Descripción y cuantificación de las intervenciones farmacoterapéuticas al ingreso de los pacientes en un centro sociosanitario / Description and Quantification of Pharmacotherapeutic Interventions at the Admission of Patients in a Nursing Home

Introducción: La atención sociosanitaria es una evaluación multidimensional e interdisciplinar para mejorar la calidad de vida del paciente institucio-nalizado. El objetivo de este estudio fue describir y cuantificar las intervenciones realizadas por un farmacéutico al ingreso de pacientes en un centro sociosanitario (CSS). Método: Estudio unicéntrico y prospectivo de 20 meses de duración realizado en un CSS de 251 camas. Se incluyeron 3 modalidades de atención sociosanitaria (ancianos pernocta, centro terapéu-tico-ocupacional pernocta y gravemente afecta-dos). Los datos se obtuvieron de la historia clínica electrónica y se registraron variables relacionadas con el paciente (fecha nacimiento, sexo, insuficien-cia renal, índice de Charlson, registro de alergias) y con el tratamiento (número de fármacos prescritos al ingreso en el CSS e interacciones, número de fármacos monitorizables farmacocinéticamente, recomendaciones de farmacovigilancia y seguri-dad, problemas relacionados con los medicamen-tos (PRM) detectados y las adaptaciones a guía farmacoterapéutica). Para el análisis estadístico, se utilizó el programa SPSS. Resultados: Se incluyeron 172 ingresos, con una edad media de 78,4 años (DS: 17,7 años) y el 65,1% fueron mujeres. La media de fármacos prescritos por paciente fue de 9,5 (DS: 4,4). En el 51,7% de los pacientes se detectó al menos un PRM, con una media de 3,2 PRM/paciente. En el 64,5% de los in-gresos se realizaron adaptaciones a la guía farma-coterapéutica, con una media de 1,3 adaptaciones/paciente. Conclusiones: El farmacéutico realiza numerosas intervenciones en un CSS, como las adaptaciones a guía y la detección de PRM, resaltando la importan-cia de su presencia y su conciliación entre niveles asistenciales (AU)

Introduction: Social health care is a multidimen-sional and interdisciplinary evaluation to improve the quality of life of the institutionalized patient. The objective of this study was to describe and quantify the interventions carried out by a specialist pharmacist at the time of patients' admission in a nursing home (NH). Method: This is a single-centre and prospective study with a duration of 20 months made in a NH with 251 beds. 3 kinds of social-healthcare were included [old people that stay the night, therapeu-tic-occupational centre (stay the night) and severely affected]. Data were obtained from the electronic clinical records. Furthermore, variables related to the patient (birth date, gender, kidney failure, Char-lson index, allergies record) and to the treatment [number of drugs prescribed on admission in a NH and interactions, number of drugs that could be monitored thanks to the pharmacokinetics, security and pharmacovigilance recommendations, drug related problems (DRPs) detected and adaptations to pharmacotherapy guide] were recorded. The pro-gram SPSS was used for the statistical analysis.Results: 172 admissions were included, with an average age of 78.4 years (SD: 17.7 years). 65.1% of admissions were women. The average of drugs prescribed per patient was 9.5 (SD: 4.4). 51.7% of patients were detected with at least one DRP, with an average of 3.2 DRPs/patient. In 64.5% of admissions, adaptations to the pharmacotherapeu-tic guide were carried out, with an average of 1.3 adaptations/patient. Conclusions: In a NH, the pharmacist performs many interventions, such as adaptations to the guide, detection of DRPs and conciliation between levels of care (AU)

Real-world prevalence and consequences of potential drug-drug interactions in the first-wave COVID-19 treatments.

WHAT IS KNOWN AND OBJECTIVE: Initial treatment recommendations of COVID-19 were based on the use of antimicrobial drugs and immunomodulators. Although information on drug interactions was available for other pathologies, there was little evidence in the treatment of COVID-19. The objective of this study was to analyse the potential drug-drug interactions (pDDIs) derived from the medication used in COVID-19 patients in the first pandemic wave and to evaluate the real consequences of such interactions in clinical practice. METHODS: Cohort, retrospective and single-centre study carried out in a third-level hospital. Adult patients, admitted with suspected COVID-19, that received at least one dose of hydroxychloroquine, lopinavir/ritonavir, interferon beta 1-b or tocilizumab and with any pDDIs according to "Liverpool Drug Interaction Group" between March and May 2020 were included. The possible consequences of pDDIs at the QTc interval level or any other adverse event according to the patient's medical record were analysed. A descriptive analysis was carried out to assess possible factors that may affect the QTc interval prolongation. RESULTS AND DISCUSSION: Two hundred and eighteen (62.3%) patients of a total of 350 patients admitted with COVID-19 had at least one pDDI. There were 598 pDDIs. Thirty-eight pDDIs (6.3%) were categorized as not recommended or contraindicated. The mean value difference between baseline and pDDI posterior ECG was 412.3 ms ± 25.8 ms vs. 426.3 ms ± 26.7 ms; p < 0.001. Seven patients (5.7%) had a clinically significant alteration of QTc. A total of 44 non-cardiological events (7.3%) with a possible connection to a pDDI were detected. WHAT IS NEW AND CONCLUSION: The number of pDDIs in patients admitted for COVID-19 in the first pandemic wave was remarkably high. However, clinical consequences occurred in a low percentage of patients. Interactions involving medications that would be contraindicated for concomitant administration are rare. Knowledge of these pDDIs and their consequences could help to establish appropriate therapeutic strategies in patients with COVID-19 or other diseases with these treatments.

Pharmaceutical care to hospital outpatients during the COVID-19 pandemic. Telepharmacy.

Hospital Pharmacy Service (HPS) in Spain have been impacted by the health  crisis caused by the COVID-19 pandemic. Thus, the outbreak has forced HPSs to adapt their outpatient consultation services to Telepharmacy to optimize clinical  outcomes and reduce the risk of contagion. The purpose of this article is to  describe and analyze the experience of HPSs with outpatient Telepharmacy  during the COVID-19 pandemic and expose the lessons learned. Measures have  been adopted in on-site outpatient pharmacy clinics to prevent exposure of  patients and professionals to the virus. These measures are based on national  and international recommendations on social distancing and hygiene. With  regard to remote outpatient pharmacy services, teleconsultation with drug  dispensing has been promoted based on five basic procedures, each with its  advantages and limitations: home drug delivery from HPSs, with the advantage  of universal access and the limitation of entailing a substantial investment in  resources; HPS coordination with primary care pharmacists, which requires no  investments but with limited access to some geographic areas; HPS coordination with community pharmacists based on a large network of pharmacies, which  requires the patient to go to the pharmacy, without confidentiality being  guaranteed for any patient; geolocation and hospital-based medication  dispensing, which provides universal access and direct traceability, but entails  investment in human resources; and HPS coordination with associations of  patients, which does not entail any additional cost but limits the information  available on the diseases of society members. Three main lessons have been learned during the pandemic: the satisfactory capacity of HPS to provide outpatient pharmacy consultation services in the setting of a public health crisis; the usefulness of Telepharmacy for the clinical follow-up, healthcare coordination, outpatient counseling, and informed dispensing and delivery of  medication (with a high level of satisfaction among patients); and the need to  foster Telepharmacy as a complementary tool through a mixed model of  outpatient pharmacy consultation service that incorporates the advantages of  each procedure and adapts to the individual needs of each patient in a context of humanized healthcare.

Los servicios de farmacia hospitalaria (SFH) en España se han visto afectados  por la crisis sanitaria provocada por SARS-CoV-2 y han tenido que adoptar sus  procedimientos de atención farmacéutica (AF) al paciente externo (PE) mediante estrategias de Telefarmacia, con los objetivos de maximizar los resultados en  salud y reducir el riesgo de contagio. El objetivo de ese artículo es describir y  analizar los procedimientos AFPE durante la pandemia SARS-CoV-2 y comunicar  las lecciones aprendidas en los SFH. En relación con las consultas externas de AF presenciales, se han adoptado medidas para minimizar el contagio viral de  pacientes y profesionales, siguiendo las recomendaciones nacionales e  internacionales de referencia de distanciamiento temporal, espacial y  recomendaciones higiénicas. En cuanto a las consultas externas de AF no  presenciales, se han potenciado las teleconsultas con dispensación del  tratamiento en base a cinco procedimientos básicos, cada uno de ellos con sus  ventajas y limitaciones: dispensación domiciliaria desde SFH que presenta las  ventajas de la universalidad de acceso, pero requiere una elevada inversión en  recursos; coordinación del SHF con farmacéuticos de atención primaria, que  conlleva una nula inversión en recursos, pero limita el acceso a determinadas zonas geográficas; coordinación del SFH con farmacéuticos comunitarios, que  utiliza una amplia red de oficinas de farmacia, pero exige el desplazamiento del  paciente sin garantías de confidencialidad para todos los casos; geolocalización y dispensación hospitalaria, que permite un acceso universal y trazabilidad directa, pero requiere un incremento en recursos humanos; y coordinación del SFH con  asociaciones de pacientes, que no requiere inversión económica, pero limita el  acceso a las patologías de los asociados. Destacamos finalmente tres lecciones  aprendidas: la capacidad de AFPE de SFH españoles ante una crisis sanitaria; la  utilidad de la Telefarmacia para el seguimiento clínico, la coordinación  asistencial, información al PE, dispensación y entrega informada (con elevada  satisfacción de los pacientes); y la necesidad de potenciar la Telefarmacia como herramienta complementaria, en un modelo mixto de AFPE que incorpore las  ventajas de cada uno de los procedimientos adaptándose a las necesidades individuales de los pacientes en un entorno de humanización de la asistencia  sanitaria.

Atención farmacéutica al paciente externo durante la pandemia COVID-19. Telefarmacia / Pharmaceutical care to hospital outpatients during the COVID-19 pandemic. Telepharmacy

Los servicios de farmacia hospitalaria (SFH) en España se han visto afectados por la crisis sanitaria provocada por SARS-CoV-2 y han tenido que adoptar sus procedimientos de atención farmacéutica (AF) al paciente externo (PE) mediante estrategias de Telefarmacia, con los objetivos de maximizar los resultados en salud y reducir el riesgo de contagio. El objetivo de ese artículo es describir y analizar los procedimientos AFPE durante la pandemia SARS-CoV-2 y comunicar las lecciones aprendidas en los SFH. En relación con las consultas externas de AF presenciales, se han adoptado medidas para minimizar el contagio viral de pacientes y profesionales, siguiendo las recomendaciones nacionales e internacionales de referencia de distanciamiento temporal, espacial y recomendaciones higiénicas. En cuanto a las consultas externas de AF no presenciales, se han potenciado las teleconsultas con dispensación del tratamiento en base a cinco procedimientos básicos, cada uno de ellos con sus ventajas y limitaciones: dispensación domiciliaria desde SFH que presenta las ventajas de la universalidad de acceso, pero requiere una elevada inversión en recursos; coordinación del SHF con farmacéuticos de atención primaria, que con-lleva una nula inversión en recursos, pero limita el acceso a determinadas zonas geográficas; coordinación del SFH con farmacéuticos comunitarios, que utiliza una amplia red de oficinas de farmacia, pero exige el desplazamiento del paciente sin garantías de confidencialidad para todos los casos; geolocalización y dispensación hospitalaria, que permite un acceso universal y trazabilidad directa, pero requiere un incremento en recursos humanos; y coordinación del SFH con asociaciones de pacientes, que no requiere inversión económica, pero limita el acceso a las patologías de los asociados. Destacamos finalmente tres lecciones aprendidas: la capacidad de AFPE de SFH españoles ante una crisis sanitaria; la utilidad de la Telefarmacia para el seguimiento clínico, la coordinación asistencial, información al PE, dispensación y entrega informada (con elevada satisfacción de los pacientes); y la necesidad de potenciar la Telefarmacia como herramienta complementaria, en un modelo mixto de AFPE que incorpore las ventajas de cada uno de los procedimientos adaptándose a las necesidades individuales de los pacientes en un entorno de humanización de la asistencia sanitaria

Hospital Pharmacy Service (HPS) in Spain have been impacted by the health crisis caused by the COVID-19 pandemic. Thus, the outbreak has forced HPSs to adapt their outpatient consultation services to Telepharmacyto optimize clinical outcomesand reduce the risk of contagion. The purpose of this article is to describe and analyze the experience of HPSs with out-patient Telepharmacy during the COVID-19 pandemic and expose the les-sons learned. Measures have been adopted in on-site outpatient pharmacy clinics to prevent exposure of patients and professionals to the virus. These measures are based on national and international recommendations on social distancing and hygiene. With regard to remote outpatient pharmacy services, teleconsultation with drug dispensing has been promoted based on five basic procedures, each with its advantages and limitations: home drug delivery from HPSs, with the advantage of universal access and the limitation of entailing a substantial investment in resources; HPS coordination with primary care pharmacists, which requires no investments but with limited access to some geographic areas; HPS coordination with community pharmacists based on a large network of pharmacies, which requires the patient to go to the pharmacy, without confidentiality being guaranteed for any patient; geolocation and hospital-based medication dispensing, which provides universal access and direct traceability, but entails investment in human resources; and HPS coordination with associations of patients, which does not entail any additional cost but limits the information available on the diseases of society members. Three main lessons have been learned during the pandemic: the satisfactory capacity of HPS to provide outpatient pharmacy consultation services in the setting of a public health crisis; the usefulness of Telepharmacy for the clinical follow-up, healthcare coordination, outpatient counseling, and informed dispensing and delivery of medication (with a high level of satisfaction among patients); and the need to foster Telepharmacy as a complementary tool through a mixed model of outpatient pharmacy consultation service that incorporates the advantages of each procedure and adapts to the individual needs of each patient in a context of humanized healthcare

Experiencia con colistina nebulizada en pacientes con bronquiectasias no fibrosis quística colonizadas por Pseudomonas aeruginosa / Experience with nebulised colistin in patients with non-cystic fibrosis bronchiectasis colonised with Pseudomonas aeruginosa

INTRODUCCIÓN: La colonización/infección crónica por Pseudomonas aeruginosa de las bronquiectasias se relaciona con daño anatómico, deterioro más rápido de la función pulmonar, aumento del número de exacerbaciones y mayor morbi-mortalidad. La colistina nebulizada disminuye la carga bacteriana, esperándose una reducción en número y gravedad de las exacerbaciones y retraso del deterioro pulmonar. El objetivo principal fue valorar si el tratamiento con colistina nebulizada, durante al menos 6 meses, reduce el número de ingresos y visitas a urgencias. MATERIAL Y MÉTODOS: Estudio observacional, retrospectivo y no intervencionista llevado a cabo en una estructura organizativa de gestión integrada. Se seleccionaron pacientes con bronquiectasias no fibrosis quística, mayores de 18 años, colonizados / infectados por P. aeruginosa que recibieron al menos 6 meses colistina nebulizada. De la historia clínica informatizada (IANUS(R) V.04.20.0503) y de la receta electrónica del SERGAS, se recogieron datos clínicos, microbiológicos y de tratamiento de los pacientes, que fueron divididos en dos periodos de tiempo: 1) 6 meses pretratamiento y durante el tratamiento y 2) 12 meses pretratamiento y durante el tratamiento, en aquellos pacientes que completaron 1 año de tratamiento. RESULTADOS: Se incluyeron 44 pacientes y de ellos, 29 (65,9%) tuvieron un seguimiento de 12 meses. El uso de colistina nebulizada disminuyó de forma significativa el número de visitas a urgencias (a los 6 meses), la frecuencia y duración de las hospitalizaciones (a los 6 y 12 meses), el consumo de antibióticos (a los 6 y 12 meses) y los cultivos positivos para P. aeruginosa. El tratamiento fue bien tolerado en casi todos los pacientes. CONCLUSIONES: El tratamiento con colistina nebulizada durante 6 y 12 meses de bronquiectasias no fibrosis quística, colonizadas / infectadas por P. aeruginosa, parece beneficioso para el paciente desde el punto de vista clínico y de calidad de vida y podría reducir el coste económico del proceso

INTRODUCTION: Chronic colonisation/infection by Pseudomonas aeruginosa of the bronchiectasis is related to a faster deterioration of lung function, an increase in the number of exacerbations and a higher morbidity and mortality. Nebulised colistin decreases bacteria load. Therefore, a reduction in the number and in the severity of exacerbations and a delay of pulmonary decline is expected. The main objective is to evaluate if the treatment with nebulised colistin, for at least 6 months reduces the number of admissions and visits to the emergency department. MATERIAL AND METHODS: Observational, retrospective and non-interventionist study carried out in an organizational structure with an integrated management. Patients with non-cystic fibrosis bronchiectasis colonised / infected by P. aeruginosa, older than 18 years, were selected. Patients must have received nebulized colistin during at least 6 months. Clinical, microbiological and therapeutic data from the patients were collected from the SERGAS computerized clinical history (IANUS(R) V.4.20.0503) and the electronic prescription, which were divided into two time periods: 1) 6 months pre-treatment and during the treatment and 2) 12 months pre-treatment and during the treatment, in those who completed 1 year of treatment. RESULTS: Forty-four patients were included and of these, 29 (65.9%) had a follow-up of 12 months. The use of nebulized colistin decreased significantly the number of visits to the emergency (at 6 months), the frequency and duration of hospitalizations admissions (at 6 and 12 months), the antibiotic consumption (at 6 and 12 months) and the positive cultures. The treatment was well tolerated in almost all patients. CONCLUSIONS: The treatment with nebulised colistin during 6 and 12 months of non-cystic fibrosis bronchiectasis, colonised/infected by P. aeruginosa, seems beneficial for the patient, from the clinical and quality of life point of view, and could reduce the economic cost of the process

Evaluation of the use of nab-paclitaxel and gemcitabine in clinical practice.

CONTEXT: Pancreatic cancer in a common tumor in our country for which there are various treatment alternatives. OBJECTIVE: Evaluate the effectiveness and safety of nab-paclitaxel and gemcitabine in everyday clinical practice. SETTINGS AND DESIGN: Observational, retrospective study at a tertiary university hospital. SUBJECTS AND METHODS: We included patients diagnosed of metastatic or locally advanced pancreatic cancer that were being treated with nab-paclitaxel and gemcitabine. We recorded response, progression-free survival (PFS), and overall survival (OS) rates together with toxicities. STATISTICAL ANALYSIS USED: We used SPSS program for Windows. We conducted descriptive statistics using averages, medians, standard deviations or ranges, and percentages. RESULTS: We included 15 patients. At 3 months, there were no complete responses; 20% showed partial responses, and in 60% of patients, the disease stabilized. The median PFS was 8.9 months and the OS was 9.6. The most important adverse reactions were neutropenia, fatigue, and nausea/vomiting. CONCLUSIONS: The treatment regimen leads to increased survival in these patients with an acceptable toxicity profile.

Factors associated with patient satisfaction in an outpatient hospital pharmacy.

OBJECTIVE: To analyse the factors leading to greater satisfaction among patients attending the outpatient hospital pharmacy (OPh). METHODS: A cross-sectional study was conducted of patients attending the OPh of a 1250-bed university hospital. A self-administered questionnaire for measuring outpatients' satisfaction was developed. Global satisfaction was measured on a scale of 1 to 10. Indices of perceived quality for accessibility, interpersonal professional-patient relationship and the convenience of the process were modelled through a principal component analysis using varimax rotation. The relationship between the principal components and overall satisfaction was evaluated using regression analysis. RESULTS: A questionnaire-based survey was conducted between May and June 2015. A total of 509 valid responses (86.9% response rate) were collected from the OPh. The overall satisfaction score was 7.81 (95% CI 7.59 to 8.04). The principal component analysis produced two components that explained 62.1% of the variance. The first component (CP1) contained questions related to the adequacy of the resources and services. The second component (CP2) contained questions about interpersonal professional-patient relationship. An additional unit in the CP2 was associated with a 3.23 increased risk of having higher satisfaction scores, while an increase of an additional unit in CP1 was associated with a 1.93 increased risk of having higher satisfaction scores. CONCLUSIONS: Our study shows that the factor which predicts the satisfaction of patients who come to the OPh is the quality of care provided by pharmacists-in particular, information provided, resolution of doubts, personal attention and time devoted to the patient.