Eficacia de la información al alta en la adherencia del paciente polimedicado / Efficiency of the Information Given at Discharge and Adherence of Polymedicated Patients

Objetivo Conocer la utilidad de un programa de información farmacoterapéutica al alta hospitalaria. Método Estudio prospectivo de 3 meses de duración en el que se aleatorizó a los pacientes en 2 grupos según recibieran o no información verbal y escrita sobre su tratamiento al alta hospitalaria. La adherencia se evaluó mediante el test de Morinsky-Green, tanto en el momento del alta, como transcurridos 30-50 días mediante entrevista telefónica. Además se recogió la información sobre la medicación del paciente en ese momento y los cambios respecto a la medicación al alta. Resultados Se incluyeron un total de 59 pacientes, 30 en el grupo control y 29 en el experimental. Entre el alta y la entrevista trascurrieron 42,1±9,6 días. Mientras que en el momento del alta el porcentaje de pacientes adherentes era mayor en el grupo control (83,3 frente a 62,1%, OR=0,33, IC 95%: 0,1 a 1,1, p=0,07), en la entrevista telefónica fue mayor en el grupo experimental (62,5 frente a 88,5%, OR=4,6, IC 95%: 1,1 a 19,8, p=0,03). Las diferencias entre ambos grupos en el resto de las variables (fallecimientos, visitas a urgencias y reingresos hospitalarios) no fueron estadísticamente significativas. En la entrevista telefónica un 70% de los pacientes sufrió algún tipo de cambio respecto al tratamiento al alta hospitalaria. Conclusiones La información al alta por parte del farmacéutico es una herramienta para mejorar la adherencia al tratamiento de los pacientes que debe tener una continuidad debido al elevado número de cambios de tratamiento que sufren estos pacientes (AU)

Objective To evaluate the utility of a post-discharge pharmaceutical care programme. Method Three-month prospective study where patients were randomised into two groups according to whether or not they received verbal and written information about their treatment at hospital discharge. Treatment compliance was assessed by the Morisky–Green test at discharge and at 30–50days via a telephone interview, also collecting information on patient medication. Results A total of 59 patients were included, 30 in the control group and 29 in the experimental group. 42.1±9.6days had elapsed between discharge and the telephone interview. While a higher percentage of patients were adherent to treatment at discharge in the control group (83.3 versus 62.1%, OR=0.33, 95% CI: 0.1–1.1, P=.07), in the telephone interview the percentage in the experimental group was greater (62.5 versus 88.5%, OR=4.6, 95% CI: 1.1–19.8, P=.03). The differences between the two groups for the rest of the variables (deaths, visits to emergency department and hospital readmissions) were not statistically significant. In the telephone interview, 70% of patients’ treatment was changed in some way since hospital discharge. Conclusion A post-discharge pharmaceutical care programme is a tool to improve treatment compliance, which needs continuity due to the large number of treatment changes suffered by these patients (AU)

[Efficiency of the information given at discharge and adherence of polymedicated patients]. / Eficacia de la información al alta en la adherencia del paciente polimedicado.

OBJECTIVE: To evaluate the utility of a post-discharge pharmaceutical care programme. METHOD: Three-month prospective study where patients were randomised into two groups according to whether or not they received verbal and written information about their treatment at hospital discharge. Treatment compliance was assessed by the Morisky Green test at discharge and at 30-50 days via a telephone interview, also collecting information on patient medication. RESULTS: A total of 59 patients were included, 30 in the control group and 29 in the experimental group. 42.1 ± 9.6days had elapsed between discharge and the telephone interview. While a higher percentage of patients were adherent to treatment at discharge in the control group (83.3 versus 62.1%, OR=0.33, 95% CI: 0.1-1.1, P=.07), in the telephone interview the percentage in the experimental group was greater (62.5 versus 88.5%, OR=4.6, 95% CI: 1.1-19.8, P=.03). The differences between the two groups for the rest of the variables (deaths, visits to emergency department and hospital readmissions) were not statistically significant. In the telephone interview, 70% of patients' treatment was changed in some way since hospital discharge. CONCLUSION: A post-discharge pharmaceutical care programme is a tool to improve treatment compliance, which needs continuity due to the large number of treatment changes suffered by these patients.

[Insulin therapy at the hospital setting]. / Insulinoterapia en el medio hospitalario.

Hyperglycemia is defined in different studies as a poor prognostic factor relating with higher risk for post-surgical infections, neurological complications, increased hospital staying, and admission to intensive care units. Appropriate use of insulin therapy is one of the key factors assuring the best management of hospitalized patients. The aim of this review was to discuss the most important aspects of insulin use at the hospital setting. We analyzed the different types of insulin commercially available and the factors determining their efficacy, as well as the different regimens and administration routes available at the hospital according to the type of patient and the type of feeding or exogenous intake of carbohydrates. The fear of inducing hypoglycemic episodes at the hospital contributes to an inappropriate prescription of the programmed insulin doses, the use of flexible rapid insulin doses in monotherapy, and setting excessively high glycemia levels. Currently, individualized management of hospital hyperglycemias should replace obsolete insulin regimens in order to reach more stringent glycemia goals and decreasing the number of complications in the hospitalized patient.

Insulinoterapia en el medio hospitalario / Insulin therapy the hospital setting

La hiperglucemia se define en diversos estudios como un factor de mal pronóstico relacionado con un mayor riesgo de infecciones postoperatorias, complicaciones neurológicas, aumento de la estancia hospitalaria e ingreso en unidades de cuidados intensivos. El uso adecuado de la terapia insulínica es una de las claves para asegurar el tratamiento óptimo del paciente ingresado en el hospital. El objetivo de esta revisión es discutir los aspectos más importantes del uso de insulina en el medio hospitalario. Se analizan tanto los tipos de insulina existentes en el mercado y los principales factores que determinan su eficacia, como las diferentes pautas y vías de administración que encontramos en el hospital en función del tipo de paciente y del tipo de alimentación o aporte exógeno de hidratos de carbono. El miedo a provocar episodios hipoglucémicos en el hospital, contribuye a una inadecuada prescripción de dosis programadas de insulina, a la utilización de pautas móviles de insulina rápida en monoterapia y al establecimiento de objetivos de glucemia demasiado elevados. Actualmente el tratamiento individualizado de las hiperglucemias hospitalarias debe sustituir a pautas de insulina obsoletas, con el fin de alcanzar objetivos glucémicos más exigentes que disminuyan las complicaciones del paciente durante su ingreso hospitalario (AU)

Hyperglycemia is defined in different studies as a poor prognostic factor relating with higher risk for post-surgical infections, neurological complications, increased hospital staying, and admission to intensive care units. Appropriate use of insulin therapy is one of the key factors assuring the best management of hospitalized patients. The aim of this review was to discuss the most important aspects of insulin use at the hospital setting. We analyzed the different types of insulin commercially available and the factors determining their efficacy, as well as the different regimens and administration routes available at the hospital according to the type of patient and the type of feeding or exogenous intake of carbohydrates. The fear of inducing hypoglycemic episodes at the hospital contributes to an inappropriate prescription of the programmed insulin doses, the use of flexible rapid insulin doses in monotherapy, and setting excessively high glycemia levels. Currently, individualized management of hospital hyperglycemias should replace obsolete insulin regimens in order to reach more stringent glycemia goals and decreasing the number of complications in the hospitalized patient (AU)

[Types of insulin therapy]. / Tipos de insulinoterapia.

Diabetes mellitus is a chronic disease associated with a series of long-term microvascular and macrovascular complications that requires continuing therapeutic control. In recent years, the pharmaceutical industry has developed new types of insulin and administration systems in order to more closely mimic human insulin secretion. In this way, insulin therapy is divided into conventional and intensive regimens according to their complexity. In type 1 diabetes mellitus (T1DM) patients, the treatment of choice is the one which achieves intensive glycemic control. In type 2 diabetes mellitus, we can start with a simplified conventional regimen which could progress into an intensive one similar to that of T1DM treatment. Both types of diabetes require an individualized treatment prescription based on the needs and characteristics of each patient.

Tipos de insulinoterapia / Types of insulin therapy

La diabetes es una enfermedad crónica asociada a una serie de complicaciones macro y microvasculares a largo plazo, que requiere un control terapéutico continuo. En los últimos años se han desarrollado nuevos tipos de insulina y de sistemas de administración, con el objetivo de aproximar las pautas de administración de la insulina al patrón de secreción endógena. Así, según su complejidad, podemos clasificar las pautas en terapia convencional y terapia intensiva. En pacientes con diabetes mellitus tipo 1 (DMT1) la terapia de elección es aquella que alcance un control intensivo de la glucemia del paciente. En la diabetes mellitus tipo 2 se puede comenzar con una pauta convencional más simplificada, que podría evolucionar hacia una terapia intensiva similar a la de la DMT1. En ambos tipos de diabetes, se debe prescribir la pauta insulínica de la forma más individualizada posible en función de las necesidades y características de cada paciente (AU)

Diabetes mellitus is a chronic disease associated with a series of long-term microvascular and macrovascular complications that requires continuing therapeutic control. In recent years, the pharmaceutical industry has developed new types of insulin and administration systems in order to more closely mimic human insulin secretion. In this way, insulin therapy is divided into conventional and intensive regimens according to their complexity. In type 1 diabetes mellitus (T1DM) patients, the treatment of choice is the one which achieves intensive glycemic control. In type 2 diabetes mellitus, we can start with a simplified conventional regimen which could progress into an intensive one similar to that of T1DM treatment. Both types of diabetes require an individualized treatment prescription based on the needs and characteristics of each patient (AU)