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Introduction: Pharmaceutical Intervention aims to optimize and rationalize the use, effectiveness, and safety of dispensed medications resolving drug-related problems (DRPs) and negative medicine outcomes (NMOs). Objectives: To evaluate Pharmaceutical Interventions in Benzodiazepines users during the COVID-19 pandemic from a Community Pharmacy. Method: Prospective observational, descriptive, and cross-sectional study (AEMPS code: DAA-CLO-2020-01) of Pharmaceutical Interventions offered by the community pharmacy between August 2020 and February 2021. Results: A total of 306 Pharmaceutical Interventions were conducted involving 127 patients. Health education and personalized medication information were the most common Pharmaceutical Interventions after detecting a high level of unfamiliarity with the Benzodiazepines among patients. Pharmaceutical Interventions leading to medical referrals accounted for 37.8% of the total, triggered by the detection of DRPs and/or NMOs or after identifying the patient as candidate for deprescription. These referrals included patients with a very high level of depression according to the Euroqol 5D-3L test. Pharmaceutical Interventions resulting in Medication Review with Follow-up Service were performed in 3.1% of patients. The patient acceptance rate of Pharmaceutical Interventions reached 98.4%. Conclusions: The high acceptance rate of Pharmaceutical Interventions reinforces the value of Community Pharmacy in optimizing and rationalizing Benzodiazepines usage, while strengthening the pharmacist-patient relationship. The COVID-19 pandemic posed challenges to pharmacist-physician collaboration despite of the availability of telecommunication protocols among healthcare professionals.
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BACKGROUND: Tolerance and dependence stand out as the most relevant risks observed during benzodiazepine (BZD) treatments. OBJECTIVES: To evaluate the degree of dependence of patients on BZD treatments using the Tyrer test; to define a profile of patients at risk of developing BZD dependence; and to discuss the role of the pharmaceutical care offered by the community pharmacy during dispensing. METHODS: Prospective cross-sectional descriptive observational study (August 2020-February 2021) involving 127 patients using BZD. They voluntarily answered a questionnaire during the dispensing pharmaceutical care service. The study was evaluated and codified (code: DAA-CLO-2020-01) by the Spanish Agency for Drugs and Health Products (AEMPS), and statistical analysis was performed with SPSS 25.0. RESULTS: 19.05% of patients using BZD were suspected of suffering from BZD tolerance, and 77.88% of all patients were identified as being at a high risk of BZD dependence. The Tyrer test for dependence indicated a mean score of 5.59 out of 13 points. An 18-fold increased risk of developing dependence was detected in the case of coexistence of high anxiety or depression. CONCLUSIONS: The community pharmacy, through protocolized care practices and supported by tools such as the Tyrer test, can play a decisive role in the detection, prevention, and resolution of the risks associated with BZD treatments.
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Introducción: El estudio y análisis del uso prolongado de Benzodiacepinas (BZD) sigue siendo un objetivo estratégicopara todos los niveles asistenciales y en especial para la Atención Farmacéutica. Los cuestionarios como herramientade investigación científica proporcionan una escala de medición que permite evaluar y comparar individuos conparámetros de fiabilidad y validez. Objetivo: Diseñar un cuestionario de recogida de datos (CDR) que permita la personalización de la dispensación deBZD según las características de los usuarios. Método: Revisión bibliográfica de las evidencias científicas existentes con expertos en Atención Farmacéutica, diseñode la encuesta e implementación piloto (pre-testing) del CRD con usuarios de BZD, y depuración de los ítems y formatode éstos a incluir en el CDR final. Resultados: El CDR diseñado y distribuido en 8 dimensiones, abarca parámetros sociodemográficos, de conocimientode la medicación, el test de adherencia Morisky-Green, la mediación de calidad de vida por Euroqol 5D3L y escala visualEVA, el test de Pfeiffer para deterioro cognitivo, el test de dependencia a BZD, la opción de registro de la intervención farmacéutica realizada y aceptación de la misma por parte del usuario y el grado de satisfacción del paciente sobre laintervención. Conclusiones: El CDR es un innovador instrumento práctico transferible a la práctica asistencial que permite caracterizaral paciente usuario de BZD en el momento de la dispensación en la farmacia comunitaria permitiendo individualizar ysistematizar la intervención farmacéutica al tiempo que fomentar el uso seguro y eficaz de la BZD por parte del paciente.(AU)
Introduction: The study and analysis of the prolonged use of Benzodiazepines (BZD) remains a strategic objective forall levels of care and especially for Pharmaceutical Care. Questionnaires as a scientific research tool provide ameasurement scale that allows the evaluation and comparison of individuals with parameters of reliability and validity. Objective: To design a data collection questionnaire (CDR) that allows the personalization of BZD dispensing accordingto the characteristics of the usersMethods: Bibliographic review of existing scientific evidence with experts in Pharmaceutical Care, design of the surveyand pilot implementation (pre-testing) of the CRD with BZD users, and refinement of the items and their format to beincluded in the final CDR. Results: The CDR designed and distributed in 8 dimensions, covers socio-demographic parameters, knowledge ofmedication, the Morisky-Green adherence test, quality of life mediation by Euroqol 5D3L and EVA visual scale, the Pfeiffertest for cognitive impairment, the BZD dependence test, the option of recording the pharmaceutical intervention carriedout and its acceptance by the user and the degree of patient satisfaction with the interventionConclusions: The CDR is an innovative practical tool that can be transferred to healthcare practice, allowing the patientto characterize the BZD user at the time of dispensing in the community pharmacy, enabling the individualization andsystematization of the pharmaceutical intervention while promoting the safe and effective use of the BZD by the patient.(AU)
Subject(s)
Humans , Pharmacies , Benzodiazepines , Pharmaceutical Services , Products Commerce , Surveys and Questionnaires , Reproducibility of ResultsABSTRACT
Users of benzodiazepines (BZDs) should have their quality of life monitored to minimize the risks associated with long-term treatments. The aim of this study is to use the EuroQol 5D-3L to analyze the quality of life of 127 patients under treatment with BZDs during the COVID-19 pandemic. The results show that lorazepam comprises 25.49% of all dispensing requests, and that the mean duration of BZDs treatments is four years (range: 0.3-25). When rating their general health status, BZDs users reported 59.29 points out of 100. Thirty-two percent of patients reported mobility problems; 16.5% reported having a lot of pain or discomfort despite being treated with BZDs, and 16.54% used a BZD together with an opioid analgesic. The EuroQol 5D-3L dimension "anxiety/depression" showed that, despite the use of BZDs, 48.2% of the patients reported being moderately anxious or depressed and 13.4% described themselves as very anxious or depressed. Nevertheless, 37.8% of BZDs users were identified as potential candidates to follow a BZD deprescription plan. In conclusion, BZDs users showed a low quality of life during the COVID-19 pandemic. Older patients and females have been identified as groups of patients that could benefit from integrating the use of the EuroQol 5D-3L instrument into the protocols of the pharmaceutical care follow up.