[Comparison of quality of life in patients living with HIV infection through pharmaceutical care according to CMO methodology vs. conventional follow-up. MAS-VIH project]. / Comparación de la calidad de vida en personas que viven con infección por VIH en seguimiento mediante atención farmacéutica según metodología capacidad motivación-oportunidad vs. seguimiento convencional. Proyecto MAS-VIH.

OBJECTIVE: To compare quality of life, in patients living with HIV infection with pharmaceutical care according to the CMO methodology: capacity, motivation and opportunity versus conventional follow-up. METHODS: Longitudinal, prospective, multicenter, health intervention study, conducted between October 2019 and November 2021 in 14 centers throughout Spain. Patients over 18 years of age, receiving antiretroviral treatment and attending the consultations of the participating Pharmacy Services for 1 year were included. Patients who did not have the autonomy to complete the planned questionnaires were excluded. At baseline, participating centers were randomized to continue using the same systematics of work (traditional follow-up) or to implement the CMO model using patient stratification models, goal setting in relation to pharmacotherapy, use of motivational interviewing, as well as longitudinal follow-up enabled by new technologies. The main variable was the difference in the number of dimensions positively affected in each follow-up arm at 24 weeks of follow-up according to the MOS-HIV questionnaire. In the CMO group, the interventions performed the most frequently were recorded. RESULTS: 151 patients were included. The median age was 51.35 years. A significant improvement in quality of life was found at the end of follow-up in the CMO group, reducing the number of patients with negatively affected dimensions (2/11 vs 8/11). The most frequent interventions carried out in the CMO group, according to the taxonomy, were Motivation (51,7%) and review and validation (49,4%). CONCLUSIONS: The quality of life of patients is higher in those centers that develop Pharmaceutical Care based on the CMO methodology compared to traditional follow-up.

[Adherence, satisfaction and health-related quality of life in HIV-infected patients with antiretroviral therapy in Spain. The ARPAS study]. / Adherencia, satisfacción y calidad de vida relacionada con la salud en pacientes infectados por el VIH con tratamiento antirretroviral en España. Estudio ARPAS.

OBJECTIVE: To determine the relationship between satisfaction with antiretroviral therapy (ART), adherence and quality of life (QoL) in adult patients diagnosed with HIV infection and ART according to the posologic load. METHOD: Multicenter, observational and cross-sectional study. Socio-demographic, clinical and of posologic load (1, 2-4 or > 4 tablets/day), adherence (SMAQ, dispensation recordings (DR) and visual analogical scale), satisfaction (ESART questionnaire) and QoL (MOS-HIV) variables were gathered. An adherent patient was defined as the one presenting simultaneously adherence according to SMAQ and DR > 95%. RESULTS: 328 patients (76% men; 46.0 ± 9.2 years) were evaluated. The posology of 1 tablet/day, 2-4 tablets/day and > 4 tablets/day occurred in 29%, 37% and 34% of the patients, respectively. Although the evaluation performed through the SMAQ questionnaire and the VAS scale independently showed statistically significant differences in favor of the 1 tablet/day scheme, the percentage (49%) of adherent patients according to the combined variable did not differ between the groups based on the posologic load. The satisfaction with ART and QoL were high in the three groups, being the 1 tablet/day scheme the one related with higher satisfaction and lower rate of adverse effects on fat metabolism. There were no differences in patients' satisfaction by the adherence level. CONCLUSIONS: Adherence, satisfaction with ART and QoL of the patients with ART are high. Although higher in patients taking 1 tablet/day, the satisfaction did not differ according to the level of adherence and no correlation was observed between satisfaction with ART and quality of life.

OBJETIVO: Determinar la relación entre satisfacción con el tratamiento antirretroviral (TAR), adherencia y calidad de vida (CV) en pacientes adultos diagnosticados de infección por VIH con TAR según la carga posológica. MÉTODO: Estudio observacional, transversal, multicéntrico. Se recogieron variables sociodemográficas, clínicas, carga posológica (1, 2-4 o más de 4 comprimidos al día), adherencia (SMAQ, registros de dispensación (RD) y escala visual analógica), de satisfacción (cuestionario ESTAR) y de CV (MOS-HIV). Se definió paciente adherente cuando simultáneamente presentaba adherencia según SMAQ y un RD > 95%. RESULTADOS: Se evaluaron 328 pacientes (76% varones; 46,0 ± 9,2 años). El esquema de 1c/día, 2-4 c/día y > 4 c/día se dio en el 29%, 37% y 34% de los pacientes respectivamente. Pese que la evaluación realizada por el cuestionario SMAQ y la escala EVA de forma independiente muestra diferencias estadísticamente significativas a favor del esquema 1c/día, el porcentaje de pacientes adherentes según la variable combinada (49%) no difiere entre los grupos en función de la carga posológica. La satisfacción al TAR y fueron elevadas en los tres grupos, siendo los esquemas 1 c/día los relacionados con mayor satisfacción y menores efectos adversos del metabolismo de las grasas. No se observaron diferencias en la satisfacción de los pacientes según la adherencia. CONCLUSIONES: La adherencia, la satisfacción al TAR y de los pacientes con TAR es alta. La satisfacción, mayor en pacientes que toman 1 c/día, no difiere en función de la adherencia y no se observó correlación entre satisfacción con el TAR y calidad de vida.

[Development and validation of a prediction model to identify HIV+ patients with drug-related problems. A prediction study]. / Desarrollo y validación de un modelo predictivo para la identificación de pacientes infectados por el VIH con problemas relacionados con los medicamentos. Estudio predictor.

OBJECTIVE: To develop and validate a prediction model for the detection of drug-related problems (DRP) in patients on antiretroviral treatment during their regular monitoring in Pharmaceutical Care Clinics before dispensing drugs. MEHOD: Open multicentre prospective study. HIV patients with and without DRP were included. Demographic, clinical and pharmacotherapy variables (related and unrelated to antiretroviral treatment) were included in the model design. To find prognostic factors for DRP, a binary logistic regression model was created after performing a univariate analysis that identified independent variables related to DRP these variables were introduced in the multivariate model for the final selection. Model validity was determined by the shrinkage method and the discriminatory power by Harrell's C-index. RESULTS: 733 patients were included. The variables "adherence", "prescription of drugs needing dosage adjustment", and "total number of drugs prescribed (apart from the antiretroviral treatment)" were independently related to the appearance of DRP. Probabilities predicted by the model, customising the coefficients using the uniform shrinkage method, showed a R(2)=0.962 for the construction sample and a R(2)=0.872 for the validation sample. The discriminatory capacity of the model was 0.816 for the construction sample and 0.779 for the validation sample. CONCLUSIONS: The developed and validated model enables detection of patients on antiretroviral treatment who are at a higher risk for experiencing a DRP. The prediction variables employed are commonly used in patient's pharmacotherapy record, allowing the model to be used in routine clinical practice.

[The role of the hospital pharmacist in the prevention, treatment and management of the side effects associated with antiretroviral treatment]. / Papel del farmacéutico de hospital en la prevención, identificación y manejo de los efectos adversos asociados al tratamiento antirretroviral.

At present, the side effects associated with antiretroviral treatment are the main reasons for discontinuation of this kind of therapy, both in clinical trials and in regular clinical practise. On the other hand, due to the change of direction that our profession has suffered in recent years, we face the need to establish a different relationship with the patient, achieving direct and effective Pharmaceutical Care within a framework of shared responsibility for therapeutic results. Pharmacist interventions should be aimed at improving the quality of life of patients, which can only be achieved with a multidisciplinary approach and individualised and adjusted to new patterns of toxicity of the drugs currently used. The pharmacist who does this work must know how to interpret these side effects, giving accurate information to the patient about both pharmacological and non-pharmacological treatment and correct pharmaceutical follow-up which clearly sets forth the criteria for referral to medical appointments. The aim of this paper is to establish baselines so that the hospital pharmacist can perform clearly and uniformly in the prevention, identification and management of major side effects: gastrointestinal, cardiovascular, dermatological, at the central nervous system and kidney level, associated with antiretroviral therapy.