Potentially inappropriate medications according to Marc, STOPP and PRISCUS criteria in a cohort of elderly HIV+ patients. The COMMPI project / Prevalencia de medicamentos potencialmente inapropiados según criterios Marc, STOPP y PRISCUS en una cohorte de pacientes VIH+ de edad avanzada. Proyecto COMMPI

Introduction: The objective is to determine the prevalence of potentially inappropriate drugs according to the Marc, STOPP, and PRISCUS lists in elderly HIV patients. Patients and methods: It was an observational, retrospective, and multicenter study. People living with HIV 65 years or older who underwent chronic concomitant treatment were included. Descriptive and multivariate analyzes were performed to study the association between polypharmacy and potentially inappropriate medication compliance. Results: A total of 55 patients were included, 81.8% men and a median age of 69 years (IQR: 67-73). The median number of comorbidities was 3 (IQR: 2-5) and the most frequent pattern of multimorbidity was cardiometabolic (62.9%). The predominant antiretroviral treatment was triple therapy (65.5%). Polypharmacy was present in 70.9% of the patients and 25.5% had major polypharmacy. The most frequent polypharmacy pattern was cardiovascular (69.2%). The percentage of potentially inappropriate medications according to the Marc, STOPP and PRISCUS lists was 65.5%, 30.9% and 14.5%, respectively (p<0.001). Adjusted for age and sex, polypharmacy was not independently associated with potentially inappropriate medication compliance in any of the lists. Conclusion: Polypharmacy and potentially inappropriate medications have a high prevalence. There is great variability in the percentage according to the list applied. Age, sex, and presence of polypharmacy are not predisposing factors to the presence of potentially inappropriate medications. (AU)

Introducción: El objetivo de este estudio es determinar la prevalencia de medicamentos potencialmente inapropiados según los listados Marc, STOPP y Priscus en pacientes VIH+ de edad avanzada. Pacientes y métodos: Estudio observacional, transversal y multicéntrico. Se incluyeron aquellos pacientes VIH+ mayores de 65 años en tratamiento antirretroviral y tratamiento concomitante crónico. Para conocer la asociación entre polifarmacia y presencia de medicación potencialmente inapropiada se llevaron a cabo análisis descriptivos y multivariante.Resultados: Se incluyeron 55 pacientes (81.8% hombres); mediana de edad 69 años (RIQ 67-73). Todos presentaban alguna comorbilidad (mediana 3, RIQ 2-5). El patrón de multimorbilidad más frecuente fue cardio-metabólico (62.9%). La triple terapia fue el esquema de tratamiento antiretroviral predominante (65.5%) y el patrón de polifarmacia más frecuente fue el cardiovascular (69.2%). Se identificó presencia de polifarmacia en un 70,9% y un 25,5% polifarmacia mayor. El cumplimiento de algún criterio según el listado Marc, STOPP y PRISCUS observó en 65,5%, 30,9% y 14,5% de los pacientes (p<0.001). Según análisis multivariante se observa que la edad, sexo o presencia de polifarmacia no son factores determinantes de presencia de medicamentos inapropiados en los listados. Conclusión. La prevalencia de medicación potencialmente inapropiada según los listados utilizados fue alta, existiendo una gran variabilidad en la identificación entre las diferentes herramientas. Edad, sexo y polifarmacia no son factores predictivosde presencia de medicamentos potencialmente inapropiados. (AU)

Sars-Cov-2 Infection in Patients on Long-Term Treatment with Macrolides in Spain: A National Cross-Sectional Study.

The aim of this study was to know the prevalence and severity of COVID-19 in patients treated with long-term macrolides and to describe the factors associated with worse outcomes. A cross-sectional study was conducted in Primary Care setting. Patients with macrolides dispensed continuously from 1 October 2019 to 31 March 2020, were considered. Main outcome: diagnosis of coronavirus disease-19 (COVID-19). Secondary outcomes: symptoms, severity, characteristics of patients, comorbidities, concomitant treatments. A total of 3057 patients met the inclusion criteria. Median age: 73 (64-81) years; 55% were men; 62% smokers/ex-smokers; 56% obese/overweight. Overall, 95% of patients had chronic respiratory diseases and four comorbidities as a median. Prevalence of COVID-19: 4.8%. This was in accordance with official data during the first wave of the pandemic. The most common symptoms were respiratory: shortness of breath, cough, and pneumonia. Additionally, 53% percent of patients had mild/moderate symptoms, 28% required hospital admission, and 19% died with COVID-19. The percentage of patients hospitalized and deaths were 2.6 and 5.8 times higher, respectively, in the COVID-19 group (p < 0.001). There was no evidence of a beneficial effect of long-term courses of macrolides in preventing SARS-CoV-2 infection or the progression to worse outcomes in old patients with underlying chronic respiratory diseases and a high burden of comorbidity.

Patients receiving a high burden of antibiotics in the community in Spain: a cross-sectional study.

Some patients in the community receive a high burden of antibiotics. We aimed at describing the characteristics of these patients, antibiotics used, and conditions for which they received antibiotics. We carried out a cross-sectional study. Setting: Thirty Health Primary Care Areas from 12 regions in Spain, covering 5,960,191 inhabitants. Patients having at least 30 packages of antibacterials for systemic use dispensed in 2017 were considered. Main outcome measures: Prevalence of antibiotic use, conditions for which antibiotics were prescribed, clinical characteristics of patients, comorbidities, concomitant treatments, and microbiological isolates. Patient's average age was 70 years; 52% were men; 60% smokers/ex-smokers; 54% obese. Overall, 93% of patients had, at least, one chronic condition, and four comorbidities on average. Most common comorbidities were cardiovascular and/or hypertension (67%), respiratory diseases (62%), neurological/mental conditions (32%), diabetes (23%), and urological diseases (21%); 29% were immunosuppressed, 10% were dead at the time of data collection. Patients received three antibiotic treatments per year, mainly fluoroquinolones (28%), macrolides (21%), penicillins (19%), or cephalosporins (12%). Most frequently treated conditions were lower respiratory tract (infections or prophylaxis) (48%), urinary (27%), and skin/soft tissue infections (11%). Thirty-five percent have been guided by a microbiological diagnosis, being Pseudomonas aeruginosa (30%) and Escherichia coli (16%) the most frequent isolates. In conclusion, high antibiotic consumers in the community were basically elder, with multimorbidity and polymedication. They frequently received broad-spectrum antibiotics for long periods of time. The approach to infections in high consumers should be differentiated from healthy patients receiving antibiotics occasionally.

Persistence profile to nucleos(t)ide analogue treatment for patients with chronic hepatitis B.

BACKGROUND: There are currently five approved nucleos(t)ide analogues (NUCs) for the management of chronic hepatitis B (CHB): lamivudine, adefovir dipivoxil, telbivudine, entecavir, and tenofovir disoproxil fumarate. OBJECTIVE: To determine the persistence rates among patients receiving NUCs for CHB at weeks 48, 96 and 144, compare them in these periods, and analyse the evolution of treatment persistence. METHODS: We conducted a retrospective study that included patients with CHB who initiated antiviral therapy and were attended to by the pharmaceutical care office between January 2002 and December 2011. Patients included in a clinical trial or patients who did not collect their medication personally were excluded. There were two different analyses: a comparative analysis of the persistence rates in three periods (weeks 1-48, weeks 48-96, and weeks 96-144); and a Kaplan-Meier analysis to evaluate the evolution of persistence. RESULTS: A total of 102 patients were included. Persistence rates were different in the three periods. They decreased during the course of the different periods, and the decline was more rapid between the first and second period. There were statistically significant differences in the non-persistence of the five drugs (p<0.005). Entecavir had the best profile of persistence, followed by tenofovir. CONCLUSIONS: This study showed that high genetic barrier drugs had a better profile of persistence in the initial treatment of patients with CHB. Data seem to suggest entecavir may offer better persistence rates than tenofovir, and the persistence rates for all five medications dropped in weeks 48-96.

Diseño y validación de una encuesta de satisfacción con la atención farmacéutica recibida en las consultas de farmacia hospitalaria / Design and validation of a satisfaction survey with pharmaceutical care received in hospital pharmacyconsultation

Objetivo: Diseñar y validar un cuestionario para valorar la satisfacción con la Atención Farmacéutica (AF) recibida en la farmacia hospitalaria. Métodos: Estudio multicéntrico en cinco hospitales andaluces. En enero 2013 se realizó una búsqueda bibliográfica en PUBMED; términos MESH pharmaceutical services, patients satisfaction and questionnaire. Seguidamente se elaboró el cuestionario, según metodología Delphi, formado por 10 ítems, con variables demográficas, sociales, farmacológicas y clínicas; donde se preguntaba al paciente sobre la repercusión de la AF en su tratamiento y enfermedad y sobre la conformidad con el servicio prestado. El paciente podía responder desde uno=muy deficiente a cinco=excelente. Se realizó una fase piloto previa a la fase de validación de los cuestionarios. Análisis descriptivos y la medida del valor del alfa de Cronbach y el coeficiente de correlación intraclase (CCI) se llevaron a cabo en ambas fases. Se utilizó el programa estadístico SPSS versión 20.0. Resultados: Se incluyeron 21 encuestas en la fase piloto y 154 en la fase de validación (índice de respuesta 100%). De esta última fase, el 62% (N=96) eran hombres. Más del 50% de los pacientes contestaron de forma “excelente” a todos los ítems de la encuesta en ambas fases. Los valores del alfa de Cronbach y CCI fueron 0.921 y 0.915 (IC95%: 0.847-0.961) y 0.916 y 0,910 (IC95%: 0.886-0.931) para fase piloto y validación, respectivamente. Conclusión: Se ha diseñado y validado un instrumento de alta fiabilidad para medir la satisfacción de los pacientes con la AF recibida en las consultas de farmacia hospitalaria (AU)

Object: To design and to validate a questionnaire to assess satisfaction with pharmaceutical care (PC) received at the hospital pharmacy. Methods: Multicentric study in five andalusian hospital in January 2013. A bibliography search was performed in PUBMED; MESH term; pharmaceutical services, patients satisfaction and questionnaire. Next, the questionnaire was produced by Delphi methodology with ten items and with the following variables; demographics, socials, pharrmacologicals and clinics which the patient was asked for the consequences of the PC in his treatment and illness and for the acceptance with the received service. The patient could answer between one= very insufficient and five= excellent. Before the validation phase questionnaire, a pilot phase was carried out. Descriptive analysis, Cronbach’s alpha coefficient and intraclass correlation coefficient (ICC) were performed in both phases. Data analysis was conducted using the SPSS statistical software package release 20.0. Results: In the pilot phase were included 21 questionnaires and 154 of them in validation phase (response index of 100%). In the last phase, 62% (N=96) of patients were men. More than 50% of patients answered “excelent” in all items of questionnaire in both phases. The Cronbach’s alpha coefficient and ICC were 0.921 and 0.915 (95%IC: 0.847-0.961) and 0.916 and 0,910 (95%IC: 0.886-0.931) in pilot and validation phases, respectively. Conclusions: A high reliability instrument was designed and validated to evaluate the patient satisfaction with PC received at hospital pharmacy (AU)

[Design and validation of a satisfaction survey with pharmaceutical care received in hospital pharmacyconsultation]. / Diseño y validación de una encuesta de satisfacción con la atención farmacéutica recibida en las consultas de farmacia hospitalaria.

OBJECT: To design and to validate a questionnaire to assess satisfaction with pharmaceutical care (PC) received at the hospital pharmacy. METHODS: Multicentric study in five andalusian hospital in January 2013. A bibliography search was performed in PUBMED; MESH term; pharmaceutical services, patients satisfaction and questionnaire. Next, the questionnaire was produced by Delphi methodology with ten items and with the following variables; demographics, socials, pharrmacologicals and clinics which the patient was asked for the consequences of the PC in his treatment and illness and for the acceptance with the received service. The patient could answer between one= very insufficient and five= excellent. Before the validation phase questionnaire, a pilot phase was carried out. Descriptive analysis, Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were performed in both phases. Data analysis was conducted using the SPSS statistical software package release 20.0. RESULTS: In the pilot phase were included 21 questionnaires and 154 of them in validation phase (response index of 100%). In the last phase, 62% (N=96) of patients were men. More than 50% of patients answered "excelent" in all items of questionnaire in both phases. The Cronbach's alpha coefficient and ICC were 0.921 and 0.915 (95%IC: 0.847-0.961) and 0.916 and 0,910 (95%IC: 0.886-0.931) in pilot and validation phases, respectively. CONCLUSIONS: A high reliability instrument was designed and validated to evaluate the patient satisfaction with PC received at hospital pharmacy.

Objetivo: Diseñar y validar un cuestionario para valorar la satisfacción con la Atención Farmacéutica (AF) recibida en la farmacia hospitalaria. Métodos: Estudio multicéntrico en cinco hospitales andaluces. En enero 2013 se realizó una búsqueda bibliográfica en PUBMED; términos MESH pharmaceutical services, patients satisfaction and questionnaire. Seguidamente se elaboró el cuestionario, según metodología Delphi, formado por 10 ítems, con variables demográficas, sociales, farmacológicas y clínicas; donde se preguntaba al paciente sobre la repercusión de la AF en su tratamiento y enfermedad y sobre la conformidad con el servicio prestado. El paciente podía responder desde uno=muy deficiente a cinco=excelente. Se realizó una fase piloto previa a la fase de validación de los cuestionarios. Análisis descriptivos y la medida del valor del alfa de Cronbach y el coeficiente de correlación intraclase (CCI) se llevaron a cabo en ambas fases. Se utilizó el programa estadístico SPSS versión 20.0. Resultados: Se incluyeron 21 encuestas en la fase piloto y 154 en la fase de validación (índice de respuesta 100%). De esta última fase, el 62% (N=96) eran hombres. Más del 50% de los pacientes contestaron de forma "excelente" a todos los ítems de la encuesta en ambas fases. Los valores del alfa de Cronbach y CCI fueron 0.921 y 0.915 (IC95%: 0.847-0.961) y 0.916 y 0,910 (IC95%: 0.886-0.931) para fase piloto y validación, respectivamente. Conclusión: Se ha diseñado y validado un instrumento de alta fiabilidad para medir la satisfacción de los pacientes con la AF recibida en las consultas de farmacia hospitalaria.

Bedaquiline in multidrug-resistant pulmonary tuberculosis GENESIS-SEFH drug evaluation report / Bedaquilina en tuberculosis pulmonar multirresistente

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