Ensayo clínico aleatorizado de un programa de atención farmacéutica al alta frente a seguimiento habitual en pacientes con insuficiencia cardiaca / Randomized clinical trial of a postdischarge pharmaceutical care program vs. regular follow-up in patients with heart failure

Objetivo: Valorar la eficacia de una intervención educativa multifactorial realizada por un farmacéutico en pacientes con insuficiencia cardiaca (IC). Método: Ensayo clínico aleatorizado, prospectivo, abierto, en pacientes ingresados por IC. Los pacientes asignados al grupo intervención recibieron información sobre la enfermedad, el tratamiento farmacológico, educación dietética y seguimiento telefónico activo. Se realizaron visitas a los 2, 6 y 12 meses. Se evaluaron los reingresos hospitalarios, días de hospitalización, cumplimiento terapéutico, satisfacción con la atención recibida y calidad de vida (EuroQol); se realizó un estudio económico para valorar el posible impacto del programa. La intervención la efectuó el servicio de farmacia en coordinación con la unidad de cardiología. Resultados: Se han incluido 134 pacientes, de edad media 75 años, nivel de estudios bajo. Los pacientes del grupo intervención presentaron un mayor nivel de adherencia al tratamiento que los pacientes del grupo control. A los 12 meses de seguimiento, los pacientes del grupo intervención reingresaron un 32,9% menos que los del grupo control. El promedio de días de hospitalización por paciente en el grupo control fue de 9,6 (DE = 18,5) frente a 5,9 (DE = 14,1) del grupo intervención. No se registraron diferencias en la calidad de vida, pero el grupo intervención presentó mayor puntuación en la escala de satisfacción a los dos meses [9,0 (DE = 1,3) vs. 8,2 (DE = 1,8) p = 0,026]. Al ajustar un modelo de supervivencia de Cox con la fracción de eyección, los pacientes del grupo intervención presentaron un menor riesgo de reingreso (Hazard ratio 0,56; IC95%: 0,32-0,97). El análisis económico evidenció un ahorro en gastos hospitalarios de 578 € por paciente favorable al grupo intervención. Conclusiones: La atención farmacéutica al alta hospitalaria permite reducir el número de reingresos en pacientes con insuficiencia cardiaca, los días totales de hospitalización y mejora la adherencia al tratamiento sin aumentar los costes de la atención

Objective: To assess the efficacy of a multifactorial educational intervention carried out by a pharmacist in patients with heart failure (HF). Method: A randomized, prospective, open clinical trial in patients admitted for HF. The patients assigned to the intervention group received information about the disease, drug therapy, diet education, and active telephone follow-up. Visits were completed at 2, 6, and 12 months. Hospital re-admissions, days of hospital stay, treatment compliance, satisfaction with the care received, and quality of life (EuroQol) were evaluated; a financial study was conducted in order to assess the possible impact of the program. The intervention was performed by the pharmacy department in coordination with the cardiology unit. Results: 134 patients were included, with a mean age of 75 years and a low educational level. The patients of the intervention group had a higher level of treatment compliance than the patients in the control group. At 12 months of follow-up, 32.9% fewer patients in the intervention group were admitted again vs. the control group. The mean days of hospital stay per patient in the control group were 9.6 (SD = 18.5) vs. 5.9 (SD = 14.1) in the intervention group. No differences were recorded in quality of life, but the intervention group had a higher score in the satisfaction scale at two months [9.0 (SD = 1.3) versus 8.2 (SD = 1.8) p = 0.026]. Upon adjusting a Cox survival model with the ejection fraction, the patients in the intervention group had a lower risk of re-admission (Hazard ratio 0.56; 95% CI: 0.32-0.97). The financial analysis evidenced savings in hospital costs of € 578 per patient that were favorable to the intervention group. Conclusions: Postdischarge pharmaceutical care allows for reducing the number of new admissions in patients with heart failure, the total days of hospital stay, and improves treatment compliance without increasing the costs of care

Randomized clinical trial of a postdischarge pharmaceutical care program vs regular follow-up in patients with heart failure.

OBJECTIVE: To assess the efficacy of a multifactorial educational intervention carried out by a pharmacist in patients with heart failure (HF). METHOD: A randomized, prospective, open clinical trial in patients admitted for HF. The patients assigned to the intervention group received information about the disease, drug therapy, diet education, and active telephone follow-up. Visits were completed at 2, 6, and 12 months. Hospital re-admissions, days of hospital stay, treatment compliance, satisfaction with the care received, and quality of life (EuroQol) were evaluated; a financial study was conducted in order to assess the possible impact of the program. The intervention was performed by the pharmacy department in coordination with the cardiology unit. RESULTS: 134 patients were included, with a mean age of 75 years and a low educational level. The patients of the intervention group had a higher level of treatment compliance than the patients in the control group. At 12 months of follow-up, 32.9% fewer patients in the intervention group were admitted again vs. the control group. The mean days of hospital stay per patient in the control group were 9.6 (SD=18.5) vs. 5.9 (SD=14.1) in the intervention group. No differences were recorded in quality of life, but the intervention group had a higher score in the satisfaction scale at two months [9.0 (SD=1.3) versus 8.2 (SD=1.8) p=0.026]. Upon adjusting a Cox survival model with the ejection fraction, the patients in the intervention group had a lower risk of re-admission (Hazard ratio 0.56; 95% CI: 0.32-0.97). The financial analysis evidenced savings in hospital costs of euro 578 per patient that were favorable to the intervention group. CONCLUSIONS: Postdischarge pharmaceutical care allows for reducing the number of new admissions in patients with heart failure, the total days of hospital stay, and improves treatment compliance without increasing the costs of care.

Is it possible to assess the "ethics" of medical school applicants?

Questions surrounding the assessment of medical school applicants' morality are difficult but they are nevertheless important for medical schools to consider. It is probably inappropriate to attempt to assess medical school applicants' ethical knowledge, moral reasoning, or beliefs about ethical issues as these all may be developed during the process of education. Attitudes towards ethical issues and ethical sensitivity, however, might be tested in the context of testing for personality attributes. Before any "ethics" testing is introduced as part of screening for admission to medical school it would require validation. We suggest a number of ways in which this might be achieved.