Primary care pharmacist-led medication review in older adult patients in coordination with general practitioners: an observational retrospective cohorts study.

Background: Polypharmacy and risk of potentially inappropriate prescribing (PIP) in older adult are being continuously increased. Including a primary care pharmacist (PCP) in the healthcare team is associated with lower rates of medication-related problems (MRPs). Objectives: To determine the impact (in terms of variation of PIP, MRPs and polymedication) of treatment reviews (TR) carried out by the PCP by comparing two cohorts: standard TR vs coordinated TR with prescribing General Practitioners (GP). To assess possible health outcomes in both groups 6 months post-TR. Methods: This is an observational study of two retrospective cohorts (2018 to 2020). All patients who met the inclusion/exclusion criteria were analyzed. Patients ≥65 years, who underwent complete TR by the PCP were included. Patients in a situation of exitus at the time of TR and those who underwent a partial TR were excluded. Control group cohort consisted of patients who underwent standard TR, and intervention group cohort consisted of those who underwent TR coordinated with GP. Sociodemographic, clinical and pharmacological variables were analyzed. Results: 181 patients were enrolled. Mean age 84.4 ± 7.2 years, 78.5% women. Variables (GP-coordinated vs standard TRs) pre-post: decrease in drugs/patient 1.9 (95%CI: 1.4-2.4) vs 0.6 (95%CI: 0.2-1.3), p < 0.05; decrease in MRPs/patient 3.1 (95%CI: 2.8-3.4) vs 1.0 (95%CI: 0.6-1.4), p < 0.05; decrease in PIP/patient 2.0 (95% CI: 1.6-2.2) vs 0.6 (95% CI: 0.2-0.9), p < 0.05. Health outcomes: there was significant difference in average primary-care visits/patient 1.3 ± 0.5 vs 2.2 ± 1.8, p < 0.05. Conclusions: Multidisciplinary interventions between PCP and GP, together with a systematic approach to TR can improve the quality of pharmacotherapy in the elderly. Prospective large follow-up studies are needed to demonstrate a positive trend in health outcomes.

[Multidisciplinar revision of treatment in nursing home patients in COVID-19 context]. / Revisión multidisciplinar del tratamiento en pacientes mayores institucionalizados en el contexto de la COVID-19.

OBJECTIVE: Having a general practitioner in nursing homes during the pandemic by COVID-19 has allowed a multidisciplinary intervention to systematically review medication in institutionalized elderly patients; the objective of this study is to evaluate the impact of this intervention in reducing the number of drugs/patient. METHODS: A prospective multicenter study before-after of an intervention involving general practitioner and primare care pharmacists in 4 nursing homes of less than 50 residents. A review algorithm was used to identify Drug-Related Problems (DRPs) that were part of the primare care pharmacists recommendations. The degree of acceptance by the physician of these recommendations was measured. RESULTS: 121 patients reviewed with a mean age of 86.1 years (SD: 7.2); 87.6% were women. Of 98 patients analyzed, had an average of 9.4 (SD: 4.0) drugs/patient, was reduced by -1.6 [CI 95% -1.3 to -1.9] p<.001 after the intervention, the different was statistically significant. 409 DRPs were identified, an average of 4.2 per patient, who were part of a recommendation of which 316 (77.3%) were accepted. Most of the recommendations concerned deprescription or dose adjustment. Psycholeptics, antihypertensives and analgesics were the therapeutic groups most commonly involved in the detected DRPs. CONCLUSIONS: A statistically significant reduction in the mean number of drugs/patient following intervention has been observed. Many DRPs have been identified through the primare care pharmacists review, which have mostly been accepted by the physician.

[Perceptions on electronic prescribing by primary care physicians in madrid healthcare service]. / Percepción de los médicos de atención primaria sobre la receta electrónica en el Servicio Madrileño de Salud.

OBJECTIVE: To investigate the opinion of Primary Care physicians regarding electronic prescribing. METHODS: Descriptive study by means of a questionnaire sent to 527 primary care physicians. PERIOD: June 2014. The questionnaire included closed questions about interest shown, satisfaction, benefits, weaknesses, and barriers, and one open question about difficulties, all of them referred to electronic prescribing. Satisfaction was measured using 1-10 scale, and benefits, weaknesses, and barriers were evaluated by a 5-ítems Likert scale. Interest was measured using both methods. The questionnaire was sent by e-mail for on line response through Google Drive® tool. A descriptive statistical analysis was performed. RESULTS: The response rate was 47% (248/527). Interest shown was 8.7 (95% CI; 8.5-8.9) and satisfaction was 7.9 (95% CI; 7.8-8). The great majority 87.9% (95% CI; 83.8-92%) of respondents used electronic prescribing where possible. Most reported benefits were: 73.4% (95% CI; 67.8-78.9%) of respondents considered that electronic prescribing facilitated medication review, and 59.3% (95% CI; 53.1-65.4) of them felt that it reduced bureaucratic burden. Among the observed weaknesses, they highlighted the following: 87.9% (95% CI; 83.8-92%) of respondents believed specialist care physicians should also be able to use electronic prescribing. Concerning to barriers: 30.2% (95% CI; 24.5-36%) of respondents think that entering a patient into the electronic prescribing system takes too much time, and 4% (95% CI; 1.6-6.5%) of them perceived the application as difficult to use. CONCLUSIONS: Physicians showed a notable interest in using electronic prescribing and high satisfaction with the application performance.

Fármacos para el trastorno por déficit de atención/hiperactividad / Drugs for attention deficit hyperactivity disorder

Se encuentran diferencias entre los diversos fármacos aprobados en España para el trastorno por déficit de atención/hiperactividad en estudios de tipo cuantitativo. No hay claras diferencias en estudios de tipo cualitativo. El número de pacientes a tratar para que uno alcance remisión completa (NNT) del metilfenidato (MTF) es de 2,2 a 5, y el tamaño del efecto (TE), de 0,9. La atomoxetina tiene un NNT de 4 y un TE de 0,7. Las ventajas del MTF de liberación inmediata (MTF-LI) respecto al de liberación prolongada (MTF-LP) residen en su bajo coste, su flexibilidad y mejores resultados en estudios cuantitativos. Por contra, el MTF-LP presenta un menor riesgo de abuso, precisa un menor número de tomas, una menor necesidad de terceros para el control de éstas y un menor riesgo de estigmatización. La combinación o cambio de MTF-LI y MTF-LP y la combinación de MTF con atomoxetina son en ocasiones necesarias para ajustar la posología de día laborable o de fin de semana. Iniciar el tratamiento con MTF-LI para luego mantener o cambiar a MTF-LP aporta ciertas ventajas en seguridad, ajuste de dosis y posología. La atomoxetina es la mejor alternativa si hay antecedente de eventos adversos con estimulantes en dosis bajas o moderadas, o falta de respuesta a los estimulantes en dosis altas. En caso de ansiedad comórbida importante, tanto el MTF como la atomoxetina tienen igual nivel de indicación. Si hay riesgo de abuso de sustancias, tanto la atomoxetina como el MTF-LP son de primera elección. Para el resto de indicaciones, el MTF constituye la primera elección (AU)

Quantitative studies have highlighted differences in several drugs approved for use in Spain in the treatment of attention deficit hyperactivity disorder. No clear differences are observed, however, in the case of qualitative studies. The number of patients needed to be treated in order for one to reach complete remission (NNT) of methylphenidate (MTF) is from 2.2 to 5, and the effect size (ES) is 0.9. Atomoxetine has an NNT of 4 and an ES of 0.7. The advantages of immediate-release MTF (IR-MTF) over the extended-release version (ER-MTF) lie in its low cost, its flexibility and the better results obtained in quantitative studies. In contrast, ER-MTF offers a lower risk of abuse, needs to be taken fewer times with less need for third parties to control administration, and there is a lower risk of stigmatisation. Combination or changes of IR-MTF and ER-MTF and the combination of MTF with atomoxetine are sometimes necessary to adjust the weekday or weekend doses. Starting treatment with IR-MTF and then maintaining or changing to ER-MTF offers certain advantages as regards safety, dose adjustments and dosage. Atomoxetine is the best alternative if there is a background of adverse events with low or moderate doses of stimulants, or lack of response to high doses of stimulants. In cases of notable comorbid anxiety, both MTF and atomoxetine have the same level of indication. If there is a risk of substance abuse, both atomoxetine and ER-MTF are the preferred treatment. For the other indications, MTF is the preferred treatment (AU)

[Drugs for attention deficit hyperactivity disorder]. / Farmacos para el trastorno por deficit de atencion/hiperactividad.

Quantitative studies have highlighted differences in several drugs approved for use in Spain in the treatment of attention deficit hyperactivity disorder. No clear differences are observed, however, in the case of qualitative studies. The number of patients needed to be treated in order for one to reach complete remission (NNT) of methylphenidate (MTF) is from 2.2 to 5, and the effect size (ES) is 0.9. Atomoxetine has an NNT of 4 and an ES of 0.7. The advantages of immediate-release MTF (IR-MTF) over the extended-release version (ER-MTF) lie in its low cost, its flexibility and the better results obtained in quantitative studies. In contrast, ER-MTF offers a lower risk of abuse, needs to be taken fewer times with less need for third parties to control administration, and there is a lower risk of stigmatisation. Combination or changes of IR-MTF and ER-MTF and the combination of MTF with atomoxetine are sometimes necessary to adjust the weekday or weekend doses. Starting treatment with IR-MTF and then maintaining or changing to ER-MTF offers certain advantages as regards safety, dose adjustments and dosage. Atomoxetine is the best alternative if there is a background of adverse events with low or moderate doses of stimulants, or lack of response to high doses of stimulants. In cases of notable comorbid anxiety, both MTF and atomoxetine have the same level of indication. If there is a risk of substance abuse, both atomoxetine and ER-MTF are the preferred treatment. For the other indications, MTF is the preferred treatment.

Prescripción inadecuada en mayores de 75 años en atención primaria: el caso de doxazosina en un área de salud / No disponible

Objetivos: Evaluar la adecuación de la prescripción de doxazosina en mayores de 75 años. Secundarios:Describir la comorbilidad y el tratamiento antihipertensivo asociados, así como el control de la tensión arterial,y analizar los efectos adversos. Material y métodos: Estudio descriptivo transversal. Ámbito: Área desalud con 31 equipos de atención primaria. Población: Mil doscientos ochenta y dos pacientes mayoresde 75 años en tratamiento con doxazosina durante septiembre y noviembre de 2006. Fuente de información:Historia clínica. Variables: Edad, sexo, tratamiento, pauta, comorbilidad, tensión arterial y efectosadversos aparecidos. En 80 historias, mediante muestreo aleatorio estratificado por sexo y equipo. Se consideróprescripción adecuada en caso de hipertrofia benigna de próstata o como antihipertensivo de cuartalínea. Resultados: La prescripción en mujeres fue adecuada en el 26,5% de los casos (índice de confianza[IC] 95%: 10,2-42,8), y en hombres, en el 47,8% (IC 95%: 32,3-63,3). La comorbilidad más frecuente fue ladislipemia, y la más relevante la cardiaca (6,2%, insuficiencia cardiaca; 20%, trastornos del ritmo cardiaco;16,3%, otras enfermedades cardiacas). En el 91,3% de los pacientes, doxazosina estaba asociada a otros antihipertensivos.El 45,5% de los participantes tenían controlada la tensión arterial sistólica. En el 51,3% de lospacientes apareció algún efecto adverso, con un 63,4% de ellos referidos a mareos o caídas. Conclusiones:La indicación fue adecuada en la mitad de los hombres y en una cuarta parte de las mujeres. A pesar de suslimitaciones de uso, algunos pacientes presentaban insuficiencia cardiaca al inicio del tratamiento. Menosde la mitad de los participantes tenían controlada la tensión sistólica. La mitad de los pacientes sufrieronmareos o caídas durante el tratamiento

Objectives: to assess the appropriateness of the prescription of doxazosin in people over the age of 75. Secondaryobjectives: to describe the comorbidity and the associated antihypertensive treatment, as well as theblood pressure control, and to analyse the adverse effects. Materials and methods: a cross-sectional descriptivestudy. Scope: a health care district with 31 primary care teams. Population: one thousand two hundredand eighty-two patients over the age of 75 undergoing a treatment with doxazosin during September andNovember 2006. Information source: medical history. Variables: age, gender, treatment, schedule, comorbidity,blood pressure and adverse effects suffered, in 80 medical histories, by means of a random samplingstratified by gender and team. The prescription was deemed to be appropriate in the cases of benign prostatichyperplasia or as a fourth-line antihypertensive. Results: The prescription in women was appropriate in26.5% of the cases (confidence index [CI] 95%: 10.2-42.8), and in men, in 47.8% (CI 95%: 32.3-63.3). Themost common comorbidity was dyslipidemia, and the most relevant one was cardiac comorbidity (6.2%,cardiac insufficiency; 20%, heart rhythm disorders; 16.3%, other cardiac diseases). In 91.3% of the patients,doxazosin was associated with other antihypertensives. The systolic blood pressure was controlled in 45.5%of the participants. Some kind of adverse effect was experienced by 51.3% of the patients, with 63.4% ofthem of concerning dizziness or falls. Conclusions: The prescription was appropriate in half of the men andin one fourth of the women. In spite of the limitations of its use, some of the patients were suffering fromcardiac insufficiency at the start of the treatment. The systolic pressure was controlled in less than half of theparticipants. Half of the patients suffered from dizziness and falls during the treatment (AU)

Encuesta de la SEFAP sobre la Farmacia de Atención Primaria y la Ley 29/2006 de garantías y uso racional del medicamento y productos sanitarios / No disponible

Transcurrido un año desde la publicación de la «Ley 29/2006 de garantías y uso racional de los medicamentos yproductos sanitarios», la Sociedad Española de Farmacéuticos de Atención Primaria (SEFAP) quiere conocer lasituación de los servicios de farmacia de atención primaria (SFAP) en el territorio nacional. Material y método.Estudio descriptivo transversal llevado a cabo mediante una encuesta con 128 ítems. Se distribuyó mediante envíoelectrónico desde la web de la SEFAP a todos los socios, especificando que se cumplimentara una encuesta por SFAP.Resultados. Se recibieron un total de 84 encuestas, desestimándose 5 por repetición del mismo SFAP o por no trabajaren un SFAP, lo que representa el 58,1% de los posibles SFAP. El 52% de las estructuras de gestión de atenciónprimaria encuestadas disponen de SFAP autorizados según la normativa vigente y el 59% son los responsables de lagestión de medicamentos. El 99% tienen establecidos sistemas de información sobre gestión de la farmacoterapia(aspectos clínicos, de efectividad, seguridad y eficiencia de la utilización de los medicamentos) y proporcionan unacorrecta información y formación sobre medicamentos y productos sanitarios a los profesionales. El 40% de los SFAPparticipa en la elaboración de criterios de selección de medicamentos para el desarrollo de protocolos y guías farmacoterapéuticasque garanticen la correcta asistencia a los pacientes, y el 27% asesora sobre el historial farmacoterapéuticode los pacientes. El 46% de las estructuras de atención primaria participa en investigación clínica en farmacoterapiade calidad, y el 42% de los SFAP participan en comités éticos y de investigación. El 99% participan confarmacovigilancia y con programas que potencian el uso seguro de los medicamentos. El 41% de los SFAP impulsanprogramas de educación a la población sobre medicamento. Y casi la mitad, el 45% de los SFAP, están participandoya en los planes estratégicos de calidad en las estructuras de gestión de atención primaria. Discusión. Los serviciosde salud deben impulsar y velar por el desarrollo de los SFAP, no sólo regularizando la situación administrativa deéstos conforme a la Ley, sino también promoviendo el desarrollo de las funciones establecidas, favoreciendo la integracióndel farmacéutico de atención primaria en todos los procesos de la cadena terapéutica, y retornando al sistemala corresponsabilidad en la calidad asistencial y la farmacoterapéutica de los pacientes

One year after the publication of Law 29/2006 on the guarantees and rational use of medicines and healthcareproducts the Spanish Society of Primary Care Pharmacists (SEFAP) wishes to know the situation of the PrimaryCare Pharmacy Services (SFAP) in Spain. Material and method: a cross-sectional descriptive study carried outby means of a survey with 128 items. It was distributed to all the members via e-mail from the SEFAP’s web,specifying that one survey should be filled out per Primary Care Pharmacy Service. Results: a total of 84 surveyswere received, 5 of which were rejected because of repetitions of the same SFAP or for not working in a SFAP,representing 58.1% of all possible SFAPs. Of the primary care management structures polled, 52% have SFAPsauthorised according to current legislation and 59% are responsible for the management of medicines. Of the total,99% have established information systems on pharmacotherapy management (clinical aspects, aspects regardingefficacy, safety and the efficiency of the use of the medicines) and provide correct information and training onmedicines and healthcare products to healthcare professionals. Of the SFAPs, 40% participate in the definition ofmedicine selection criteria for the development of protocols and pharmacotherapeutic guides that guarantee thecorrect pharmacotherapeutic care of patients, and 27% provide advice on the patients’ pharmacotherapeutic history.Of the Primary Care structures, 46% participate in clinical research on quality pharmacotherapy, and 42%of the SFAPs participate in Ethical and Research Committees. Moreover, 99% participate with Pharmacovigilanceand with programmes that promote the safe use of medicines. Of the SFAPs 41% promote educational programmesfor the population on medication. Nearly half of the SFAPs, namely 45%, already participate in strategic plans forquality in the primary care management structures. Discussion: the Health Services should promote and watchover the development of the SFAPs, not only through the regularisation of the administrative situation of the SFAPsaccording to the Law, but also through the promotion of the development of the established functions, encouragingthe involvement of the primary care pharmacist in all the processes of the therapeutic chain, returning to thesystem joint responsibility in the quality of the care and pharmacotherapy of the patients (AU)