ARBs) in patients regularly attending a community pharmacy and the influence of a change in patients' adherence to pharmacological treatment. DESIGN: Retrospective cohort study of a random sample of consecutive patients collecting their medication. SETTING: 40 community pharmacies in Alicante (Southeast Spain). PARTICIPANTS: 602 consecutive ≥18 years old patients following treatment with ARBs at least 3 previous refills were included. MAIN OUTCOME MEASURES: Prevalence of uncontrolled blood pressure (BP) and adherence to prescribed pharmacological treatment (measured through both the Batalla and the Morisky-Green tests). A multivariate Poisson regression model was used to estimate the adjusted risk ratio (RRa) for non-adherence to pharmacological treatment by the presence of a change in patient's adherence and other significant variables. RESULTS: 161/602 (13.7%) patients presented uncontrolled BP. According to the Morisky test, 410/602 (68.2%) patients were considered adherent to pharmacological treatment and 231/602 (38.4%) patients according to the Batalla test. According to the Morisky-Green test, in the multivariable analysis, patients with a previous change in pill appearance were less likely to be adherent than those patients with no change in their pharmacological treatment (RRa 0.45; CI 95% 0.22 to 0.90; p=0.024). Systolic BP was higher in patients with a change in pill appearance in the previous 3 refills (median BP 142 mm Hg; IQR 136-148) than in those who did not have a change (median BP 127 mm Hg; IQR 118-135; p<0.001). CONCLUSIONS: There was a low percentage of adherence and nearly 15% of uncontrolled BP in patients who regularly collected their medication. Switching between pills of different appearances was associated with lower patient adherence to pharmacological treatment and a higher uncontrolled BP than no change in pharmacological treatment or change only in package but not in pill appearance.

Modelling intestinal absorption of salbutamol sulphate in rats.

The objective was to develop a semiphysiological population pharmacokinetic model that describes the complex salbutamol sulphate absorption in rat small intestine. In situ techniques were used to characterize the salbutamol sulphate absorption at different concentrations (range: 0.15-18 mM). Salbutamol sulphate at concentration of 0.29 mM was administered in presence of verapamil (10 and 20 mM), grapefruit juice and sodium azide (NaN3) (0.3, 3 and 6 mM). Different pharmacokinetic models were fitted to the dataset using NONMEM. Parametric and non-parametric bootstrap analyses were employed as internal model evaluation techniques. The validated model suggested instantaneous equilibrium between salbutamol sulphate concentrations in lumen and enterocyte, and the salbutamol sulphate absorption was best described by a simultaneous passive diffusion (ka = 0.636 h(-1)) and active absorption (VMax = 0.726 mM/h, Km = 0.540 mM) processes from intestinal lumen to enterocyte, together with an active capacity-limited P-gp efflux (V'max = 0.678 mM/h, K'm = 0.357 mM) from enterocyte to intestinal lumen. The extent of salbutamol sulphate absorption in rat small intestine can be improved by NaN3, grapefruit juice and verapamil.

Análisis bibliométrico y temático de la producción científica existente en la base de datos bibliográfica MEDLINE sobre farmacia comunitaria / Bibliometric and thematic analysis of the scientific literature on community pharmacy services, in the MEDLINE bibliographic database

Objetivo: Analizar y caracterizar, mediante técnica bibliométrica, la documentación científica relacionada con la farmacia comunitaria indizada en la base de datos bibliográfica MEDLINE. Método: Estudio descriptivo transversal. Los datos se obtuvieron de la base de datos MEDLINE interrogando los términos a estudio en los campos de descriptores, título y resumen; fecha de búsqueda diciembre 2017. Se calculó el tamaño muestral mediante estimación de parámetros poblacionales en una población infinita (n=386). El método de muestreo fue el aleatorio simple sin reposición. Resultados: Se analizaron 386 referencias. El número de originales fue de 308 (79,79%), identificando 215 instituciones, con Índice de Cooperación de 3,66 autores/artículo. El idioma predominante fue el inglés con 354 (91,71%) artículos. La obsolescencia, según el Índice de Burton-Kebler fue de 7 años y el Índice de Price del 33,42%. El núcleo de Bradford lo constituyeron 4 revistas. El descriptor más utilizado fue Community Pharmacy Services (n=300; 20,65%) y el área temática más representada Health Care Category, (n=551; 37,92%). Conclusiones: La producción científica sobre farmacia comunitaria, indizada en la base MEDLINE representa un área de conocimiento de plena vigencia que está iniciando la fase de "explosión de la información", con claro hegemonía anglosajona. Existe buen número de artículos de investigación, pero con relación institucional e índice de colaboración bajos. La clasificación temática se corresponde plenamente con la materia investigada

Objective: Analyze and characterize, through bibliometric technique, the scientific documentation related to community pharmacy indexed in the MEDLINE bibliographic database Methods: Cross-sectional descriptive study. The data was obtained from the MEDLINE database by interrogating the study terms in the descriptor, title and summary fields. Search date was December 2017. The sample size was calculated by estimating population parameters in an infinite population (n = 386). Sampling method: simple random sample without replacement. Results: A total of 386 references were analyzed. The number of originals was 308 (79.79%), identifying 215 institutions, with a Cooperation Index of 3.66 authors / article. The predominant language was English with 354 (91.71%) articles. The obsolescence, according to the Burton-Kebler Index, was 7 years and the Price Index was 33.42%. The core of Bradford included 4 journals. The most widely used descriptor was "Community Pharmacy Services" on 300 (20.65%) occasions and the most represented theme area Health Care Category, which was repeated 551 (37.92%) times. Conclusions: The scientific production on community pharmacy, indexed in the MEDLINE database, represents a well-known area of knowledge that is starting the "information explosion" phase, with clear Anglo-Saxon hegemony. There are a good number of research articles, but with both, low institutional relationship and collaboration index. The thematic classification is fully concordant with the researched subject