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 / 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

Objetivo. Comparar la calidad de vida en personas que viven con infección por el Virus de la Inmunodeficiencia Humana según el modelo de Atención Farmacéutica que reciben en los Servicios de Farmacia Hospitalaria: CMO (capacidad, motivación y oportunidad), versus seguimiento convencional. Método. Estudio longitudinal, prospectivo, multicéntrico, realizado entre octubre-2019 y noviembre-2021 en 14 Servicios de Farmacia Hospitalaria de España. Se incluyeron pacientes mayores de 18 años, que recibían tratamiento antirretroviral y acudían a las consultas de Atención Farmacéutica durante ≥1 año. Se excluyeron aquellos pacientes sin autonomía para completar los cuestionarios previstos. Los centros fueron aleatorizados a seguir utilizando la misma sistemática de trabajo (seguimiento tradicional) o implementar el modelo CMO, utilizando la estratificación, establecimiento de objetivos farmacoterapéuticos, uso de entrevista motivacional, así como el seguimientolongitudinal con nuevas tecnologías. La variable principal fue la diferencia en el número de dimensiones afectadas negativamente, en cada rama, a las 24 semanas, según cuestionario MOS-HIV. En el brazo CMO se registraron las intervenciones más frecuentemente realizadas.Resultados. Se incluyeron 151 pacientes. La mediana de edad fue de 51,3 años. Se encontró mejora significativa de la calidad de vida al final del seguimiento en el grupo CMO, reduciéndose el número de pacientes con dimensiones afectadas negativamente (2/11 vs 8/11). Las intervenciones más frecuentes llevadas a cabo, según la taxonomía, fueron: Motivación (51,7%) y Revisión y validación del TAR (49,4%). Conclusiones. La calidad de vida de los pacientes es superior en aquellos centros que desarrollan Atención Farmacéutica basada en metodología CMO en comparación con el seguimiento tradicional. (AU)

Objective. To compare quality of life, in patients livingwith HIV infection with pharmaceutical care according to the CMO methodology: capacity, motivation and opportunity versus conventional follow-up. Method. 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. (AU)

Actualización 2022 de los indicadores para la calidad asistencial y la atención farmacéutica a las personas que viven con el virus de la inmunodeficiencia humana / 2022 update of the indicators for quality of care and pharmaceutical care for people living with human immunodeficiency virus

Objetivo: actualizar y definir los indicadores para la mejora de la calidad asistencial y la atención farmacéutica a las personas que viven con infección por VIH en España. Método: el presente proyecto, que actualiza la versión anterior del documento de 2013, se desarrolló en 4 fases de trabajo realizadas entre enero y junio de 2022.En la fase 1, de organización, se creó un grupo de trabajo conformado por 7 especialistas en farmacia hospitalaria con amplia experiencia en atención farmacéutica y procedentes de distintos servicios del territorio nacional. Adicionalmente otros 34 especialistas, participaron en la valoración de los indicadores a través de 2 rondas de evaluación online para generación del consenso.Para la fase 2, inicialmente, se llevó a cabo una revisión bibliográfica con el objetivo de establecer una base a partir de la cual poder definir una propuesta de criterios de calidad e indicadores. A continuación, se realizó una propuesta preliminar de criterios y se establecieron revisiones para su ajuste en varias reuniones de trabajo telemáticas.En la fase 3 se estableció el consenso basado en la metodología de consenso Delphi-Rand/UCLA.Adicionalmente todos los indicadores clasificados como adecuados y necesarios fueron agrupados según 2 niveles de recomendación de monitorización, de manera que pueda orientar a los servicios en la prioridad de su medición: claves y avanzados.Por último, en la fase 4 se elaboró el documento final del proyecto, junto con las fichas descriptivas correspondientes para cada indicador con la finalidad de facilitar su medición y evaluación por parte de los servicios de farmacia hospitalaria. Resultados: se obtuvo un listado consensuado de ítems conformado por 79 indicadores adecuados y necesarios que permiten establecer un seguimiento y monitorización de la calidad y actividad de la atención farmacéutica a las personas que viven con VIH. De los mismos, 60 fueron establecidos como clave y 19 avanzados. Conclusiones: (AU)

Objective: To update and define indicators for improving the quality of care and pharmaceutical care for people living with HIV infection in Spain. Method: The present project, which updates the previous version of the 2013 document, was developed in four work phases carried out between January and June 2022.In phase 1, the organization phase, a working group was created, made up of seven hospital pharmacy specialists with extensive experience in pharmaceutical care and from different SFHs in Spain. In addition, another 34 specialists participated in the evaluation of the indicators through two rounds of online evaluation to generate consensus.For phase 2, initially, a review of the identified reference literature was carried out with the aim of establishing a basis from which to define a proposal for quality criteria and indicators. Then, a preliminary proposal of criteria was made and revisions were established for their adjustment in several telematic work meetings.In phase 3, consensus was established based on the Delphi-Rand/UCLA consensus methodology.In addition, all the indicators classified as appropriate and necessary were grouped according to two levels of monitoring recommendation, so as to guide the hospital pharmacy services in the priority of their measurement: key and advanced.Finally, in phase 4, the final project document was prepared, along with the corresponding descriptive sheets for each indicator in order to facilitate the measurement and evaluation of the indicators by the hospital pharmacy services. Results: Following the consensus methodology used, a list of items made up of 79 appropriate and necessary indicators was drawn up to establish a follow-up and monitoring of the quality and activity of pharmaceutical care for people living with HIV. Of these, 60 were established as key and 19 advanced. Conclusions ... (AU)

[Translated article] 2022 update of the indicators for quality of care and pharmaceutical care for people living with human immunodeficiency virus.

OBJECTIVE: To update and define indicators for improving the quality of care and Pharmaceutical Care for people living with HIV infection in Spain. METHOD: The present project, which updates the previous version of the 2013 document, was developed in four work phases carried out between January and June 2022. In phase 1, the organization phase, a working group was created, made up of seven hospital pharmacy specialists with extensive experience in pharmaceutical care and from different SFHs in Spain. In addition, another 34 specialists participated in the evaluation of the indicators through two rounds of online evaluation to generate consensus. For phase 2, initially, a review of the identified reference literature was carried out with the aim of establishing a basis from which to define a proposal for quality criteria and indicators. Then, a preliminary proposal of criteria was made and revisions were established for their adjustment in several telematic work meetings. In phase 3, consensus was established based on the Delphi-Rand/UCLA consensus methodology. In addition, all the indicators classified as appropriate and necessary were grouped according to two levels of monitoring recommendation, so as to guide the hospital pharmacy services in the priority of their measurement: key and advanced. Finally, in phase 4, the final project document was prepared, along with the corresponding descriptive sheets for each indicator in order to facilitate the measurement and evaluation of the indicators by the hospital pharmacy services. RESULTS: Following the consensus methodology used, a list of items made up of 79 appropriate and necessary indicators was drawn up to establish a follow-up and monitoring of the quality and activity of Pharmaceutical Care for people living with HIV. Of these, 60 were established as key and 19 advanced. CONCLUSIONS: The indicators defined and updated, since the previous version of 2013, are intended to be a tool for professionals to guide decision-making and facilitate the measurement and assessment of the most relevant aspects of the quality and pharmaceutical care of people living with HIV.

2022 update of the indicators for quality of care and pharmaceutical care for people living with human immunodeficiency virus. / Actualización 2022 de los indicadores para la calidad asistencial y la atención farmacéutica a las personas que viven con el virus de la inmunodeficiencia humana.

OBJECTIVE: To update and define indicators for improving the quality of care and pharmaceutical care for people living with HIV infection in Spain. METHOD: The present project, which updates the previous version of the 2013 document, was developed in four work phases carried out between January and June 2022. In phase 1, the organization phase, a working group was created, made up of seven hospital pharmacy specialists with extensive experience in pharmaceutical care and from different SFHs in Spain. In addition, another 34 specialists participated in the evaluation of the indicators through two rounds of online evaluation to generate consensus. For phase 2, initially, a review of the identified reference literature was carried out with the aim of establishing a basis from which to define a proposal for quality criteria and indicators. Then, a preliminary proposal of criteria was made and revisions were established for their adjustment in several telematic work meetings. In phase 3, consensus was established based on the Delphi-Rand/UCLA consensus methodology. In addition, all the indicators classified as appropriate and necessary were grouped according to two levels of monitoring recommendation, so as to guide the hospital pharmacy services in the priority of their measurement: key and advanced. Finally, in phase 4, the final project document was prepared, along with the corresponding descriptive sheets for each indicator in order to facilitate the measurement and evaluation of the indicators by the hospital pharmacy services. RESULTS: Following the consensus methodology used, a list of items made up of 79 appropriate and necessary indicators was drawn up to establish a follow-up and monitoring of the quality and activity of pharmaceutical care for people living with HIV. Of these, 60 were established as key and 19 advanced. CONCLUSIONS: The indicators defined and updated, since the previous version of 2013, are intended to be a tool for professionals to guide decision-making and facilitate the measurement and assessment of the most relevant aspects of the quality and pharmaceutical care of people living with HIV.

Patient Experience Evaluation of the CMO-Based Pharmaceutical Care Model vs Usual Care in People Living with HIV.

Objective: To compare patient experience in a real-life population of people living with HIV (PLWH) who received pharmaceutical care (PC) based on the Capacity-Motivation-Opportunity (CMO) model versus the traditional model. Methods: Prospective cohort study in PLWH receiving either CMO-based PC or traditional PC in Spain between October 2019 and June 2021 (24 weeks), performed by the pharmacy department of 14 Spanish hospitals. Participants were adult patients with a clinical diagnosis of HIV treated with antiretrovirals who had been monitored in the participating hospital pharmacies for >1 year. Patient experience (IEXPAC questionnaire), clinical outcomes (cholesterol, triglycerides, HDL, glycated haemoglobin, and blood pressure), adherence to treatment, virologic control and patient satisfaction were determined. Results: Patient experience in the CMO group at week 24 was significantly better (7.6 vs 6.9) than in the traditional group, with a higher mean improvement. Adherence was better in the CMO group, particularly with regard to concomitant medications (53.2% to 91.7%, p<0.001); no changes were observed in the traditional group. Patient satisfaction improved in the CMO group vs the traditional group (48 vs 44, p<0.001). Conclusion: To our knowledge, this is the first study to compare CMO vs traditional methodology. The CMO model showed an overall improvement in real-life patient experience, satisfaction, and adherence to treatment compared to the traditional methodology.

Mejora de calidad del área de pacientes externos mediante participación del paciente y metodología Lean

Objetivo: Mejorar la calidad del proceso de dispensación y atenciónfarmacéutica a pacientes externos mediante la participación del pacientey la aplicación de la metodología Lean y analizar los resultados obtenidos en cuanto a eficiencia e impacto en la satisfacción de los pacientes.Método: Estudio observacional, prospectivo y unicéntrico. Se creó ungrupo de trabajo con los diferentes profesionales implicados en la atención al paciente externo para aplicar la metodología Lean y detectaroportunidades de mejora. Para conocer la experiencia del paciente seutilizó la técnica del grupo focal. El impacto en la satisfacción de lospacientes se midió mediante encuestas de satisfacción que se enviaron através del correo electrónico en diciembre de 2019 (antes de implantarlas principales medidas) y en diciembre de 2020.Resultados: Teniendo en cuenta la perspectiva de los pacientes yde los profesionales sanitarios, se identificaron más de 30 acciones demejora de las que se priorizaron 9, relacionadas fundamentalmente concambios estructurales y de circuitos. Se consiguió mejorar significativamente los tiempos de espera (el 35% de los pacientes esperaban másde 30 minutos frente al 4,5% en el análisis realizado después de lasintervenciones). Los aspectos que mostraron diferencias estadísticamentesignificativas en las encuestas entre los dos periodos fueron el tiempo de espera y la satisfacción global, en ambos casos el grado de satisfacciónfue superior una vez implantadas las acciones de mejora. (AU)

Objective: To improve the quality of the dispensing process and pharmaceutical care in the Outpatient Pharmacy through patient participationand Lean methodology, and to analyse the results obtained in terms ofefficiency and patient satisfaction.Method: Prospective observational single-centre study. A working groupwas organized with the health care staff involved in outpatient care toapply Lean methodology and detect improvement opportunities. Weused a focus group technique to understand the patients’ experience. Theimpact on patient satisfaction was measured through a mass survey mailed out in December 2019 (before introducing the main measures) and inDecember 2020.Results: More than 30 improvement actions were identified after surveying the opinions of the patients and health care staff involved. Nineactions were prioritized, which were mainly related to structural andcircuit changes. Waiting times significantly improved (35% of patientswaited for more than 30 minutes before the improvement actions vs4.5% afterward). The results showed that waiting times and overall satisfaction significantly improved in the period between the two surveys. Inboth cases, the degree of satisfaction was higher after introducing theimprovement actions. (AU)

Improvement of outpatient pharmacy through patient participation and Lean methodology.

OBJECTIVE: To improve the quality of the dispensing process and  pharmaceutical care in the Outpatient Pharmacy through patient participation and Lean methodology, and to analyse the results obtained in  terms of efficiency and patient satisfaction. METHOD: Prospective observational single-centre study. A working group was  organized with the health care staff involved in outpatient care to apply Lean  methodology and detect improvement opportunities. We used a focus group  technique to understand the patients' experience. The impact on patient  satisfaction was measured through a mass survey mailed out in December  2019 (before introducing the main measures) and in December 2020. RESULTS: More than 30 improvement actions were identified after surveying the opinions of the patients and health care staff involved. Nine actions were prioritized, which were mainly related to structural and circuit changes. Waiting times significantly improved (35% of patients waited for more than 30 minutes before the improvement actions vs 4.5% afterward). The results showed that waiting times and overall  satisfaction significantly improved in the period between the two surveys. In both cases, the degree of satisfaction was higher after introducing the improvement actions. CONCLUSIONS: We analysed the situation of our Outpatient Service and designed the most appropriate improvement actions according to the resources available. This initiative was achieved through patient  participation (via a focus group and mass surveys), the participation of health  care staff, and the application of Lean methodology.

Objetivo: Mejorar la calidad del proceso de dispensación y atención farmacéutica a pacientes externos mediante la participación del  paciente y la aplicación de la metodología Lean y analizar los resultados  obtenidos en cuanto a eficiencia e impacto en la satisfacción de los pacientes. Método: Estudio observacional, prospectivo y unicéntrico. Se creó un grupo de  trabajo con los diferentes profesionales implicados en la atención al  paciente externo para aplicar la metodología Lean y detectar oportunidades de  mejora. Para conocer la experiencia del paciente se utilizó la técnica del grupo  focal. El impacto en la satisfacción de los pacientes se midió mediante  encuestas de satisfacción que se enviaron a través del correo electrónico en  diciembre de 2019 (antes de implantar las principales medidas) y en diciembre  de 2020.Resultados: Teniendo en cuenta la perspectiva de los pacientes y de los  profesionales sanitarios, se identificaron más de 30 acciones de mejora de las  que se priorizaron 9, relacionadas fundamentalmente con cambios  estructurales y de circuitos. Se consiguió mejorar significativamente los  tiempos de espera (el 35% de los pacientes esperaban más de 30 minutos  frente al 4,5% en el análisis realizado después de las intervenciones). Los  aspectos que mostraron diferencias estadísticamente significativas en las  encuestas entre los dos periodos fueron el tiempo de espera y la satisfacción  global, en ambos casos el grado de satisfacción fue superior una vez  implantadas las acciones de mejora.Conclusiones: La participación del paciente, a través del grupo focal y  encuestas masivas, unido a la participación de los profesionales sanitarios implicados en el proceso, a través de la metodología Lean, ha permitido analizar la realidad de nuestro servicio y diseñar las acciones de  mejora más adecuadas en función de los recursos disponibles.

Effect of a Structured Pharmaceutical Care Intervention Versus Usual Care on Cardiovascular Risk in HIV Patients on Antiretroviral Therapy: INFAMERICA Study.

BACKGROUND: HIV+ patients have increased their life expectancy with a parallel increase in age-associated comorbidities. OBJECTIVE: To determine the effectiveness of an intensive pharmaceutical care follow-up program in comparison to a traditional model among HIV-infected patients with moderate/high cardiovascular risk. METHOD: This was a multicenter, prospective, randomized study of a structured health intervention conducted between January-2014 and June-2015 with 12 months of follow-up at outpatient pharmacy services. The selected patients were randomized to a control group (usual care) or intervention group (intensive pharmaceutical care). The interventional program included follow-up of all medication taken by the patient to detect and work toward the achievement of pharmacotherapeutic objectives related to cardiovascular risk and making recommendations for improving diet, exercising, and smoking cessation. Individual motivational interview and periodic contact by text messages about health promotion were used. The primary end point was the percentage of patients who had reduced the cardiovascular risk index, according to the Framingham-score. RESULTS: A total of 53 patients were included. As regards the main variable, 20.7% of patients reduced their Framingham-score from high/very high to moderate/low cardiovascular risk versus 12.5% in the control group ( P=0.016). In the intervention group, the number of patients with controlled blood pressure increased by 32.1% ( P=0.012); 37.9% of patients overall stopped smoking ( P=0.001), and concomitant medication adherence increased by 39.4% at the 48-week follow-up ( P=0.002). Conclusion and Relevance: Tailored pharmaceutical care based on risk stratification, motivational interviewing, and new technologies might lead to improved health outcomes in HIV+ patients at greater cardiovascular risk.

[Antiretroviral therapy of HIV infection: duration and reasons for changing the first therapeutic regimen in 518 patients]. / Tratamiento antirretroviral de la infección por el virus de la inmunodeficiencia humana: duración y motivos de cambio del primer esquema terapéutico en 518 pacientes.

BACKGROUND AND OBJECTIVE: Different combinations of antiretroviral drugs are used as initial HIV therapy but comparative studies between them are not frequent. The objectives of this study are to determine the median duration of different therapy combinations in naive patients between 1998-2000 and the main reasons for changing or stopping this first antiretroviral therapy (ARVT). PATIENTS AND METHOD: This study included a total of 518 naive patients who began antiretroviral therapy patients from 1998-2000. Using a Kaplan-Meier analysis the median duration of different combinations was determined. In addition, the main reasons for changing or stopping this first treatment were analysed. RESULTS: First ARVT median duration was 427 days (IQR: 114-890). 47% of patients stopped their first therapy due to adverse effects, 6% voluntarily withdrew from it, in 9% of patients the therapy was not effective and 15% of them were lost of follow up. Only 9% of them continued with the same ARVT at the end of the study but if we add 7% of treatment simplifications we can consider 16% of first ARVT successful. CONCLUSIONS: A median duration of 427 days, similar to other studies, is shorter than we would prefer for HIV, a condition that requires continuous treatment. On the other hand, the study corroborates that secondary effects are the principal problem associated with ARVT.

Tratamiento antirretroviral de la infección por el virus de la inmunodeficiencia humana: duración y motivos de cambio del primer esquema terapéutico en 518 pacientes / Antiretroviral therapy of VIH infection: duration and reasons for changing the first therapeutic regimen in 518 patients

Fundamento y objetivo: Las combinaciones de fármacos antirretrovirales utilizadas como pautas de inicio de tratamiento de la infección por el virus de la inmunodeficiencia humana (VIH) son diversas y hay pocos datos comparativos entre ellas. El objetivo de este estudio es conocer la mediana de duración de las distintas combinaciones utilizadas como inicio del tratamiento antirretroviral (TAR) en pacientes naïve entre los años 1998-2000 y cuáles fueron los motivos más frecuentes de cambio o finalización de éste. Pacientes y método: En el estudio se incluyó a 518 pacientes naïve infectados por el VIH que iniciaron TAR durante el período 1998-2000. Se determinó la duración mediana de las distintas combinaciones mediante un análisis de la supervivencia de Kaplan-Meier. Paralelamente, se realizó un análisis descriptivo de los principales motivos de finalización del tratamiento de estos pacientes. Resultados: La mediana de duración del primer TAR fue de 427 días (intervalo intercuartil, 114-890). Los principales motivos de finalización del primer TAR fueron efectos secundarios (47%), fracaso terapéutico (9%) y abandono voluntario (6%). En un 15% de los pacientes fueron pérdidas de seguimiento y tan sólo el 9% continuaba con el primer tratamiento al final del estudio, que, junto con un 7% que pudo simplificar su TAR, pueden considerarse como un 16% de «éxitos del primer TAR». Conclusiones: La mediana de duración obtenida, similar a la descrita por otros autores, es relativamente corta para una infección como la producida por el VIH que requiere un tratamiento continuado. Por otro lado, se confirma que los efectos secundarios son el principal problema del TAR

Background and objective: Different combinations of antiretroviral drugs are used as initial HIV therapy but comparative studies between them are not frequent. The objectives of this study are to determine the median duration of different therapy combinations in naive patients between 1998-2000 and the main reasons for changing or stopping this first antiretroviral therapy (ARVT). Patients and method: This study included a total of 518 naive patients who began antiretroviral therapy patients from 1998-2000. Using a Kaplan-Meier analysis the median duration of different combinations was determined. In addition, the main reasons for changing or stopping this first treatment were analysed. Results: First ARVT median duration was 427 days (IQR: 114-890). 47% of patients stopped their first therapy due to adverse effects, 6% voluntarily withdrew from it, in 9% of patients the therapy was not effective and 15% of them were lost of follow up. Only 9% of them continued with the same ARVT at the end of the study but if we add 7% of treatment simplifications we can consider 16% of first ARVT successful. Conclusions: A median duration of 427 days, similar to other studies, is shorter than we would prefer for HIV, a condition that requires continuous treatment. On the other hand, the study corroborates that secondary effects are the principal problem associated with ARVT

Problemas relacionados con la medicación / Problems related to medication

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