Multimodal Interventions to Improve the Management of Chronic Non-Malignant Pain in Primary Care Using Participatory Research.

BACKGROUND: The use of diverse therapies combined with a multidisciplinary approach and prevention initiatives for patients with chronic non-malignant pain (CNMP) can improve health and have a positive impact on psychotropic drug use and the self-management of pain. PURPOSE: This purpose of this study has been two-fold: to conduct a literature review with a view to selecting best evidence recommendations for CNMP and to prioritize self-care recommendations using a participatory methodology for the analysis and selection of interventions. METHODS: A qualitative, descriptive, and documentary method based on participatory action research was used. FINDINGS: Based on the study results, a multimodal psychosocial intervention program has been designed for CNMP that includes psychoeducational therapy, pharmacological therapy, physical exercise, and health assets. DISCUSSION: The findings are consistent with previous studies underlining the need to invest in resources for the management of CNMP, including strategies for good differential diagnoses and pharmacological treatments combined with non-pharmacological treatments to confer greater well-being for people living with pain who want to participate in their own recovery.

Resultados negativos asociados a la medicación en los pacientes con fibrilación auricular permanente atendidos en un servicio de urgencias hospitalario / Medication-related negative outcomes in patients with permanent atrial fibrillation attended in a hospital emergency department

Objetivos: Detectar la frecuencia de resultados negativos asociados a la medicación (RNM) en los pacientes con fibrilación auricular permanente (FAP) atendidos en un servicio de urgencias hospitalario (SUH), y evaluar su tipología, evitabilidad y gravedad en función de su relación con la terapia farmacológica para la fibrilación auricular (FA). Metodología: Estudio observacional descriptivo de una serie de casos con análisis transversal que incluyó a los pacientes atendidos con FAP en un servicio de urgencias (SU) de un hospital de tercer nivel durante 3 meses. Un farmacéutico entrevistó a los pacientes recogiendo datos demográficos, problemas de salud, grado de dependencia y terapia farmacológica. Un grupo evaluador, formado por un urgenciólogo y un farmacéutico, revisaron los cuestionarios y las historias clínicas para la evaluación de los RNM según el método Dáder. Resultados: Del total de 210 pacientes evaluados se incluyeron finalmente 198 pacientes con una edad media de 80,5 (DE 7,3) años, de los cuales 114 (57,5%) fueron mujeres. Ciento treinta y cuatro (67,7%) pacientes sufrieron un RNM, de los cuales 61 (45,5%) estaban relacionadas con el tratamiento de la FA (RNM-RTFA). De los 61 pacientes con RNM-RTFA, 24 (39,3%) fueron RNM de seguridad y 36 (59%) estaban causados por los fármacos para el control de la frecuencia. De los 73 pacientes con RNM no relacionadas con el tratamiento de la FA (RNM-NRTFA), 34 (46,6%) fueron RNM de necesidad y 38 (52,1%) eran por antibióticos. Entre los dos grupos, hubo diferencias estadísticamente significativas en cuanto a la evitabilidad (RNM-RTFA 55,7% vs RNM-NRTFA 78,1%; p = 0,010), pero no para la gravedad (p = 0,265). Conclusiones: Casi dos tercios de los pacientes con FAP que acuden a un SUH sufren un RNM relacionado o no con la medicación específica para la FA, siendo más evitables los RNM del grupo de fármacos no relacionados con el tratamiento de esta enfermedad (AU)

Objectives: To detect the frequency of negative outcomes associated with medication in patients with permanent atrial fibrillation (AF) who are attended in a hospital emergency department, and to assess type and severity of such outcomes related to AF medications as well as the rate of preventable negative outcomes. Methods: Descriptive, observational cross-sectional study in patients with permanent AF who were attended in the emergency department of a tertiary care hospital during a 3-month period. A pharmacist interviewed the patients to record demographic characteristics, health problems, degree of functional impairment, and current drug treatments. An emergency physician and a pharmacist reviewed the patients’ questionnaires and medical histories and evaluated them using the Dader method of pharmacotherapeutic follow-up. Results: Of the 210 patients assessed, 198 entered the final analysis. They had a mean (SD) age of 80.5 (7.3) years, and 114 (57.5%) were women. One handred and thirty-four (67.7%) patients had medication-related negative outcomes; 61 (45.5%) of the outcomes were related to treatment for permanent AF. Twenty-four of these 61 patients (39.3%) had problems affecting safety; 36 (59%) of the problems were caused by drugs to control heart rate. Of the 73 patients with negative outcomes unrelated to AF medication, 34 (46.6%) were related to necessary medications and 38 (52.1%) were taking antibiotics. The frequencies of avoidable negative outcomes were significantly different between the group of patients with problems related to drug therapy for AF (where 55.7% were due to medications considered unnecessary) and those with problems unrelated to AF medications (where 78.1% were from avoidable medications) (P=.010). However, the level of seriousness was similar. Conclusions: Nearly two-thirds of patients with permanent AF who come to the emergency department have a medication-related negative outcome that may or may not be related to AF treatment. Problems from drugs taken for reasons other than AF could more easily be avoided (AU)

[Medication-related negative outcomes in patients with permanent atrial fibrillation attended in a hospital emergency department]. / Resultados negativos asociados a la medicación en los pacientes con fibrilación auricular permanente atendidos en un servicio de urgencias hospitalario.

OBJECTIVES: To detect the frequency of negative outcomes associated with medication in patients with permanent atrial fibrillation (AF) who are attended in a hospital emergency department, and to assess type and severity of such outcomes related to AF medications as well as the rate of preventable negative outcomes. MATERIAL AND METHODS: Descriptive, observational cross-sectional study in patients with permanent AF who were attended in the emergency department of a tertiary care hospital during a 3-month period. A pharmacist interviewed the patients to record demographic characteristics, health problems, degree of functional impairment, and current drug treatments. An emergency physician and a pharmacist reviewed the patients' questionnaires and medical histories and evaluated them using the Dader method of pharmacotherapeutic follow-up. RESULTS: Of the 210 patients assessed, 198 entered the final analysis. They had a mean (SD) age of 80.5 (7.3) years, and 114 (57.5%) were women. One handred and thirty-four (67.7%) patients had medication-related negative outcomes; 61 (45.5%) of the outcomes were related to treatment for permanent AF. Twenty-four of these 61 patients (39.3%) had problems affecting safety; 36 (59%) of the problems were caused by drugs to control heart rate. Of the 73 patients with negative outcomes unrelated to AF medication, 34 (46.6%) were related to necessary medications and 38 (52.1%) were taking antibiotics. The frequencies of avoidable negative outcomes were significantly different between the group of patients with problems related to drug therapy for AF (where 55.7% were due to medications considered unnecessary) and those with problems unrelated to AF medications (where 78.1% were from avoidable medications) (P=.010). However, the level of seriousness was similar. CONCLUSION: Nearly two-thirds of patients with permanent AF who come to the emergency department have a medication- related negative outcome that may or may not be related to AF treatment. Problems from drugs taken for reasons other than AF could more easily be avoided.

OBJETIVO: Detectar la frecuencia de resultados negativos asociados a la medicación (RNM) en los pacientes con fibrilación auricular permanente (FAP) atendidos en un servicio de urgencias hospitalario (SUH), y evaluar su tipología, evitabilidad y gravedad en función de su relación con la terapia farmacológica para la fibrilación auricular (FA). METODO: Estudio observacional descriptivo de una serie de casos con análisis transversal que incluyó a los pacientes atendidos con FAP en un servicio de urgencias (SU) de un hospital de tercer nivel durante 3 meses. Un farmacéutico entrevistó a los pacientes recogiendo datos demográficos, problemas de salud, grado de dependencia y terapia farmacológica. Un grupo evaluador, formado por un urgenciólogo y un farmacéutico, revisaron los cuestionarios y las historias clínicas para la evaluación de los RNM según el método Dáder. RESULTADOS: Del total de 210 pacientes evaluados se incluyeron finalmente 198 pacientes con una edad media de 80,5 (DE 7,3) años, de los cuales 114 (57,5%) fueron mujeres. Ciento treinta y cuatro (67,7%) pacientes sufrieron un RNM, de los cuales 61 (45,5%) estaban relacionadas con el tratamiento de la FA (RNM-RTFA). De los 61 pacientes con RNM-RTFA, 24 (39,3%) fueron RNM de seguridad y 36 (59%) estaban causados por los fármacos para el control de la frecuencia. De los 73 pacientes con RNM no relacionadas con el tratamiento de la FA (RNM-NRTFA), 34 (46,6%) fueron RNM de necesidad y 38 (52,1%) eran por antibióticos. Entre los dos grupos, hubo diferencias estadísticamente significativas en cuanto a la evitabilidad (RNM-RTFA 55,7% vs RNM-NRTFA 78,1%; p = 0,010), pero no para la gravedad (p = 0,265). CONCLUSIONES: Casi dos tercios de los pacientes con FAP que acuden a un SUH sufren un RNM relacionado o no con la medicación específica para la FA, siendo más evitables los RNM del grupo de fármacos no relacionados con el tratamiento de esta enfermedad.

Medication list assessment in Spanish hospital emergency departments.

BACKGROUND: Medication errors lead to morbidity and mortality among emergency department (ED) patients. An inaccurate medication history is one of the underlying causes of these errors. OBJECTIVES: This study was performed to determine the prevalence of patients with discrepancies between the medical list information contained in the clinical history compiled on admission to the ED and the list of medications patients are actually taking, to characterize the discrepancies found, and to analyze whether certain factors are associated with the risk of discrepancies. METHODS: We conducted a cross-sectional, descriptive, observational, multicenter study with an analytic component in the EDs of 11 hospitals in Spain. We compared pharmacist-obtained medication lists (PML) with ED-obtained medication lists (EDML). Discrepancy was defined as one or more differences (in drug or dosage or route of administration) between the EDML and PML. The endpoints were the proportion of patients with discrepancies in their home medical lists, and the prevalence of certain factors among patients with discrepancies and those without. RESULTS: We detected 1476 discrepancies in 387 patients; no discrepancies were found in 20.7%. The most frequent discrepancies involved incomplete information (44.2%) and omission (41.8%). In the bivariate analysis, age, number of medications, and Charlson comorbidity score were significantly associated with discrepancy. In the multivariate analysis, number of medications and hospital were the variables associated with discrepancy. CONCLUSIONS: The EDML differed from the list of medications patients were actually taking in 79.3% of cases. Incomplete information and omission were the most frequent discrepancies. Age, number of medications, and comorbidities were related to the risk of discrepancies.

Validación de un cuestionario para medir el conocimiento de los pacientes sobre sus medicamentos / Validation of a questionnaire to assess patient knowledge of their medicines

ObjetivoEl grado de conocimiento de los pacientes sobre sus medicamentos está altamente asociado a la mejora de su uso racional y de los resultados de la farmacoterapia. El objetivo del estudio ha sido diseñar y validar un cuestionario que mida el grado de conocimiento de los pacientes sobre los medicamentos.DiseñoA) Cuestionario: revisión bibliográfica, varias técnicas cualitativas (panel de expertos, tormenta de ideas, método Delphi) y pruebas piloto. B) Validación del cuestionario.EmplazamientoUna farmacia comunitaria de Málaga capital.ParticipantesPacientes que acudieron a la farmacia seleccionada solicitando un medicamento.Mediciones principalesSe determinó la capacidad discriminante de los ítems. Se evaluó la validez de contenido y de constructo (cálculo del coeficiente rho de Spearman-Brown y análisis factorial de componentes principales [AFCP]) y la fiabilidad mediante la determinación de la consistencia interna, la equivalencia (concordancia interobservadores) y su estabilidad (test-retest).ResultadosEl cuestionario definitivo, formado por 11 ítems que engloban las dimensiones del conocimiento halladas, se pasó a 102 pacientes (tasa de respuesta del 95,3%) con una edad media de 46,86 años (desviación estándar [DE]: 16,70).El tiempo medio de cumplimentación fue de 4,9min (DE: 2,2). El AFCP mostró una estructura probable de 4 factores, que en conjunto explicaban el 67% de la variancia total. El coeficiente rho de Spearman-Brown fue de 0,30 (p<0,05). El alfa de Cronbach fue de 0,677, el coeficiente kappa fue de 0,99 y el coeficiente de correlación intraclase fue de 0,745 (intervalo de confianza del 95%: 0,49 a 0,87).ConclusionesEl cuestionario diseñado es ágil, válido y fiable para medir el grado de conocimiento de los pacientes sobre los medicamentos que utilizan(AU)

ObjectivePatient knowledge of their medicines is closely associated to a better rational use of drugs, thus achieving better health outcomes from their use. The objective of this study is to design and validate a questionnaire to assess the level of knowledge patients have about their medicines.Design(A) Questionnaire: Literature review, some qualitative techniques (expert panel, brainstorming, Delphi method) and some pilot studies. (B) Questionnaire validation.SettingA community pharmacy in the city of Malaga.ParticipantsPatients attending the selected pharmacy, asking for at least one medicine.Main measurementsThe discriminant capacity of the items was assessed. Content and construct validity were analysed using the Spearman's Rho coefficient and Factor Analysis method. Reliability was assessed by measuring internal consistency, equivalence (inter-observer concordance) and test-retest reliability.ResultsThe final questionnaire, with 11 items explaining the different dimensions of knowledge found, was completed by 102 patients (a response rate of 95.3%) with a mean age of 46.6 years (SD 16.70). Mean time to complete it was 4.9min (SD 2.2). Factor analysis showed a probable structure of 4 factors explaining the 67% of the total variance. The Spearman-Brown Rho coefficient was 0.30 (p<0.05). Cronbach α was 0.677, Kappa's coefficient=0.99 and intra-class correlation coefficient=0.745 (95% CI: 0.49–0.87).ConclusionsThe designed questionnaire is dynamic, valid and reliable, being able to measure the level of patient knowledge on the medicines they use(AU)

[Validation of a questionnaire to assess patient knowledge of their medicines]. / Validación de un cuestionario para medir el conocimiento de los pacientes sobre sus medicamentos.

OBJECTIVE: Patient knowledge of their medicines is closely associated to a better rational use of drugs, thus achieving better health outcomes from their use. The objective of this study is to design and validate a questionnaire to assess the level of knowledge patients have about their medicines. DESIGN: (A) Questionnaire: Literature review, some qualitative techniques (expert panel, brainstorming, Delphi method) and some pilot studies. (B) Questionnaire validation. SETTING: A community pharmacy in the city of Malaga. PARTICIPANTS: Patients attending the selected pharmacy, asking for at least one medicine. MAIN MEASUREMENTS: The discriminant capacity of the items was assessed. Content and construct validity were analysed using the Spearman's Rho coefficient and Factor Analysis method. Reliability was assessed by measuring internal consistency, equivalence (inter-observer concordance) and test-retest reliability. RESULTS: The final questionnaire, with 11 items explaining the different dimensions of knowledge found, was completed by 102 patients (a response rate of 95.3%) with a mean age of 46.6 years (SD 16.70). Mean time to complete it was 4.9 min (SD 2.2). Factor analysis showed a probable structure of 4 factors explaining the 67% of the total variance. The Spearman-Brown Rho coefficient was 0.30 (p<0.05). Cronbach alpha was 0.677, Kappa's coefficient=0.99 and intra-class correlation coefficient=0.745 (95% CI: 0.49-0.87). CONCLUSIONS: The designed questionnaire is dynamic, valid and reliable, being able to measure the level of patient knowledge on the medicines they use.

[Risk indicators of preventable morbidity related to drug utilization]. / Indicadores de riesgo de morbilidad prevenible causada por medicamentos.

OBJECTIVE: To select clinical situations that can be used as risk indicators of preventable morbidity caused by drugs at the community pharmacies, and to study their acceptability, in terms of pertinence and relevance. METHODS: We used the Delphi technique, in 2 rounds, by a panel of 14 medical doctors and pharmacists experts, to study the relevance of 68 types of clinical situations as risk indicators of preventable morbidity related to drug utilization used by health professionals in community pharmacies, with scientific evidence of foreseeable adverse result, frequent situations in ambulatory care and with controllable cause and result. RESULTS: 43 of the 68 indicators were considered usable and pertinent. The indicators referred three areas: drug type (medications of narrow therapeutic margin, with individualized dose and adverse reactions frequent and severe), health problem (chronic problems, especially asthma, cardiac, thyroid and prostate illness, and pain), and patient (old or with several medications. Pharmacists systematically overvalued some indicators in relation to the doctors, but differences were not significant. CONCLUSIONS: Forty-three indicators were selected as valuable to identify situations of preventable morbidity related to drug utilization.

Indicadores de riesgo de morbilidad prevenible causada por medicamentos / Risk indicators of preventable morbidity related to drug utilization

Objetivos: Seleccionar y estudiar la aceptabilidad, en términos de relevancia y pertinencia, de ciertas situaciones clínicas que puedan usarse como indicadores de riesgo de morbilidad prevenible causada por medicamentos y que sean utilizables en las farmacias comunitarias. Método: Método Delphi, en 2 rondas, con un panel de 14 expertos médicos y farmacéuticos que valoraron la relevancia y pertinencia de 68 tipos de situaciones clínicas como indicadores de morbilidad potencial relacionada con medicamentos, detectable por el profesional en su medio, con evidencia científica de resultado adverso previsible, frecuentes en el medio ambulatorio y con causa y resultado controlables. Resultados: Se consideraron utilizables y pertinentes 43 de los 68 indicadores estudiados, que se referían a 3 ámbitos: tipo de medicamento (medicamentos de estrecho margen terapéutico, con dosis individualizada y con reacciones adversas frecuentes y graves), problema de salud (problemas crónicos, especialmente asma, enfermedad cardíaca, tiroidea, prostática y dolor) y tipo de paciente (ancianos y/o polimedicados). Los farmacéuticos sobrevaloraron sistemáticamente ciertos indicadores en relación con los médicos, aunque las diferencias no fueron significativas. Conclusiones: Se identificaron 43 indicadores de morbilidad potencial relacionada con los medicamentos e identificables por los profesionales en su entorno

Objective: To select clinical situations that can be used as risk indicators of preventable morbidity caused by drugs at the community pharmacies, and to study their acceptability, in terms of pertinence and relevance. Methods: We used the Delphi technique, in 2 rounds, by a panel of 14 medical doctors and pharmacists experts, to study the relevance of 68 types of clinical situations as risk indicators of preventable morbidity related to drug utilization used by health professionals in community pharmacies, with scientific evidence of foreseeable adverse result, frequent situations in ambulatory care and with controllable cause and result. Results: 43 of the 68 indicators were considered usable and pertinent. The indicators referred three areas: drug type (medications of narrow therapeutic margin, with individualized dose and adverse reactions frequent and severe), health problem (chronic problems, especially asthma, cardiac, thyroid and prostate illness, and pain), and patient (old or with several medications. Pharmacists systematically overvalued some indicators in relation to the doctors, but differences were not significant. Conclusions: Forty-three indicators were selected as valuable to identify situations of preventable morbidity related to drug utilization

Disponibilidad y coexistencia de especialidades farmacéuticas publicitarias con otras especialidades de igual composición / No disponible

En la actualidad en España existen tres tipos de medicamentos en función de su estatus de dispensación: los que necesitan receta médica y los que no la necesitan; estos últimos pueden ser publicitarios (les está permitido hacer publicidad de los mismos dirigida a la población) o no publicitarios. A los medicamentos publicitarios se les reserva la denominación de Especialidades Farmacéuticas Publicitarias, tienen una legislación específica y los principios activos que las componen y las condiciones en las que éstos puedan utilizarse han de estar previamente autorizados por Orden Ministerial. El presente trabajo pretende conocer cuantos de estos principios activos autorizados disponen de Especialidades Farmacéuticas Publicitarias en el mercado y si existen medicamentos de diferente estatus de dispensación con la misma composición cuali y cuantitativa que las Especialidades Farmacéuticas Publicitaria y en qué grado puede darse esta coexistencia. Cerca de la mitad de los principios activos autorizados para medicamentos publicitarios no cuenta con ninguno de ellos comercializado. El arsenal terapéutico del que puede disponer el farmacéutico en la dispensación de especialidades farmacéuticas de su competencia es más reducido del que la legislación vigente permite, dándose la circunstancia de que para determinados trastornos menores que pudieran tratarse con EFP, solamente se disponen de Especialidades Farmacéuticas de prescripción médica. Se produce coexistencia entre EFP y especialidades de prescripción médica para un mismo principio activo autorizado. Esto se da en concretamente en 29 casos (10,01%). Esto es causa de problemas para el farmacéutico comunitario por la ambigüedad de la norma y por sus consecuencias jurídicas (AU)

No disponible

La Atención Farmacéutica como método para mejorar la salud de los pacientes y la coordinación entre los profesionales médicos y farmacéuticos (Contestación a Enrique Costas Lombardía) / No disponible

No disponible