RESUMEN
BACKGROUND: Non-adherence to medications continues to be a burden worldwide, with significant negative consequences. Community pharmacist interventions seem to be effective at improving medication adherence. However, more evidence is needed regarding their impact on disease-specific outcomes. The aim was to evaluate the impact of a community pharmacist-led adherence management intervention on adherence and clinical outcomes in patients with hypertension, asthma and chronic obstructive pulmonary disease (COPD). METHODS: A 6-month cluster randomised controlled trial was conducted in Spanish community pharmacies. Patients suffering from hypertension, asthma and COPD were recruited. Patients in the intervention group received a medication adherence management intervention and the control group received usual care. The intervention was based on theoretical frameworks for changing patient behaviour. Medication adherence, disease-specific outcomes (Asthma Control Questionnaire (ACQ) scores, Clinical COPD Questionnaire (CCQ) scores and blood pressure levels) and disease control were evaluated. A multilevel regression model was used to analyse the data. RESULTS: Ninety-eight pharmacies and 1186 patients were recruited, with 1038 patients completing the study. Patients receiving the intervention had an OR of 5.12 (95% CI 3.20 to 8.20, p<0.05) of being adherent after the 6 months. At the end of the study, patients in the intervention group had lower diastolic blood pressure levels (mean difference (MD) -2.88, 95% CI -5.33 to -0.43, p=0.02), lower CCQ scores (MD -0.50, 95% CI -0.82 to -0.18, p<0.05) and lower ACQ scores (MD -0.28, 95% CI -0.56 to 0.00, p<0.05) when compared with the control group. CONCLUSIONS: A community pharmacist-led medication adherence intervention was effective at improving medication adherence and clinical outcomes in patients suffering from hypertension, asthma and COPD. Future research should explore the implementation of these interventions in routine practice. TRIAL REGISTRATION NUMBER: ACTRN12618000410257.
Asunto(s)
Asma , Hipertensión , Farmacias , Enfermedad Pulmonar Obstructiva Crónica , Asma/tratamiento farmacológico , Humanos , Hipertensión/tratamiento farmacológico , Cumplimiento de la Medicación , Farmacéuticos , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológicoRESUMEN
Objetivos: Evaluar la adecuación de los sitios web destinados a proporcionar información para la realización de seguimiento farmacoterapéutico a 4 códigos de conducta. Métodos: Estudio descriptivo del cumplimiento de los criterios de calidad de 19 sitios web seleccionados por ser los de mayor utilización por los farmacéuticos en un estudio previo. Se realizó un análisis descriptivo y se estimó el coeficiente kappa para valorar la concordancia entre evaluadores (criterios de Fleiss) . Resultados y conclusiones: Fisterra fue la página mejor valorada en los 4 códigos, y la fuente de acceso a guías clínicas mejor calificada. La Cochrane Library y Pubmed las mejor valoradas en revisiones y fuentes secundarias. JAMA y British Medical Journal fueron las revistas mejor calificadas seguidas de Atención Primaria y Medicina Clínica. Entre los vademécums, el BOT y el Martindale obtuvieron las mejores calificaciones y el Boletín Terapéutico Andaluz y el Butlletí Groc recibieron altas calificaciones de entre los boletines de medicamentos. La Organización Mundial de la Salud fue la agencia mejor calificada. Los sitios con menor calificación fueron Pharmaceutical Care, Seguimiento Farmacoterapéutico y el Vademécum Internacional España MediMedia-Medicom. La concordancia entre evaluadores fue aceptable para los 4 códigos. Conclusiones: La calidad de los sitios web que utilizan los farmacéuticos es muy variable, aunque la mayoría superan los 60 puntos (sobre 100) en los 4 códigos de conducta usados en la evaluación
Objectives: To assess adherence to four codes of conduct in websites providing information useful for pharmacotherapy follow-up. Methods: We performed a descriptive study of adherence to quality criteria in 19 websites. These sites had been identified in a previous study as being those most frequently used by pharmacists. A descriptive analysis was performed and the kappa coefficient was calculated to evaluate interrater concordance (Fleiss' criteria for evaluation of the kappa index). Results: The most highly rated source of clinical practice guidelines and that which adhered most closely to the 4 codes of conduct was Fisterra. The websites most highly rated in reviews and secondary sources were the Cochrane Library and PubMed. The most highly rated journals were JAMA and the BMJ, followed by Atención Primaria and Medicina Clínica. Among drug information guides, the highest scores were obtained by BOT and Martindale's. The highest rated drug bulletins were the Boletín Terapéutico Andaluz and Butlletí Groc. The most highly rated agency was the World Health Organization. The journals with the lowest scores were Pharmaceutical Care and Seguimiento Farmacoterapéutico followed by the Spanish Internacional Vademecum MediMedia-Medicom. According to Fleiss's criteria, interrater concordance was acceptable for the 4 codes. Conclusions: The quality of the web sites evaluated varied widely, although most received scores of more than 60 points (out of 100) in the 4 codes of conduct used for evaluation
