Satisfacción percibida por los pacientes y por el personal auxiliar de farmacia del área de atención a pacientes externos como método de mejora de la calidad / Satisfaction perceived by outpatients and pharmacy auxiliaries in a Hospital Pharmacy Department, as a method of improving quality

Objetivo. Evaluar el grado de satisfacción de pacientes atendidos y auxiliares de farmacia del área de pacientes externos del servicio de farmacia tras una reestructuración del espacio y del procedimiento de dispensación. Métodos. Tres meses después de la reestructuración del área (enero de 2009), se entregaron encuestas de satisfacción (anónimas y voluntarias) durante 2 semanas a una muestra de los 3.300 pacientes/mes atendidos y a los auxiliares que trabajaron en ella. Ambas constaban de ocho preguntas cerradas con formato tipo Likert referentes al espacio físico, la organización, la dispensación y la satisfacción global (variable principal) más una pregunta abierta para recoger sugerencias. Resultados. Recibieron la encuesta 265 pacientes (tasa de respuesta, 94%). El aspecto mejor valorado fue la confidencialidad (4,2±0,7) y el peor, la zona de espera (3,2±1). Se entregaron y se contestaron 26 encuestas por parte de los auxiliares. La mayor puntuación se obtuvo en la instalación del lector del código de barras (3,9±0,6) y la menor, en la organización del almacén (3,1±1,2). En la pregunta abierta se recogieron comentarios sobre falta de personal, dificultad del sistema informático, organización y poca claridad de las prescripciones. El grado de satisfacción global de los pacientes fue de 4,2±0,6 y el de los auxiliares, 3,7±0,7. Conclusiones. Los resultados nos han proporcionado una información útil para evaluar cambios y detectar puntos de mejora. En la mayoría de las cuestiones se ha detectado un mayor grado de satisfacción en los pacientes que en los trabajadores. Son necesarias nuevas acciones de mejora en el espacio físico y en la organización(AU)

Objectives. To evaluate the satisfaction of pharmacy auxiliaries, and patients attending the Outpatient Pharmacy, after the restructuring of the physical space and the process of dispensing drugs. Methods. Three months after the restructuring of the Area (January 2009), we gave satisfaction surveys (anonymously and voluntarily) over 2weeks, to a sample of the 3,300 patients who came per month and another to pharmacy auxiliaries who had worked in the area. The surveys consisted of eight closed questions with a Likert-type format about the physical space and organization, dispensing process and overall satisfaction (primary endpoint). In addition, there was an open question to gather suggestions. Results. A total of 265 patients received the questionnaire (response rate 94%). The most valued aspect was the confidentiality (4.2±0.7) and the worst was the waiting area (3.2±1). There was a 100% response rate from the 26 pharmacy auxiliaries who received the questionnaire. The highest score was obtained by the installation of the bar-code reader (3.9±0.6) and the lowest for organization of the stores (3.1±1.2). They added comments about the lack of personnel, computer systems, organization of space and the lack of clarity of the prescription. The overall patient satisfaction was 4.2±0.6 and that of the auxiliaries was 3.7±0.7. Conclusions. The results of patients and employees satisfaction surveys have been useful information to assess changes in the area and identify points for improvement. In most of the issues the satisfaction was greater in patients than employees. We believe it is necessary to carry out actions for improving physical space and organization(AU)

[Satisfaction perceived by outpatients and pharmacy auxiliaries in a Hospital Pharmacy Department, as a method of improving quality]. / Satisfacción percibida por los pacientes y por el personal auxiliar de farmacia del área de atención a pacientes externos como método de mejora de la calidad.

OBJECTIVES: To evaluate the satisfaction of pharmacy auxiliaries, and patients attending the Outpatient Pharmacy, after the restructuring of the physical space and the process of dispensing drugs. METHODS: Three months after the restructuring of the Area (January 2009), we gave satisfaction surveys (anonymously and voluntarily) over 2 weeks, to a sample of the 3,300 patients who came per month and another to pharmacy auxiliaries who had worked in the area. The surveys consisted of eight closed questions with a Likert-type format about the physical space and organization, dispensing process and overall satisfaction (primary endpoint). In addition, there was an open question to gather suggestions. RESULTS: A total of 265 patients received the questionnaire (response rate 94%). The most valued aspect was the confidentiality (4.2 ± 0.7) and the worst was the waiting area (3.2 ± 1). There was a 100% response rate from the 26 pharmacy auxiliaries who received the questionnaire. The highest score was obtained by the installation of the bar-code reader (3.9 ± 0.6) and the lowest for organization of the stores (3.1 ± 1.2). They added comments about the lack of personnel, computer systems, organization of space and the lack of clarity of the prescription. The overall patient satisfaction was 4.2 ± 0.6 and that of the auxiliaries was 3.7 ± 0.7. CONCLUSIONS: The results of patients and employees satisfaction surveys have been useful information to assess changes in the area and identify points for improvement. In most of the issues the satisfaction was greater in patients than employees. We believe it is necessary to carry out actions for improving physical space and organization.

Continuidad del seguimiento farmacoterapéutico en los pacientes polimedicados después del alta hospitalaria / Continuity of pharmacotherapy follow-up in polymedicated patients after hospital discharge

Objetivo: Dar continuidad al seguimiento farmacoterapéutico delos pacientes polimedicados, después del alta hospitalaria, mediante la coordinación de los médicos y farmacéuticos del hospital con los médicos de atención primaria y los farmacéuticos comunitarios. Métodos: Estudio prospectivo, comparativo, realizado en la unidad de pluripatologías de nuestro hospital, en los centros de salud y en las oficinas de farmacia que atienden a los pacientes. Durante 6 meses se entrevistó a los pacientes ingresados (≥65 años, con ≥5 medicamentos al alta y autosuficientes para adquirir y tomar su medicación) a fin de conocer su adherencia y quién les informaba habitualmente sobre su tratamiento. Al alta, recibieron información verbal y escrita sobre sus medicamentos y se evaluaron sus conocimientos al respecto. Los pacientes de los centros de salud participantes fueron asignados al grupo de intervención y recibieron información estandarizada por parte de su médico de cabecera y su farmacéutico comunitario. El resto (grupo control) recibieron la atención habitual. Un mes después del alta, se entrevistó telefónicamente a los pacientes para conocer quién les había proporcionado información y si habían mejorado sus conocimientos y su cumplimiento. Resultados: Se incluyeron 108 pacientes, de los que 53 se asignaron al grupo de intervención (77,8 ± 6,4 años) y 55 al grupo control (77,5 ± 8,8 años), con 8,4 ± 2,1 y 8,9 ± 3,7 medicamentos prescritos alta, respectivamente. Participaron 11 centros de salud y 43 oficinas de farmacia. Un mes después del alta, el porcentaje de pacientes informados por el farmacéutico comunitario aumentó del 11 al 54% en el grupo de intervención, mientras que en el grupo control no se incrementó. El 35% de los pacientes del grupo de intervención habían mejorado sus conocimientos sobre los medicamentos, frente al 8% del grupo control. El incremento de los pacientes adherentes fue mayor en el grupo de intervención (25%) que en el grupo control (10%). Conclusiones: La coordinación entre hospital, centro de salud y oficina de farmacia ha permitido que el paciente reciba una información sobre medicamentos estandarizada y continuada en el tiempo, que estimamos que ha contribuido a mejorar el uso de los medicamentos y a aumentar la adherencia al tratamiento (AU)

Objective: To give continuity of pharmacotherapy follow-up inpolymedicated patients after hospital discharge based on coordination of the hospital physicians and pharmacists with the primary care physicians and the community pharmacists. Methods: A prospective, comparative study was made in the Pluripathology Unit of the Hospital, in the Health Centers and in the patients Community Pharmacies. During 6 months, the admitted patients (≥ 65 years, with≥ 5 drugs at discharge and self-sufficiency to acquire and take their medication) were interviewed to determine their adherence and who had informed them usually of their treatment. At discharge, the patients received verbal and written drug information and their knowledge about them was evaluated. The patients of the participating Health Centers were assigned to the intervention group and received standardized information from their primary care physician and community pharmacist. The rest (control group) received the usual care. One month after discharge, the patients were interviewed by telephone to determine who provided them with information and whether their knowledge and adherence had improved. Results: A total of 108 patients were included: 53 were assigned to the intervention group (77.8 ± 6.4 years) and 55 to the control group (77.5 ± 8.8 years). With 8.4 ± 2.1 and 8.9 ± 3.7 drugs prescribed at the time of discharge. Eleven Health Centers and 43 Community Pharmacies participated in this study. One month after discharge, the percentage of patients informed by the community pharmacist increased from 11% to 54% in the intervention group, while no increase was recorded in the control group. In turn, 35% of the patients in the intervention group had improved their knowledge of the medication, versus8% in the control group. Conclusions: The coordination among the Hospital, Health Center and Community Pharmacy has allowed the patients to receive standardized and continued information on their medications. We consider that this in turn has contributed to improve drug use and adherence to therapy (AU)

[Role of new biological therapy in psoriasis treatment]. / Papel de los nuevos tratamientos biológicos en la psoriasis.

Psoriasis is an inflammatory disease mediated by immune system T cells. The use of current systemic immunosuppressive therapies is limited by an inability to maintain disease remission safely knowledge on. Advances in recombinant DNA technology and the increase in knowledge on psoriasis immunopathology knowledge have led to the development of numerous biologic agents for the treatment of the disease. In this review the mechanisms of action for these new agents, as well as their safety profiles and efficacy data have been analyzed.

[Use of maintenance fluid therapy in surgery]. / Utilizacíon de fluidterapia de maintenimiento en cirurgía.

OBJECTIVE: To analyze the use of various maintenance fluid therapy regimens, as well as their adequacy to hospital recommendations, in adult in-patients admitted to a general surgery ward during 1 year. MATERIAL AND METHODS: Data on solution type and volume, fluid therapy regimen, and duration in days were retrospectively collected for each administered solution from computerized medical orders within the Unit-Dose Drug Distribution Area. A database was developed including the composition of available solutions within our hospital, so that electrolytes, glucose and volumes administered may be calculated. RESULTS: Out of 354 patients undergoing fluid therapy 125 were selected to receive maintenance regimens. Fluid therapy was administered for more than 5 days in 31% of patients. The most commonly supplied fluids were 5% glucose (43%) and 0.9% saline + 1500 mL of 5% glucose + 60 mEq potassium chloride (CIK). Amongst patients receiving the recommended volume/day (84%) 50% received sodium and potassium more than twice as much the recommended amount, and 70% received glucose amounts not covering minimal daily requirements. Potassium was administered according to recommendations in 85% of patients. CONCLUSIONS: There is an excessive use of 0.9% saline and 5% glucose to the detriment of 1/3 glucosaline and 10% glucose, which translates as an excessive daily sodium and defective daily glucose provision. In our hospital we have recommended maintenance fluid therapy regimens, as well as fluids more appropriate for postoperative electrolyte replacement; however, their use is still deficient.