Adaptaciones de la dispensación hospitalaria a pacientes con hemofilia durante la pandemia COVID-19 en España y su influencia en la adherencia / Adaptations of hospital dispensing to haemophilia patients during the COVID-19 pandemic in Spain and its influence on adherence

Introducción: El estado de alarma decretado por la pandemia del virus SARS COV-2 del 14 de marzo hasta el 21 de junio, ha supuesto un desafío para el área de pacientes externos de los Servicios de Farmacia. Nos centramos en los pacientes con hemofilia que se administran factores de la coagulación de forma crónica para prevenir hemorragias.Objetivos: Analizar durante este periodo el porcentaje de pacientes que han recogido su medicación, han mantenido la adherencia al tratamiento y las barreras encontradas para ello. Cuantificar el número y gravedad de episodios hemorrágicos (EH) sufridos y su relación con la pandemia. Analizar la prevalencia y gravedad de COVID en hemofílicos.Métodos: Uno objetivo, utilizando los registros del hospital y otro subjetivo, mediante encuesta oral durante la consulta de atención farmacéutica presencial o telemática.Resultados: El 80% de los pacientes retiraron medicación durante el periodo de estudio, un 30% en domicilio. El último mes las dispensaciones a domicilio se acompañaron de consulta telemática.Un 24% de pacientes disminuyó su adherencia respecto al 2019. Las principales causas fueron dificultad para acudir al hospital, y percepción de no necesitar tratamiento ante la inactividad.No se registraron más EH o ingresos por causas imputables a la pandemia.No hubo ningún enfermo COVID-19 grave y la incidencia de pacientes con síntomas leves fue similar a la población general.Conclusión: La mayoría de los pacientes con hemofilia pudieron acceder a su medicación. La adherencia se redujo. Los EH no aumentaron por causas atribuibles a la pandemia. La incidencia de COVID-19 fue similar a la población. (AU)

Introduction: The state of alarm decreed by the SARS COV-2 virus pandemic from March 14th to June 21st, has meant a challenge for the outpatient area of the pharmacy services. We focus on hemophilia patients who are chronically administered clotting factors to prevent bleeding.Objectives: To analyse during this period the percentage of patients who have collected their medication, maintained adherence to treatment and the barriers encountered in doing so. To quantify the number and severity of haemorrhagic episodes (HD) suffered and their relationship with the pandemic. Analyse the prevalence and severity of COVID in haemophiliacs.Methods: One objective, using hospital records, and one subjective, using an oral survey during the face-to-face or telematic pharmaceutical care consultation.Results: 80% of patients withdrew medication during the study period, 30% at home. In the last month, home deliveries were accompanied by telematic consultation.24% of patients decreased their adherence with respect to 2019. The main causes were difficulty in going to hospital, and perception of not needing treatment in the face of inactivity.There were no more HD or admissions for reasons attributable to the pandemic.There were no serious COVID-19 patients and the incidence of patients with mild symptoms was similar to the general population.Conclusion: Most haemophilia patients were able to access their medication. Adherence was reduced. HD did not increase due to causes attributable to the pandemic. The incidence of COVID-19 was similar to the population. (AU)

Drug cost avoidance in clinical trials of breast cancer.

BACKGROUND: The objectives of this study were to determine if clinical trials in breast cancer, with an investigational drug, created direct drug cost savings for the healthcare system related to cost avoidance of the best standard of care treatments used in these studies. The aim was to quantify this potential drug cost avoidance. METHODS: We conducted a retrospective observational study of the drug cost avoidance during the study period (2014-2016). We included clinical trials with investigational drug, managed by pharmacy department and provided by the sponsor. The patients included had a therapeutic alternative defined as standard treatment that should have been received in case of not participating in the clinical trial. Direct cost savings, to national healthcare system, associated to clinical trials were calculated. RESULTS: Thirty-seven clinical trials with a total of 89 breast cancer patients were included in the study. A total of 62.2% were phase III and 75.7% belonged to the pharmaceutical industry. They provided a total cost avoidance of 957,246€ (1,130,028$), an average cost avoidance per patient of 10,756€ (12,697$). CONCLUSIONS: Our study suggests that those clinical trials in which investigational drug are provided or refunded by the sponsor provide substantial cost savings. Due to the shortage of published articles that calculate the cost avoided in medication, we cannot compare directly the results obtained in the different institutions.

[Failure mode and effects analysis to improve quality in clinical trials]. / Análisis modal de fallos y efectos para mejorar la calidad en los ensayos clínicos.

INTRODUCTION: The failure mode and effects analysis (FMEA) has been used as a tool in risk management and quality improvement. The objective of this study is to identify the weaknesses in processes in the clinical trials area, of a Pharmacy Department (PD) with great research activity, in order to improve the safety of the usual procedures. METHODS: A multidisciplinary team was created to analyse each of the critical points, identified as possible failure modes, in the development of clinical trial in the PD. For each failure mode, the possible cause and effect were identified, criticality was calculated using the risk priority number and the possible corrective actions were discussed. RESULTS: Six sub-processes were defined in the development of the clinical trials in PD. The FMEA identified 67 failure modes, being the dispensing and prescription/validation sub-processes the most likely to generate errors. All the improvement actions established in the AMFE were implemented in the Clinical Trials area. DISCUSSION: The FMEA is a useful tool in proactive risk management because it allows us to identify where we are making mistakes and analyze the causes that originate them, to prioritize and to adopt solutions to risk reduction. The FMEA improves process safety and quality in PD.

Impact of the implementation of vasoactive drug protocols on safety and efficacy in the treatment of critically ill patients.

WHAT IS KNOWN AND OBJECTIVE: The correct management of high-alert medications is a priority issue in expert recommendations for improving the clinical safety of patients. Objectives were to assess the impact of the implementation of vasoactive drug (VAD) protocols on safety and efficacy in the treatment of critically ill patients. METHODS: A prospective before-and-after study on the implementation of different VAD protocols, comparing medication errors (MEs) rates, mean intensive care unit (ICU) stay, mean blood pressure (MAP), heart rate (HR) and oxygen saturation. RESULTS AND DISCUSSION: The study included 432 patients. There was a statistically significant decrease in prescribing errors (55·9%), validation errors (68·1%) and medication administration records (MAR) errors (78·8%). No differences were found between the two phases in ICU stay, MAP, HR and oxygen saturation. WHAT IS NEW AND CONCLUSION: Implementation of protocols decreases variability in clinical practice, reduces the incidence of MEs and maintains the effectiveness of VAD therapy in critically ill patients.

Atención farmacéutica a pacientes en tratamiento con AINE / Pharmaceutical care to patients under treatment with NSAIDs

Introducción: La automedicación es, en general, una conducta presente en todas las sociedades, y con frecuencia se autoprescriben antiinflamatorios sin control sanitario y sin que el paciente sea consciente de la intensidad y gravedad de las reacciones adversas que pueden provocar. Desde la oficina de farmacia se debe realizar una correcta atención farmacéutica y mejorar los resultados de la farmacoterapia previniendo, detectando y resolviendo los problemas relacionados con medicamentos antes de que éstos den lugar a morbilidad y mortalidad. Objetivos: 1) Analizar los principios activos más demandados, así como la forma de dispensación más frecuente. 2) Valorar la eficacia y la eficiencia de los medicamentos en las enfermedades para las que se prescriben. 3) Evaluar el grado de conocimiento de los pacientes sobre su farmacoterapia. 4) Realizar un análisis del seguimiento farmacoterapéutico a pacientes crónicos. Material y métodos: Estudio observacional, prospectivo, monocéntrico y concurrente llevado a cabo en pacientes tratados con antiinflamatorios, mediante encuestas y seguimiento farmacoterapéutico de los pacientes crónicos. Resultados: Los pacientes refirieron una disminución en el grado de dolor de 4 puntos según la escala visual analógica (EVA). Se redujo un 23,3% el número de pacientes con presión arterial sistólica (PAS) >=140 mmHg, y un 13,3% los pacientes con presión arterial diastólica (PAD) >=90 mmHg. Más del 90% declararon conocer mejor su enfermedad y su tratamiento, y el 58% mejoraron su adherencia a éste. La calidad de vida del paciente se vio aumentada en casi un 10% según el test EuroQol-5D. Conclusiones: La atención farmacéutica se presenta como una alternativa de calidad muy eficaz para conseguir mejorar el resultado de los tratamientos y la asistencia sanitaria(AU)

Introduction: Self-medication is generally present in all societies. Nonsteroidal anti-infl ammatory medications are one of the most commonly self-administered drugs and many patients without being aware of their side effects that can cause. From the pharmacy must make a proper pharmaceutical care and improve outcomes of drug therapy in preventing, detecting and solving drug therapy problems before they result in morbidity and mortality. Objectives: 1) To analyze the most demanded active principle and the most common form of dispensation. 2) To assess the effectiveness and efficiency of drugs for diseases those are prescribed. 3) To analyze the level of awareness of patients regards their drug thera py. 4) To assess the impact of pharmaceutical care to chronic patients. Methodology: The method used was a single-center prospective observational study in patients receiving anti-infl ammatory by questionnaires drafted and pharmaceutical intervention at pharmaceutical care for chronic patients. Results: The patients reported a reduction of 4 points in degree of pain according to the visual analog scale (VAS). The number of patients with systolic blood pressure (SBP) >=140 mmHg, and the number of patients with diastolic blood pressure (DBP) >=90 mmHg, was reduced 23.3 and 13.3%, respectively. Over 90% reported understand better their disease and treatment, 58% improved adherence. The patient’s quality of life was increased by almost 10% according to the test EuroQol-5D. Conclusions: Pharmaceutical care is presented as a very effective quality alternative to achieve better treatment outcomes and healthcare(AU)