[Analysis of the evolution of outpatient pharmaceutical care in hospital pharmacy services in Spain after the implementation and development of the MAPEX initiative]. / Analisis de la evolución de la atención farmacéutica al paciente externo en los servicios de farmacia hospitalaria en España tras la puesta en marcha y desarrollo de la iniciativa MAPEX.

INTRODUCTION AND OBJECTIVE: In 2015, the Spanish Society of Hospital Pharmacy (SEFH) launched the Strategic Map for Outpatient Pharmaceutical Care (MAPEX), with the purpose of adapting the activity offered in Hospital Pharmacy outpatient clinics to the new healthcare context. The aim of the present study was to analyse the evolution of outpatient pharmaceutical care in Hospital Pharmacy Services in Spain in the period 2016-2021 after the implementation and development of the MAPEX initiative. MATERIAL AND METHOD: The implementation and development of the project was carried out by a group of experts from SEFH and consisted of five phases: creation of the structure, consensus conference, situation analysis, development of strategic initiatives and evolutionary analysis. To analyse the evolutionary development, a specific 43-item questionnaire was developed that addressed aspects related to structure, context, integration, processes, outcomes and research and was answered in 2016 and 2021 (in the latter case by adding 3 additional questions). RESULTS: 141 hospitals participated in the status survey in 2016 and 138 in 2021. Significant differences were found in all dimensions analysed. None of the aspects assessed suffered a setback in this period. The most highly rated aspects at the general level were the improvement of the care model (65.0%) and at the local level, the incorporation of non-face-to-face pharmaceutical care (42.8%). Further progress in the coming years in the expansion and practical application of the methodology proposed in the project was considered a priority. CONCLUSIONS: The implementation and development of the MAPEX initiative has had a positive impact in terms of quality of care for outpatient pharmaceutical care in Hospital Pharmacy services in Spain.

[Status of the structure, process and outcoms of pharmaceutical care to HIV patient in Spain. Origen study]. / Situación actual de la estructura, procesos y resultados de la Atención Farmacéutica al paciente VIH en España. Proyecto ORIGEN.

OBJECTIVES: To describe the structure, process and outcomes with which hospital pharmacist performs health care activity, teaching and research about Pharmaceutical Care (PC) in HIV patients in Spain. METHODS: Observational, cross-sectional and multicenter study carried out between November 2011-February 2012 in spanish hospitals. The inclusion criteria were: hospitals pharmacy services that dispensed antiretroviral medication to HIV patients. The questionnaire had 41 questions structured in 9 groups: hospital type and person conducting the survey, structure and resources, health care activities, interventions, communication with the rest of the multidisciplinary team, adherence, and quality records, management and pharmacoeconomy and teaching and research. Descriptive analysis was performed. To analyze the existence of statistically significant relationships, we applied fisher test, chi-square or logistic regression. RESULTS: 86 hospitals completed the survey. In 93%, PC consultation was not classified by pathologies. 27.9% provided continuing PC to all patients. Adherence was determined regularly or when pharmacist suspected poor adherence (57.5 %). 20% of hospital s teaching had a program that allowed a high level of training in PC to HIV patient. 52,3% of participating centers had published scientific articles related to HIV. CONCLUSIONS: Pharmaceutical care to HIV patients in Spain need to adapt to a new situation. For this, hospital pharmacists have to consider several issues such as chronicity, comorbidity, incorporation of new technologies and the stratification of patients in order to make it more efficient.

Objetivos: Describir la estructura, proceso y resultados con la que se lleva a cabo la actividad asistencial, docente e investigadora en torno a la Atención Farmacéutica (AF) al paciente VIH en los hospitales españoles. Material y métodos: Estudio observacional, transversal, pragmático y multicéntrico realizado entre Noviembre 2011-Febrero 2012. Participaron servicios de farmacia de hospitales españoles que dispensaran medicación antirretroviral para pacientes VIH. El cuestionario presentaba 41 preguntas estructuradas en 9 bloques: tipo de hospital y persona que realiza la encuesta, estructura y recursos disponibles, actividad asistencial, intervenciones, comunicación con el resto del equipo multidisciplinar, adherencia, registros y calidad, gestión y farmacoeconomía y docencia e investigación. Se realizó un análisis descriptivo y se aplicó la prueba de fisher, Chi cuadrado o regresión logística para analizar la existencia de relaciones estadísticamente significativas. Resultados: 86 hospitales cumplimentaron la encuesta. En el 93%, la consulta de AF era compartida con el resto de patologías. El 27,9% proporcionaba AF continuada a todos los pacientes. El 57,5% determinaban la adherencia periódicamente o en casos de sospecha de mala adhesión. El 20% de los hospitales docentes tenían un programa que permitía un alto nivel de formación en AF al paciente VIH. El 52,3% de los hospitales no habían publicado artículos científicos relacionados con el VIH. Conclusiones: La AF al paciente VIH+ en España debe adaptarse a un nuevo escenario donde se han de considerar aspectos como la cronicidad, la pluripatología, la incorporación de nuevas tecnologías y la necesidad de estratificación de los pacientes para hacerla más eficiente.

Desarrollo y validación de un modelo predictivo para la identificación de pacientes infectados por el VIH con problemas relacionados con los medicamentos. Estudio predictor / Development and validation of a prediction model to identify HIV+ patients with drug-related problems. A prediction study

Objetivo: Desarrollar y validar un modelo predictivo para la detección de problemas relacionados con los medicamentos (PRM) en pacientes con tratamiento antirretroviral (TAR), durante su seguimiento periódico en consultas de atención farmacéutica (AF) y previamente a la dispensación. Método Para encontrar factores pronósticos de PRM, se realizó un modelo de regresión logística binaria tras un análisis univariante, el cual identificó variables independientes relacionadas con PRM que fueron introducidas en el modelo multivariante para la selección final. La validez del modelo se determinó por el método Shrinkage y la capacidad discriminatoria por el estadístico C-Harrell. Estudio multicéntrico, abierto, prospectivo. Se incluyeron pacientes infectados por el VIH con y sin PRM. Para el diseño del modelo se incluyeron variables demográficas, clínicas y farmacoterapéuticas (relacionadas o no con el TAR).Resultados Se incluyeron 733 pacientes. Las variables «adherencia», «prescripción de fármacos con necesidad de ajuste posológico» y «número de medicamentos totales prescritos (al margen del TAR)» se relacionaban de manera independiente con la aparición de PRM. Las probabilidades predichas por el modelo, personalizando los coeficientes por el método shrinkage uniforme mostraron un valor R2=0,962 para la muestra de construcción y R2=0,872 para la de validación. La capacidad discriminatoria del modelo fue de 0,816 para la muestra de construcción y 0,779 para la de validación. Conclusiones El modelo predictivo desarrollado y validado permite la detección de pacientes con tratamiento antirretroviral y con mayor riesgo de sufrir un PRM. Las variables predictoras utilizadas se corresponden con las manejadas habitualmente en la historia farmacoterapéutica del paciente, permitiendo su empleo sistemático en la práctica asistencial (AU)

Objective: To develop and validate a prediction model for the detection of drug-related problems (DRP) in patients on antiretroviral treatment during their regular monitoring in Pharmaceutical Care Clinics before dispensing drugs. Method: Open multicentre prospective study. HIV patients with and without DRP were included. Demographic, clinical and pharmacotherapy variables (related and unrelated to antiretroviral treatment) were included in the model design. To find prognostic factors for DRP, a binary logistic regression model was created after performing a univariate analysis that identified independent variables related to DRP these variables were introduced in the multivariate model for the final selection. Model validity was determined by the shrinkage method and the discriminatory power by Harrell’s C-index. Results: 733 patients were included. The variables ‘‘adherence’’, ‘‘prescription of drugs needing dosage adjustment’’, and ‘‘total number of drugs prescribed (apart from the antiretroviral treatment)’’ were independently related to the appearance of DRP. Probabilities predicted by the model, customising the coefficients using the uniform shrinkage method, showed aR2= 0.962 for the construction sample and a R2= 0.872 for the validation sample. The discriminatory capacity of the model was 0.816 for the construction sample and 0.779 for the validationsample. Conclusions: The developed and validated model enables detection of patients on antiretroviral treatment who are at a higher risk for experiencing a DRP. The prediction variables employed are commonly used in patient’s pharmacotherapy record, allowing the model to be used in routine clinical practice (AU)

[Development and validation of a prediction model to identify HIV+ patients with drug-related problems. A prediction study]. / Desarrollo y validación de un modelo predictivo para la identificación de pacientes infectados por el VIH con problemas relacionados con los medicamentos. Estudio predictor.

OBJECTIVE: To develop and validate a prediction model for the detection of drug-related problems (DRP) in patients on antiretroviral treatment during their regular monitoring in Pharmaceutical Care Clinics before dispensing drugs. MEHOD: Open multicentre prospective study. HIV patients with and without DRP were included. Demographic, clinical and pharmacotherapy variables (related and unrelated to antiretroviral treatment) were included in the model design. To find prognostic factors for DRP, a binary logistic regression model was created after performing a univariate analysis that identified independent variables related to DRP these variables were introduced in the multivariate model for the final selection. Model validity was determined by the shrinkage method and the discriminatory power by Harrell's C-index. RESULTS: 733 patients were included. The variables "adherence", "prescription of drugs needing dosage adjustment", and "total number of drugs prescribed (apart from the antiretroviral treatment)" were independently related to the appearance of DRP. Probabilities predicted by the model, customising the coefficients using the uniform shrinkage method, showed a R(2)=0.962 for the construction sample and a R(2)=0.872 for the validation sample. The discriminatory capacity of the model was 0.816 for the construction sample and 0.779 for the validation sample. CONCLUSIONS: The developed and validated model enables detection of patients on antiretroviral treatment who are at a higher risk for experiencing a DRP. The prediction variables employed are commonly used in patient's pharmacotherapy record, allowing the model to be used in routine clinical practice.

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.

Evolución de la adherencia al tratamiento antirretoviral del 2000 al 2008 / Evolution of antiretroviral treatment adherence from 2000 to 2008

Objetivos Evaluar la adherencia al tratamiento antirretroviral en la cohorte de pacientes VIH de nuestro hospital y ver su evolución a lo largo de 9 años; así como conocer el patrón individual de la adherencia con el tiempo. Métodos Estudio descriptivo de la evolución de la adherencia media anual y el porcentaje anual de pacientes con adherencias superiores al 95%, desde el 2000 al 2008. Se analizó el patrón individual de adherencia con el tiempo y se clasificó a los pacientes en adherentes consistentes, no adherentes consistentes y fluctuantes. Resultados En el análisis de 577 pacientes, la adherencia basal fue significativamente mayor en los pacientes naive respecto a los pretratados. La adherencia media anual aumentó ligeramente y se mantuvo en valores cercanos al 95%. Al igual que el porcentaje de pacientes con adherencia superior al 95%, que aumentó desde el 64% en el 2000 al 79% en 2008.En cuanto al patrón individual de adherencia con el tiempo, de los 468 pacientes analizados, la mayoría (59%) fueron adherentes consistentes, un 4% no adherente y el resto (37%) presentaban fluctuaciones en su adherencia. Conclusiones En nuestra cohorte los valores de adherencia global se mantienen con el tiempo e incluso presentan una tendencia positiva; resultado de una monitorización sistemática de la adherencia e implantación de estrategias dirigidas a mantener la adherencia (AU)

Objectives To evaluate antiretroviral treatment adherence in the HIV patient cohort of our hospital and observe their evolution over a 9-year period; also to determine the individual pattern of adherence over time. Methods Descriptive study of the evolution of average annual adherence and the annual percentage of adherent patients greater than 95% from 2000 to 2008. We analysed the individual pattern of adherence over time and patients were classified into consistently adherent, consistently non-adherent, and fluctuating. Results In the analysis of 577 patients, baseline adherence was significantly greater in naïve patients with respect to those who were pre-treated. Average annual adherence increased slightly and stayed at values around 95%. As with the percentage of patients with adherence greater than 95%, which increased from 64% in 2000 to 79% in 2008.In terms of the individual pattern of adherence over time, of the 468 patients analysed, the majority (59%) were consistently adherent, 4% non-adherent, and the rest (37%) fluctuated in their adherence. Conclusions In our cohort the overall adherence values maintained themselves over time and even show a positive trend, likely the result of systematic monitoring of adherence and implementation strategies to maintain adherence (AU)

Papel del farmacéutico de hospital en la prevención, identificación y manejo de los efectos adversos asociados al tratamiento antirretroviral / The role of the hospital pharmacist in the prevention, treatment and management of the side effects associated with antiretroviral treatment

Resumen En la actualidad los efectos adversos asociados al tratamiento antirretroviral es la principal causa de discontinuación de este tipo de terapia, tanto en ensayos clínicos como en la práctica clínica habitual. Por otro lado, debido al cambio de orientación que nuestra profesión ha sufrido en los últimos años, nos enfrentamos a la necesidad de establecer una relación totalmente diferente con el paciente, realizando atención farmacéutica de manera directa y eficaz, en un marco asistencial de corresponsabilidad en los resultados terapéuticos. Las intervenciones farmacéuticas deben estar dirigidas a mejorar la calidad de vida de los pacientes, lo que solo puede conseguirse con un abordaje multidisciplinar e individualizado y ajustada a los nuevos patrones de toxicidad de los fármacos actualmente utilizados. El farmacéutico que realiza esta labor debe saber interpretar estos efectos adversos, dar una información precisa al paciente tanto del tratamiento farmacológico como no farmacológico del mismo y realizar un seguimiento farmacoterapéutico correcto donde se establezcan claramente los criterios de derivación a las consultas médicas. El objetivo de este documento es establecer las líneas básicas para que el farmacéutico de hospital realice una labor uniforme y clara en la prevención, identificación y manejo de los principales efectos adversos: gastrointestinales, cardiovasculares, dermatológicos, a nivel del sistema nervioso central y renales, asociados al tratamiento antirretroviral (AU)

Abstract At present, the side effects associated with antiretroviral treatment are the main reasons for discontinuation of this kind of therapy, both in clinical trials and in regular clinical practise. On the other hand, due to the change of direction that our profession has suffered in recent years, we face the need to establish a different relationship with the patient, achieving direct and effective Pharmaceutical Care within a framework of shared responsibility for therapeutic results. Pharmacist interventions should be aimed at improving the quality of life of patients, which can only be achieved with a multidisciplinary approach and individualised and adjusted to new patterns of toxicity of the drugs currently used. The pharmacist who does this work must know how to interpret these side effects, giving accurate information to the patient about both pharmacological and non-pharmacological treatment and correct pharmaceutical follow-up which clearly sets forth the criteria for referral to medical appointments. The aim of this paper is to establish baselines so that the hospital pharmacist can perform clearly and uniformly in the prevention, identification and management of major side effects: gastrointestinal, cardiovascular, dermatological, at the central nervous system and kidney level, associated with antiretroviral therapy (AU)

[Evolution of antiretroviral treatment adherence from 2000 to 2008]. / Evolución de la adherencia al tratamiento antirretoviral del 2000 al 2008.

OBJECTIVES: To evaluate antiretroviral treatment adherence in the HIV patient cohort of our hospital and observe their evolution over a 9-year period; also to determine the individual pattern of adherence over time. METHODS: Descriptive study of the evolution of average annual adherence and the annual percentage of adherent patients greater than 95% from 2000 to 2008. We analysed the individual pattern of adherence over time and patients were classified into consistently adherent, consistently non-adherent, and fluctuating. RESULTS: In the analysis of 577 patients, baseline adherence was significantly greater in naïve patients with respect to those who were pre-treated. Average annual adherence increased slightly and stayed at values around 95%. As with the percentage of patients with adherence greater than 95%, which increased from 64% in 2000 to 79% in 2008. In terms of the individual pattern of adherence over time, of the 468 patients analysed, the majority (59%) were consistently adherent, 4% non-adherent, and the rest (37%) fluctuated in their adherence. CONCLUSIONS: In our cohort the overall adherence values maintained themselves over time and even show a positive trend, likely the result of systematic monitoring of adherence and implementation strategies to maintain adherence.

[The role of the hospital pharmacist in the prevention, treatment and management of the side effects associated with antiretroviral treatment]. / Papel del farmacéutico de hospital en la prevención, identificación y manejo de los efectos adversos asociados al tratamiento antirretroviral.

At present, the side effects associated with antiretroviral treatment are the main reasons for discontinuation of this kind of therapy, both in clinical trials and in regular clinical practise. On the other hand, due to the change of direction that our profession has suffered in recent years, we face the need to establish a different relationship with the patient, achieving direct and effective Pharmaceutical Care within a framework of shared responsibility for therapeutic results. Pharmacist interventions should be aimed at improving the quality of life of patients, which can only be achieved with a multidisciplinary approach and individualised and adjusted to new patterns of toxicity of the drugs currently used. The pharmacist who does this work must know how to interpret these side effects, giving accurate information to the patient about both pharmacological and non-pharmacological treatment and correct pharmaceutical follow-up which clearly sets forth the criteria for referral to medical appointments. The aim of this paper is to establish baselines so that the hospital pharmacist can perform clearly and uniformly in the prevention, identification and management of major side effects: gastrointestinal, cardiovascular, dermatological, at the central nervous system and kidney level, associated with antiretroviral therapy.

[Survey of the pharmaceutical care situation of the HIV patient in Spain]. / Encuesta de la situación de la atención farmacéutica en el paciente con VIH en España.

OBJECTIVE: To understand the Pharmaceutical Care (PC) given to HIV+ patients in Spain. METHOD: In the year 2004, a survey on PC provided to HIV+ patients was conducted among pharmacists. The survey, with 33 questions, aimed to determine the material and human resources used in this area, as well as specific aspects of PC, and finally the pharmacist's opinion. The survey was distributed through the SEFH (Spanish Society of Hospital Pharmacists) webpage and at HIV conferences. RESULTS: Data was collected from 68 hospitals, most of them public. The most important strengths included the availability of material resources, extensive consulting hours, and the intervention of the pharmacist at key moments (treatment initiation, changes in treatment and changes at the request of the patient). Verbal information was provided in most hospitals, accompanied by written information in 68% of cases. Although 81% of hospitals monitored compliance, less than half did it in a systematic manner, with the most widely used method being the dispensing records. Dispensing data was recorded, and to a lesser extent, the patients' drug treatment histories were available. Differences were seen among the hospitals depending on their size. The pharmacist considered that the PC was acceptable, but that there was room for improvement, and considered the measures available insufficient, highlighting the need for specific personnel and training. CONCLUSIONS: The PC situation of HIV patients is of a good standard, but there is still a lot to be done to achieve acceptable, quality PC.

Encuesta de la situación de la atención farmacéutica en el paciente con VIH en España / Survey of the pharmaceutical care situation of the VIH patient in Spain

Objetivo: Conocer la situación de la atención farmacéutica (AF) alpaciente con VIH en España.Método: En el año 2004 se realizó una encuesta sobre AF al pacientecon VIH dirigida a farmacéuticos. La encuesta, de 33 preguntas, intentabaconocer los recursos materiales y humanos destinados aesta área, así como aspectos concretos de la AF y, finalmente, la opinióndel farmacéutico. La encuesta se distribuyó a través de la páginaweb de la SEFH y las jornadas de VIH.Resultados: Se recogieron datos de 68 hospitales, mayoritariamentepúblicos. Como puntos fuertes destacan la disponibilidad de recursosmateriales, un horario de atención amplio y la intervencióndel farmacéutico en los momentos clave (inicios, cambios de tratamientoy a petición del paciente). En la mayoría de los hospitales sefacilitaba información oral, acompañada de información escrita en el68% de los casos. Aunque el 81% de los hospitales controlaban laadhesión, menos de la mitad lo hacían de forma sistemática; el métodomás empleado era el registro de dispensación. Se registrabandatos de dispensación y, en menor medida, se disponía de una historiafarmacoterapéutica del paciente. Se observaron diferencias entrelos hospitales según su tamaño. El farmacéutico opinaba que laAF era aceptable pero mejorable y consideraba insuficientes los mediosdisponibles, destacando la necesidad de personal y formaciónespecífica.Conclusiones: La situación de la AF en el paciente con VIH tiene unbuen nivel, pero queda mucho por hacer para alcanzar una AF aceptabley de calidad

Objective: To understand the Pharmaceutical Care (PC) given toHIV+ patients in Spain.Method: In the year 2004, a survey on PC provided to HIV+ patientswas conducted among pharmacists. The survey, with 33 questions,aimed to determine the material and human resources used in thisarea, as well as specific aspects of PC, and finally the pharmacist’sopinion. The survey was distributed through the SEFH (Spanish Societyof Hospital Pharmacists) webpage and at HIV conferences.Results: Data was collected from 68 hospitals, most of them public.The most important strengths included the availability of material resources,extensive consulting hours, and the intervention of the pharmacistat key moments (treatment initiation, changes in treatmentand changes at the request of the patient). Verbal information wasprovided in most hospitals, accompanied by written information in68% of cases. Although 81% of hospitals monitored compliance, lessthan half did it in a systematic manner, with the most widely usedmethod being the dispensing records. Dispensing data was recorded,and to a lesser extent, the patients’ drug treatment histories wereavailable. Differences were seen among the hospitals depending ontheir size. The pharmacist considered that the PC was acceptable, butthat there was room for improvement, and considered the measuresavailable insufficient, highlighting the need for specific personnel andtraining.Conclusions: The PC situation of HIV patients is of a good standard,but there is still a lot to be done to achieve acceptable, quality PC

Características psicométricas de la escala de satisfacción con el / tratamiento antirretroviral (ESTAR): estudio ARPAS (I) / No disponible

Objetivo: Evaluar las características psicométricas, la validez convergente y la fiabilidad de la escala de satisfacción con el tratamientoantirretroviral (ESTAR).Método: La satisfacción de los pacientes con el TAR se determinó mediante la ESTAR, desarrollada en castellano a partir de la versióninglesa HIV-Treatment-Satisfaction-Questionnaire (HIVTSQ).Para su evaluación, se midió la consistencia interna y la fiabilidad test-retest. Se efectuó el análisis de constructo estudiando la covarianzay la correlaciones de las cuestiones, y se valoró la validez convergente empleando como estándar el cuestionario MOS-HIV (MedicalOutcomes Study HIV Health Survey), y la validez de contenido mediante la correlación entre la ESTAR y las variables clínicas y terapéuticas.Resultados: La ESTAR se estructura en dos dimensiones (desatisfacción clínica y de satisfacción con el estilo de vida) con ligeras modificaciones sobre la versión original; la cuestión 4, desechada en la versión original, es reformulada en la versión española, y la cuestión 9 se extrajo por su baja comunalidad. Respecto a la fiabilidad test-retest, todos las cuestiones presentan coeficientes de correlación intraclase significativos (p < 0,001). La consistencia interna presenta valores más altos que la versión original en la dimensión estilo de vida (α = 0,81 frente a α = 0,74) y en la puntuación total (α = 0,84 frente a α = 0,82). Respecto a la validezconvergente, la ESTAR presenta correlaciones significativas con la totalidad y con diversas dimensiones del MOS-HIV, destacando la asociación con las dimensiones salud mental, problemas de salud y función cognitiva.Conclusiones: La ESTAR se muestra como un instrumentoadecuado y fiable para evaluar la satisfacción con el TAR de los pacientes infectados por el VIH

Objective: To evaluate the psychometric characteristics, convergent validity and reliability of the antiretroviral treatment satisfactionscale (ESTAR, escala de satisfacción con el tratamientoantirretroviral ).Method: Patient satisfaction with ART was determined using the ESTAR questionnaire, developed in Spanish based on the English language version of the HIV-Treatment-Satisfaction Questionnaire(HIVTSQ). In order to evaluate this, internal consistency and test-retest reliability were measured. The construct analysis was performedby studying the covariance and correlation of the questions, and the convergent validity was assessed by using the MOS-HIV (Medical Outcomes Study HIV Health Survey) questionnaire as the standard, as was the content validity by the correlation between theESTAR and the clinical and therapeutic variables.Results: The ESTAR is structured in two dimensions (clinical satisfaction and satisfaction with lifestyle) with slight modifications to the original version; question 4, discarded in the original version,has been reworded in the Spanish version, and question 9was deleted because of low communality. As regards the testretest reliability, all the questions show significant intraclass correlation coefficients (p < 0.001). The internal consistency shows higher values than the original version in the lifestyle dimension (α = 0.81 vs. α =0.74) and in the total score (α = 0.84 vs. α = 0.82). With regard to convergent validity, the ESTAR presents significant correlations with the MOS-HIV as a whole and with different imensions of it, especially the association with mental health, health distress and cognitive functioning dimensions.Conclusions: The ESTAR turns out to be a suitable, reliable instrument for evaluating satisfaction with ART by HIV+ patients

Preferencias, satisfacción y adherencia con el tratamientoantirretroviral: estudio ARPAS (II) / No disponible

Objetivo: Describir el estudio ARPAS y analizar las características sociodemográficas, clínicas y las preferencias de los pacientes con el tratamiento antirretroviral (TAR), así como la relación entrela adherencia y la satisfacción con el TAR y la calidad de vida.Método: El estudio ARPAS ha evaluado a pacientes adultos,diagnosticados de infección por VIH y con TAR, mediante un protocolo que incluye variables sociodemográficas, clínicas, terapéuticas y de calidad de vida. La adherencia se estimó mediante el cuestionarioSMAQ, la satisfacción mediante el cuestionario ESTAR, la calidad de vida mediante el MOS-HIV y las preferencias con el tratamiento se determinaron mediante un cuestionario elaborado a partir del consenso de un equipo experto en el seguimiento terapéutico de estospacientes. Se realizó un análisis univariante estratificado en funciónde la adherencia y un análisis de regresión logística para estudiar la asociación de las variables independientes con la adherencia.Resultados: Se evaluaron 234 pacientes (73,7% varones;43,2 ± 7,8 años). El tiempo medio desde el diagnóstico y desde el inicio del TAR fue, respectivamente, de 10,1 ± 5,7 y 7,4 ± 4,4 años. El régimen terapéutico de dos tomas diarias (bid) se dio en el 71% de los pacientes, y el de una toma (qd) en el 21%. El 47,3% de los pacientes cumplieron criterios de adherencia según el SMAQ. El porcentaje de los pacientes con qd adherentes alTAR fue mayor que el resto de esquemas posológicos (55,3 vs. 45,1%), aunque no significativamente (p = 0,251). No se observaron diferencias en las variables sociodemográficas y clínicas en función de la adherencia. Se observó una preferencia electivasobre los regímenes terapéuticos más sencillos que contrasta con la valoración de las características de los TAR, donde se antepone la potencia sobre la durabilidad, tolerancia y, en último lugar, comodidad de tomar el TAR. El análisis univariante muestra unamayor puntuación en las escalas de satisfacción (50,4 ± 7,8 vs.46,5 ± 9,7, p = 0,001) y calidad de vida (81,6 ± 10,7 vs. 75,7 ± 11,8, p < 0,001) en los pacientes adherentes respecto de los no adherentes. Los modelos multivariante confirman la existencia de una asociación significativa entre adherencia y satisfacción, y adherencia y calidad de vida.Conclusiones: Los pacientes consideran prioritario tratarse con un TAR potente, duradero y bien tolerado y, dentro de las preferencias entre las diferentes pautas, destacan los regímenes de una toma diaria. El estudio ARPAS demuestra la relación directa entre adherencia y satisfacción con el TAR, y entre adherencia y calidad de vida, de forma que las estrategias de mejora de la adherencia deben incluir necesariamente aspectos que permitan mejorar la satisfacción del paciente con su tratamiento e incrementarla calidad de vida

Objective: To describe the ARPAS study and analyse thesociodemographic and clinical characteristics and patient preferenceswith regards the antiretroviral treatment (ART), as well as the relationship between compliance and satisfaction with the ART and quality of life.Method: The ARPAS study has looked at adult patients diagnosed with HIV and on ART, using a protocol including sociodemographic, clinical, therapeutic and quality of life variables. Compliance was estimated using the SMAQ questionnaire; satisfactionwas measured using the ESTAR questionnaire, as was quality of life with the MOS-HIV Health Survey, and treatment preferences were determined using a questionnaire prepared based on the consensus of an expert team in the field of therapeutic monitoringof these patients. A stratified univariate analysis according to compliance and a logistic regression analysis were carried out to study the association of the independent variables with compliance.Results: A total of 234 patients were evaluated (73.7% male; 43.2 ± 7.8 years of age). The average time since diagnosis and from the initiation of ART was 10.1 ± 5.7 and 7.4 ± 4.4 years respectively.The therapeutic regime of twice-daily doses (bid) wasapplied to 71% of the patients, and once daily (qd) in 21%. A total of 43% of the patients fulfilled compliance criteria according to the SMAQ. The percentage of the patients with qd complying with theART was greater than the remaining dosing schedules (55.3 vs. 45.1%), although not significantly (p = 0.251). No differences were observed in the sociodemographic and clinical variables in terms ofcompliance. An elective preference was observed for the simplest of the therapeutic regimes which contrasts with the evaluation of the ART characteristics, where power is given preference over durability,tolerance and lastly, the convenience of taking the ART. The univariate analysis showed the highest score on the satisfaction scales (50.4 ± 7.8 vs. 46.5 ± 9.7, p = 0.001) and quality of life (81.6± 10.7 vs. 75.7 ± 11.8, p < 0.001) in compliant patients with respect to non-compliers. The multivariate models confirm the existence of a significant association between compliance and satisfaction, and between compliance and quality of life.Conclusions: Patients consider treatment with a powerful,long-lasting and well-tolerated ART a priority and among their preferences for different treatment regimes, once-daily dosing regimes are highlighted. The ARPAS study showed a direct relationship between compliance and satisfaction with ART, and between complianceand quality of life, in a manner that the strategies improving compliance must necessarily include aspects that allow them to improve patient satisfaction with treatment and quality of life

[Psychometric characteristics of the antiretroviral treatment satisfaction scale (ESTAR): ARPAS study (I)]. / Características psicométricas de la escala de satisfacción con el tratamiento antirretroviral (ESTAR): estudio ARPAS (I).

OBJECTIVE: To evaluate the psychometric characteristics, convergent validity and reliability of the antiretroviral treatment satisfaction scale (ESTAR, escala de satisfacción con el tratamiento antirretroviral). METHOD: Patient satisfaction with ART was determined using the ESTAR questionnaire, developed in Spanish based on the English language version of the HIV-Treatment-Satisfaction Questionnaire (HIVTSQ). In order to evaluate this, internal consistency and test-retest reliability were measured. The construct analysis was performed by studying the covariance and correlation of the questions, and the convergent validity was assessed by using the MOS-HIV (Medical Outcomes Study HIV Health Survey) questionnaire as the standard, as was the content validity by the correlation between the ESTAR and the clinical and therapeutic variables. RESULTS: The ESTAR is structured in two dimensions (clinical satisfaction and satisfaction with lifestyle) with slight modifications to the original version; question 4, discarded in the original version, has been reworded in the Spanish version, and question 9 was deleted because of low communality. As regards the test-retest reliability, all the questions show significant intraclass correlation coefficients (p<0.001). The internal consistency shows higher values than the original version in the lifestyle dimension (a=0.81 vs. a=0.74) and in the total score (a=0.84 vs. a=0.82). With regard to convergent validity, the ESTAR presents significant correlations with the MOS-HIV as a whole and with different dimensions of it, especially the association with mental health, health distress and cognitive functioning dimensions. CONCLUSIONS: The ESTAR turns out to be a suitable, reliable instrument for evaluating satisfaction with ART by HIV+ patients.

[Preferences, satisfaction and compliance with antiretroviral treatment: ARPAS study (II)]. / Preferencias, satisfacción y adherencia con el tratamiento antirretroviral: estudio ARPAS (II).

OBJECTIVE: To describe the ARPAS study and analyse the sociodemographic and clinical characteristics and patient preferences with regards the antiretroviral treatment (ART), as well as the relationship between compliance and satisfaction with the ART and quality of life. METHOD: The ARPAS study has looked at adult patients diagnosed with HIV and on ART, using a protocol including sociodemographic, clinical, therapeutic and quality of life variables. Compliance was estimated using the SMAQ questionnaire; satisfaction was measured using the ESTAR questionnaire, as was quality of life with the MOS-HIV Health Survey, and treatment preferences were determined using a questionnaire prepared based on the consensus of an expert team in the field of therapeutic monitoring of these patients. A stratified univariate analysis according to compliance and a logistic regression analysis were carried out to study the association of the independent variables with compliance. RESULTS: A total of 234 patients were evaluated (73.7% male; 43.2+/-7.8 years of age). The average time since diagnosis and from the initiation of ART was 10.1+/-5.7 and 7.4+/-4.4 years respectively. The therapeutic regime of twice-daily doses (bid) was applied to 71% of the patients, and once daily (qd) in 21%. A total of 43% of the patients fulfilled compliance criteria according to the SMAQ. The percentage of the patients with qd complying with the ART was greater than the remaining dosing schedules (55.3 vs. 45.1%), although not significantly (p=0.251). No differences were observed in the sociodemographic and clinical variables in terms of compliance. An elective preference was observed for the simplest of the therapeutic regimes which contrasts with the evaluation of the ART characteristics, where power is given preference over durability, tolerance and lastly, the convenience of taking the ART. The univariate analysis showed the highest score on the satisfaction scales (50.4+/-7.8 vs. 46.5+/-9.7, p=0.001) and quality of life (81.6+/-10.7 vs. 75.7+/-11.8, p<0.001) in compliant patients with respect to non-compliers. The multivariate models confirm the existence of a significant association between compliance and satisfaction, and between compliance and quality of life. CONCLUSIONS: Patients consider treatment with a powerful, long-lasting and well-tolerated ART a priority and among their preferences for different treatment regimes, once-daily dosing regimes are highlighted. The ARPAS study showed a direct relationship between compliance and satisfaction with ART, and between compliance and quality of life, in a manner that the strategies improving compliance must necessarily include aspects that allow them to improve patient satisfaction with treatment and quality of life.