Pharmacy and therapeutics committees strategy to address olmesartan safety issues at a primary care level.

Background Olmesartan, an antihypertensive drug, has been associated with a severe and potentially life-threatening sprue-like enteropathy, consisting of a serious, chronic diarrhoea and malabsorption syndrome. Treatment with this drug should be discontinued if patients develop such symptoms. Objective To retrospectively determine the reduction in olmesartan prescription following a strategy promoted by pharmacy and therapeutics committees within daily clinical practice to manage updated safety information on olmesartan. Setting Three primary healthcare centres. Method In May 2016, local pharmacy and therapeutics committees integrated by general practitioners, nursing staff and clinical pharmacists sent information about olmesartan safety issues to general practitioners, together with an individual list of their patients who were then being treated with olmesartan. Moreover, information about dose equivalents between angiotensin II receptor blockers and angiotensin II receptor blockers versus angiotensin-converting-enzyme inhibitors was also attached. The strategy aimed to promote individual benefit/risk assessment by general practitioners of the continuation of olmesartan treatment as a means to achieving a decrease in the risk of sprue-like enteropathy. The investigation team retrospectively reviewed the clinical records. Main outcome measure Reduction of olmesartan prescription. Results Olmesartan was discontinued in 44.4% of patients (197/444) in the year after the safety alert e-mail. In their medical records general practitioners registered that, after informing about olmesartan safety warnings, in four cases (0.9%), patients reported gastrointestinal symptoms. Conclusion A multidisciplinary strategy implemented to promote individual benefit/risk assessment regarding continuation of olmesartan treatment showed an important reduction in olmesartan prescriptions 1 year later.

Solicitud de VIH en condiciones indicadoras en atención primaria: resultados de una colaboración / Indicator condition guided human immunodeficiency virus requesting in primary health care: results of a collaboration

INTRODUCCIÓN: La búsqueda de pacientes con VIH mediante condiciones indicadoras (CI) es una estrategia para aumentar la detección precoz de dicho virus. El objetivo es analizar si una colaboración en 3 centros de atención primaria para concienciar de su importancia influyó en la proporción de serologías VIH solicitadas. MÉTODOS: Estudio multicéntrico, retrospectivo, de comparación basal y poscolaborativa. La colaboración consistió en sesiones formativas y la participación en el estudio HIDES (años 2009-2010). Se incluyeron pacientes entre 18 y 64 años con nuevos diagnósticos de herpes zóster, eccema seborreico, síndrome mononucleósico y leucopenia/trombocitopenia en 3 centros de atención primaria en 2008 (situación basal) y 2012 (poscolaborativa). Se evaluaron variables sociodemográficas, condicionantes de riesgo para VIH, solicitud de serología de VIH y resultado. RESULTADOS: Se incluyeron 1.219 CI (558 en 2008 y 661 en 2012). En 2008, el número de solicitudes de pruebas de VIH en pacientes con una CI fue del 3,9% y aumentó al 11,8% en 2012 (p < 0,0001). La tasa de infección por VIH fue del 2,2% (IC95%: 0,4-7,3) (n = 2). Se estimó que se habrían diagnosticado 25 nuevos casos (12 en 2008 y 13 en 2012) si se hubiera hecho la prueba a todos los pacientes con CI. Los factores predictores de solicitud del VIH fueron tener una CI en el año 2012, una menor edad, tener un síndrome mononucleósico y no ser español. CONCLUSIONES: Tras la colaboración con atención primaria, se triplicó la petición de VIH. Sin embargo, no se solicitó en el 88%, implicando pérdidas diagnósticas. Son necesarias nuevas estrategias para mejorar la detección precoz de VIH

INTRODUCTION: The search of HIV infected patients guided by indicator conditions (IC) is a strategy used to increase the early detection of HIV. The objective is to analyze whether a collaboration to raise awareness of the importance of early detection of HIV in 3 primary care centers influenced the proportion of HIV serology requested. METHODS: Multicenter retrospective study was conducted comparing the baseline and a post-collaboration period. The collaboration consisted of training sessions and participation in the HIDES study (years 2009-2010). Patients between 18 and 64 years old with newly diagnosed herpes zoster, seborrheic eczema, mononucleosis syndrome, and leucopenia/thrombocytopenia in 3 primary care centers in 2008 (baseline period) and 2012 (post-collaboration period). The sociodemographic variables, HIV risk conditions, requests for HIV serology, and outcomes were evaluated. RESULTS: A total of 1,219 ICs were included (558 in 2008 and 661 in 2012). In 2008 the number of HIV tests in patients with an IC was 3.9%, and rose to 11.8% in 2012 (P < .0001). The HIV infection rate was 2.2% (95% CI: 0.4-7.3) (n = 2). It was estimated that 25 new cases (12 in 2008 and 13 in 2012) would have been diagnosed if they had performed the test on all patients with IC. Predictors of HIV request were, having an IC in 2012, a younger age, having an mononucleosis syndrome, and not being Spanish. CONCLUSIONS: The HIV request demand tripled, after the collaboration with primary care centers, however in 88% the test was not requested, resulting in diagnostic losses. New strategies are needed to raise awareness of the importance of early detection of HIV

[Indicator condition guided human immunodeficiency virus requesting in primary health care: results of a collaboration]. / Solicitud de VIH en condiciones indicadoras en atención primaria: resultados de una colaboración.

INTRODUCTION: The search of HIV infected patients guided by indicator conditions (IC) is a strategy used to increase the early detection of HIV. The objective is to analyze whether a collaboration to raise awareness of the importance of early detection of HIV in 3 primary care centers influenced the proportion of HIV serology requested. METHODS: Multicenter retrospective study was conducted comparing the baseline and a post-collaboration period. The collaboration consisted of training sessions and participation in the HIDES study (years 2009-2010). Patients between 18 and 64 years old with newly diagnosed herpes zoster, seborrheic eczema, mononucleosis syndrome, and leucopenia/thrombocytopenia in 3 primary care centers in 2008 (baseline period) and 2012 (post-collaboration period). The sociodemographic variables, HIV risk conditions, requests for HIV serology, and outcomes were evaluated. RESULTS: A total of 1,219 ICs were included (558 in 2008 and 661 in 2012). In 2008 the number of HIV tests in patients with an IC was 3.9%, and rose to 11.8% in 2012 (P<.0001). The HIV infection rate was 2.2% (95% CI: 0.4-7.3) (n=2). It was estimated that 25 new cases (12 in 2008 and 13 in 2012) would have been diagnosed if they had performed the test on all patients with IC. Predictors of HIV request were, having an IC in 2012, a younger age, having an mononucleosis syndrome, and not being Spanish. CONCLUSIONS: The HIV request demand tripled, after the collaboration with primary care centers, however in 88% the test was not requested, resulting in diagnostic losses. New strategies are needed to raise awareness of the importance of early detection of HIV.