Adherencia subóptima al tratamiento en la esclerosis múltiple / Adherence to treatment in multiple sclerosis

Objetivo Conocer la adherencia al tratamiento con interferón beta y acetato de glatirámero de pacientes con esclerosis múltiple, así como el porcentaje de discontinuación y sus causas. Método Estudio observacional, longitudinal prospectivo y multicéntrico de ámbito nacional en el que se seleccionaron pacientes con esclerosis múltiple que acudieron a los servicios de farmacia hospitalarios para recoger medicación. La variable principal de valoración fue el porcentaje de adherencia durante un año, medido como la relación entre las dosis de fármaco dispensadas y las necesarias. Secundariamente se midieron las discontinuaciones de tratamiento y sus causas. Resultados Se incluyeron, durante un periodo de seis meses, 543 pacientes en 39 servicios de farmacia. El tiempo medio de exposición a los fármacos durante el estudio fue de 312 días y la adherencia media en ese periodo del 61,5% (IC 95%: 59,4-63,5). De los 543 participantes en el estudio, 34 (6,26%) discontinuaron el tratamiento, en la mayoría de los casos por criterio médico. Conclusiones La adherencia terapéutica durante un año en los pacientes con esclerosis múltiple ha sido inferior a la óptima. Es necesario analizar las causas y establecer medidas correctoras (AU)

Objective To find out if patients with multiple sclerosis adhere to treatment with beta interferons and glatiramer acetate, the percentage of withdrawal and its causes. Methods Observational, longitudinal, prospective, national, multicentre study which selected multiple sclerosis patients who attended the hospital pharmacy department to collect their medication. The main variable was the adherence percentage during a year, measured as the relationship between the dose of the dispensed and necessary drug. Treatment withdrawals and their causes were then measured. Results Over a six-month period, 543 patients from 39 pharmacy departments were included. The average time exposed to the drugs during the study period was 312 days and the average adherence in this period was 61.5% (95% CI: 59.4-63.5). Thirty-four (6.26%) of the 543 study participants withdrew treatment, which for most cases was decided by the doctor. Conclusions Multiple sclerosis patients’ treatment adherence during a period of one year has been lower than the ideal. The causes should therefore be analysed and corrective measures established (AU)

Adherence to treatment in multiple sclerosis.

OBJECTIVE: To find out if patients with multiple sclerosis adhere to treatment with beta interferons and glatiramer acetate, the percentage of withdrawal and its causes. METHODS: Observational, longitudinal, prospective, national, multicentre study which selected multiple sclerosis patients who attended the hospital pharmacy department to collect their medication. The main variable was the adherence percentage during a year, measured as the relationship between the dose of the dispensed and necessary drug. Treatment withdrawals and their causes were then measured. RESULTS: Over a six-month period, 543 patients from 39 pharmacy departments were included. The average time exposed to the drugs during the study period was 312 days and the average adherence in this period was 61.5% (95% CI: 59.4-63.5). Thirty-four (6.26%) of the 543 study participants withdrew treatment, which for most cases was decided by the doctor. CONCLUSIONS: Multiple sclerosis patients' treatment adherence during a period of one year has been lower than the ideal. The causes should therefore be analysed and corrective measures established.

Incidencia de resultados negativos de medicación en un servicio de urgencias hospitalario y factores asociados / Incidence rate of adverse drug effects in a hospital emergency unit and its associated factors

Introducción Los resultados negativos de la medicación (RNM) motivan entre un 0,86–38,2% de las urgencias hospitalarias y en un alto porcentaje son evitables. La prescripción racional y el seguimiento farmacoterapéutico reducen la aparición de estos problemas de salud. Método Estudio en el servicio de urgencias de un hospital de tercer nivel con selección de pacientes por muestreo aleatorio bietápico. La información se obtuvo de un cuestionario validado y de la historia clínica. Los datos se estructuraron dentro del siguiente esquema causa-efecto: 1) factores potenciales de riesgo de un RNM; 2) efectos provocados de manera plausible por fármacos; 3) consecuencias del RNM, y 4) potenciales factores de confusión. La información obtenida fue evaluada según la metodología Dáder por cuatro evaluadores independientes. Resultados Se incluyeron 840 pacientes en el estudio, de los cuales el 33% acudió a urgencias por un RNM. Los RNM se observaron con mayor frecuencia en las mujeres, con mayor consumo de fármacos, en los pacientes mayores, en aquellos con alguna enfermedad de base y en los pertenecientes a clases sociales más desfavorecidas. Los factores que determinan el riesgo de aparición de los RNM son la cantidad de medicamentos consumidos, el sexo y el índice de prácticas de la salud. Discusión Un tercio de las urgencias hospitalarias fueron debidas a RNM y se asociaron a los mismos factores que otros estudios (número de fármacos consumidos, sexo femenino, edad y clase social). Además, se observó un predominio de los RNM en los pacientes con valores bajos del índice de prácticas de la salud y en aquellos con enfermedades de base (AU)

Introduction Adverse drug effects (ADEs) are the reason for 0.86% to 38.2% of hospital emergency admissions, and a large percentage of them are avoidable. Rational prescription and pharmacotherapy monitoring decrease the appearance of such health problems. Method Study performed in a tertiary hospital emergency unit with patients selected using a two-phase random sample. The information was obtained from a validated questionnaire and from the clinical history. The data were grouped according to the following cause-effect schema: 1-Potential risk factors for an ADE. 2-Effects likely to be caused by drugs. 3-Consequences of ADEs. 4-Potential confounding factors. The information obtained was evaluated by four independent evaluators using the Dader method.Results840 patients were included in the study, and 33% of them came to the emergency unit due to an ADE. ADEs were more frequently observed in female patients, those with higher drug consumption, older patients, those with an underlying illness and in those from underprivileged backgrounds. The factors determining risk of an ADE are the quantity of drugs consumed, sex and the health practices index. Discussion One third of hospital emergency admissions were due to ADEs, and these were associated with the same factors found in other studies (number of drugs consumed, female sex, age and social background). In addition, we observed that ADEs are predominant in patients with low values on the health practices index, and in those with underlying illnesses (AU)

[Incidence rate of adverse drug effects in a hospital emergency unit and its associated factors]. / Incidencia de resultados negativos de medicación en un servicio de urgencias hospitalario y factores asociados.

INTRODUCTION: Adverse drug effects (ADEs) are the reason for 0.86% to 38.2% of hospital emergency admissions, and a large percentage of them are avoidable. Rational prescription and pharmacotherapy monitoring decrease the appearance of such health problems. METHOD: Study performed in a tertiary hospital emergency unit with patients selected using a two-phase random sample. The information was obtained from a validated questionnaire and from the clinical history. The data were grouped according to the following cause-effect schema: 1-Potential risk factors for an ADE. 2-Effects likely to be caused by drugs. 3-Consequences of ADEs. 4-Potential confounding factors. The information obtained was evaluated by four independent evaluators using the Dader method. RESULTS: 840 patients were included in the study, and 33% of them came to the emergency unit due to an ADE. ADEs were more frequently observed in female patients, those with higher drug consumption, older patients, those with an underlying illness and in those from underprivileged backgrounds. The factors determining risk of an ADE are the quantity of drugs consumed, sex and the health practices index. DISCUSSION: One third of hospital emergency admissions were due to ADEs, and these were associated with the same factors found in other studies (number of drugs consumed, female sex, age and social background). In addition, we observed that ADEs are predominant in patients with low values on the health practices index, and in those with underlying illnesses.

Ibuprofeno frente a indometacina en el tratamiento del ductus arterioso persistente (DAP) / A comparison of ibuprofen and indomethacin in patent ductus arteiiosus (PDA)

El conducto (ductus) arterioso persistente (DAP) es una enfermedad frecuente en el prematuro. La indometacina intravenosa es el tratamiento estándar para su cierre, pero recientemente se ha empezado a utilizar el ibuprofeno intravenoso como alternativa o, incluso, como fármaco de primera elección, ya que algunas revisiones de evidencia Ahan mostrado igual eficacia, aunque menos oliguria y mayor porcentaje de enfermedad pulmonar crónica (EPC). Sin embargo, a pesar del cambio en la prescripción, también existe la apreciación clínica de mayor porcentaje de fracasos en los recién nacidos tratados con ibuprofeno. Este estudio pretende comparar ibuprofeno frente a indometacina en el cierre del DAP para evaluar su efectividad y seguridad. Material y métodos: se realizó un estudio retrospectivo transversal que abarcó el período comprendido desde el 01/01/2000 al 31/12/2004. Se evaluaron los casos diagnosticados de DAP en prematuros de bajo peso al nacer. Resultados: los resultados muestran que en el 62% de los casos donde se utilizó un cierre farmacológico se hizo con indometacina (en un período de 3 años) frente al 38% con ibuprofeno (en un período de 2 años). Los parámetros de eficacia muestran que el número de dosis necesaria para el cierre del DAP se duplica para el ibuprofeno, así como la necesidad de un nuevo ciclo de tratamiento. El porcentaje de reapertura de DAP fue de un 45,6% frente al 11,1% y el número de casos donde no se cerró el DAP también fue mayor para el ibuprofeno (9% frente al 0%). Otros parámetros como necesidad de cierre quirúrgico y porcentaje de fracaso a la semana de la primera dosis fueron similares para los dos fármacos. En cuanto a la seguridad los parámetros de EPC y mortalidad del recién nacido se muestran desfavorables para el ibuprofeno y en ninguno de los recién nacidos tratados se produjo oliguria. Conclusión: el ibuprofeno presenta algunos parámetros de eficacia desfavorables frente a indometacina, lo que incrementa su coste. En cuanto a la seguridad nuestros datos concuerdan con revisiones publicadas, aunque no se produjo oliguria con ninguno de los fármacos

Patent ductus arteriosus (PDA) is a frequent disease in the premature baby. Intravenous Indomethacin is the standard treatment used to close the duct but recently intravenous ibuprofen has been prescribed as an alternative or even a firstchoice drug because recent type Aevidence has shown it to be equally effective although with less oliguria and a large percentage of chronic pulmonary disease( CPD). However, with this change of prescription a higher percentage of failures in new-born children treated with Ibuprofen has been perceived. This study attempts to compare Ibuprofen with Indomethacin and to assess their safety and effectiveness in treating PDA. Material and methods: a cross-sectional retrospective study was carried out that included the period 01/01/2000 to 31/12/2004. The cases of PDA diagnosed in premature babies with low birth weight were evaluated. Results: the results show that in those cases where the duct was closed by pharmacological means 62% were treated with indomethacin (over a three year period) and 38% with ibuprofen (over a two year period). The parameters of effectiveness show that the number of doses needed to close the duct is double for Ibuprofen and a new cycle of treatment is required. The percentage of cases where the duct reopened was 45% with ibuprofen as opposed to 11% with indomethacin and the number of cases where the PDA failed to close was also greater with Ibuprofen (9% compared to 0%). Other parameters such as the need to close the PDA surgically and the percentage of failures a week after the first close were similar for both drugs. As regards safety the parameters of CPD and the mortality of the new-born babies were unfavourable for Ibuprofen although there was no evidence of oliguria in any of the children treated. Conclusions: ibuprofen, unlike Indomethacin, displays certain unfavourable parameters regarding its effectiveness and is also more costly. As far as safety is concerned our data agree with other published studies although oliguria did not take place with either of the drugs