Negative outcomes associated with medication in patients with chronic atrial fibrillation who present at the emergency department.

WHAT IS KNOWN AND OBJECTIVE: Medication is the main treatment option for patients with chronic atrial fibrillation. However, medication can have negative effects. We aimed to detect negative outcomes associated with medication that led to patients with chronic atrial fibrillation presenting themselves to hospital emergency departments. We assessed the severity of those outcomes and comment on whether they could have been avoided. METHODS: This descriptive, cross-sectional study included all patients with chronic atrial fibrillation who attended the emergency department of our tertiary hospital. We used the Dader method to identify and evaluate the negative outcomes associated with medication through interviews with patients and scrutiny of the clinical charts. RESULTS AND DISCUSSION: Of the 198 eligible patients who presented at the emergency department, 134 (67·7%) did so because of negative outcomes associated with medication (41% related to necessity, 32·1% to effectiveness and 26·9% to safety); 67·9% of those negative outcomes could have been avoided. In terms of severity, 6·7% were mild, 31·3% moderate, 51·5% severe and 10·4% fatal. The Anatomical Therapeutic Chemical Classification anatomical group most frequently associated with negative outcomes was the cardiovascular system, followed by blood/blood-forming organs. WHAT IS NEW AND CONCLUSION: A high percentage of patients with chronic atrial fibrillation presenting at hospital emergency departments had negative outcomes associated with medication. Some led to deaths. More than half of these were severe, and most could have been avoided.

Desarrollo y validación de un cuestionario de satisfacción de pacientes con el seguimiento farmacoterapéutico en farmacias comunitarias / Development and validation of a patient satisfaction questionnaire on pharmaceutical care in community pharmacies

Objetivo. Desarrollar y validar un cuestionario de rápida administración para valorar la satisfacción de los pacientes con el servicio de seguimiento farmacoterapéutico (SFT) en las farmacias comunitarias españolas. Material y métodos. Se diseñó un cuestionario autoadministrable semiestructurado centrado en la percepción de los pacientes sobre la experiencia acumulativa con el servicio de SFT. El mismo fue revisado por un panel de 8 expertos en 2 rondas. La validación se realizó en farmacias comunitarias que aceptaron participar y que prestaban el servicio de SFT. Se incluyeron a todos los pacientes o a sus cuidadores que concurrieron durante el período de estudio y que supieran leer y escribir. A fines de valorar las evidencias de validez como estructura interna se realizó un análisis factorial exploratorio de componentes principales y la fiabilidad se estimó a través del coeficiente alfa de Cronbach. Resultados. Participaron 8 farmacias comunitarias pertenecientes a 7 provincias de España y se obtuvieron 103 cuestionarios. El análisis factorial reveló un único componente explicando el 33,6% de la varianza total. Se obtuvo un coeficiente alfa de Cronbach de 0,75. Los pacientes expresaron comentarios adicionales en un 9,7% de los cuestionarios que se relacionaron a resaltar la atención recibida y a agradecer por el servicio de SFT recibido. Conclusiones. El cuestionario desarrollado ha presentado evidencias de validez de contenido, validez como estructura interna y fiabilidad para valorar la satisfacción de los pacientes con el servicio de SFT en las farmacias comunitarias españolas (AU)

Objective. To develop and validate a rapid administration questionnaire to assess patient satisfaction with the pharmaceutical care (PhC) service in Spanish community pharmacies. Methods. A semi-structured and self-administered questionnaire was designed focused on the cumulative experience of patients with the PhC service. This was reviewed by a panel of 8 experts in 2 rounds. The validation was carried out in community pharmacies that performed the PhC service and agreed to participate. All patients or their caregivers who attended a pharmacy during the study period, and who could read and write, were included. An exploratory factor analysis was performed to assess the validity as evidence of internal structure and reliability was estimated using Cronbach's alpha coefficient. Results. A total of 8 community pharmacies belonging to 7 provinces of Spain took part and 103 questionnaires were obtained. Factor analysis revealed a single component explaining 33.6% of the total variance. We obtained a Cronbach's alpha coefficient of 0.75. Patients additional comments expressed in 9.7% of the questionnaires were related to emphasising, and thanking for, the care provided by the PhC service. Conclusions. The questionnaire developed has provided evidence of content validity, internal structure validity, and reliability to assess the patient satisfaction with the PhC service in Spanish community pharmacies (AU)

Impacto de la intervención farmacéutica en la adherencia al tratamiento antirretroviral en pacientes de un hospital de Lima (Perú) / Pharmacist intervention in the improvement of adherence in HIV/AIDS patients with antiretroviral treatment in Lima (Peru)

Introducción: La atención farmacéutica mejora la adherencia del paciente al tratamiento, por lo que es necesario que el farmacéutico cuente con instrumentos para evaluarla y mejorarla mediante su intervención en el seguimiento farmacoterapéutico (SFT). Objetivos: Evaluar el impacto de la intervención farmacéutica en la mejora de la adherencia de los pacientes con virus de la inmunodeficiencia humana (VIH) y sida, e identificar los factores que influyen en ella y que pueden ser modificados por la intervención farmacéutica en el SFT. Métodos: Se realizó SFT durante 23 meses a 52 pacientes mayores de 18 años de edad, con tratamiento antirretroviral durante más de 3 meses, que dieron su consentimiento informado. La adherencia se evaluó con el CEAT-VIH (cuestionario para evaluar la adhesión al tratamiento antirretroviral) al inicio y al final de 6 meses de SFT. Resultados: La puntuación total del CEAT-VIH (p <0,05; intervalo de confianza del 95%), el cumplimiento del tratamiento (p <0,001) y la percepción del paciente respecto a su enfermedad y tratamiento antirretroviral (p <0,001) incrementaron significativamente su valor. La educación al paciente para incrementar la adherencia al tratamiento (46%) fue la intervención farmacéutica más frecuente. Conclusiones: Se demuestra que la intervención del farmacéutico, mediante el SFT, mejora la adherencia al tratamiento antirretroviral. El farmacéutico mejoró los aspectos de cumplimiento y percepción del paciente sobre su tratamiento y enfermedad. Los farmacéuticos pueden utilizar el CEAT-VIH como instrumento para evaluar la adherencia en la práctica del SFT (AU)

Introduction: Pharmaceutical care improves medication adherence that is why is important that the pharmacist uses instruments to evaluate and improves it through pharmaceutical intervention at pharmaceutical care. Objective: To evaluate the impact of the pharmaceutical intervention in the improvement of the medication adherence of the patients with HIV and AIDS, and to identify the factors that influence on medication adherence and which one could be modified by the pharmaceutical intervention during pharmaceutical care. Methods: Pharmacotherapeutic follow-up was realized for 23 months to 52 patients, older than 18 years, with antiretroviral treatment for up to three months, consent informed was obtained from patients. Medication adherence was evaluated with CEAT-HIV (questionnaire to evaluate the adhesion to the antiretroviral treatment) at the beginning and at the end of the study (6 months). Results: The final score from CEAT-HIV (p <0.05; 95% IC), treatment compliance (p <0.001) and patient’s beliefs to the disease and antiretroviral treatment (p <0.001) improved significantly with the pharmaceutical intervention. The more frequent pharmaceutical intervention was education to the patient to increment the adherence to the treatment (46%). Conclusion: These results demonstrate that the pharmacists’ intervention through pharmacotherapeutic follow-up improves the adherence to the antiretroviral treatment. The pharmacist was able to improve aspects of compliance and patient’s beliefs about the treatment and disease. The pharmacist could utilize CEAT-VIH as an instrument to evaluate the adherence in HIV/AIDS patients (AU)

[Development and validation of a patient satisfaction questionnaire on pharmaceutical care in community pharmacies]. / Desarrollo y validación de un cuestionario de satisfacción de pacientes con el seguimiento farmacoterapéutico en farmacias comunitarias.

OBJECTIVE: To develop and validate a rapid administration questionnaire to assess patient satisfaction with the pharmaceutical care (PhC) service in Spanish community pharmacies. METHODS: A semi-structured and self-administered questionnaire was designed focused on the cumulative experience of patients with the PhC service. This was reviewed by a panel of 8 experts in 2 rounds. The validation was carried out in community pharmacies that performed the PhC service and agreed to participate. All patients or their caregivers who attended a pharmacy during the study period, and who could read and write, were included. An exploratory factor analysis was performed to assess the validity as evidence of internal structure and reliability was estimated using Cronbach's alpha coefficient. RESULTS: A total of 8 community pharmacies belonging to 7 provinces of Spain took part and 103 questionnaires were obtained. Factor analysis revealed a single component explaining 33.6% of the total variance. We obtained a Cronbach's alpha coefficient of 0.75. Patients additional comments expressed in 9.7% of the questionnaires were related to emphasising, and thanking for, the care provided by the PhC service. CONCLUSIONS: The questionnaire developed has provided evidence of content validity, internal structure validity, and reliability to assess the patient satisfaction with the PhC service in Spanish community pharmacies.

Adecuación de la prescripción al alta hospitalaria en pacientes con enfermedad pulmonar obstructiva crónica / Compliance of prescriptions for chronic obstructive pulmonary disease patients given upon hospital discharge

Objective Measure the degree of compliance of prescriptions given to Chronic Obstructive Pulmonary Disorder (COPD) patients upon hospital discharge by comparing them to international recommendations. Identify factors that influence the degree of compliance. Evaluate the effect of that degree of compliance on the number of COPD exacerbations. Method Retrospective observational study. We selected all episodes identified as COPD in a tertiary hospital during 2006. By consulting the clinical history database, we accessed the hospital discharge report and calculated the treatment's degree of proximity to the recommendations issued in the Global Initiative for Chronic Obstructive Lung Disease (GOLD). For each episode, we calculated the number of exacerbations in the six following months. Descriptive, bivariate statistical analysis. Results We obtained 365 episodes. The mean degree of compliance was 82% (SD=15.9). The patient's age and the severity of the disease did not influence the degree of compliance. We observed an inverse correlation between the hospital stay and the degree of compliance (p=0.026). Discharge reports issued by the Pneumonology Department had a significantly higher degree of compliance (p<0.001). No statistically significant relationship was found between the degree of compliance and the number of exacerbations. Conclusions The degree of compliance is high according to the GOLD recommendations. The Pneumology Department had the highest degree of compliance, and a higher degree of compliance was related to a shorter hospital stay. The treatment compliance had no effect on the number of exacerbations of the disease (AU)

Objetivo Cuantificar el grado de adecuación de la prescripción al alta hospitalaria a las recomendaciones internacionales en pacientes con EPOC. Identificar los factores que influyen sobre el grado de adecuación. Evaluar la influencia del grado de adecuación sobre el número de reagudizaciones de la EPOC. Método Estudio observacional retrospectivo. Se seleccionaron todos los episodios del año 2006 con diagnóstico principal codificado como EPOC en un hospital terciario. A través de la consulta de la historia clínica digital, se accedió al informe de alta hospitalaria y se calculó el grado de adecuación a las recomendaciones de Global Initiative for Chronic Obstructive Lung Disease; se contabilizó para cada episodio el número de reagudizaciones en los 6 meses posteriores. Análisis estadístico descriptivo y bivariante. Resultados Se obtuvieron 365 episodios. El grado de adecuación medio fue del 82% (SD=15,9). La edad del paciente y la gravedad de la enfermedad no influyeron sobre el grado de adecuación. Se observó relación inversa entre estancia hospitalaria y grado de adecuación (p=0,026). Los informes de alta hospitalaria a cargo del servicio de neumología presentaron significativamente mayor grado de adecuación (p<0,001). No se halló relación estadísticamente significativa entre grado de adecuación y número de exacerbaciones. Conclusiones El grado de adecuación a las recomendaciones de Global Initiative for Chronic Obstructive Lung Disease es elevado. Se detecta mayor adecuación en el servicio de neumología y un mayor grado de adecuación se relaciona con una menor estancia hospitalaria. El grado de adecuación no influye sobre el número de reagudizaciones de la enfermedad (AU)

[Compliance of prescriptions for chronic obstructive pulmonary disease patients given upon hospital discharge]. / Adecuación de la prescripción al alta hospitalaria en pacientes con enfermedad pulmonar obstructiva crónica.

OBJECTIVE: Measure the degree of compliance of prescriptions given to Chronic Obstructive Pulmonary Disorder (COPD) patients upon hospital discharge by comparing them to international recommendations. Identify factors that influence the degree of compliance. Evaluate the effect of that degree of compliance on the number of COPD exacerbations. METHOD: Retrospective observational study. We selected all episodes identified as COPD in a tertiary hospital during 2006. By consulting the clinical history database, we accessed the hospital discharge report and calculated the treatment's degree of proximity to the recommendations issued in the Global Initiative for Chronic Obstructive Lung Disease (GOLD). For each episode, we calculated the number of exacerbations in the six following months. Descriptive, bivariate statistical analysis. RESULTS: We obtained 365 episodes. The mean degree of compliance was 82% (SD=15.9). The patient's age and the severity of the disease did not influence the degree of compliance. We observed an inverse correlation between the hospital stay and the degree of compliance (p=0.026). Discharge reports issued by the Pneumonology Department had a significantly higher degree of compliance (p<0.001). No statistically significant relationship was found between the degree of compliance and the number of exacerbations. CONCLUSIONS: The degree of compliance is high according to the GOLD recommendations. The Pneumology Department had the highest degree of compliance, and a higher degree of compliance was related to a shorter hospital stay. The treatment compliance had no effect on the number of exacerbations of the disease.

Factores de riesgo en una población anciana: escalas de valoración para la prevención de fracturas de cadera / Factors of risk in an elderly population: evaluation scales for the prevention of hip fractures

Objetivos: Describir y cuantificar factores de riesgo (FR) en una población hospitalizada por fractura de cadera (FC), utilizar escalas de valoración en pacientes susceptibles de tenerla y establecer las recomendaciones para su prevención. Metodología: Estudio descriptivo transversal en 87 pacientes mayores de 64 años, con una edad media de 83 años, ingresados por FC. El 77% fueron mujeres. Se cuantificó y se evaluó los FR en esta población. El 81,6% tuvo caídas y el 42,5% fracturas después de los 50 años. Todas las FC fueron por caídas desde bipedestación. Metodología: Se realizó una charla educacional farmaceuticomédica al ingreso y un repaso completo al alta hospitalaria. Las variables analizadas fueron edad, sexo, FR, motivo de la FC, antecedentes genéticos y mortalidad intrahospitalaria, entre otras. En todos los pacientes se aplicó la escala Black y en 75 la escala FRAX® (fracture risk assessment tool). Resultados: El 42,5% señaló antecedentes hereditarios. El 98,9% consumía productos lácteos. El 48,3% presentó efecciones osteoarticulares aunque sólo el 8% recibía tratamiento. El 75% esperó al menos 5 días para su intervención. El 12,6% falleció durante la hospitalización. Según la escala de Black, el 85,1% presentó alto riesgo de tener una nueva FC y, según la escala FRAX, el 12% tiene probabilidad de que esto ocurra en los siguientes 10 años. Conclusión: La mayoría de los pacientes mostraron un alto número de FR de FC previo al ingreso hospitalario que no se detectaron a tiempo. Las escalas de Black y FRAX son herramientas útiles para valorar pacientes susceptibles de tener una FC. Una educación preventiva centrada en los FR disminuiría las FC (AU)

Objective: Describe and quantify risk factors (RF) present in a population hospitalized for hip fracture (HF), apply evaluation scales in patients susceptible to HF and conclude recommendations to prevent them. Methods: Descriptive cross-sectional study in 87 patients over 64 yrs old admitted for HF. RF were quantified and evaluated in this population. A pharmaceutical-medical education was given at admission and a full reviewed at discharge. The 87 patients studied (77.0% female) had mean age of 83 yrs. 81.6% suffered falls; 42.5% had previous fractures since the age of 50 yrs. All HF were for falls from standing Methods Variables: age, sex, RF, HF cause, genetic history, hospital mortality, among others. The index Black was applied to all patients and the scale FRAX to 75 patients. Results: The 42.5% of the patients reported genetic background. 98.9% consumed milk products. The 48.3% presented osteoarticular diseases and only 8.0% received treatment. The 75% waited at least 5 days to undergo surgery. Hospital mortality was 12.6%. According to index Black, 85.1% had a high risk of a new HF. According to SF, 12% were likely to suffer a new HF in the following 10 yrs. Conclusion: Most patients showed a high number of RF for HF prior hospitalization that was not detected in time. Index Black and Scale Frax are useful tools to detect patients susceptible to HF. Preventive education, particularly focussed on RF, would decrease HF (AU)

Situación del seguimientofarmacoterapéutico en la atenciónhospitalaria / Situation of pharmaceutical care in progressive patient care

En estas páginas se examina la situación actual del seguimiento farmacoterapéutico (SFT) en la atención hospitalaria, desde la farmacia clínica y el SFT como práctica asistencial hasta la evidencia hallada sobre la implantación de éste en los servicios hospitalarios. La mayoría de los pacientes ingresados sufren problemas de saluda tribuibles a la farmacoterapia administrada, y el tipo de problemas que presentan varía de forma notable entre grupos de pacientes de distintas unidades de hospitalización. Conocer estas diferencias es clínicamente valioso, porque permite dirigir esfuerzos para su prevención según el servicio donde esté ingresado cada paciente. Históricamente, la farmacia clínica ha definido y desarrollado procesos para ofrecer la mejor calidad asistencial en relación con la farmacoterapia. Sin embargo, sin la perspectiva integradora del SFT puede quedar limitada sólo a los procesos. Precisamente es la visión del paciente como eje de actuación y la integración de conocimientos y habilidades que proporciona el SFT lo que crea un sistema global de atención sin fisuras. Para brindar esta atención, el SFT aplica métodos que desarrollan una secuencia racional que evalúa y monitoriza la farmacoterapia cumpliendo sus objetivos terapéuticos. Últimamente los programas de SFT han experimentado un gran auge, pero deben demostrar su eficiencia para que éste pueda ser considerado un método sanitario viable. El reto es avanzar en la implantación del SFT, y aplicar metodologías idóneas, que cumplan con las condiciones éticas pertinentes, para evaluar su efectividad y su eficiencia. Los pacientes que reciben SFT deben obtener de éste resultados en salud concretos, y las instituciones hospitalarias deben reconocer sus efectos beneficiosos a partir de unos costes razonables (AU)

This paper presents the current situation of pharmaceutical care in progressive patient care within the clinical pharmacy, from the pharmaceutical care practice to the evidence found on this implementation in hospital services.The most of the patients have health problems due to administered drugs and these types of problems vary notably among patient’s group from different hospitalization units. The knowledge of these differences is clinically valuable, because it allows to focus in their prevention according to the hospital units in which the patient is located. Historically, clinical pharmacy has defined and developed processes to provide the best welfare quality related to the drug-therapy. Nevertheless, without the pharmaceutical care integrated perspective it can remain limited just to the processes. Precisely, the patient's vision as the centre of the action and the integration of knowledge and skills provided by pharmaceutical care create a complete global care system. In order to offer this comprehensive health care, the pharmaceutical care applies methods that develop a rational sequence to evaluate the drug-therapy and achieve therapeutic goals. Pharmaceutical care programs have reached its peak and development recently, but they must demonstrate its efficiency to be considered an affordable health technology. The challenge is to advance in pharmaceutical care implementation and to apply suitable methodologies within ethical pertinent conditions to evaluate effectiveness and efficiency. Pharmaceutical care should obtain specific results in health for patients attended and hospitals must recognize the beneficial effects with regard to few reasonable costs (AU)

[Pharmacotherapy follow-up for patients admitted to the Internal Medicine Department of Hospital Infanta Margarita]. / Seguimiento farmacoterapéutico en pacients ingresados en el Servicio de Medicina Interna del Hospital Infanta Margarita.

INTRODUCTION: In pharmacotherapeutic follow-up a pharmacist is responsible for drug-related patient needs (DRPN) by detecting, preventing and solving medication-related problems aiming at specific results to improve patient quality of life. Drug-related problems are pharmacotherapy failures leading to failed therapeutic goals or undesirable events. MATERIAL AND METHODS: In this study, Daders methodology for pharmacotherapeutic follow-up was used in patients admitted to the Internal Medicine Department of Hospital Infanta Margarita, Cabra-Córdoba, Spain. RESULTS: In all, 85 DRPNs (2.7 DRPNs per patient) were identified, and 36 pharmaceutical procedures were performed, with physicians accepting 92% of said procedures. Forty-nine percent of drug-related problems were related to need, 40% to effectiveness, and 11% to safety. CONCLUSIONS: The presence of a pharmacist at the Internal Medicine Department allows the detection of DRPNs that are mostly related to need and effectiveness. Pharmaceutical procedures are widely accepted by medical teams.

Seguimiento farmacoterapéutico en pacientes ingresados en el Servicio de Medicina Interna del Hospital Infanta Margarita / Pharmacotherapy follow-up for patients admitted to the Internal Medicine Department of Hospital Infanta Margarita

Introducción: El seguimiento farmacoterapéutico es la práctica en la que el farmacéutico se responsabiliza de las necesidades del paciente relacionadas con los medicamentos (PRM) mediante la detección, prevención y resolución de problemas relacionados con la medicación con el fin de alcanzar resultados concretos que mejoren la calidad de vida del paciente. Los problemas relacionados con los medicamentos son fallos en la farmacoterapia que conducen a que no se alcancen los objetivos terapéuticos o se produzcan efectos no deseados. Material y métodos: En este estudio la metodología Dáder para el seguimiento farmacoterapéutico fue aplicada en pacientes del Servicio de Medicina Interna del Hospital Infanta Margarita de Cabra (Córdoba).Resultados: Fueron identificados un total de 85 PRM (2,7 PRM por paciente) y realizadas 36 intervenciones farmacéuticas y los médicos aceptaron el 92 por ciento de las intervenciones. El 49 por ciento de los problemas relacionados al tratamiento farmacológico estaban relacionados con la necesidad, el 40 por ciento con la efectividad y el 11 por ciento con la seguridad. Conclusiones: La presencia del farmacéutico en el Servicio de Medicina Interna permite detectar PRM, que están mayoritariamente relacionados con la necesidad y efectividad. Las intervenciones farmacéuticas son ampliamente aceptadas por el equipo médico (AU)

[Drug therapy follow-up in patients admitted to a Surgery Department]. / Seguimiento del tratamiento farmacológico en pacientes ingresados en un Servicio de Cirugía.

INTRODUCTION: Patients admitted to surgery departments receive multiple drugs before, during and after surgical procedures. Anti-infectious therapy, anesthetics, anti-embolic agents, and analgesics stand out amongst others. Our objective was to implement pharmacotherapeutic follow-up as a means to detect, prevent, and solve medication-related problems (MRPs) in inpatients, and to establish consensus strategies to solve avoidable MRPs. MATERIAL AND METHODS: An observational prospective study of 22 patients hospitalized in a Surgery Department, Hospital Infanta Margarita, Cabra (Córdoba) was conducted. Dader methodology was adapted for drug therapy follow-up in the hospital setting. RESULTS: In all, 108 MRPs were detected; 22.04% were associated with medication needs (MRP1:13.6% and MRP2: 8.5%), 40.68% with ineffectiveness (MRP3: 22.0% and MRP4: 18.6%), and 37.28% with lack of safety (MRP5: 10.2% and MRP6: 27.1%). Out of 108 MRPs found, 64 (59.3%) were avoidable; 97 pharmaceutical interventions were carried out (89.8% of cases), acting in 63 (58%) MRPs detected in cooperation with physicians, while 46 MRPs were solved (42%). We found 1 MRP in each 2.6 patients -- admission days, and 1 MRP per 4.5 patients -- admission days occurred after pharmaceutical intervention during the study period. CONCLUSIONS: The use of pharmacotherapeutic follow-up in patients admitted to this department has improved the quality of health care.

Seguimiento del tratamiento farmacológico en pacientes ingresados en un Servicio de Cirugía / Drug therapy follow-up in patients admitted to a Surgery Department

Introducción: Los pacientes ingresados en un Servicio de Cirugía están polimedicados antes, durante y después de una intervención quirúrgica; destacan la terapia antiinfecciosa, anestésica, antiembólica y analgésica entre otras. Fue el objetivo de este implantar el seguimiento farmacoterapéutico para detectar, prevenir y resolver problemas relacionados con los medicamentos (PRM) en los pacientes ingresados y establecer estrategias consensuadas para resolver los PRM evitables. Material y métodos: Estudio observacional prospectivo en 22 pacientes hospitalizados en el Servicio de Cirugía del Hospital Infanta Margarita de Cabra (Córdoba). Se adaptó la metodología Dáder para el seguimiento de tratamiento farmacológico para ser utilizada el ámbito hospitalario. Resultados: Se detectaron 108 PRM de los cuales el 22,04 por ciento estuvieron relacionados con la necesidad de la medicación (PRM 1:13,6 por ciento y PRM 2: 8,5 por ciento), el 40,68 por ciento por inefectividad (PRM 3: 22,0 por ciento y PRM 4: 18,6 por ciento) y el 37,28 por ciento por inseguridad (PRM 5: 10,2 por ciento y PRM 6: 27,1 por ciento). De los 108 PRM encontrados 64 (59,3 por ciento) eran evitables; se llevaron a cabo 97 intervenciones farmacéuticas (89,8 por ciento de los casos) actuando con el equipo médico en 63 (58 por ciento) de los PRM detectados y resolviendo 46 PRM (42 por ciento).Se encontró 1 PRM por cada 2,6 pacientes-día ingresados y tras la intervención farmacéutica sucedió 1 PRM por cada 4,5 pacientes-día ingresados durante el tiempo de estudio. Conclusiones: La realización del seguimiento farmacoterapéutico en los pacientes ingresados en este Servicio ha supuesto una mejora de la calidad de la atención sanitaria prestada (AU)