Comparación de la calidad de vida en personas que viven con infección por VIH en seguimiento mediante atención farmacéutica según metodología capacidad motivación-oportunidad vs. seguimiento convencional. Proyecto MAS-VIH / Comparison of quality of life in patients living with HIV infection through pharmaceutical care according to CMO methodology vs. conventional follow-up. MAS-VIH project

Objetivo. Comparar la calidad de vida en personas que viven con infección por el Virus de la Inmunodeficiencia Humana según el modelo de Atención Farmacéutica que reciben en los Servicios de Farmacia Hospitalaria: CMO (capacidad, motivación y oportunidad), versus seguimiento convencional. Método. Estudio longitudinal, prospectivo, multicéntrico, realizado entre octubre-2019 y noviembre-2021 en 14 Servicios de Farmacia Hospitalaria de España. Se incluyeron pacientes mayores de 18 años, que recibían tratamiento antirretroviral y acudían a las consultas de Atención Farmacéutica durante ≥1 año. Se excluyeron aquellos pacientes sin autonomía para completar los cuestionarios previstos. Los centros fueron aleatorizados a seguir utilizando la misma sistemática de trabajo (seguimiento tradicional) o implementar el modelo CMO, utilizando la estratificación, establecimiento de objetivos farmacoterapéuticos, uso de entrevista motivacional, así como el seguimientolongitudinal con nuevas tecnologías. La variable principal fue la diferencia en el número de dimensiones afectadas negativamente, en cada rama, a las 24 semanas, según cuestionario MOS-HIV. En el brazo CMO se registraron las intervenciones más frecuentemente realizadas.Resultados. Se incluyeron 151 pacientes. La mediana de edad fue de 51,3 años. Se encontró mejora significativa de la calidad de vida al final del seguimiento en el grupo CMO, reduciéndose el número de pacientes con dimensiones afectadas negativamente (2/11 vs 8/11). Las intervenciones más frecuentes llevadas a cabo, según la taxonomía, fueron: Motivación (51,7%) y Revisión y validación del TAR (49,4%). Conclusiones. La calidad de vida de los pacientes es superior en aquellos centros que desarrollan Atención Farmacéutica basada en metodología CMO en comparación con el seguimiento tradicional. (AU)

Objective. To compare quality of life, in patients livingwith HIV infection with pharmaceutical care according to the CMO methodology: capacity, motivation and opportunity versus conventional follow-up. Method. Longitudinal, prospective, multicenter, health intervention study, conducted between October 2019 and November 2021 in 14 centers throughout Spain. Patients over 18 years of age, receiving antiretroviral treatment and attending the consultations of the participating Pharmacy Services for 1 year were included. Patients who did not have the autonomy to complete the planned questionnaires were excluded. At baseline, participating centers were randomized to continue using the same systematics of work (traditional follow-up) or to implement the CMO model using patient stratification models, goal setting in relation to pharmacotherapy, use of motivational interviewing, as well as longitudinal follow-up enabled by new technologies. The main variable was the difference in the number of dimensions positively affected in each follow-up arm at 24 weeks of follow-up according to the MOS-HIV questionnaire. In the CMO group, the interventions performed the most frequently were recorded. Results. 151 patients were included. The median age was 51.35 years. A significant improvement in quality of life was found at the end of follow-up in the CMO group, reducing the number of patients with negatively affected dimensions (2/11 vs 8/11). The most frequent interventions carried out in the CMO group, according to the taxonomy, were Motivation (51,7%) and review and validation (49,4%) Conclusions. The quality of life of patients is higher in those centers that develop Pharmaceutical Care based on the CMO methodology compared to traditional follow-up. (AU)

Telematic interview in telepharmacy: consensus document for farmacotherapeutic monitoring and informed drug delivery.

Telepharmacy is defined as the practice of remote pharmaceutical care, using information and communication technologies. Given its growing importance in outpatient pharmaceutical care, the Spanish Society of Hospital Pharmacy developed a consensus document, "Guía de entrevista telemática en atención farmacéutica," as part of its strategy for the development and expansion of telepharmacy, with key recommendations for effective pharmacotherapeutic monitoring and informed dispensing and delivery of medications through telematic interviews. The document was developed by a working group of hospital pharmacists with experience in the field. It highlights the benefits of telematic interviewing for patients, hospital pharmacy professionals, and the healthcare system as a whole, reviews the various tools for conducting telematic interviews, and provides recommendations for each phase of the interview. These recommendations cover aspects such as tool/platform selection, patient selection, obtaining authorization and consent, assessing technological skills, defining objectives and structure, scheduling appointments, reviewing medical records, and ensuring humane treatment. Telematic interview is a valuable complement to face-to-face consultations but its novelty requires a strategic and formal framework that this consensus document aims to cover. The use of appropriate communication tools and compliance with recommended procedures ensure patient safety and satisfaction. By implementing telematic interviews, healthcare institutions can improve patient care, optimize the use of resources and promote continuity of care.

Simplification and Multidimensional Adaptation of the Stratification Tool for Pharmaceutical Care in People Living With HIV.

BACKGROUND: People living with human immunodeficiency virus (HIV) require specific pharmaceutical care (PC). Although the 2017 Capacity-Motivation-Opportunity (CMO) PC model allows a multidisciplinary approach that focuses on patient needs, it is too complex and presents room for improvement. OBJECTIVE: The aim of this study is to simplify and adapt the previous 2017 PC tool through a multidimensional approach to improve HIV patient care, to prove the validity of the model in real-life patients. METHODS: The new PC tool was generated by keeping some of the variables of the 2017 document and conducting a literature search. Content validity was determined by a 2-round Delphi methodology with an expert panel of 42 pharmacists. Consensus for the first and second rounds was defined as ≥70% agreement. The tool generated was validated in 407 real-life patients. RESULTS: Thirty-seven experts completed the first round of the Delphi survey and 36 the second. No consensus was reached for 3 variables, any of the frequency options and 4 interventions, while the experts agreed not to include 1 intervention in round 1. Consensus to include them was found for all but 1 variable and 1 intervention in round 2. The final tool obtained to select and stratify HIV-positive patients was composed of 9 dimensions divided into 17 variables. The new tool was validated with real-life patients and 3 priority levels were defined. CONCLUSIONS AND RELEVANCE: We created a new pyramid of score thresholds to classify patients into priority levels. The new tool simplifies the 2017 model and improves its utility to help HIV-positive patients, owing to its multidimensional approach.

The Telepharmacy patient prioritisation model of the Spanish Society of Hospital Pharmacy.

The Spanish Society of Hospital Pharmacy Position Paper on Telepharmacy states that the inclusion of patients should take into account  ethical considerations and, therefore, be based on the concept of equity. Thus, it establishes that Telepharmacy should not be limited to specific  pathologies or medicines, but should be based on the individual needs of each patient: it also highlights the need to rely on selection or prioritisation models to help identify patients who can benefit from  Telepharmacy. The aim of this article is to present the Spanish Society of  Hospital Pharmacy Telepharmacy Patient Prioritisation Model, which establishes  key recommendations and a reference prioritisation model to guide  hospital pharmacists in the identification and prioritisation of patients  who are candidates for inclusion in Telepharmacy programmes. This model was  developed based on the experience of a group of experts in their clinical  practice as well as on a review of the main reference documents available in  this field. It comprises 25 criteria, grouped into 8 minimum inclusion criteria, 5 continuity criteria, and 12 recommended criteria. The latter criteria are divided  into high, medium, and low priority criteria. Patients are prioritised according  to their scores on meeting the recommended criteria, such that those with the  highest scores are given the highest priority. As stated in the Spanish Society  of Hospital Pharmacy Position Paper on Telepharmacy, pharmacotherapeutic  monitoring can be conducted via remote consultation without sending  medication, but not vice versa; thus, the 25 criteria defined apply to  Telepharmacy programmes in the area of the remote dispensing and informed  delivery of medicines, but only 19 of them apply to pharmacotherapeutic  monitoring programmes. The model presented is intended to be a reference  guide and should be adapted to the particular characteristics and  circumstances of each pharmacy service, depending on demand and available  resources.

La Sociedad Española de Farmacia Hospitalaria, en su Documento de  osicionamiento sobre Telefarmacia, establece que la inclusión de pacientes debe tener en cuenta consideraciones éticas y, por tanto, estar  basada en el concepto de equidad. Por ello, establece que la Telefarmacia no  debe restringirse por patologías ni medicamentos, sino en función de las  necesidades individuales de cada paciente, y destaca la necesidad de apoyarse en modelos de selección o priorización que ayuden en la  identificación de los pacientes que puedan beneficiarse de la Telefarmacia. El  objetivo de este artículo es presentar el "Modelo de priorización de pacientes  en Telefarmacia de la Sociedad Española de Farmacia Hospitalaria", que pretende establecer recomendaciones clave y un modelo de priorización de referencia que sirva de orientación a los farmacéuticos especialistas en farmacia hospitalaria para la identificación y priorización de pacientes candidatos a ser incluidos en programas de Telefarmacia. El modelo  a sido desarrollado en base a la experiencia de un grupo de expertos en su práctica clínica y a la revisión de los principales documentos de referencia disponibles en este ámbito y está conformado por un total de 25  criterios, agrupados en 8 criterios mínimos de inclusión, 5 criterios de  continuidad y 12 criterios recomendables. Estos últimos se dividen en criterios  de alta, media y baja prioridad. En función de las puntuaciones obtenidas del  cumplimiento de los criterios recomendables, se establece el orden de  prioridad de pacientes, de modo que aquellos que mayor puntuación obtengan  serán los más prioritarios. Tal como recoge el "Documento de Posicionamiento sobre Telefarmacia de la Sociedad Española de Farmacia Hospitalaria", puede  haber seguimiento farmacoterapéutico por teleconsulta sin envío de medicación, pero no al contrario, por lo que los 25 criterios definidos aplican a  programas de Telefarmacia en el ámbito de la dispensación y entrega informada de medicamentos a distancia, pero solamente 19 de ellos aplican para los programas de seguimiento farmacoterapéutico. El modelo que se  presenta ha sido concebido como un marco de referencia y deberá adaptarse a las características y circunstancias particulares de cada servicio de farmacia,  en función de la demanda y de los recursos disponibles.

Modelo de priorización de pacientes en Telefarmacia de la Sociedad Española de Farmacia Hospitalaria / The Telepharmacy patient prioritisation model of the Spanish Society of Hospital Pharmacy

La Sociedad Española de Farmacia Hospitalaria, en su Documento de Posicionamiento sobre Telefarmacia, establece que la inclusión de pacientesdebe tener en cuenta consideraciones éticas y, por tanto, estar basada enel concepto de equidad. Por ello, establece que la Telefarmacia no deberestringirse por patologías ni medicamentos, sino en función de las necesidades individuales de cada paciente, y destaca la necesidad de apoyarseen modelos de selección o priorización que ayuden en la identificaciónde los pacientes que puedan beneficiarse de la Telefarmacia. El objetivode este artículo es presentar el “Modelo de priorización de pacientes enTelefarmacia de la Sociedad Española de Farmacia Hospitalaria”, quepretende establecer recomendaciones clave y un modelo de priorizaciónde referencia que sirva de orientación a los farmacéuticos especialistas enfarmacia hospitalaria para la identificación y priorización de pacientescandidatos a ser incluidos en programas de Telefarmacia. El modelo hasido desarrollado en base a la experiencia de un grupo de expertos en supráctica clínica y a la revisión de los principales documentos de referenciadisponibles en este ámbito y está conformado por un total de 25 criterios,agrupados en 8 criterios mínimos de inclusión, 5 criterios de continuidad y 12 criterios recomendables. Estos últimos se dividen en criterios de alta,media y baja prioridad. En función de las puntuaciones obtenidas del cumplimiento de los criterios recomendables, se establece el orden de prioridadde pacientes, de modo que aquellos que mayor puntuación obtengan seránlos más prioritarios. (AU)

The Spanish Society of Hospital Pharmacy Position Paper on Telepharmacy states that the inclusion of patients should take into account ethicalconsiderations and, therefore, be based on the concept of equity. Thus,it establishes that Telepharmacy should not be limited to specific pathologies or medicines, but should be based on the individual needs of eachpatient: it also highlights the need to rely on selection or prioritisationmodels to help identify patients who can benefit from Telepharmacy. Theaim of this article is to present the Spanish Society of Hospital PharmacyTelepharmacy Patient Prioritisation Model, which establishes key recommendations and a reference prioritisation model to guide hospital pharmacists in the identification and prioritisation of patients who are candidatesfor inclusion in Telepharmacy programmes. This model was developedbased on the experience of a group of experts in their clinical practiceas well as on a review of the main reference documents available in thisfield. It comprises 25 criteria, grouped into 8 minimum inclusion criteria,5 continuity criteria, and 12 recommended criteria. The latter criteria aredivided into high, medium, and low priority criteria. Patients are prioritisedaccording to their scores on meeting the recommended criteria, such that those with the highest scores are given the highest priority. (AU)

Prevalence of polypharmacy and associated factors among patients living with HIV infection in Spain: The POINT study.

PURPOSE: Survival in people living with HIV (PLWH) has increased and thus people are aging with HIV, increasing the frequency of multimorbidity and polypharmacy. This cross-sectional study was conducted to evaluate the prevalence of polypharmacy among PLWH who were on antiretroviral treatment and were followed in an outpatient setting by the pharmacy department of several hospitals across Spain. In addition, we aimed to evaluate factors associated with polypharmacy and treatment complexity among this population. MATERIAL AND METHODS: We recorded information on demographic data, data on disease control including viral load and CD4 count at the time of inclusion, comorbidities, pharmacologic treatment and drugs interactions. Polypharmacy was defined as the use of 6 or more different drugs, including antiretroviral medication; major polypharmacy was defined as the use of ≥11 different drugs. RESULTS: Overall, 1225 PLWH were eligible in the study. The median (IQR) age was 49 (40-54). Comorbidities were present in 819 (67%) PLWH and 571 (47%) had two or more comorbidities. Overall, 397 (32.4%, 95% CI 29.8-34.9) PLWH met the criteria for polypharmacy, and 67 (5.5%, 95% CI, 4.2-6.7) had major polypharmacy. Several factors were associated with polypharmacy such as type of antiretroviral treatment, presence of potential interactions, the use of several types of medications and the number of comorbidities. Treatment complexity was also a factor strongly associated with polypharmacy; for each point increase in the medication regimen complexity index (MRCI), the likelihood of polypharmacy increased 2.3-fold. CONCLUSIONS: Polypharmacy is frequent among PLWH in Spain and contributes to a relevant extent to treatment complexity.

Prevalence of polypharmacy and associated factors among patients living with HIV infection in Spain: The POINT study / Prevalencia y factores asociados a la polifarmacia en pacientes VIH+ en España. Estudio POINT

PurposeSurvival in people living with HIV (PLWH) has increased and thus people are aging with HIV, increasing the frequency of multimorbidity and polypharmacy. This cross-sectional study was conducted to evaluate the prevalence of polypharmacy among PLWH who were on antiretroviral treatment and were followed in an outpatient setting by the pharmacy department of several hospitals across Spain. In addition, we aimed to evaluate factors associated with polypharmacy and treatment complexity among this population.Material and methodsWe recorded information on demographic data, data on disease control including viral load and CD4 count at the time of inclusion, comorbidities, pharmacologic treatment and drugs interactions. Polypharmacy was defined as the use of 6 or more different drugs, including antiretroviral medication; major polypharmacy was defined as the use of ≥11 different drugs.ResultsOverall, 1225 PLWH were eligible in the study. The median (IQR) age was 49 (40–54). Comorbidities were present in 819 (67%) PLWH and 571 (47%) had two or more comorbidities. Overall, 397 (32.4%, 95% CI 29.8–34.9) PLWH met the criteria for polypharmacy, and 67 (5.5%, 95% CI, 4.2–6.7) had major polypharmacy. Several factors were associated with polypharmacy such as type of antiretroviral treatment, presence of potential interactions, the use of several types of medications and the number of comorbidities. Treatment complexity was also a factor strongly associated with polypharmacy; for each point increase in the medication regimen complexity index (MRCI), the likelihood of polypharmacy increased 2.3-fold.ConclusionsPolypharmacy is frequent among PLWH in Spain and contributes to a relevant extent to treatment complexity.

ObjetivoLa supervivencia de las personas con infección por el VIH ha aumentado notablemente en los últimos años incrementado la edad de estos sujetos. Ello se asocia con una mayor presencia de multimorbilidad y polifarmacia. El objetivo de este estudio es evaluar la prevalencia de la polifarmacia en pacientes VIH+ con tratamiento antirretroviral activo seguidos en las consultas externas de los servicios de farmacia hospitalaria en toda España. Adicionalmente, analizar los factores asociados a polifarmacia y a la complejidad farmacoterapéutica en esta población.Material y métodosEstudio multicéntrico, transversal. Se recogieron variables demográficas, variables relacionadas con el control de la enfermedad como la carga viral y los linfocitos CD4, las comorbilidades, el tratamiento farmacológico completo del paciente y la presencia de interacciones. La polifarmacia se definió como el uso de al menos 6 fármacos incluyendo el TAR. Se definió polifarmacia mayor como la toma de más de 11 fármacos diferentes. Se midió la complejidad farmacoterapéutica por la escala de valoración Medication Regimen Complexity Index (MRCI).ResultadosSe incluyeron 1.225 pacientes. La mediana (RIQ) de edad fue de 49 años (40-54). En total 819 (67,0%) pacientes presentaban al menos una comorbilidad en el momento del estudio, teniendo 2 o más comorbilidades, el 47,0% de los mismos. Un total de 397 (32,4%; IC 95%: 29,8-34,9) pacientes cumplieron los criterios de polifarmacia y 67 (5,5%; IC 95%: 4,2-6,7) los de polifarmacia mayor. Los factores asociados con la polifarmacia fueron: el tratamiento antirretroviral, la presencia de interacciones potenciales, el uso de diferentes tipos de fármacos y el número de comorbilidades. La complejidad farmacoterapéutica se asoció de forma importante con la presencia de polifarmacia, incrementándose su probabilidad de aparición entre 2 y 3 veces por cada incremento en un punto en su escala de valoración.Conclusión

Patient Experience Evaluation of the CMO-Based Pharmaceutical Care Model vs Usual Care in People Living with HIV.

Objective: To compare patient experience in a real-life population of people living with HIV (PLWH) who received pharmaceutical care (PC) based on the Capacity-Motivation-Opportunity (CMO) model versus the traditional model. Methods: Prospective cohort study in PLWH receiving either CMO-based PC or traditional PC in Spain between October 2019 and June 2021 (24 weeks), performed by the pharmacy department of 14 Spanish hospitals. Participants were adult patients with a clinical diagnosis of HIV treated with antiretrovirals who had been monitored in the participating hospital pharmacies for >1 year. Patient experience (IEXPAC questionnaire), clinical outcomes (cholesterol, triglycerides, HDL, glycated haemoglobin, and blood pressure), adherence to treatment, virologic control and patient satisfaction were determined. Results: Patient experience in the CMO group at week 24 was significantly better (7.6 vs 6.9) than in the traditional group, with a higher mean improvement. Adherence was better in the CMO group, particularly with regard to concomitant medications (53.2% to 91.7%, p<0.001); no changes were observed in the traditional group. Patient satisfaction improved in the CMO group vs the traditional group (48 vs 44, p<0.001). Conclusion: To our knowledge, this is the first study to compare CMO vs traditional methodology. The CMO model showed an overall improvement in real-life patient experience, satisfaction, and adherence to treatment compared to the traditional methodology.

Potentially inappropriate prescriptions and therapeutic complexity in older HIV patients with comorbidities.

BACKGROUND: The prolonged current survival of human immunodeficiency virus (HIV) patients exposes them to new problems arising from the comorbidities they face. OBJECTIVES: To describe the situation of comorbidities, polypharmacy, therapeutic complexity and adherence in people living with HIV over 65 years of age and to assess the presence of potentially inappropriate prescriptions (PIP) by applying deprescription criteria. METHODS: Observational study including HIV people (> 65 years) from a university tertiary level hospital. Demographic, clinical and pharmacotherapeutic characteristics of the patients and their treatments were studied. The prevalence of polypharmacy (> 5 medications) and the pharmacotherapy complexity, quantified by the Medication Regimen Complexity Index (MRCI), were calculated. Therapeutic adherence was assessed by the Simplified Medication Adherence Questionnaire (SMAQ) and the medication possession ratio, according to prescription dispensing records. The Screening Tool of Older People's Prescriptions (STOPP) and List of Evidence-baSed depreScribing for CHRONic patients (LESS-CHRON) criteria were applied to identify PIP. MAIN OUTCOME MEASURE: PIP in elderly people living with HIV. RESULTS: Thirty patients were included, 73% of whom were men, with a median age of 71 years (IQR 67 - 76) and a median duration of infection of 17 years (IQR, 9 - 21). Seventy percent of the patients suffered from dyslipemia, 66.7% from hypertension, 43.3% from diabetes and 26.7% from mental health disorders. Seventy percent of the patients took more than 5 medications and 30% more than 10. The MRCI of concomitant medications was higher (18.3 points) than the MRCI of antiretroviral therapy (5.1 points), 66.7% of the studied population was classified as adherent. Finally, 70% of the patients present some PIP according to the STOPP or LESS-CHRON criteria. The polypharmacy was significantly associated (p = 0.008) with meeting deprescription criteria. CONCLUSION: The elderly people living with HIV present numerous comorbidities and met the criteria for polypharmacy. Their pharmacotherapy complexity is mainly determined by the concomitant treatments. There is a high prevalence of meeting deprescription criteria in people living with HIV over the age of 65 and a clear relationship between polypharmacy and deprescription. The optimization of pharmacotherapy is necessary in this population.

Prevalence of polypharmacy and associated factors among patients living with HIV infection in Spain: The POINT study.

PURPOSE: Survival in people living with HIV (PLWH) has increased and thus people are aging with HIV, increasing the frequency of multimorbidity and polypharmacy. This cross-sectional study was conducted to evaluate the prevalence of polypharmacy among PLWH who were on antiretroviral treatment and were followed in an outpatient setting by the pharmacy department of several hospitals across Spain. In addition, we aimed to evaluate factors associated with polypharmacy and treatment complexity among this population. MATERIAL AND METHODS: We recorded information on demographic data, data on disease control including viral load and CD4 count at the time of inclusion, comorbidities, pharmacologic treatment and drugs interactions. Polypharmacy was defined as the use of 6 or more different drugs, including antiretroviral medication; major polypharmacy was defined as the use of ≥11 different drugs. RESULTS: Overall, 1225 PLWH were eligible in the study. The median (IQR) age was 49 (40-54). Comorbidities were present in 819 (67%) PLWH and 571 (47%) had two or more comorbidities. Overall, 397 (32.4%, 95% CI 29.8-34.9) PLWH met the criteria for polypharmacy, and 67 (5.5%, 95% CI, 4.2-6.7) had major polypharmacy. Several factors were associated with polypharmacy such as type of antiretroviral treatment, presence of potential interactions, the use of several types of medications and the number of comorbidities. Treatment complexity was also a factor strongly associated with polypharmacy; for each point increase in the medication regimen complexity index (MRCI), the likelihood of polypharmacy increased 2.3-fold. CONCLUSIONS: Polypharmacy is frequent among PLWH in Spain and contributes to a relevant extent to treatment complexity.

Prevalencia de polifarmacia y complejidad farmacoterapéutica en personas mayores con VIH en España. Estudio POINT / Prevalence of polypharmacy and pharmacotherapy complexity in elderly people living with HIV in Spain. POINT study

OBJETIVO: Determinar la prevalencia de polifarmacia en personas que viven con VIH de al menos 65 años en tratamiento antirretroviral. Describir el tratamiento antirretroviral, determinar la prevalencia de comorbilidades, el tipo de medicación concomitante más frecuente, la adherencia, la complejidad farmacoterapéutica y las interacciones. MÉTODO: Estudio observacional, transversal y multicéntrico en el que se incluyeron a personas que viven con VIH de al menos 65 años con trata-miento antirretroviral activo. Se recogieron variables demográficas, clínicas (carga viral, linfocitos CD4 y comorbilidades) y farmacoterapéuticas (tipo de tratamiento antirretroviral, regímenes con single-tablet-regimen, polifarmacia -seis principios activos incluyendo tratamiento antirretroviral-, polifarmacia mayor -11 principios activos incluyendo tratamiento antirretroviral-). Se midió la adherencia al tratamiento antirretroviral con los registros de dispensación y con el Simplified Medication Adherence Questionnaire, y la adherencia al tratamiento concomitante mediante los registros de dispensación y el cuestionario Morisky-Green. Se calculó el índice de complejidad farmacoterapéutica a través del Medication Regimen Complexity Index. Se revisaron las interacciones con la base de datos de Liverpool y Lexicomp. RESULTADOS: Se incluyeron 74 pacientes (86,5% hombres) con una me-diana de edad de 69 (66,7-72,0) años. La vía sexual fue la forma más frecuente de adquisición (67,6%). Presentaron indetectabilidad del virus el 89,2% de los pacientes y con una cifra de linfocitos CD4 de más de 200/ml el 94,6%. La mediana de comorbilidades fue de 3,5 (2,0-5,0): cardiovascular 52,7%, sistema nervioso central 50,0%, hepática 17,6%y enfermedad pulmonar crónica 8,1%. Recibieron triple terapia el 81,1% y single-tablet-regimen el 48,6%. La mediana de fármacos concomitantes fue 5,0 (2,0-7,0), polifarmacia 71,6% y polifarmacia mayor 25,7%. Medicamentos antihipertensivos y del sistema cardiovascular fueron prescritos en un 56,8% de los pacientes, hipolipemiantes 50,0%, antiulcerosos 33,8% y psicofármacos 32,4%. La adherencia según registros de dispensación del tratamiento antirretroviral fue del 85,1% y de la medicación concomitan-te del 62,8%. La mediana del Medication Regimen Complexity Index del tratamiento completo fue 13,0 (8,0-17,6). Tenían al menos una interacción potencial el 55,4% y al menos una contraindicada el 12,2% de los pacientes. CONCLUSIONES: Las personas mayores que viven con VIH tienen una alta prevalencia de polifarmacia, complejidad farmacoterapéutica, baja adherencia al tratamiento e interacciones, por lo que la optimización farmacoterapéutica debe ser una prioridad en este tipo de pacientes

OBJECTIVE: To determine the prevalence of polypharmacy in persons li-ving with HIV of at least 65 years of age receiving antiretroviral treatment. A characterization of antiretroviral treatment, as well as a determination of the prevalence of comorbidities; of the most common types of concomitant medication; of adherence rates; of the pharmacotherapeutic complexity; and of drug-drug interactions were also among the goals of the study. METHOD: This was a multi-center, cross-sectional observational study that included persons living with HIV aged 65 years or more who were on active antiretroviral treatment. Demographic, clinical (viral load, CD4 count and comorbidities) and pharmacotherapeutic (type of antiretroviral treatment: single tablet regimen, polypharmacy [six active ingredients or more] and major polypharmacy [11 active ingredients or more] variables were considered). Adherence to antiretroviral treatment was measured by dispensation records and the Simplified Medication Adherence Questionnaire, while adherence to concomitant medication was measured using dispensation records and the Morisky-Green questionnaire. The Medication Regimen Complexity Index was calculated. Drug-drug interactions were analyzed using the Liverpool and Lexicomp databases. RESULTS: Seventy-four patients (86.5% male) were included, with a median age of 69 years (66.7-72.0). The sexual route was the most common route of transmission of the disease (67.6%). The virus was undetectable in 89.2% of patients; the CD4 count was over 200/mL in 94.6% of the sample. The median number of comorbidities was 3.5 (2.0-5.0), 52.7% of them being cardiovascular; 50.0% related to the central nervous system; 17.6% hepatic; and 8.1% consisting in chronic pulmonary disease. A total of 81.1% of patients received triple therapy and 48.6% single ta-blet regimen. The median number of concomitant drugs administered was 5.0 (2.0-7.0), polypharmacy was observed in 71.6% of cases and major polypharmacy in 25.7%. Antihypertensive and cardiovascular drugs were prescribed to 56.8% of patients, lipid-lowering drugs to 50.0%, antiulcer agents to 33.8% and psychoactive drugs to 32.4%. According to dispensation records, adherence to antiretroviral treatment was 85.1% and to concomitant medication 62.8%. The median Medication Regimen Complexity Index for the whole treatment was 13.0 (8.0-17.6). Potential drug-drug interactions were observed in 55.4% of patients and contraindicated interactions in 12.2%. CONCLUSIONS: Elderly persons living with HIV exhibit a high prevalence of polypharmacy, pharmacotherapeutic complexity, poor adherence and drug-drug interactions. For that reason, pharmacotherapeutic optimization must be a priority in these patients

Prevalence of polypharmacy and pharmacotherapy complexity in elderly people living with HIV in Spain. POINT study.

OBJECTIVE: To determine the prevalence of polypharmacy in persons living with  HIV of at least 65 years of age receiving antiretroviral treatment. A  characterization of antiretroviral treatment, as well as a determination of the  prevalence of comorbidities; of the most common types of concomitant medication; of adherence rates; of the pharmacotherapeutic  complexity; and of drug-drug interactions were also among the goals of the  study. METHOD: This was a multi-center, cross-sectional observational study that  included persons living with HIV aged 65 years or more who were on active  antiretroviral treatment. Demographic, clinical (viral load, CD4 count and  comorbidities) and pharmacotherapeutic (type of antiretroviral treatment: single tablet regimen, polypharmacy [six active ingredients or more] and major  polypharmacy [11 active ingredients or more] variables were considered).  Adherence to antiretroviral treatment was measured by dispensation records and the Simplified Medication Adherence Questionnaire, while adherence to  concomitant medication was measured using dispensation records and the  Morisky-Green questionnaire. The Medication Regimen Complexity Index was  calculated. Drug-drug interactions were analyzed using the Liverpool and  Lexicomp databases. RESULTS: Seventy-four patients (86.5% male) were included, with a median age  of 69 years (66.7-72.0). The sexual route was the most common route of  transmission of the disease (67.6%). The virus was undetectable in 89.2% of  patients; the CD4 count was over 200/mL in 94.6% of the sample. The median  number of comorbidities was 3.5 (2.0-5.0), 52.7% of them being cardiovascular; 50.0% related to the central nervous system; 17.6% hepatic; and 8.1%  consisting in chronic pulmonary disease. A total of 81.1% of patients received  triple therapy and 48.6% single tablet regimen. The median number of  concomitant drugs administered was 5.0 (2.0-7.0), polypharmacy was observed  in 71.6% of cases and major polypharmacy in 25.7%. Antihypertensive and  cardiovascular drugs were prescribed to 56.8% of patients, lipid-lowering drugs  to 50.0%, antiulcer agents to 33.8% and psychoactive drugs to 32.4%.  According to dispensation records, adherence to antiretroviral treatment was  85.1% and to concomitant medication 62.8%. The median Medication Regimen Complexity Index for the whole treatment was 13.0 (8.0-17.6). Potential drug- drug interactions were observed in 55.4% of patients and contraindicated interactions in 12.2%. CONCLUSIONS: Elderly persons living with HIV exhibit a high prevalence of  polypharmacy, pharmacotherapeutic complexity, poor adherence and drug-drug  interactions. For that reason, pharmacotherapeutic optimization must be a  priority in these patients.

Objetivo: Determinar la prevalencia de polifarmacia en personas que viven con  VIH de al menos 65 años en tratamiento antirretroviral. Describir el tratamiento  antirretroviral, determinar la prevalencia de comorbilidades, el tipo de  medicación concomitante más frecuente, la adherencia, la complejidad farmacoterapéutica y las interacciones.Método: Estudio observacional, transversal y multicéntrico en el que se incluyeron a personas que viven con VIH de al menos 65 años con  tratamiento antirretroviral activo. Se recogieron variables demográficas, clínicas (carga viral, linfocitos CD4 y comorbilidades) y farmacoterapéuticas (tipo  de tratamiento antirretroviral, regímenes con single- tablet-regimen, polifarmacia ­seis principios activos incluyendo tratamiento  antirretroviral­, polifarmacia mayor ­11 principios activos incluyendo  tratamiento antirretroviral­). Se midió la adherencia al tratamiento  antirretroviral con los registros de dispensación y con el Simplified Medication  Adherence Questionnaire, y la adherencia al tratamiento concomitante mediante  los registros de dispensación y el cuestionario Morisky-Green. Se calculó el  índice de complejidad farmacoterapéutica a través del Medication Regimen  Complexity Index. Se revisaron las interacciones con la base de datos de  Liverpool y Lexicomp. Resultados: Se incluyeron 74 pacientes (86,5% hombres) con una mediana de  edad de 69 (66,7-72,0) años. La vía sexual fue la forma más frecuente de  adquisición (67,6%). Presentaron indetectabilidad del virus el 89,2% de los  pacientes y con una cifra de linfocitos CD4 de más de 200/ml el 94,6%. La  mediana de comorbilidades fue de 3,5 (2,0-5,0): cardiovascular 52,7%, sistema  nervioso central 50,0%, hepática 17,6% y enfermedad pulmonar crónica 8,1%.  Recibieron triple terapia el 81,1% y single-tablet-regimen el 48,6%. La mediana  de fármacos concomitantes fue 5,0 (2,0-7,0), polifarmacia 71,6% y polifarmacia mayor 25,7%. Medicamentos antihipertensivos y del sistema cardiovascular  fueron prescritos en un 56,8% de los pacientes, hipolipemiantes 50,0%,  antiulcerosos 33,8% y psicofármacos 32,4%. La adherencia según registros de  dispensación del tratamiento antirretroviral fue del 85,1% y de la medicación  concomitante del 62,8%. La mediana del Medication Regimen Complexity Index  del tratamiento completo fue 13,0 (8,0-17,6). Tenían al menos una interacción potencial el 55,4% y al menos una contraindicada el 12,2% de los pacientes.Conclusiones: Las personas mayores que viven con VIH tienen una alta  prevalencia de polifarmacia, complejidad farmacoterapéutica, baja adherencia al  tratamiento e interacciones, por lo que la optimización farmacoterapéutica debe  ser una prioridad en este tipo de pacientes.

Systematic review for the development of a pharmaceutical and medical products prioritization framework.

OBJECTIVE: To identify and analyze the criteria, approaches, and conceptual frameworks, used for national/international priority setting. DATA SOURCES: We performed a search of the main biomedical databases (Medline/PubMed, Embase, Centre for Reviews and Dissemination, and Cochrane), and we reviewed assessment agency websites, among other sources. STUDY DESIGN: An systematic review of the literature was carried out. DATA COLLECTION: Eligibility criteria for inclusion were based on set of predefined criteria. Systematic reviews and/or qualitative studies (interviews, surveys, expert consensus, etc) that aimed to identify prioritization criteria or develop general operational frameworks for the selection of health priorities were included. A critical analysis is made of all the aspects that may be useful for any public body that intends to establish priorities in health. PRINCIPAL FINDINGS: We found that there are no standardized criteria for priority setting, although common trends have been identified regarding key elements. Eight key domains were identified: 1) need for intervention; 2) health outcomes; 3) type of benefit of the intervention; 4) economic consequences; 5) existing knowledge on the intervention/quality and uncertainties of the regarding evidence; 6) implementation and complexity of the intervention/feasibility; 7) justice and ethics; and 8) overall context. CONCLUSIONS: Our review provides a thorough analysis of the relevant issues and offers key recommendations regarding considerations for developing a national prioritization framework. Findings are envisioned to be useful for different public organizations that are aiming to establish healthcare priorities.

Bioequivalence studies with anti-TNF biosimilars.

Introduction: Biosimilars, as defined by the European Medicines Agency, have been used in Europe since 2006. The landscape was considerably expanded when the first biosimilar of a monoclonal was approved and introduced in the European market. CT-P13 was developed by Celltrion as an infliximab biosimilar in 2013, not without controversy. As these complex molecules cannot be completely identical, some experts, clinicians, and even patients were skeptical regarding the real bioequivalence of the drugs. Currently, several new infliximab and adalimumab biosimilars are available or will reach the market in a few months. Areas covered: Our goal is to review, mainly from a clinical perspective, the available evidence for bioequivalence of anti-TNF biosimilars. We aim to take into account not only preclinical studies, mostly done for regulatory issues, but also data from clinical studies. Expert opinion: We can conclude that bioequivalence with originator is well demonstrated in those drugs which have followed European Medicines Agency regulatory pathways. Switching from originator to biosimilar appears safe for all indications. However, there are few data available for switching from one biosimilar to another, or for complete interchangeability. Prospective studies and strict pharmacovigilance are recommended.

Polypharmacy in older adults with human immunodeficiency virus infection compared with the general population.

BACKGROUND: The percentage of older HIV-positive patients is growing, with an increase in age-related comorbidities and concomitant medication. OBJECTIVES: To quantify polypharmacy and profile types of non-antiretroviral drugs collected at community pharmacies in 2014 by HIV-positive individuals on antiretroviral therapy and to compare these findings with those of the general population. METHODS: HIV-positive patients (n=199) were compared with a group of patients from the general population (n=8,172), aged between 50 and 64 years. The factors compared were prevalence of polypharmacy (≥5 comedications with cumulative defined daily dose [DDD] per drug over 180), percentage of patients who collected each therapeutic class of drug, and median duration for each drug class (based on DDD). Results were stratified by sex. RESULTS: Polypharmacy was more common in HIV-positive males than in the male general population (8.9% vs 4.4%, P=0.010). Polypharmacy was also higher in HIV-positive females than in the female general population (11.3% vs 3.4%, P=0.002). Percentage of HIV-positive patients receiving analgesics, anti-infectives, gastrointestinal drugs, central nervous system (CNS) agents, and respiratory drugs was higher than in the general population, with significant differences between male populations. No differences were observed in proportion of patients receiving cardiovascular drugs. The estimated number of treatment days (median DDDs) were higher in HIV-positive males than in males from the general population for anti-infectives (32.2 vs 20.0, P<0.001) and CNS agents (238.7 vs 120.0, P=0.002). A higher percentage of HIV-positive males than males from the general population received sulfonamides (17.1% vs 1.5%, P<0.001), macrolides (37.1% vs 24.9%, P=0.020), and quinolones (34.3% vs 21.2%, P=0.009). CONCLUSION: Polypharmacy is more common in HIV-positive older males and females than in similarly aged members of the general population. HIV-positive patients received more CNS drugs and anti-infectives, specifically sulfonamides, macrolides, and quinolones, but there were no differences in the percentage of patients receiving cardiovascular drugs. It is essential to investigate nonantiretroviral therapy medication use in the HIV-positive population to ensure these patients receive appropriate management.

Prevalence of concomitant medications in older HIV+ patients and comparison with general population.

OBJECTIVE: The increasing population of human immunodeficiency virus (HIV)-infected elderly patients results in a higher number of comorbidities and greater incidence of polypharmacy in addition to antiretroviral therapy (ART). The aim of this study is to describe the use of concomitant medication in older HIV-infected patients and to compare it with older general population. METHODS: The study included HIV-positive outpatients (>49 years) who received ART in 2011. Co-medication dispensed by pharmacies in that year was collected. Defined daily dose (DDD) for each drug was calculated by patient. A comparison was made between the use of co-medication among men between 50 and 64 years old in general population against the HIV-infected population. RESULTS: The study was based on 118 patients (77% men), of which 82% took at least one co-medication and 58% at least five. The commonest co-medications used by HIV-positive patients were antibiotics (44%); analgesics (44%); anti-inflammatories (39%); antacids (38%); and psycholeptics (38%). The medicines used for the greatest number of days per HIV-positive patient were those related to the renin-angiotensin system; anti-diabetics; lipid modifying agents; antithrombotics; and calcium channel blockers. In comparison with the general male population, a higher proportion of HIV-infected patients used antibiotics (42 vs 30%, P = 0.018), antiepileptics (16 vs 5%, P = 0.000), psycholeptics (35 vs 17%, P = 0.000) and COPD medications (14 vs 7%, P = 0.008). The duration of antibiotics and psycholeptic use in HIV-infected patients was longer compared to the general population (P < 0.05). CONCLUSIONS: Older HIV-positive patients frequently take a higher number of co-medication, which increases the risk of adverse events, interactions with other medication, and may lead to poorer treatment adherence.

Clinical characteristics and antiretroviral treatment of older HIV-infected patients.

BACKGROUND: The number of Human Immunodeficiency Virus (HIV) patients aged 50 years or over is growing year on year, due to both late diagnoses and the chronicity of the illness. This increase is a new phenomenon. OBJECTIVE: To describe the clinical and epidemiological characteristics of the older HIV infected population and determine if there are differences in antiretroviral treatment between younger and older patients. SETTING: This study was conducted in the outpatient hospital pharmacy service of a University Hospital in Spain. METHOD: A descriptive study involving HIV infected patients aged 50 years or older who received ambulatory antiretroviral therapy between January and December 2011. Variables related to HIV and to antiretroviral therapy were collected. A comparison of antiretroviral drugs used was made with the populations older and younger than 50 years. MAIN OUTCOME MEASURE: Antiretroviral therapy differences between older and younger HIV-patients. RESULTS: 130 patients (20% of the antiretroviral treated patients) were 50 or over and 77% of these was aged between 50 and 59. At the time of diagnosis, 50% suffered an advanced state of disease. At the end of the study period, 58% had CD4 lymphocyte levels of over 500 cells/mm(3) and 90% had an undetectable viral load. The antiretroviral therapy of the older group that was based on protease inhibitors was used in the 51.5% of the patients compared with 54.4% in the younger group. The figures for nonnucleoside reverse transcriptase inhibitors based therapy were 43.8 and 39.8%, respectively. The older population used treatments that included tenofovir (56.9 vs. 64.8%, p = 0.105) less frequently and used more treatments that included abacavir (26.9 vs. 19.1%, p = 0.054) than the under 50's. CONCLUSION: Half the older HIV-infected patients were diagnosed with an advanced disease and the majority showed a positive response to antiretroviral therapy. There are no statistically significant differences between the frequency of antiretroviral therapy use in older and younger HIV-patients, although older HIV-patients has less often used treatments with tenofovir and more often used treatments with abacavir.