Impact of pharmaceutical care for asthma patients on health-related outcomes: An umbrella review.

Recent systematic reviews suggest that pharmacists' interventions in asthma patients have a positive impact on health-related outcomes. Nevertheless, the association is not well established, and the role of clinical pharmacists is poorly represented. The aim of this overview of systematic reviews is to identify published systematic reviews assessing the impact of pharmacists' interventions on health-related outcomes measured in asthma patients. PubMed, Embase, Scopus, and Cochrane Library were searched from inception to December 2022. Systematic reviews of all study designs and settings were included. Methodological quality was assessed using AMSTAR 2. Two investigators performed study selection, quality assessment and data collection independently. Nine systematic reviews met the inclusion criteria. Methodological quality was rated as high in one, low in two, and critically low in six. Reviews included 51 primary studies reporting mainly quality of life, asthma control, lung capacity, and therapeutic adherence. Only four studies were carried out in a hospital setting and only two reviews stated the inclusion of severe asthma patients. The quality of the systematic reviews was generally low, and this was the major limitation of this overview of systematic reviews. However, solid evidence supports that pharmaceutical care improves health-related outcomes in asthma patients.

Atención farmacéutica y asma: protocolo de una revisión de revisiones sistemáticas / Pharmaceutical care and asthma: Protocol of an umbrella review of systematic reviews

Introducción las revisiones sistemáticas y metaanálisis recientes sugieren que las intervenciones por parte de farmacéuticos en pacientes asmáticos tienen un impacto positivo en resultados en salud. Sin embargo, la asociación no está bien establecida y el papel de los farmacéuticos clínicos está pobremente representado, así como el de los pacientes con asma grave. El objetivo de esta revisión de revisiones es identificar revisiones sistemáticas publicadas que evalúen el impacto de las intervenciones farmacéuticas en resultados en salud medidos en pacientes asmáticos, así como describir los componentes clave de las intervenciones, los resultados medidos y cualquier asociación entre las intervenciones farmacéuticas y los resultados en salud medidos. Métodos se hará una busqueda en PubMed, Embase, Scopus y la Cochrane Library desde el primer registro hasta diciembre de 2022. Se considerará la inclusión de revisiones sistemáticas de todo tipo de estudios primarios, severidad del asma o nivel asistencial que midan resultados en salud. La calidad metodológica se medirá usando A Measurement Tool to Assess Systematic Reviews 2. Dos investigadores independientes realizarán la selección de los estudios, la evaluación de la calidad y la extracción de datos. Cualquier discrepancia será solventada por un tercer investigador. Ambos resultados, narrativos y metaanálisis, de los estudios primarios incluidos en las revisiones sistemáticas serán sintetizados. Si los datos son apropiados para un análisis cuantitativo, las medidas de asociación se expresarán como cociente de riesgos y diferencia de medias. Discusión los primeros resultados del establecimiento de una red multidisciplinar para el manejo de los pacientes asmáticos mostraron beneficios en integrar los diferentes niveles asistenciales en el control de la enfermedad y la reducción de la morbilidad...(AU)

Introduction Recent systematic reviews and meta-analyses suggest that pharmacists' interventions in asthma patients have a positive impact on health-related outcomes. Nevertheless, the association is not well established and the role of clinical pharmacists is poorly represented, as well as severe asthma patients. The aim of this overview of systematic reviews is to identify published systematic reviews assessing the impact of pharmacists' interventions on health-related outcomes measured in asthma patients, as well as to describe key components of the interventions, the outcomes assessed and any associations between pharmacists' interventions and health-related outcomes. Methods PubMed, Embase, Scopus and the Cochrane Library will be searched from inception to December 2022. Systematic reviews of all study designs, severity of asthma and level of care that measured health-related outcomes will be considered. Methodological quality will be assessed using A Measurement Tool to Assess Systematic Reviews 2. Two independent investigators will perform the study selection, quality assessment and data collection, any discrepancy will be solved by a third investigator. Both narrative findings and meta-analysis of primary study data included in the systematic reviews will be synthesized. If data are appropriate for quantitative synthesis, the measures of association will be expressed as the risk ratio and difference in means. Discussion The first results on the establishment of a multidisciplinary network for the management of asthmatic patients have shown the benefits of integrating different levels of care in disease control and morbidity reduction. Further studies showed benefits in hospital admissions, patients' basal oral corticosteroid dose, exacerbations and quality of life of asthma patients...(AU)

Pharmaceutical care and asthma: Protocol of an umbrella review of systematic reviews. / [Artículo traducido] Atención farmacéutica y asma: protocolo de una revisión de revisiones sistemáticas.

INTRODUCTION: Recent systematic reviews and meta-analyses suggest that pharmacists' interventions in asthma patients have a positive impact on health-related outcomes. Nevertheless, the association is not well established and the role of clinical pharmacists is poorly represented, as well as severe asthma patients. The aim of this overview of systematic reviews is to identify published systematic reviews assessing the impact of pharmacists' interventions on health-related outcomes measured in asthma patients, as well as to describe key components of the interventions, the outcomes assessed and any associations between pharmacists' interventions and health-related outcomes. METHODS: PubMed, Embase, Scopus and the Cochrane Library will be searched from inception to December 2022. Systematic reviews of all study designs, severity of asthma and level of care that measured health-related outcomes will be considered. Methodological quality will be assessed using A Measurement Tool to Assess Systematic Reviews 2. Two independent investigators will perform the study selection, quality assessment and data collection, any discrepancy will be solved by a third investigator. Both narrative findings and meta-analysis of primary study data included in the systematic reviews will be synthesized. If data are appropriate for quantitative synthesis, the measures of association will be expressed as the risk ratio and difference in means. DISCUSSION: The first results on the establishment of a multidisciplinary network for the management of asthmatic patients have shown the benefits of integrating different levels of care in disease control and morbidity reduction. Further studies showed benefits in hospital admissions, patients' basal oral corticosteroid dose, exacerbations and quality of life of asthma patients. A systematic review is the most appropriate design in order to summarize the literature and identify the evidence of the benefits of interventions performed by clinical pharmacists in asthma patients, especially those with severe uncontrolled asthma, and encourage future studies to stablish the role of clinical pharmacists in asthma units. REGISTRATION DETAILS: Systematic review registration number: CRD42022372100.

Selection of interventions aimed at improving medication adherence in patients with multimorbidity.

OBJECTIVES: To select interventions aimed at improving medication adherence in patients with multimorbidity by means of a standardised methodology. METHODS: A modified Delphi methodology was used to reach consensus. Interventions that had demonstrated their efficacy in improving medication adherence in patients with multimorbidity or in similar populations were identified from a literature search of several databases (PubMed, EMBASE, the Cochrane Library, Center for Reviews and Dissemination, and Web of Science). 11 experts in medication adherence and/or chronic disease scored the selected interventions for appropriateness according to three criteria: strength of the evidence that supported each intervention, usefulness in patients with multimorbidity, and feasibility of implementation in clinical practice. The final set of interventions was selected according to appropriateness and agreement based on the Delphi methodology. RESULTS: 566 articles were retrieved in the literature search. Nine systematic reviews were included. 33 interventions were initially selected for evaluation by the panellists. Consensus after two Delphi rounds was reached on 16 interventions. Five interventions were categorized as educational, six as behavioural and five were related to other aspects of interest. CONCLUSIONS: The interventions selected following a comprehensive and standardized methodology, could be used to improve medication adherence in patients with multimorbidity.

Identification of the Medication Regimen Complexity Index as an Associated Factor of Nonadherence to Antiretroviral Treatment in HIV Positive Patients.

BACKGROUND: Multiple studies have identified a relationship between the complexity of a medication regimen and non-adherence. However, most studies in people who live with HIV (PLWH) have focused on antiretroviral use and have failed to consider the impact of other medications. OBJECTIVE: The aim of our study is to identify the Medication Regimen Complexity Index (MRCI) as an associated factor for nonadherence to antiretroviral treatment (ART). The secondary aim is to analyze the relationship between clinical and pharmacotherapeutical variables and adherence to antiretroviral treatment and to generate an adherence model. METHODS: A transversal, observational study. Patients included were PLWH over 18 years of age on active antiretroviral therapy. Patients who participated in clinical trials or who did not meet the inclusion criteria were excluded. We had studied HIV transmission mode, viral load, treatment status, number of comorbidities and complexity index as factors associated with adherence to ART. RESULTS: We included 619 patients in the study. Number of comorbidities ( p = 0.021; OR = 1.038-1.570); viral load ( p = 0.023; OR = 1.108-4.505) and MRCI ( p < 0.001; OR = 1.138-1.262) (ART and concomitant treatment) were the independent associated factors to ART nonadherence. The value of the Hosmer and Lemeshow test confirmed the validity of this model (P = 0.333). CONCLUSION: A higher MRCI was associated with non-adherence. Therefore, the regimen complexity calculation may be appropriate in daily practice for identifying patients at a higher risk of becoming non-adherent.

Novel tool for deprescribing in chronic patients with multimorbidity: List of Evidence-Based Deprescribing for Chronic Patients criteria.

AIM: To create a tool to identify drugs and clinical situations that offers an opportunity of deprescribing in patients with multimorbidity. METHODS: A literature review completed with electronic brainstorming, and subsequently, a panel of experts using the Delphi methodology were applied. The experts assessed the criteria identified in the literature and brainstorming as possible situations for deprescribing. They were also asked to assess the influence of life prognosis in each criterion. A tool was composed of the most appropriate criteria according to the strength of their evidence, usefulness in patients with multimorbidity and applicability in clinical practice. RESULTS: Out of a total of 100, 27 criteria were selected to be included in the final list. It was named the LESS-CHRON criteria (List of Evidence-baSed depreScribing for CHRONic patients), and was organized by the anatomical group of the Anatomical, Therapeutic, Chemical (ATC) classification system of the drug to be deprescribed. Each criterion contains: drug indication for which it is prescribed, clinical situation that offers an opportunity to deprescribe, clinical variable to be monitored and the minimum time to follow up the patient after deprescribing. CONCLUSIONS: The "LESS-CHRON criteria" are the result of a comprehensive and standardized methodology to identify clinical situations for deprescribing drugs in chronic patients with multimorbidity. Geriatr Gerontol Int 2017; 17: 2200-2207.

Intervenciones para la mejora de la adherencia al tratamiento en pacientes pluripatológicos: resumen de revisiones sistemáticas / Interventions for improving adherence to treatment in patients with multiple pathologies: overview of systematic reviews

Objetivo: Evaluar la evidencia disponible respecto a la eficacia de intervenciones destinadas a mejorar la adherencia al tratamiento que sean aplicables a pacientes pluripatológicos (PP). Diseño: Revisión de revisiones sistemáticas. Fuentes de datos: Se consultaron (septiembre de 2013): Pubmed, EMBASE, the Cochrane Library, CRD y WoS para detectar intervenciones para la mejora de la adherencia en PP, o en su defecto, pacientes con patologías definitorias de pluripatología o polimedicados. Selección de estudios: Se incluyeron revisiones sistemáticas de ensayos clínicos con PP o de características similares. Estas debían comparar la eficacia de cualquier intervención destinada a mejorar el cumplimiento del tratamiento autoadministrado prescrito con la práctica habitual u otra intervención. Extracción de datos: Se extrajo información sobre la población en estudio, la intervención ensayada y la eficacia de la misma en términos de mejora de la adherencia. Resultados: Se recuperaron 566 artículos de los que se seleccionaron 9 revisiones sistemáticas. Ninguna se centraba específicamente en PP. Sí consideraban pacientes con múltiples patologías crónicas, patologías definitorias de pluripatología o polimedicados. La eficacia global de las intervenciones fue modesta, no observándose diferencias relevantes entre las intervenciones de carácter conductual, educativo o combinado. Algunos componentes de estas intervenciones como son el asesoramiento al paciente o las estrategias de simplificación posológica parecen ser herramientas eficaces en la mejora de la adherencia en este grupo poblacional. Conclusiones: Existe una gran heterogeneidad de intervenciones orientadas a la mejora de la adherencia de eficacia modesta, no habiendo sido diseñadas para una población de PP (AU)

Objective: To assess the available scientific evidence regarding the efficacy of interventions aimed to enhance medication adherence in patients with multiple chronic conditions (PMCC). Design: Overview of systematic reviews. Data sources: The following databases were consulted (September 2013): Pubmed, EMBASE, the Cochrane Library, CRD and WoS to identify interventions aimed to enhance medication adherence in PMCC, or otherwise, patients with chronic diseases common in the PMCC, or polypharmacy. Study selection: Systematic reviews of clinical trials focused on PMCC or similar were included. They should compare the efficacy of any intervention aimed to improve compliance to prescribed and self-administered medications with clinical practice or other interventions. Data extraction: Information about the study population, nature of intervention and efficacy in terms of improved adherence was extracted. Results: 566 articles were retrieved of which 9 systematic reviews were included. None was specifically focused on PMCC but considered patients with chronic diseases common in the PMCC, patients with more than one chronic disease and polypharmacy. The overall effectiveness of interventions was modest without relevant differences between behavioural, educational and combined interventions. Some components of these interventions including patient counselling and regimen simplification appear to be effective tools in improving adherence in this population group. Conclusion: There is a large heterogeneity of interventions aimed to improve adherence with modest efficacy, none in PMCC (AU)

[Interventions for improving adherence to treatment in patients with multiple pathologies: overview of systematic reviews]. / Intervenciones para la mejora de la adherencia al tratamiento en pacientes pluripatológicos: resumen de revisiones sistemáticas.

OBJECTIVE: To assess the available scientific evidence regarding the efficacy of interventions aimed to enhance medication adherence in patients with multiple chronic conditions (PMCC). DESIGN: Overview of systematic reviews. DATA SOURCES: The following databases were consulted (September 2013): Pubmed, EMBASE, the Cochrane Library, CRD and WoS to identify interventions aimed to enhance medication adherence in PMCC, or otherwise, patients with chronic diseases common in the PMCC, or polypharmacy. STUDY SELECTION: Systematic reviews of clinical trials focused on PMCC or similar were included. They should compare the efficacy of any intervention aimed to improve compliance to prescribed and self-administered medications with clinical practice or other interventions. DATA EXTRACTION: Information about the study population, nature of intervention and efficacy in terms of improved adherence was extracted. RESULTS: 566 articles were retrieved of which 9 systematic reviews were included. None was specifically focused on PMCC but considered patients with chronic diseases common in the PMCC, patients with more than one chronic disease and polypharmacy. The overall effectiveness of interventions was modest without relevant differences between behavioural, educational and combined interventions. Some components of these interventions including patient counselling and regimen simplification appear to be effective tools in improving adherence in this population group. CONCLUSION: There is a large heterogeneity of interventions aimed to improve adherence with modest efficacy, none in PMCC.

Metodología de conciliación del tratamiento farmacológico en pacientes pluripatológicos / Pharmacological treatment conciliation methodology in patients with multiple conditions

OBJETIVO: Realizar una revisión bibliográfica para identificar las diferentes metodologías empleadas en el proceso de conciliación de los tratamientos farmacológicos que sean aplicables a pacientes pluripatológicos. DISEÑO: Revisión sistemática. Fuentes de datos: Se realizó una revisión bibliográfica (febrero de 2012) en las bases de datos Pubmed, EMBASE, CINAHL, PsycINFO e Índice Médico Español de métodos de conciliación del tratamiento en pacientes pluripatológicos, o en su defecto, ancianos o polimedicados. Selección de estudios: Se recuperaron 273 artículos, de los que se seleccionaron 25. Extracción de datos: Se extrajo información relativa a la metodología empleada: nivel asistencial en el que se realiza, fuentes de información, uso de formulario, tiempo establecido, profesional responsable, información recogida y variables registradas como errores de conciliación. RESULTADOS: La mayoría de estudios fueron al ingreso y al alta hospitalarios Como principales fuentes de información destacan la entrevista y la historia clínica. En la mayoría de trabajos no se especifica un tiempo preestablecido, ni se usa formulario, y el principal responsable es el farmacéutico clínico. Además de la medicación domiciliaria, los hábitos de automedicación y la fitoterapia también son registrados. Se recogen como errores de conciliación desde omisiones de fármacos hasta interacciones medicamentosas. CONCLUSIONES: Existe gran heterogeneidad en la metodología empleada para la actividad de la conciliación. No existe ningún trabajo realizado específicamente en el paciente pluripatológico, que por su complejidad y susceptibilidad a errores de conciliación requiere una metodología estandarizada

OBJECTIVE: To carry out a ibliographic review in order to identify the different methodologies used along the reconciliation process of drug therapy applicable to polypathological patients. DESIGN: We performed a literature review. Data sources: The bibliographic review (February 2012) included the following databases: Pubmed, EMBASE, CINAHL, PsycINFO and Spanish Medical Index (IME). The different methodologies, identified on those databases, to measure the conciliation process in polypathological patients, or otherwise elderly patients or polypharmacy, were studied. Study selection Two hundred and seventy three articles were retrieved, of which 25 were selected. Data extraction Specifically: the level of care, the sources of information, the use of registration forms, the established time, the medical professional in charge and the registered variables such as errors of reconciliation. RESULTS: Most of studies selected when the patient was admitted into the hospital and after the hospital discharge of the patient. The main sources of information to be highlighted are: the interview and the medical history of the patient. An established time is not explicitly stated on most of them, nor the registration form is used. The main professional in charge is the clinical pharmacologist. Apart from the home medication, the habits of self-medication and phytotherapy are also identified. The common errors of reconciliation vary from the omission of drugs to different forms of interaction with other medicinal products (drugs interactions). CONCLUSIONS: There is a large heterogeneity of methodologies used for reconciliation. There is not any work done on the specific figure of the polypathological patient, which precisely requires a standardized methodology due to its complexity and its susceptibility to errors of reconciliation

[Pharmacological treatment conciliation methodology in patients with multiple conditions]. / Metodología de conciliación del tratamiento farmacológico en pacientes pluripatológicos.

OBJECTIVE: To carry out a bibliographic review in order to identify the different methodologies used along the reconciliation process of drug therapy applicable to polypathological patients. DESIGN: We performed a literature review. Data sources The bibliographic review (February 2012) included the following databases: Pubmed, EMBASE, CINAHL, PsycINFO and Spanish Medical Index (IME). The different methodologies, identified on those databases, to measure the conciliation process in polypathological patients, or otherwise elderly patients or polypharmacy, were studied. Study selection Two hundred and seventy three articles were retrieved, of which 25 were selected. Data extraction Specifically: the level of care, the sources of information, the use of registration forms, the established time, the medical professional in charge and the registered variables such as errors of reconciliation. RESULTS: Most of studies selected when the patient was admitted into the hospital and after the hospital discharge of the patient. The main sources of information to be highlighted are: the interview and the medical history of the patient. An established time is not explicitly stated on most of them, nor the registration form is used. The main professional in charge is the clinical pharmacologist. Apart from the home medication, the habits of self-medication and phytotherapy are also identified. The common errors of reconciliation vary from the omission of drugs to different forms of interaction with other medicinal products (drugs interactions). CONCLUSIONS: There is a large heterogeneity of methodologies used for reconciliation. There is not any work done on the specific figure of the polypathological patient, which precisely requires a standardized methodology due to its complexity and its susceptibility to errors of reconciliation.

Use of monoclonal antibodies for metastatic colorectal cancer in the Andalusian public health system.

BACKGROUND: The place of monoclonal antibodies in metastatic colorectal cancer has not been clearly defined. OBJECTIVE: To determine the treatment pattern of monoclonal antibodies in colorectal cancer patients in the Andalusian Public Healthcare System. METHOD: Data were collected from all patients treated with these drugs from July 2009 to December 2010 from pharmacy programs and medical records. RESULTS: Three hundred patients were included, of whom 227 received the antibody at the forefront. The proportion of patients who received bevacizumab in the first line is greater than that of cetuximab (62.1 vs. 37.5 % respectively) and similar in the second line and subsequent (47.8 vs. 53.8 % and 48.5 vs. 46.2 % respectively). XELOXbevacizumab was the most frequently prescribed scheme (35.3 %) followed by FOLFOX-monoclonal antibody schemes, regardless that this was bevacizumab or cetuximab (22.5 %). The median progression free survival (PFS) was 11.7 months for patients receiving cetuximab, 9.6 months for patients receiving bevacizumab and 8.2 months for those who received no monoclonal antibody in the first line. CONCLUSION: Bevacizumab was the antibody of choice in first line, showing utilization rates similar to cetuximab in second line and subsequent. The median PFS in our study is related to the PFS of the major clinical trials.

Errores de conciliación al ingreso hospitalario en pacientes pluripatológicos mediante metodología estandarizada / Medication reconciliation on hospital admission in patients with multiple chronic diseases using a standardised methodology

Objetivos: Conocer la incidencia de los errores de conciliación en el ingreso hospitalario en pacientes pluripatológicos a través de una metodología estandarizada. Material y método: Estudio observacional prospectivo en pacientes pluripatológicos ingresados en un hospital de tercer nivel. Se realizó conciliación al ingreso hospitalario siguiendo la metodología considerada como más adecuada para estos pacientes por un panel de expertos, según el método Delphi. La fuente de información principal utilizada fue la historia clínica digital, tanto la hospitalaria como la de atención primaria, recurriendo a la entrevista clínica en caso necesario. Se registraron tanto las discrepancias justificadas por el clínico como los errores de conciliación. Se analizó el tipo de error, los grupos farmacológicos implicados y se valoró la gravedad de cada uno de ellos. Resultados: Se incluyeron 114 pacientes, encontrándose errores de conciliación en el 75,4% de ellos. Los pacientes tenían 1.397 fármacos prescritos, de los cuales 234 presentaron discrepancias que requirieron aclaración con el clínico responsable. De estas 234 discrepancias, el clínico modificó la prescripción en 184 de ellas, consideradas errores de conciliación. Los tipos de error fueron: omisión de medicamentos (139), comisión (9), dosis, pauta o vía diferentes (24) y por prescripción incompleta (12). Entre los subgrupos farmacoterapéuticos más afectados por los errores se encontraron los antianémicos, vitaminas, y psicoanalépticos. Conclusiones: El porcentaje de pacientes pluripatológicos con errores de conciliación es elevado. El desarrollo de una metodología dirigida especialmente a los pacientes pluripatológicos consigue detectar y disminuir en un alto porcentaje los errores de medicación relacionados con los cambios de niveles asistenciales (AU)

Objectives: To determine the incidence of medication errors when admitting patients with multiple chronic conditions to hospital, using a standard method. Material and method: A prospective, observational study was conducted on patients with multiple chronic conditions admitted to a tertiary hospital. The medication reconciliation was performed using the standard method considered the most suitable for these patients by an expert panel, following the Delphi methodology. The main information source used for this was the computerised clinical notes, both in primary care and in the hospital, recurring to a clinical interview if necessary. Discrepancies justified by the clinician, as well as reconciliation errors were recorded. The type of error and the pharmacological group involved were analysed and the seriousness of each one of them was assessed. Results: A total of 114 patients were included, with reconciliation errors being found in 75.4% of cases. The patients had 1397 prescribed drugs, of which 234 had discrepancies that required clarification by the clinician responsible. The clinician modified the prescription in 184 of these discrepancies, which were considered reconciliation errors. The types of error were: medication omission (139), commission (9), dose, prescription or different routes (24) and by incomplete prescription (12). Anti-anaemic drugs, vitamins, and psychoanaleptics were among the pharmacotherapeutic groups most affected by the errors. Conclusions: The percentage of patients with multiple chronic conditions with errors is elevated. The development of methods particularly directed at patients with multiple chronic conditions manages to detect and decrease a high percentage of medication errors associated with changes of care levels (AU)

Evaluación de la adecuación del tratamiento farmacológico en pacientes pluripatológicos / Evaluation of the appropriateness of pharmacotherapy in patients with high comorbidity

Objetivo: Analizar la adecuación del tratamiento farmacológico y realizar, si es necesario, intervenciones para su mejora en una cohorte de pacientes pluripatológicos. Diseño: Estudio descriptivo, prospectivo, de 21 meses de duración. Emplazamiento: Área Hospitalaria Virgen del Rocío. Participantes: Pacientes pluripatológicos incluidos para un proyecto de atención integrada. Métodos: La variable principal consistió en el número de inadecuaciones detectadas. Para evaluar la adecuación del tratamiento farmacológico el farmacéutico especialista siguió un procedimiento normalizado que consistía en la aplicación del cuestionario Medication Aproppriateness Index (MAI) modificado como método implícito y de la lista de criterios Screening Tool of Older Person's potentially inappropriate Prescription/Screening Tool to Alert doctors to the Right (STOPP-START) como método explícito. Resultados: Se incluyeron un total de 244 pacientes, con una edad media de 76 ± 8 (± DE) años siendo el 50% hombres. El número medio de diagnósticos por paciente fue de 8 ± 3 (± DE) y de fármacos de 12 ± 4 (± DE). Se detectaron un total de 840 inadecuaciones, siendo la mayoritaria la presencia de interacciones. Respecto a los criterios STOPP los más frecuentemente incumplidos fueron: clase de medicamento duplicada y uso prolongado de benzodiacepinas de vida media larga o con metabolitos de acción larga, y para los START los IECA en la insuficiencia cardiaca crónica y estatinas y antiagregantes en la diabetes mellitus si coexisten uno o más factores de riesgo. Conclusiones: El gran número de inadecuaciones detectadas pone de manifiesto la importancia de evaluar la adecuación del tratamiento farmacológico en el paciente pluripatológico. Para ello es recomendable utilizar una estrategia de intervención farmacéutica combinada que incluya tanto un método implícito como un método explícito (AU)

Objetive: To analyze the appropriateness of pharmacotherapy and, if necessary, carry out interventions for its improvement in a cohort of patients with multiple chronic conditions. Design: Descriptive, prospective study of 21 months duration. Location: Hospital Universitario Virgen del Rocío. Participants: Patients with multiple chronic conditions included in a project for integrated healthcare. Methods: The primary endpoint was the number of inappropriate treatments. To evaluate the appropriateness of pharmacotherapy, the specialist in hospital pharmacy followed a standardized procedure consisting of the Medication Appropriateness Index (MAI) questionnaire, modified as an implicit method, and the list of criteria of the Screening Tool of Older Person's Potentially Inappropriate Prescription/Screening Tool to Alert doctors to the Right (STOPP-START) as an explicit method. Results: A total of 244 patients were included, with a mean age of 76 ± 8 (± SD) years. Half (50%) of the patients were men. The mean number of diagnoses per patient was 8 ± 3 (± SD) and 12 ± 4 drugs (± SD). A total of 840 inappropriate treatments were detected, most of them being due to the presence of interactions. The STOPP criteria most not complied with, were duplicate drug class, and prolonged use of benzodiazepines with long half-life or long-acting metabolites, and START for ACE inhibitors in chronic heart failure and statins and antiplatelets in diabetes mellitus, if one or more coexisting risk factors. Conclusions: We detected a large number of inappropriate treatments. This highlights the importance of evaluating the appropriateness of drug treatment in patients with multiple conditions. It is advisable to use a combined pharmacist intervention strategy that includes both an implicit method and an explicit method (AU)

[Medication reconciliation on hospital admission in patients with multiple chronic diseases using a standardised methodology]. / Errores de conciliación al ingreso hospitalario en pacientes pluripatológicos mediante metodología estandarizada.

OBJECTIVES: To determine the incidence of medication errors when admitting patients with multiple chronic conditions to hospital, using a standard method. MATERIAL AND METHOD: A prospective, observational study was conducted on patients with multiple chronic conditions admitted to a tertiary hospital. The medication reconciliation was performed using the standard method considered the most suitable for these patients by an expert panel, following the Delphi methodology. The main information source used for this was the computerised clinical notes, both in primary care and in the hospital, recurring to a clinical interview if necessary. Discrepancies justified by the clinician, as well as reconciliation errors were recorded. The type of error and the pharmacological group involved were analysed and the seriousness of each one of them was assessed. RESULTS: A total of 114 patients were included, with reconciliation errors being found in 75.4% of cases. The patients had 1397 prescribed drugs, of which 234 had discrepancies that required clarification by the clinician responsible. The clinician modified the prescription in 184 of these discrepancies, which were considered reconciliation errors. The types of error were: medication omission (139), commission (9), dose, prescription or different routes (24) and by incomplete prescription (12). Anti-anaemic drugs, vitamins, and psychoanaleptics were among the pharmacotherapeutic groups most affected by the errors. CONCLUSIONS: The percentage of patients with multiple chronic conditions with errors is elevated. The development of methods particularly directed at patients with multiple chronic conditions manages to detect and decrease a high percentage of medication errors associated with changes of care levels.

[Evaluation of the appropriateness of pharmacotherapy in patients with high comorbidity]. / Evaluación de la adecuación del tratamiento farmacológico en pacientes pluripatológicos.

OBJECTIVE: [corrected] To analyze the appropriateness of pharmacotherapy and, if necessary, carry out interventions for its improvement in a cohort of patients with multiple chronic conditions. DESIGN: Descriptive, prospective study of 21 months duration. LOCATION: Hospital Universitario Virgen del Rocío. PARTICIPANTS: Patients with multiple chronic conditions included in a project for integrated healthcare. METHODS: The primary endpoint was the number of inappropriate treatments. To evaluate the appropriateness of pharmacotherapy, the specialist in hospital pharmacy followed a standardized procedure consisting of the Medication Appropriateness Index (MAI) questionnaire, modified as an implicit method, and the list of criteria of the Screening Tool of Older Person's Potentially Inappropriate Prescription/Screening Tool to Alert doctors to the Right (STOPP-START) as an explicit method. RESULTS: A total of 244 patients were included, with a mean age of 76 ± 8 (± SD) years. Half (50%) of the patients were men. The mean number of diagnoses per patient was 8 ± 3 (± SD) and 12 ± 4 drugs (± SD). A total of 840 inappropriate treatments were detected, most of them being due to the presence of interactions. The STOPP criteria most not complied with, were duplicate drug class, and prolonged use of benzodiazepines with long half-life or long-acting metabolites, and START for ACE inhibitors in chronic heart failure and statins and antiplatelets in diabetes mellitus, if one or more coexisting risk factors. CONCLUSIONS: We detected a large number of inappropriate treatments. This highlights the importance of evaluating the appropriateness of drug treatment in patients with multiple conditions. It is advisable to use a combined pharmacist intervention strategy that includes both an implicit method and an explicit method.

Adecuación del tratamiento farmacológico en pacientes pluripatológicos / Suitability of pharmacological treatment in patients with multiple chronic conditions

Objetivo: Identificar herramientas de medida de la adecuación del tratamiento farmacológico de utilidad en el paciente pluripatológico (PP). Diseño: Revisión sistemática. Fuentes de datos: Se consultaron las siguientes bases de datos (diciembre de 2009): Pubmed, EMBASE, CINAHL, Psyc INFO e Índice Médico Español para detectar herramientas de medida de la adecuación del tratamiento en pacientes pluripatológicos o, en su defecto, ancianos o polimedicados. Selección de estudios: Se incluyeron estudios tanto con metodología cualitativa como cuantitativa, tanto trabajos teóricos como de campo, ya fuesen originales o revisiones, y se incluyeron trabajos de todos los ámbitos del sistema sanitario. Se recuperaron 108 artículos, de los que se seleccionaron 39. La consulta de sus referencias bibliográficas permitió incorporar 20 trabajos más, en total 59 artículos. Extracción de datos: De entre todas las herramientas detectadas, fueron seleccionadas aquellas con posible utilidad para el paciente pluripatológico. Se clasificaron los métodos en implícitos y explícitos y se tabularon las características de los trabajos de campo. Resultados: Se identificaron 2 métodos implícitos (MAI y Hamdy) y 6 métodos explícitos (criterios Beers, IPET, STOPP/START, ACOVE, CRIME y NORGEP). Ninguno era específico para pluripatológicos. El cuestionario MAI, los criterios Beers y sus modificaciones son los más usados en la literatura médica. Las ventajas de los criterios explícitos hacen que muchos de ellos se hayan desarrollado recientemente. Conclusiones: Existen diversas herramientas para la medida de la adecuación y, sin embargo, ninguna de ellas ha sido diseñada para una población de PP, que por sus características diferenciales requiere un abordaje específico(AU)

Objective: To identify tools for measuring the appropriateness of drug therapy useful in patients with multiple chronic conditions. Design: We performed a literature review. Data sources: The following database were consulted (December 2009): Pubmed, EMBASE, CINAHL, Psyc INFO and Spanish Medical Index (IME) to detect tools for measuring the appropriateness of treatment in patients with multiple chronic conditions, or otherwise elderly or polypharmacy. Study selection: Studies were identified both qualitative and quantitative methodology, both theoretical and field work, both original and revised work and included work from all areas of the health system. 108 articles were retrieved, of which we selected 59. The consultation of their references include 20 jobs allowed, resulting in a total of 59 articles. Data extraction: Of all the tools identified, the researchers performed a selection of those with possible utility for classified PP. The articles were classified into implicit and explicit methods and the characteristics of the field works were tabulated. Results: We identified two implicit methods (MAI and Hamdy) and 6 explicit methods (Beers criteria, IPET, STOPP/START, ACOVE, CRIME and NORGEP). None was specific to patients with multiple chronic conditions. The questionnaire MAI, the Beers criteria and its modifications are most often used in literature. The advantages of explicit criteria means that many of them have been developed recently. Conclusion: There are several tools to measure the appropriateness and none of them has been designed for a population of patients with multiple chronic conditions yet, which by its nature requires a specific approach spreads(AU)

[Suitability of pharmacological treatment in patients with multiple chronic conditions]. / Adecuación del tratamiento farmacológico en pacientes pluripatológicos.

OBJECTIVE: To identify tools for measuring the appropriateness of drug therapy useful in patients with multiple chronic conditions. DESIGN: We performed a literature review. DATA SOURCES: The following database were consulted (December 2009): Pubmed, EMBASE, CINAHL, PsycINFO and Spanish Medical Index (IME) to detect tools for measuring the appropriateness of treatment in patients with multiple chronic conditions, or otherwise elderly or polypharmacy. STUDY SELECTION: Studies were identified both qualitative and quantitative methodology, both theoretical and field work, both original and revised work and included work from all areas of the health system. 108 articles were retrieved, of which we selected 59. The consultation of their references include 20 jobs allowed, resulting in a total of 59 articles. DATA EXTRACTION: Of all the tools identified, the researchers performed a selection of those with possible utility for classified PP. The articles were classified into implicit and explicit methods and the characteristics of the field works were tabulated. RESULTS: We identified two implicit methods (MAI and Hamdy) and 6 explicit methods (Beers criteria, IPET, STOPP/START, ACOVE, CRIME and NORGEP). None was specific to patients with multiple chronic conditions. The questionnaire MAI, the Beers criteria and its modifications are most often used in literature. The advantages of explicit criteria means that many of them have been developed recently. CONCLUSION: There are several tools to measure the appropriateness and none of them has been designed for a population of patients with multiple chronic conditions yet, which by its nature requires a specific approach spreads.

Selection of tools for reconciliation, compliance and appropriateness of treatment in patients with multiple chronic conditions.

BACKGROUND: The healthcare models developed for patients with multiple chronic diseases agree on the need for improving drug therapy in these patients. The issues of patient compliance, appropriateness of prescriptions and the reconciliation process are of vital importance for patients receiving multiple drug treatment. OBJECTIVE: To identify and select the most appropriate tools for measuring treatment compliance and appropriateness in multiple-disease patients, as well as the best reconciliation strategy. METHODS: The study used the Delphi methodology. We identified compliance and appropriateness questionnaires and scales, as well as functional organisation models for reconciliation that had been used in patients with multiple chronic conditions. Based on the strength of the evidence, their usefulness in these patients and ease of use, the panel selected the most appropriate ones. RESULTS: We selected 46 indications for the panel: 5 on compliance, 20 on appropriateness, and 31 on reconciliation. The tool considered most appropriate and with a high degree of agreement was the "Adherence to Refills and Medication Scale" questionnaire. For appropriateness, the Medication Appropriateness Index questionnaire was considered appropriate. The STOPP/START criteria were the most appropriate. The greatest degree of agreement regarding reconciliation was on the information that needed to be collected and the variables considered as discrepancies. CONCLUSIONS: The "Adherence to Refills and Medication Scale" questionnaire for compliance, the STOPP/START criteria, the Medication Appropriateness Index questionnaire for appropriateness and the development of a specific strategy for reconciliation were considered appropriate for the assessment of drug therapy in patients with multiple chronic conditions.

The coffee constituent chlorogenic acid induces cellular DNA damage and formation of topoisomerase I- and II-DNA complexes in cells.

Chlorogenic acid (CGA) is a plant polyphenol with known antioxidant properties. Although some studies suggest that CGA has anticancer properties, others indicate that this dietary constituent may cause DNA damage and induce carcinogenic effects. Because CGA is widely consumed in the form of coffee, it is important to further evaluate the putative DNA-damaging activity of CGA. Here we have employed two standard techniques commonly used for DNA damage detection (the comet assay and the γ- H2AX focus assay) and observed that CGA (0.5-5 mM) induces DNA damage in normal and cancer cells. We report for the first time that CGA induces high levels of topoisomerase I- and topoisomerase II-DNA complexes in cells (TARDIS assay). Catalase pretreatment abolished the formation of these topoisomerase-DNA complexes and reduced the cytotoxic activity of CGA, therefore indicating that hydrogen peroxide plays an important role in these activities. Lung cancer cells (A549) were more sensitive than normal lung fibroblasts (MRC5) to the cytotoxic activity of CGA, supporting previous findings that CGA may induce selective killing of cancer cells. Taking into consideration our results and the pharmacokinetic profile of CGA, the possible cancer preventive, carcinogenic and therapeutic potential of this dietary agent are discussed.

Guanidine-reactive agent phenylglyoxal induces DNA damage and cancer cell death.

BACKGROUND: DNA-damaging compounds (e.g., alkylating agents, cytotoxic antibiotics and DNA topoisomerase poisons) are the most widely used anticancer drugs. The inability of tumor cells to properly repair some types of DNA damage may explain why specific DNA-damaging drugs can selectively kill tumor cells. Phenylglyoxal is a dicarbonyl compound known to react with guanidine groups such as that of the DNA base guanine, therefore suggesting that phenylglyoxal could induce DNA damage and have anticancer activity. METHODS: Cellular DNA damage was measured by the alkaline comet assay and the γH2AX focus assay. Formation of topoisomerase I- and topoisomerase II-DNA complexes was assessed by the TARDIS assay, an immunofluorescence technique that employs specific antibodies to DNA topo I or topo II to detect the protein covalently bound to the DNA in individual cells. Cell growth inhibition and cytotoxicity were determined by XTT, MTT and clonogenic assays. Apoptosis was assessed by the Annexin V flow cytometry assay. RESULTS: Phenylglyoxal induced cellular DNA damage and formation of high levels of topoisomerase I- and topoisomerase II-DNA complexes in cells. These topoisomerase-DNA complexes were abolished by catalase pretreatment and correlated well with the induction of apoptosis. Phenylglyoxal-induced cell death was partially prevented by catalase pretreatment and was higher in lung cancer cells (A549) than in normal lung fibroblasts (MRC5). Mammalian cell lines defective in nucleotide excision repair (NER), homologous recombination (HR) and non-homologous end joining (NHEJ) were more sensitive to phenylglyoxal than parental cells; this suggests that phenylglyoxal may induce bulky distortions in the shape of the DNA double helix (which are repaired by the NER pathway) and DNA double-strand breaks (which are repaired by HR and NHEJ). CONCLUSION: This report shows that phenylglyoxal is a new DNA-damaging agent with anticancer activity, and suggests that tumor cells with defects in NER, HR and NHEJ may be hypersensitive to the cytotoxic activity of phenylglyoxal.