ABSTRACT
INTRODUCTION AND OBJECTIVE: In 2015, the Spanish Society of Hospital Pharmacy (SEFH) launched the Strategic Map for Outpatient Pharmaceutical Care (MAPEX), with the purpose of adapting the activity offered in Hospital Pharmacy outpatient clinics to the new healthcare context. The aim of the present study was to analyse the evolution of outpatient pharmaceutical care in Hospital Pharmacy Services in Spain in the period 2016-2021 after the implementation and development of the MAPEX initiative. MATERIAL AND METHOD: The implementation and development of the project was carried out by a group of experts from SEFH and consisted of five phases: creation of the structure, consensus conference, situation analysis, development of strategic initiatives and evolutionary analysis. To analyse the evolutionary development, a specific 43-item questionnaire was developed that addressed aspects related to structure, context, integration, processes, outcomes and research and was answered in 2016 and 2021 (in the latter case by adding 3 additional questions). RESULTS: 141 hospitals participated in the status survey in 2016 and 138 in 2021. Significant differences were found in all dimensions analysed. None of the aspects assessed suffered a setback in this period. The most highly rated aspects at the general level were the improvement of the care model (65.0%) and at the local level, the incorporation of non-face-to-face pharmaceutical care (42.8%). Further progress in the coming years in the expansion and practical application of the methodology proposed in the project was considered a priority. CONCLUSIONS: The implementation and development of the MAPEX initiative has had a positive impact in terms of quality of care for outpatient pharmaceutical care in Hospital Pharmacy services in Spain.
Subject(s)
Pharmacy Service, Hospital , Humans , Outpatients , Spain , Ambulatory Care , Delivery of Health CareABSTRACT
OBJETIVOS: Comparar la eficacia y seguridad de la infiltración de plasma rico en plaquetas preparado respecto a ácido hialurónico en pacientes con coxartrosis refractaria a tratamiento conservador. Así como correlacionar el impacto clínico entre las diferentes concentraciones celulares. MATERIALES Y MÉTODOS: Ensayo clínico fase III, doble-ciego, controlado, en el que se aleatorizaron a los pacientes en dos grupos de tratamiento (PRP o AH) con una única infiltración de cadera ecoguiada. El seguimiento fue de 12 meses, registrando escala de dolor (EVA) y escalas funcionales (HHS y WOMAC), analgesia consumida, respondedores (criterios OARSI) y efectos adversos. Se analizaron, en el grupo experimental, las concentraciones celulares en sangre periférica y en el PRP infiltrado. RESULTADOS: Se incluyeron un total de 74 pacientes. Ambos grupos de tratamiento presentaron mejoría en las escalas EVA, WOMAC, HHS y reducción del consumo de analgesia en el tiempo (p < 0,05). Únicamente encontramos diferencias significativas entre grupos al año de tratamiento en los valores de HHS (Grupo PRP 70,9 [3,7-58] grupo AH 60,2[43-74,2] p < 0,05). No se registraton efectos adversos en ninguno de los grupos. Encontramos correlación entre la concentración de plaquetas en pacientes respondedores (un mes postratamiento; no respondedores 449[438-578] x103 plaquetas/μl, respondedores 565 [481-666] x103 plaquetas/μl, p < 0,044). Se correlaciona la concentración de leucocitos con las escalas clínico-funcionales (EVA 6 meses, r=0,748, p < 0,013, subescala rigidez WOMAC 6 meses, r=0,748, p < 0,013). Los pacientes con estadios de coxartrosis iniciales (KL 1 y 2) tienen mayor probabilidad de responder al tratamiento con plasma rico en plaquetas (11,51 OR, IC 95% 2,34-50,65, p < 0,03). CONCLUSIONES: La infiltración única de PRP es eficaz en términos de mejoría funcional, reducción del dolor y disminución del consumo de analgesia en coxartrosis. Los sistemas de preparación abiertos, son un procedimiento seguro para la obtención de PRP. Se deben indicar las infiltraciones de cadera en estadios evolutivos iniciales. Se debe tener en cuenta la composición celular para garantizar una repuesta clínica positiva
AIMS OF THE STUDY: To compare efficacy and safety of a home-made platelet-rich plasma (PRP) solution versus hyaluronic acid in patients with hip osteoarthritis not responding to conservative treatment and to correlate cellular composition of PRP to clinical outcomes. MATERIAL AND METHODS: This is a phase III clinical trial, double-blinded, controlled and randomised into two treatment groups (PRP and hyaluronic acid). Patients received one hip ultrasound-guided injection. Follow up was 12 months. Pain was assessed using VAS score, HHS and WOMAC were used as functional scores, analgesia, adverse events, cellular components (PRP group) in peripheral blood and in PRP were recorded. Clinical response was assessed using OARSI criteria. RESULTS: Seventy-four patients were included. Both groups improved in VAS, WOMAC and HHS score and reduced the amount of analgesia (p<.05). Significant differences were seen at 1 year post-treatment in HHS score (PRP 70.9 [3.7-58], hyaluronic acid 60.2[43-74.2] p<.05). No adverse events were observed in none of the groups. Platelet concentration was different between responders and non-responders (at 1 month, non-responders 449[438-578] x103 platelets/μl versus responders 565 [481-666] x103 platelets/μl, p<.044). There was a correlation between leukocytes concentration and clinical scores (VAS at six months, r=0.748, p<.013, WOMAC at 6 months r=0.748, p <.013). Patients with early stage hip OA showed higher response rate to PRP compared with late stage (11.51 OR, 95%CI 2.34-50.65, p<.03). CONCLUSIONS: Platelet-rich plasma injection improved hip function, reduced pain and the use of analgesia. It is important to bear in mind the cellular composition in order to achieve a better clinical response
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Hyaluronic Acid/therapeutic use , Intracellular Signaling Peptides and Proteins/therapeutic use , Osteoarthritis, Hip/therapy , Platelet-Rich Plasma , Viscosupplements/therapeutic use , Double-Blind Method , Follow-Up Studies , Injections, Intra-Articular , Treatment Outcome , Ultrasonography, InterventionalABSTRACT
AIMS OF THE STUDY: To compare efficacy and safety of a home-made platelet-rich plasma (PRP) solution versus hyaluronic acid in patients with hip osteoarthritis not responding to conservative treatment and to correlate cellular composition of PRP to clinical outcomes. MATERIAL AND METHODS: This is a phase III clinical trial, double-blinded, controlled and randomised into two treatment groups (PRP and hyaluronic acid). Patients received one hip ultrasound-guided injection. Follow up was 12 months. Pain was assessed using VAS score, HHS and WOMAC were used as functional scores, analgesia, adverse events, cellular components (PRP group) in peripheral blood and in PRP were recorded. Clinical response was assessed using OARSI criteria. RESULTS: Seventy-four patients were included. Both groups improved in VAS, WOMAC and HHS score and reduced the amount of analgesia (p<.05). Significant differences were seen at 1 year post-treatment in HHS score (PRP 70.9 [3.7-58], hyaluronic acid 60.2[43-74.2] p<.05). No adverse events were observed in none of the groups. Platelet concentration was different between responders and non-responders (at 1 month, non-responders 449[438-578] x103 platelets/µl versus responders 565 [481-666] x103 platelets/µl, p<.044). There was a correlation between leukocytes concentration and clinical scores (VAS at six months, r=0.748, p<.013, WOMAC at 6 months r=0.748, p <.013). Patients with early stage hip OA showed higher response rate to PRP compared with late stage (11.51 OR, 95%CI 2.34-50.65, p<.03). CONCLUSIONS: Platelet-rich plasma injection improved hip function, reduced pain and the use of analgesia. It is important to bear in mind the cellular composition in order to achieve a better clinical response.
