Pharmaceutical recommendations for therapeutic appropriateness in multiple sclerosis patients. / Recomendaciones farmacéuticas de adecuación terapéutica en pacientes con esclerosis múltiple.

OBJECTIVE: To determine the prevalence of PIMDINAC criteria and to implement pharmacological interventions in a population with multiple sclerosis over 55 years of age. METHODS: Retrospective observational open-label study including patients with multiple sclerosis aged 55 years and older between December 2022 and February 2023. The main variable determined was the percentage of compliance with the PIMDINAC criteria. RESULTS: Ninety-five patients were included, with the presence of PIMDINAC criteria detected in 67.4%. The most frequently detected criterion was non-adherence to concomitant treatment (84,4%), followed by drug-drug interactions (56.2%) and potentially inappropriate medication (25%). A total of 20 pharmaceutical interventions were performed in 17 patients (17.9%). Potentially inappropriate medication was responsible for 11 interventions, non-adherence for 7 and drug-drug interactions for 2. The 81.8% of interventions were accepted, resulting in the discontinuation of 15 inappropriately prescribed drugs. The prevalence of PIMDINAC criteria in this group of patients is high. The study revealed that PIMDINAC criteria were prevalent in 67.4% of the study population, with polypharmacy playing an important role, suggesting the potential for a multidisciplinary approach, through pharmaceutical interventions to address unnecessary or duplicate treatments.

Clinical and Ecological Impact of an Educational Program to Optimize Antibiotic Treatments in Nursing Homes (PROA-SENIOR): A Cluster, Randomized, Controlled Trial and Interrupted Time-Series Analysis.

BACKGROUND: Antimicrobial stewardship programs (ASPs) are recommended in nursing homes (NHs), although data are limited. We aimed to determine the clinical and ecological impact of an ASP for NHs. METHODS: We performed a cluster, randomized, controlled trial and a before-after study with interrupted time-series analyses in 14 NHs for 30 consecutive months from July 2018 to December 2020 in Andalusia, Spain. Seven facilities implemented an ASP with a bundle of 5 educational measures (general ASP) and 7 added 1-to-1 educational interviews (experimental ASP). The primary outcome was the overall use of antimicrobials, calculated monthly as defined daily doses (DDD) per 1000 resident days (DRD). RESULTS: The total mean antimicrobial consumption decreased by 31.2% (-16.72 DRD; P = .045) with respect to the preintervention period; the overall use of quinolones and amoxicillin-clavulanic acid dropped by 52.2% (P = .001) and 42.5% (P = .006), respectively; and the overall prevalence of multidrug-resistant organisms (MDROs) decreased from 24.7% to 17.4% (P = .012). During the intervention period, 12.5 educational interviews per doctor were performed in the experimental ASP group; no differences were found in the total mean antimicrobial use between groups (-14.62 DRD; P = .25). Two unexpected coronavirus disease 2019 waves affected the centers increasing the overall mean use of antimicrobials by 40% (51.56 DRD; P < .0001). CONCLUSIONS: This study suggests that an ASP for NHs appears to be associated with a decrease in total consumption of antimicrobials and prevalence of MDROs. This trial did not find benefits associated with educational interviews, probably due to the coronavirus disease 2019 pandemic. Clinical Trials Registration. NCT03543605.

Pharmacist-driven antimicrobial stewardship program in a long-term care facility by assessment of appropriateness.

METHODS: A prospective quasi-experimental study to implement an ASP in a LTCF. Antibiotic prescriptions for suspected infections initiated in any setting for LTCF residents were included. We assessed appropriateness and prospective audits and feedback of each inappropriate antimicrobial prescription were carried out. Associations of variables with appropriate antibiotic prescribing were estimated using logistic regression. RESULTS: A total of 416 antibiotic prescriptions were included. The mean consumption of antibiotics was reduced from 63.2 defined daily doses per 1000 residents days (DRD) in the preintervention period to 22.8 in the intervention period (- 63.8%), with a significant drop in fluoroquinolones (81.4%). Overall, 46.6% of antibiotic prescriptions were judged inappropriate, mainly because of a use not recommended in treatment guidelines (63.2%). Multivariable analysis showed that empirical therapy, some classes of antibiotics (cephalosporins, fluoroquinolones, fosfomycin calcium, macrolides) and prescription initiation in the emergency department were independent predictors of antimicrobial inappropriateness. CONCLUSIONS: Pharmacist-led ASP in a LTCF has being effective in reducing consumption of antibiotics by improving appropriateness of treatment decisions. However, ASP should include interventions in the emergency department because of the high inappropriate use in this setting.

Pharmacist-led antimicrobial stewardship programme in a small hospital without infectious diseases physicians.

Pharmacists may be tasked to lead antibiotic stewardship programmes (ASP) implementation in small hospitals in absence of infectious diseases (ID) physicians. The objectives are to evaluate the effectiveness of a pharmacist-led ASP in a hospital without ID physician support, with special focus on indicators of the hospital use of antimicrobial agents based on consumption and asess the potential clinical and economic impact of pharmacist interventions (PIs) through the CLEO tool. A prospective quasi-experimental study to implement an ASP in a 194-bed hospital. We evaluated changes in antimicrobial use measured as mean defined daily doses per 1000 patient-days (AUD) for intervention versus preintervention period. A total of 847 antimicrobial PIs were proposed, being 88.3% accepted. Discontinuation due to excessive duration was the most frequently performed PI (23.4%). Most of PIs was classified as major or moderate clinical impact, 41.7% and 37.8% respectively. The global consumption of antimicrobial was reduced from 907.1 to 693.8 AUD, with a signifcant drop in carbapenems and quinolones. Direct expenditure of antibiotics decreased significantly. Pharmacist-led ASP has being effective in reducing consumption of antibiotics. In the absence of ID physician´s support and oversight, pharmacists could lead the improvement of the use of antimicrobials.

Pharmacist-driven antimicrobial stewardship program in a long-term care facility by assessment of appropriateness.

Antimicrobials are the most frequently prescribed drugs in long-term care facilities (LTCF). Antibiotic stewardship programs (ASP) are coordinated interventions promoting the responsible use of antibiotics to improve patient outcomes and reduce antibiotic resistant bacterias. The objectives are to evaluate the effectiveness of a pharmacist-led ASP in a LTCF, to characterise antibiotic therapy and assess the appropriateness of antibiotic prescriptions. A prospective quasi-experimental study to implement an ASP in a LTCF. Antibiotic prescriptions for suspected infections initiated in any setting for LTCF residents were included. We assessed appropriateness and prospective audits and feedback of each inappropriate antimicrobial prescription were carried out. Associations of variables with appropriate antibiotic prescribing were estimated using logistic regression. A total of 416 antibiotic prescriptions were included. The mean consumption of antibiotics was reduced from 63.2 defined daily doses per 1000 residents-days (DRD) in the preintervention period to 22.8 in the intervention period (- 63.8%), with a signifcant drop in fluoroquinolones (81.4%). Overall, 46.6% of antibiotic prescriptions were judged inappropriate, mainly because of a use not recommended in treatment guidelines (63.2%). Multivariable analysis showed that empirical therapy, some classes of antibiotics (cephalosporins, fluoroquinolones, fosfomycin calcium, macrolides) and prescription initiation in the emergency department were independent predictors of antimicrobial inappropriateness. Pharmacist-led ASP in a LTCF has being effective in reducing consumption of antibiotics by improving appropriateness of treatment decisions. However, ASP should include interventions in the emergency department because of the high inappropriate use in this setting.

Conciliación de la medicación al ingreso en el servicio de cirugía ortopédica y traumatológica / Medication reconciliation at admission to The Orthopaedic Surgery and Traumatology Department

INTRODUCCIÓN: Identificar las discrepancias existentes entre la medicación prescrita al ingreso en el servicio de traumatología y la medicación habitual de los pacientes, determinar la prevalencia de errores de conciliación y analizar el grado de aceptación de las intervenciones farmacéuticas realizadas para su resolución. MÉTODO: Estudio prospectivo de dos años de duración en un hospital comarcal público de España donde se seleccionaron los pacientes ingresados en traumatología con algún medicación domiciliario prescrito. Tras 24-48 horas del ingreso, el farmacéutico realizó la conciliación de la medicación, comparando la orden médica prescrita al ingreso con el tratamiento domiciliario. Se identificaron las discrepancias comunicándose al médico y se analizó el grado de aceptación de las recomendaciones. RESULTADOS: Se incluyeron 756 pacientes, con un total de 834 episodios de hospitalización; 66,1% mujeres, edad media: 72 ± 12,3 años, media de medicamentos domiciliarios por paciente: 8,1 ± 4,3. Se analizaron 8422 prescripciones, identificándose un 57,5% de discrepancias. La mayoría de las discrepancias no justificadas se debieron a omisión de medicamento (75%) seguido de la modificación de la posología o vía de un medicamento (19,1%). En el 87,4% de los episodios se encontró al menos una discrepancia. Las recomendaciones propuestas por el farmacéutico fueron aceptadas en el 69,9% de los casos. CONCLUSIONES: Existe un alta prevalencia de errores de conciliación al ingreso en el servicio de traumatología. Esta metodología ha permitido la coordinación del farmacéutico con el resto de profesionales implicados en la conciliación de la medicación, con el fin de detectar y resolver las discrepancias de medicación y reducir así los errores

INTRODUCTION: We aim to describe a method that would ensure continuity of patient care as regards drug therapy at admission to the orthopaedic surgery and traumatology department, identify the reconciliation discrepancies, determine the prevalence of reconciliation errors and analyse the acceptance of the pharmacist interventions. METHODS: Prospective observational study was conducted for two years in a regional public hospital in Spain. The study included patients hospitalized in the Orthopaedic Surgery and Traumatology Department with chronic medi¬cation prescribed. At 24-48 hours after hospital admission, the pharmacist compared the pre-admission pharmaco¬logical treatment of patients with the medication received in hospital to identify and reconciliation discrepancies. They were communicated and we analysed the acceptance of the pharmacist interventions. RESULTS: The study included 756 patients, with a total of 834 hospitalization episodes, 66,1% of whom were women, mean age: 72±12,3 years and a mean of 8,1±4,3 drugs. We analysed 8422 prescriptions, 57,5% reconciliation discrep¬ancies. The most frequent unjustified discrepancies were drug omission (75,2%), following by modification of the dose or route of administration (19,1%). There was at least one medication reconciliation discrepancy in 87,4% of hospitalization episodes. Pharmacist recommendations were accepted in 69,9% of cases. CONCLUSIONS: There was a high prevalence of reconciliation errors among patients admitted to the Orthopaedic Surgery and Traumatology Department. This methodology has allowed a workflow to be established that facilitates coordination between the pharmacist and others healthcare providers, to identify and resolve medication discrepancies to reduce medication errors

Variabilidad de la prestación farmacéutica a centros sociosanitarios residenciales desde los servicios de farmacia de hospital / Variability of pharmaceutical provision to nursing homes from hospital pharmacy services

Objetivo: Analizar la situación y la posible variabilidad de la prestación farmacéutica a centros sociosanitarios residenciales públicos incluidos en un proyecto piloto vinculados a un servicio de farmacia de hospital del Servicio Andaluz de Salud. Método: Estudio multicéntrico transversal. Se diseñó un cuestionario que incluye preguntas englobadas en: características del centro, legislación, guía farmacoterapéutica y prescripción, preparación y transporte, dispensación, administración, actividad farmacéutica y datos asistenciales. Resultados: Se incluyeron los 13 centros del proyecto piloto; todos respondieron las 36 preguntas del cuestionario. Todos disponían de depósito de medicamentos. Todos dispensaban en dosis unitaria individualizada. Tres centros sociosanitarios no disponían de puesto de trabajo para el farmacéutico. El farmacéutico no se desplazaba al centro en tres de ellos. Conclusiones: Aunque existe cierta variabilidad en la prestación farmacéutica a los centros sociosanitarios del pilotaje, se han identificado tanto fortalezas (por ejemplo, dispensación de medicamentos en dosis unitaria), como puntos de mejora (como el aumento de la presencia del farmacéutico en los centros)

Objective: To analyse the situation and the possible variability of pharmaceutical provision to public nursing homes included in the "Project pilot" from hospital pharmacy services of the Andalusian Health Service. Method: Cross-sectional multicenter study. A questionnaire of 36 questions including: nursing homes characteristics, legislation, pharmacotherapeutic guide and prescription, preparation and transport, dispensation, administration, pharmaceutical activity and healthcare data. Results: We included 13 nursing homes. Everyone had a medicines store. All dispensed in individualized unit dose. Three nursing homes did not have a work space for the pharmacist. The pharmacist did not move to the nursing home in three of them. Conclusions: Although there is variability in the pharmaceutical provision to nursing homes included in the "Pilot Project", we have identified strengths (unit dose system of medication distribution) and opportunities to improve (increase of the time of presence of the pharmacist in the nursing homes)

[Variability of pharmaceutical provision to nursing homes from hospital pharmacy services]. / Variabilidad de la prestación farmacéutica a centros sociosanitarios residenciales desde los servicios de farmacia de hospital.

OBJECTIVE: To analyse the situation and the possible variability of  pharmaceutical provision to public nursing homes included in the "Project  pilot" from hospital pharmacy services of the Andalusian Health Service. METHOD: Cross-sectional multicenter study. A questionnaire of 36 questions including: nursing homes characteristics, legislation,  pharmacotherapeutic guide and prescription, preparation and transport,  dispensation, administration, pharmaceutical activity and healthcare data. RESULTS: We included 13 nursing homes. Everyone had a medicines store. All  dispensed in individualized unit dose. Three nursing homes did not have  a work space for the pharmacist. The pharmacist did not move to the nursing  home in three of them. CONCLUSIONS: Although there is some variability in the pharmaceutical provision to nursing homes included in the "Pilot Project", we  have identified strengths such as the dispensing of medicines as unit  dose system and opportunities to improve such as the increase of the  pharmacist's presence in nursing homes.

Objetivo: Analizar la situación y la posible variabilidad de la prestación farmacéutica a centros sociosanitarios residenciales públicos  incluidos en un proyecto piloto vinculados a un servicio de farmacia de hospital del Servicio Andaluz de Salud.Método: Estudio multicéntrico transversal. Se diseñó un cuestionario que incluye preguntas englobadas en: características del centro, legislación, guía farmacoterapéutica y prescripción, preparación y transporte, dispensación, administración, actividad farmacéutica y datos asistenciales.Resultados: Se incluyeron los 13 centros del proyecto piloto; todos  respondieron las 36 preguntas del cuestionario. Todos disponían de depósito de medicamentos. Todos dispensaban en dosis unitaria  individualizada. Tres centros sociosanitarios no disponían de puesto de  trabajo para el farmacéutico. El farmacéutico no se desplazaba al centro en  tres de ellos. Conclusiones: Aunque existe cierta variabilidad en la prestación  farmacéutica a los centros sociosanitarios del pilotaje, se han identificado fortalezas, como la dispensación de medicamentos en dosis  unitaria, y puntos de mejora como el aumento de la presencia del  farmacéutico en los centros.

Adequancy of treatment with canaglifozin alter alerts pharmacovigilance in the health management área / Adecuación del tratamiento con canaglifozina tras alerta de farmacovigilancia en un área de gestión sanitaria

Objective: To analyze the impact of a strategy on the suitability of canaglizozin, and its level of acceptance, after issuing recommendations based on drug surveillance alerts issued by the Spanish Medicines and Medical Devices Agency (AEMPS). Method: A prospective intervention from may 2016 to october 2016. Location: South Seville Health Management Area. Participants: Patients with active canagliflozin prescription. Interventions: The study was conducted in three phases, the first one linked to the issuance of the safety information note on the canaglifozin by the AEMPS, the obtaining of the patient lists and the recommendations of the adequacy in the sending of letters. A second phase where the medical professional performed the actions and a final phase in which the degree of acceptance of the recommendations made by the Pharmacy Service is evaluated. Main measurements: Suitability of canaglizozin treatment and the level of acceptance by physicians. Results: A total of 61 patients at baseline were included in treatment canagliflozin. Of the total number of patients referred to, some type of intervention was performed by the family and community medicine doctor after the pharmaceutical intervention (PI), by means of letters (n = 30), 56.7% were monitored, 33.3% were discontinued and 10.0% were closely monitored Conclusions: Interventions aimed at reviewing patients on canagliptin, based on pharmacovigilance alerts, have been effective, with a high degree of acceptance by the family and community medicine practitioner (AU)

Objetivo: Analizar el impacto de una estrategia de adecuación de canaglifozina tras la emisión de recomendaciones en base a las notas de farmacovigilancia emitidas por la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), así como el grado de aceptación. Método: Estudio prospectivo de intervención desde mayo de 2016 a octubre de 2016. Emplazamiento: Área de Gestión Sanitaria Sur de Sevilla. Participantes: Pacientes con prescripción activa de canaglifozina. Intervenciones: Se realizó en tres fases: la primera ligada a la emisión de una nota informativa de seguridad sobre canaglifozina por la AEMPS, la obtención de listados de pacientes y las recomendaciones de adecuación mediante cartas, una segunda fase en la que el médico realizaba las actuaciones y una última fase en la cual se evalúo el grado de aceptación de las recomendaciones. Variables principales: Adecuación del tratamiento con canaglifozina y grado de aceptación de las recomendaciones por los facultativos médicos. Resultados: Se incluyeron un total de 61 pacientes en nuestro estudio en tratamiento con canaglifozina. Del total de los pacientes a los que se les realizó algún tipo de intervención por el médico de atención primaria tras la intervención farmacéutica (IF), realizada mediante el envío de cartas (n=30), al 56,7% se les monitorizó, al 33,3% se le suspendió el tratamiento y al 10,0% se les vigiló estrechamente. Conclusiones: Las intervenciones dirigidas a la revisión de pacientes en tratamiento con canaglizozin, en base a las alertas de farmacovigilancia, han sido efectivas, con un alto grado de aceptación por el especialista en medicina familiar y comunitaria (AU)

Adequancy of treatment with canaglifozin alter alerts pharmacovigilance in the health management area.

OBJECTIVE: To analyze the impact of a strategy on the suitability of canaglizozin, and its level of acceptance, after issuing recommendations based on drug surveillance alerts issued by the Spanish Medicines and Medical Devices Agency (AEMPS). DESIGN: A prospective intervention from may 2016 to october 2016. Location: South Seville Health Management Area. Participants: Patients with active canagliflozin prescription. Interventions: The study was conducted in three phases, the first one linked to the issuance of the safety information note on the canaglifozin by the AEMPS, the obtaining of the patient lists and the recommendations of the adequacy in the sending of letters. A second phase where the medical professional performed the actions and a final phase in which the degree of acceptance of the recommendations made by the Pharmacy Service is evaluated. MAIN MEASUREMENTS: Suitability of canaglizozin treatment and the level of acceptance by physicians. RESULTS: A total of 61 patients at baseline were included in treatment canagliflozin. Of the total number of patients referred to, some type of intervention was performed by the family and community medicine doctor after the pharmaceutical intervention (PI), by means of letters (n = 30), 56.7% were monitored, 33.3% were discontinued and 10.0% were closely monitoredConclusions: Interventions aimed at reviewing patients on canagliptin, based on pharmacovigilance alerts, have been effective, with a high degree of acceptance by the family and community medicine practitioner.

Objetivo: Analizar el impacto de una estrategia de adecuación de canaglifozina tras la emisión de recomendaciones en base a las notas de farmacovigilancia emitidas por la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), así como el grado de aceptación.Diseño: Estudio prospectivo de intervención desde mayo de 2016 a octubre de 2016.Emplazamiento: Área de Gestión Sanitaria Sur de Sevilla. Participantes: Pacientes con prescripción activa de canaglifozina. Intervenciones: Se realizó en tres fases: la primera ligada a la emisión de una nota informativa de seguridad sobre canaglifozina por la AEMPS, la obtención de listados de pacientes y las recomendaciones de adecuación mediante cartas, una segunda fase en la que el médico realizaba las actuaciones y una última fase en la cual se evalúo el grado de aceptación de las recomendaciones.Variables principales: Adecuación del tratamiento con canaglifozina y grado de aceptación de las recomendaciones por los facultativos médicos.Resultados: Se incluyeron un total de 61 pacientes en nuestro estudio en tratamiento con canaglifozina. Del total de los pacientes a los que se les realizó algún tipo de intervención por el médico de atención primaria tras la intervención farmacéutica (IF), realizada mediante el envío de cartas (n=30), al 56,7% se les monitorizó, al 33,3% se le suspendió el tratamiento y al 10,0% se les vigiló estrechamente.Conclusiones: Las intervenciones dirigidas a la revisión de pacientes en tratamiento con canaglizozin, en base a las alertas de farmacovigilancia, han sido efectivas, con un alto grado de aceptación por el especialista en medicina familiar y comunitaria.

Suitability of teriparatide and level of acceptance of pharmacotherapeutic recommendations in a healthcare management area.

OBJECTIVE: To analyse the suitability of teriparatide prescriptions for osteoporosis treatment in a health management area, as well as the level of acceptance of pharmacotherapeutic recommendations made to physicians. DESIGN: A prospective interventional study conducted from february 2015 to june 2015. SETTING: South Seville Health Management Area. PARTICIPANTS: Patients receiving teriparatide. MAIN MEASUREMENTS: Suitability of teriparatide prescriptions according to Clinical Practice Guidelines and level of acceptance of pharmacotherapeutic recommendations. RESULTS: Teriparatide prescriptions were unsuitable in 45 patients (68.2%); 11 due to no indication, 17 patients did not have previous treatments with first-line drugs, 6 due to contraindications and 9 patients were treated for more than 24 months with the drug. Besides, 4 prescriptions were unsuitable because of combination with other therapies. The acceptance of pharmacotherapeutic recommendations was 64.4%, leading to teriparatide discontinuation in 21 patients (72.4%), and a switch to alendronate or ibandronate in another 8 patients. CONCLUSIONS: A high percentage of teriparatide prescriptions is unsuitable in our health care management area, but it has decreased after pharmacist intervention.

Objetivo: Analizar la adecuación de la prescripción de teriparatida en el tratamiento de la osteoporosis en un área de gestión sanitaria, así como el grado de aceptación por el médico de las recomendaciones de intervención realizadas. Diseño: Estudio prospectivo de intervención desde febrero de 2015 a junio de 2015. Emplazamiento: Área de Gestión Sanitaria Sur de Sevilla. Participantes: Pacientes con prescripción activa de teriparatida. Mediciones principales: Adecuación de la prescripción de teriparatida y grado de aceptación por el médico de las recomendaciones farmacoterapéuticas. Resultados: La prescripción de teriparatida fue inadecuada en 45 pacientes (68,2%). Once pacientes no cumplían los criterios de tratamiento, mientras que 17 no habían tenido prescrito previamente otro medicamento para la prevención de fracturas. Seis pacientes presentaban alguna contraindicación. En 9 pacientes la duración de la terapia fue superior a los 24 meses recomendados. Cuatro de ellas (dos ya inadecuadas) por combinación inadecuada con otros medicamentos. El grado de aceptación de las recomendaciones farmacoterapéuticas realizadas por farmacia fue del 64,4%, produciéndose en 21 pacientes (72,4%) la suspensión de teriparatida y en 8, el cambio a otro medicamento de primera línea: ibandrónico, en tres de ellos, y alendrónico, en el resto. Conclusiones: El número de pacientes con prescripciones inadecuadas de teriparatida es elevado en nuestra área, pero ha disminuido tras realizar intervenciones con recomendaciones farmacoterapéuticas de adecuación del tratamiento.

Persistence to single-tablet regimen versus less-drug regimen in treatment experienced HIV-infected patients on antiretroviral therapy.

BACKGROUND: Decreased antiretroviral therapy persistence is associated with increased rates of virologic failure, development of antiretroviral resistance, and increased morbidity and mortality. Different therapeutic strategies, such as single-tablet regimens (STR) and less-drug regimens (LDR), have been developed in order to simplify antiretroviral therapy (ART) and increase persistence. OBJECTIVES: The primary objective was to compare antiretroviral persistence among patients receiving STRs and patients receiving LDRs. A secondary objective was to identify factors associated with non-persistence. METHODS: This was a retrospective study that included treatment- experienced HIV-infected patients who received ART based on STR or LDR. Baseline patient characteristics collected included demographic information, HIV risk transmission, substance abuse during the therapy, presence of psychiatric disorder and hepatitis B or C virus infection. Kaplan-Meier analysis and Log rank was utilized to compare persistence to STR and LDR. To identify independent predictors of non-persistence we developed a multivariate Cox regression analysis. RESULTS: A total of 244 patients were included, 176 with STR and 68 with LDR. 60 (34.1%) patients discontinued in the STR group and 13 (19.1%) in the LDR group. The Cox regression model showed that the only variable associated with higher risk of non-persistence was the substance abuse (HR = 2.59; p = 0.005). Adverse events were the main reason for ART discontinuation in the STR group and virologic failure in the LDR group. CONCLUSIONS: Persistence to STR and LDR seems to be similar in pretreated HIV-infected patients. Drug abuse was the only factor identified with a higher risk of non-persistence.

Objetivos: Analizar y comparar la persistencia entre las estrategias basadas en Single-Tablet Regimen (STR) y Less Drug Regimen (LDR) en pacientes VIH+. El objetivo secundario del estudio fue determinar factores predictores de persistencia. Material y métodos: Estudio observacional retrospectivo que incluyo los siguientes criterios: pacientes VIH+ con tratamiento antirretroviral (TAR) con un regimen basado en STR o LDR. Se recogieron variables demograficas, factores de riesgo de adquisicion, consumo de drogas, presencia de algun trastorno psiquiatrico y coinfeccion por el virus de la hepatitis B o C. Para comparar la persistencia entre ambas estrategias se realizo un analisis de supervivencia de Kaplan-Meir y se aplico el metodo de log-rank. Se realizo un analisis de regresion de Cox para identificar los factores predictores de persistencia. Resultados: Se incluyeron 244 pacientes, 176 con STR y 68 con LDR. El 34,1% (n = 60) de los pacientes que recibieron un regimen STR abandonaron y en el LDR el 19,1% (n = 13). Los efectos adversos fueron la principal causa de abandono del tratamiento en los pacientes que recibieron STR y el fallo virologico en el regimen LDR. La persistencia de las estrategias STR y LDR fue similar, no encontrandose diferencias estadisticamente significativas entre ambas. El consumo de drogas fue el unico factor predictivo asociado con una menor persistencia (HR = 2,59; p = 0,005). Conclusiones: La persistencia entre los regimenes STR y LDR fue similar, no detectandose diferencias significativas entre ambos. El consumo de drogas fue el unico factor independiente asociado con una menor persistencia del tratamiento antirretroviral.

Suitability of teriparatide and level of acceptance of pharmacotherapeutic recommendations in a healthcare management área / Adecuación de la teriparatida y grado de aceptación de las recomendaciones farmacoterapéuticas en un área de gestión sanitaria

Objective: To analyse the suitability of teriparatide prescriptions for osteoporosis treatment in a health management area, as well as the level of acceptance of pharmacotherapeutic recommendations made to physicians. Design: A prospective interventional study conducted from february 2015 to june 2015. Setting: South Seville Health Management Area. Participants: Patients receiving teriparatide. Main measurements: Suitability of teriparatide prescriptions according to Clinical Practice Guidelines and level of acceptance of pharmacotherapeutic recommendations. Results: Teriparatide prescriptions were unsuitable in 45 patients (68.2%); 11 due to no indication, 17 patients did not have previous treatments with first-line drugs, 6 due to contraindications and 9 patients were treated for more than 24 months with the drug. Besides, 4 prescriptions were unsuitable because of combination with other therapies. The acceptance of pharmacotherapeutic recommendations was 64.4%, leading to teriparatide discontinuation in 21 patients (72.4%), and a switch to alendronate or ibandronate in another 8 patients. Conclusions: A high percentage of teriparatide prescriptions is unsuitable in our health care management area, but it has decreased after pharmacist intervention (AU)

Objetivo: Analizar la adecuación de la prescripción de teriparatida en el tratamiento de la osteoporosis en un área de gestión sanitaria, así como el grado de aceptación por el médico de las recomendaciones de intervención realizadas. Diseño: Estudio prospectivo de intervención desde febrero de 2015 a junio de 2015. Emplazamiento: Área de Gestión Sanitaria Sur de Sevilla. Participantes: Pacientes con prescripción activa de teriparatida. Mediciones principales: Adecuación de la prescripción de teriparatida y grado de aceptación por el médico de las recomendaciones farmacoterapéuticas. Resultados: La prescripción de teriparatida fue inadecuada en 45 pacientes (68,2%). Once pacientes no cumplían los criterios de tratamiento, mientras que 17 no habían tenido prescrito previamente otro medicamento para la prevención de fracturas. Seis pacientes presentaban alguna contraindicación. En 9 pacientes la duración de la terapia fue superior a los 24 meses recomendados. Cuatro de ellas (dos ya inadecuadas) por combinación inadecuada con otros medicamentos. El grado de aceptación de las recomendaciones farmacoterapéuticas realizadas por farmacia fue del 64,4%, produciéndose en 21 pacientes (72,4%) la suspensión de teriparatida y en 8, el cambio a otro medicamento de primera línea: ibandrónico, en tres de ellos, y alendrónico, en el resto Conclusiones: El número de pacientes con prescripciones inadecuadas de teriparatida es elevado en nuestra área, pero ha disminuido tras realizar intervenciones con recomendaciones farmacoterapéuticas de adecuación del tratamiento (AU)

Persistence to single-tablet regimen versus less-drug regimen in treatment experienced HIV-infected patients on antiretroviral therapy / Persistencia entre las estrategias terapéuticas single-tablet y less drug en pacientes VIH+ previamente tratados

Background: Decreased antiretroviral therapy persistence is associated with increased rates of virologic failure, development of antiretroviral resistance, and increased morbidity and mortality. Different therapeutic strategies, such as single-tablet regimens (STR) and less-drug regimens (LDR), have been developed in order to simplify antiretroviral therapy (ART) and increase persistence. Objectives: The primary objective was to compare antiretroviral persistence among patients receiving STRs and patients receiving LDRs. A secondary objective was to identify factors associated with non-persistence. Methods: This was a retrospective study that included treatment-experienced HIV-infected patients who received ART based on STR or LDR. Baseline patient characteristics collected included demographic information, HIV risk transmission, substance abuse during the therapy, presence of psychiatric disorder and hepatitis B or C virus infection. Kaplan-Meier analysis and Log rank was utilized to compare persistence to STR and LDR. To identify independent predictors of non-persistence we developed a multivariate Cox regression analysis. Results: A total of 244 patients were included, 176 with STR and 68 with LDR. 60 (34.1%) patients discontinued in the STR group and 13 (19.1%) in the LDR group. The Cox regression model showed that the only variable associated with higher risk of non-persistence was the substance abuse (HR = 2.59; p = 0.005). Adverse events were the main reason for ART discontinuation in the STR group and virologic failure in the LDR group. Conclusions: Persistence to STR and LDR seems to be similar in pretreated HIV-infected patients. Drug abuse was the only factor identified with a higher risk of non-persistence (AU)

Objetivos: Analizar y comparar la persistencia entre las estrategias basadas en Single-Tablet Regimen (STR) y Less Drug Regimen (LDR) en pacientes VIH+. El objetivo secundario del estudio fue determinar factores predictores de persistencia. Material y métodos: Estudio observacional retrospectivo que incluyó los siguientes criterios: pacientes VIH+ con tratamiento antirretroviral (TAR) con un régimen basado en STR o LDR. Se recogieron variables demográficas, factores de riesgo de adquisición, consumo de drogas, presencia de algún trastorno psiquiátrico y coinfección por el virus de la hepatitis B o C. Para comparar la persistencia entre ambas estrategias se realizó un análisis de supervivencia de Kaplan-Meir y se aplicó el método de log-rank. Se realizó un análisis de regresión de Cox para identificar los factores predictores de persistencia. Resultados: Se incluyeron 244 pacientes, 176 con STR y 68 con LDR. El 34,1% (n = 60) de los pacientes que recibieron un ré- gimen STR abandonaron y en el LDR el 19,1% (n = 13). Los efectos adversos fueron la principal causa de abandono del tratamiento en los pacientes que recibieron STR y el fallo virológico en el régimen LDR. La persistencia de las estrategias STR y LDR fue similar, no encontrándose diferencias estadísticamente significativas entre ambas. El consumo de drogas fue el único factor predictivo asociado con una menor persistencia (HR = 2,59; p = 0,005). Conclusiones: La persistencia entre los regímenes STR y LDR fue similar, no detectándose diferencias significativas entre ambos. El consumo de drogas fue el único factor independiente asociado con una menor persistencia del tratamiento antirretroviral (AU)

[Patients'adherence-related beliefs about medicines prescribed for long-term conditions in HIV patients]. / Influencia de las creencias hacia los medicamentos en la adherencia al tratamiento concomitante en pacientes VIH+

PURPOSE: To assess adherence and beliefs about long-term medicines for other chronic conditions among HIV-infected patients as well as to evaluate their relationship. METHOD: A cross-sectional study was conducted from may to july 2014 in HIV-infected patients treated with antiretroviral treatment (ART) and ≥1 long-term medicines for other chronic diseases. The variables analysed in the study were demographics: sex, age, education, employment status, living situation; clinical: mode of transmission, HIV plasma viral load, T-CD4+, CDC classification; and pharmacotherapeutics: type of ART, adherence to long-term medicines for other chronic conditions using the 4-item Morisky Medication Adherence (MMAS) Scale. MMAS scores were dichotomised into adherent/non-adherent. The Beliefs about Medicines Questionnaires (BMQ) was used to assess patients' beliefs about the long-term medicines. The BMQ-Specific has two scales (necessity and concern) with five questions each that uses a 5-point Likert scale. Internal consistency within BMQ scales was measured with Cronbach's α and their association with adherence was assessed with t-Student tests, using SPSS 20.0. RESULTS: We included 126 patients (80.4% male, mean age 49.0 ± 8.3). The mean of long-term medicines was 2.9 ± 2.0. The percentage of non-adherent patients was 54.0%. 63.5% of patients had AIDS, that showed statistically significant relationship with non-adherence. Concerns were negatively related to self-reported adherence (14.6 ± 5.7 vs. 12.1 ± 6.1; p=0.019). No relationship between adherence and necessity was found (17.3 ± 5.6 vs. 18.8 ± 4.4; p=0.188). Internal consistency for BMQ-Specific was high (Cronbach's α=0.724). CONCLUSION: Higher concerns are associated with higher self-reported adherence to long-term medicines in HIV infected-patients.

Objetivo: Determinar a adherencia y las creencias hacia la medicacion para patologias cronicas concomitantemente prescrita al TAR en pacientes infectados por el VIH, asi como determinar si existen diferencias significativas en las creencias entre los pacientes adherentes y no adherentes al los tratamientos concomitantes al TAR. Método: Estudio transversal llevado a cabo durante mayo y julio 2014 en pacientes VIH+ con tratamiento antirretroviral y uno o mas medicamentos para patologias cronicas. Se recogieron variables sociodemograficas: edad, sexo, educacion, situacion laboral, si vivia solo; clinicas: modo de transmision de la infeccion, carga viral plasmatica, T-CD4, estadio; y farmacoterapeuticas: tipo de tratamiento antirretroviral, comedicacion y adherencia a esta mediante el cuestionario Morisky. Se midieron las creencias hacia dicha comedicacion mediante el Beliefs about Medicines Questionnare (BMQ), que incluye dos escalas, necesidad y preocupacion. Los datos se analizaron con SPSSR 20.0. Se aplico la prueba t de Student. La fiabilidad del cuestionario se estimo mediante el alfa de Cronbach. Resultados: Se incluyeron 126 pacientes (80.4% hombres, 49}8.3 anos). El numero de medicamentos concomitantes fue 2.9}2.0. Se clasifico como no adherente al 54.0%. El 63.5% tenia sida, que se identifico como una variable independiente predictora de no adherencia. Las diferencias en la escala de preocupacion entre los pacientes no adherentes y adherentes fue estadisticamente significativa (14.6}5.7 vs. 12.1}6.1; p=0.019), mientras que en aquellas relativas a la necesidad no hubo diferencias (17.3}5.6 vs. 18.8}4.4; p=0.188). La fiabilidad del BMQ-especifico, asi como de las escalas de necesidad y preocupacion, fue buena (0.724, 0.794, 0.785, respectivamente). Conclusiones: Los pacientes VIH positivos con otras patologias cronicas no adherentes presentan creencias negativas relacionadas con la preocupacion en cuanto a la comedicacion.

Influencia de las creencias hacia los medicamentos en la adherencia al tratamiento concomitante en pacientes VIH+ / Patients’adherence-related beliefs about medicines prescribed for long-term conditions in HIV patients

Objetivo: Determinar a adherencia y las creencias hacia la medicación para patologías crónicas concomitantemente prescrita al TAR en pacientes infectados por el VIH, así como determinar si existen diferencias significativas en las creencias entre los pacientes adherentes y no adherentes al los tratamientos concomitantes al TAR. Método: Estudio transversal llevado a cabo durante mayo y julio 2014 en pacientes VIH+ con tratamiento antirretroviral y uno o más medicamentos para patologías crónicas. Se recogieron variables sociodemográficas: edad, sexo, educación, situación laboral, si vivía solo; clínicas: modo de transmisión de la infección, carga viral plasmática, T-CD4, estadío; y farmacoterapéuticas: tipo de tratamiento antirretroviral, comedicación y adherencia a ésta mediante el cuestionario Morisky. Se midieron las creencias hacia dicha comedicación mediante el Beliefs about Medicines Questionnare (BMQ), que incluye dos escalas, necesidad y preocupación. Los datos se analizaron con SPSS® 20.0. Se aplicó la prueba t de Student. La fiabilidad del cuestionario se estimó mediante el alfa de Cronbach. Resultados: Se incluyeron 126 pacientes (80.4% hombres, 49±8.3 años). El número de medicamentos concomitantes fue 2.9±2.0. Se clasificó como no adherente al 54.0%. El 63.5% tenía sida, que se identificó como una variable independiente predictora de no adherencia. Las diferencias en la escala de preocupacion entre los pacientes no adherentes y adherentes fue estadisticamente significativa (14.6±5.7 vs. 12.1±6.1; p=0.019), mientras que en aquellas relativas a la necesidad no hubo diferencias (17.3±5.6 vs. 18.8±4.4; p=0.188). La fiabilidad del BMQ-específico, así como de las escalas de necesidad y preocupación, fue buena (0.724, 0.794, 0.785, respectivamente). Conclusiones: Los pacientes VIH positivos con otras patologías crónicas no adherentes presentan creencias negativas relacionadas con la preocupación en cuanto a la comedicación

Purpose: To assess adherence and beliefs about long-term medicines for other chronic conditions among HIV-infected patients as well as to evaluate their relationship. Method: A cross-sectional study was conducted from may to july 2014 in HIV-infected patients treated with antiretroviral treatment (ART) and >1 long-term medicines for other chronic diseases. The variables analysed in the study were demographics: sex, age, education, employment status, living situation; clinical: mode of transmission, HIV plasma viral load ,T-CD4+, CDC classification; and pharmacotherapeutics: type of ART, adherence to long-term medicines for other chronic conditions using the 4-item Morisky Medication Adherence (MMAS) Scale. MMAS scores were dichotomised into adherent/non-adherent. The Beliefs about Medicines Questionnaires (BMQ) was used to assess patients' beliefs about the long-term medicines. The BMQ-Specific has two scales (necessity and concern) with five questions each that uses a 5-point Likert scale. Internal consistency within BMQ scales was measured with Cronbach's αand their association with adherence was assessed with t-Student tests, using SPSS 20.0. Results: We included 126 patients (80.4% male, mean age 49.0±8.3). The mean of long-term medicines was 2.9±2.0. The percentage of non-adherent patients was 54.0%. 63.5% of patients had AIDS, that showed statistically significant relationship with non-adherence. Concerns were negatively related to self-reported adherence (14.6±5.7 vs. 12.1±6.1; p=0.019). No relationship between adherence and necessity was found (17.3±5.6 vs. 18.8±4.4; p=0.188). Internal consistency for BMQ-Specific was high (Cronbach's α=0.724). Conclusion: Higher concerns are associated with higher self-reported adherence to long-term medicines in HIV infected-patients

Concurrent use of comedications reduces adherence to antiretroviral therapy among HIV-infected patients.

BACKGROUND: The use of highly active antiretroviral therapy has significantly reduced morbidity and mortality, thus increasing life expectancy of human immunodeficiency virus (HIV)-infected individuals, transforming HIV into a chronic disease. Accordingly, there has been an increase in the number of comorbidities concomitantly present in these individuals and also an increased use of comedications, which may negatively impact antiretroviral therapy adherence. These factors can affect adherence to antiretroviral therapy. The role of the HIV clinical pharmacist is essential to achieve therapeutic objectives and enhance adherence. OBJECTIVE: To determine the influence of the comorbidities and comedications on antiretroviral therapy adherence among HIV-infected patients receiving services from a clinical pharmacist. METHODS: We conducted a prospective observational study that included HIV-infected outpatients who attended the pharmaceutical care office of a hospital pharmacy service, which initiated antiretroviral treatment between January 2002, and December 2011. The variables analyzed in the study were demographics (sex and age), HIV transmission mode, and the following variables at the time of comedication collection: hepatitis C virus or hepatitis B virus coinfection, HIV plasma viral load (copies/mL) and CD4+ T-cell count (cells/µL), Centers for Disease Control and Prevention HIV classification, number of hospital admissions and emergency room visits, and antiretroviral therapy-related features (type at baseline, treatment-naïve status, and number of changes since starting antiretroviral therapy). For follow-up at 12 months, antiretroviral therapy adherence was measured through pharmacy dispensing records and the Morisky Medication Adherence Scale (MMAS). Patients were considered adherent if antiretroviral therapy adherence through dispensing records was greater than 90%, and the MMAS score was 4. Other variables were number of comorbidities and number of comedications for other chronic diseases (non-HIV drugs). According to the number of comorbidities, patients were categorized as having multiple chronic conditions (polypathology) if they had 2 or more chronic diseases. Polypharmacy was defined specifically as the use of 5 or more prescription medications in a medication regimen. In addition, a complexity therapeutic index of antiretroviral therapy was calculated for each patient. We determined the risk of drug-related problems using the tool Predictor Index. To identify independent predictors of adherence to antiretroviral therapy, we performed a univariate logistic regression. Afterward, those variables that showed statistical significance in the univariate analysis and those with P less than 0.25 were included in a multivariate model. The sample size was estimated by the Freeman equation. RESULTS: We included 594 patients in the study (80.1% men, median age 47 years). In the univariate analysis, the variables that showed statistically significant relationships with antiretroviral therapy adherence were HIV transmission mode, detectable viral load, CD4+ T-cell count, AIDS-defining condition, hospital admission, antiretroviral therapy-naïve treatment, type of antiretroviral therapy, high risk of drug-related problems, polypathology, and polypharmacy. Multivariate analysis showed that independent predictors of nonadherence to antiretroviral therapy were HIV transmission by intravenous drug use (OR = 0.56, 95% CI = 0.35-0.90), previous treatment with antiretroviral therapy (OR = 0.09, CI = 0.04-0.24), nontreatment changes (OR = 0.12, CI = 0.05-0.31), high risk of drug-related problems (OR = 0.38, CI = 0.23-0.63), and polypharmacy (OR = 0.36, CI = 0.21-0.61). The value of the Hosmer and Lemeshow test confirmed the validity of this model (P = 0.378). CONCLUSIONS: Recently, the number of HIV-infected patients with polypharmacy has been higher, increasing the risk of nonadherence. Furthermore, previous treatment with antiretroviral therapy, HIV transmission by intravenous drug use, and high risk of drug-related problems are also associated with lower adherence.

High quantity but limited quality in healthcare applications intended for HIV-infected patients.

OBJECTIVE: The aim of this study was to evaluate, through the creation of a specific questionnaire, the information quality in mobile applications (apps) aimed at human immunodeficiency virus (HIV)-infected patients. We also established a quality rating and identified the main strengths and weaknesses of this kind of health app. MATERIALS AND METHODS: Smartphone apps specifically related to HIV/acquired immunodeficiency syndrome (AIDS) were searched. We conducted a key word search with the terms "HIV," "AIDS," and "acquired immune deficiency syndrome" in the Apple™ (Cupertino, CA) App Store and the Android™ Google™ (Mountain View, CA) Play Store. A questionnaire was developed based on the different quality recommendations for health apps up to December 2012. The recommendations consulted were as follows: the Happtique Health App Certification Program, the Food and Drug Administration (Mobile Medical Applications), and recommendations for the design, use, and evaluation of health apps of the Agency of Health Quality in Andalusia. A group of 17 experts assessed the importance of the different sections by using a Delphi method. RESULTS: In total, 41 health apps were analyzed. Only one app (2.4%), called in Practice HIV, approached class A. The remaining were classed as follows: 2 (4.9%) class B, 1 (2.4%) class C, 5 (12.2%) class D and E, and 27 (65.9%) class F (not exceeding minimum criteria). The design and the relevance were highlighted among the strengths. The main areas for improvement are provision of services and confidentiality in addition to privacy policies. CONCLUSIONS: The quality of the revised apps is limited. Only one app complied with the excellence criteria, and over 50% of the apps did not exceed minimum quality standards. The worst rated aspects were political advertising and logical security.