[Supply medicinal products improvement in outpatient care in a hospital pharmacy service]. / Mejora de la dispensación a pacientes externos de un servicio de farmacia hospitalaria.

INTRODUCTION: Pharmaceutical care to outpatients is currently one of the main occupations of hospital pharmacy services (PEX). There are several questionnaires to measure the satisfaction of the PEX of a pharmacy service, and the results of these questionnaires can generate improvement actions that result in satisfaction. OBJECTIVES: To verify if a satisfaction questionnaire for outpatients is valid for the generation of improvements in the care provided, and if after its implementation, the same questionnaire is able to detect changes in satisfaction. MATERIAL AND METHOD: Prospective study of a single center carried out in a tertiary hospital in 2015 and 2016. A questionnaire previously validated with 16 Likert-type items was used. Demographic and classification data were collected. A descriptive analysis was performed and the internal consistency was calculated using the Cronbach's α value. RESULTS: A total of 258 questionnaires were collected in 2015 and 493 in 2016. There were no differences in the baseline characteristics of the patients and users of the service. The items with the lowest satisfaction scores in 2015 (comfort of the waiting room, dispensing privacy, drug pick-up time and medication pick-up time) guided the improvement actions to be implemented. In 2016 there was an improvement in the waiting time until collection in 12.3% (p = 0.002); in the comfort of the waiting room 4.9% (p = 0.304); business hours for medication collection, 10.7% (p = 0.013); and in the confidentiality of the dispensation 4% (p = 0.292). The remaining scores fluctuated minimally, with no statistical significance at all. A 5.1% improvement in overall satisfaction was found (p < 0.001). Satisfaction values obtained as a whole were high. CONCLUSIONS: The satisfaction questionnaire is a valid instrument for generating actions to improve the care received in an outpatient unit of a pharmacy service. This same questionnaire is a tool to monitor the changes implemented to improve the care received.

Influencia de un programa de conciliación terapéutica en la tasa de reingreso de pacientes ancianos / Influence of a medication reconciliation program in elderly patients on readmission rate

Objetivo: Principal: medir el impacto en la tasa de reingreso a los 30 días de un programa de conciliación terapéutica al ingreso y al alta en pacientes mayores de 65 años. Secundarios: detectar, clasificar y analizar las discrepancias, errores de conciliación (EC) y prescripción de medicamentos potencialmente inadecuados (MPI). Material y Método: Estudio observacional prospectivo, no controlado, no aleatorizado, unicéntrico, con pacientes mayores de 65 años, ingresados en Medicina Interna y Geriatría. Se realizó conciliación terapéutica al ingreso y al alta, registrando medicación habitual, discrepancias justificadas, no justificadas, EC, MPI y medicamentos de alto riesgo (MAR). Se calculó la tasa de reingreso y se comparó con la tasa del año 2013 para cada servicio médico. Resultados: 91 pacientes con una media de 86 (71-99) años, el 47% con MAR y 8,9 medicamentos crónicos por paciente. Se conciliaron 1113 medicamentos, con 836 discrepancias justificadas, 56 EC y 36 MPI. Los EC se produjeron por omisión (n=34), diferente dosis o vía (n=16), prescripción incompleta (n=1), medicamento equivocado (n=1) y comisión (n=19). Por gravedad se detectaron en las categorías B (n=16), C (n=30), D (n=9) y E (n=1). El 31,9% de los pacientes tuvo un EC. Las tasas de reingreso para Medicina Interna y Geriatría fueron respectivamente de 12,2% y 14,3% frente a las globales de 2013 de 17,9% (RR=0,652; IC95% 0,279-1,521; p=0,322) y 16,3% (RR=0,895; IC95% 0,443-1,812; p=0,758). Conclusiones: Las tasas de reingreso a los 30 días en los pacientes conciliados fueron inferiores a las globales de 2013, aunque no estadísticamente significativas

Objective: To measure the impact of a pharmacist-based medication reconciliation program on readmission rates 30 days after its implementation, at admission and discharge, in patients aged 65 years and older. Secondary objectives were to detect and classify medication discrepancies, reconciliation errors (RE) and the prescription of potentially inappropriate medications in elderly patients (PIM). Methods: Prospective observational, uncontrolled, nonrandomized, single-center study performed in patients aged 65 years and older, hospitalized in the Internal Medicine and Geriatrics units. Medication reconciliation was performed by a pharmacist at admission and discharge. The pharmacist recorded chronic medication, justified and unjustified discrepancies, RE, PIM and high-risk medications (HRM). 30-day readmission rate was calculated and then compared with the 2013 rate for each medical unit. Results: A total of 91 patients were included, with an average age of 86 (71-99) years, 47% with HRM and 8.9 chronic medications per patient. 1113 medications were reconciled, of which 836 had justified discrepancies, 56 RE and 36 PIM. The RE were caused by omission (n=34), discrepancies in via or dose (n=16), incomplete prescription (n=1), wrong drug (n=1) and commission (n=19). Regarding its seriousness, RE were classified as B (n=16), C (n=30), D (n=9) and E (n=1). 31.9% of the patients had a RE. 30-day readmission rates for Internal Medicine and Geriatrics units were respectively 12,2% and 14,3%, compared with 2013 overall rate of 17,9% (RR=0,652; IC95% 0,279-1,521; p=0,322) and 16,3% (RR=0,895; IC95% 0,443-1,812; p=0,758). Conclusions: 30-day readmission rates were lower than 2013 overall rate with the medication reconciliation program. However, this is not statistically significant

[Antibiotic treatment optimization by means of antibiotic treatment experts participation]. / Optimización del tratamiento antibiótico mediante la participación de expertos en antibióticos.

BACKGROUND: Antibiotics account for a high percentage of hospital pharmacy expenses. An elevated proportion of the prescriptions are considered inappropriate. Infectious diseases specialist could help other physicians in improving antibiotics prescriptions. METHODS: Treatments in all patients hospitalized in four surgical wards were checked daily and recommendations were made in cases with signs of inadequate antibiotics prescriptions. The program was carried out during for 4 months and the results were compared with a similar period of the previous year. RESULTS: 562 treatments of 393 patients were reviewed . Five hundred twenty four recommendations were made (90% of them were accepted). There was a significant reduction in the number of inadequate prescriptions. Antibiotic expenditure decreased by 29,262 euros (7,240 euros/month), implying a reduction of 2.35 euros/hospitalization-bed/day. There were no statistically significant differences in the amount of hospital resistant bacteria nor in mortality between the two periods. CONCLUSIONS: Following application of a non-compulsory control program, antibiotic prescription improved and expenditure decreased, with no change in mortality. Acceptation of the program by the physicians of the departments implicated was favourable.

Optimización del tratamiento antibiótico mediante la participación de expertos en antibióticos / Antibiotic treatment optimization by means of antibiotic experts participation

Antecedentes: Los antibióticos representan un porcentaje elevado del gasto de farmacia de un hospital. Una elevada proporción de las prescripciones se consideran inapropiadas. La ayuda prestada por infectólogos con una formación extensa en el manejo de los antibióticos podría mejorar la prescripción de este tipo de medicamentos. Métodos: Revisión diaria de las prescripciones antibióticas realizadas en cuatro salas de hospitalización de varias especialidades quirúrgicas. Examen diario de los casos que cumplían algunos de los signos de sospecha de prescripción inadecuada. Si existían casos sugestivos de este tipo de prescripción se efectuaba una recomendación a los médicos prescriptores. La intervención se realizó durante 4 meses. Se compararon los resultados con un periodo similar del año anterior. Resultados: Se revisaron 562 tratamientos en 393 pacientes. Se realizaron 524 recomendaciones (el 90% fueron aceptadas). Se logró una reducción importante de prescripciones consideradas inadecuadas. Se consiguió una disminución del gasto en antibióticos de 29.363 € (7.240 €/mes), lo que supone un ahorro de 2,35 €/cama de hospitalización/día. No hubo diferencias estadísticamente significativas ni en la en mortalidad ni en el aislamiento de bacterias nosocomiales resistentes Conclusiones: Empleando un programa de asesoramiento sobre el tratamiento antibiótico se consiguió una mejor utilización y una disminución del gasto en antibióticos, sin variaciones en la mortalidad. El programa fue muy bien aceptado por los médicos de los servicios implicados

Background: Antibiotics account for a high percentage of hospital pharmacy expenses. An elevated proportion of the prescriptions are considered inappropriate. Infectious diseases specialist could help other physicians in improving antibiotics prescriptions Methods: Treatments in all patients hospitalized in four surgical wards were checked daily and recommendations were made in cases with signs of inadequate antibiotics prescriptions. The program was carried out during for 4 months and the results were compared with a similar period of the previous year. Results: 562 treatments of 393 patients were reviewed . Five hundred twenty four recommendations were made (90% of them were accepted). There was a significant reduction in the number of inadequate prescriptions. Antibiotic expenditure decreased by 29,262 euros (7,240 euros/month), implying a reduction of 2.35 euros/hospitalizationbed/ day. There were no statistically significant differences in the amount of hospital resistant bacteria nor in mortality between the two periods. Conclusions: Following application of a non-compulsory control program, antibiotic prescription improved and expenditure decreased, with no change in mortality. Acceptation of the program by the physicians of the departments implicated was favourable