Remote pharmaceutical care for patients with rheumatoid arthritis and psoriasis.

BackgroundAccess to drugs with hospital-restricted dispensation, such as those for patients with rheumatoid arthritis or psoriasis, is regulated by healthcare policy. These drugs have the greatest cost-effective impact on the healthcare system. This is why a model for Pharmaceutical Care based on follow-up teleconsultations was defined in our hospital to improve patient well-being. Objective To evaluate clinical changes on patients when our remote Pharmaceutical Care model is applied and describe the work carried out by pharmacists when applying it. Setting Pharmacy Department of a Hospital in Barcelona, Spain. Method Cross-sectional observational study of the remote Pharmaceutical Care model developed by Clinical Pharmacists. All patients diagnosed with psoriasis or rheumatoid arthritis who were receiving active treatment with Hospital/Specialist only drugs, during the period from May to December 2018, were included. Main outcome measures The corresponding healthcare activity was recorded and to determine the utility of the model, the clinical response to treatment of patients included in the study was recorded. Results The implementation of teleconsultation is statistically related to the biological treatment response of patients with psoriasis (p = 0.006) and rheumatoid arthritis (p = 0.019). In those patients the healthcare activity of calculating and/or recording clinical variables of effectiveness/safety is statistically associated to biological treatment response (65.62% vs 35%, p = 0.015 and 73.14% vs 53.26%, p = 0.003). Conclusions The implementation of the model described lends added value to traditional pharmacotherapeutic management of biological treatments in patients with rheumatoid arthritis and psoriasis since response is improved but patient well-being is not diminished.

Impacto de una intervención para mejorar el uso del sondaje uretral y reducir las infecciones del tracto urinario / Impact of an intervention to improve indwelling urinary catheter use and reduce urinary tract infections

Objetivo. Evaluar el impacto de una intervención en la adecuación del uso y en la mejora del cuidado del sondaje uretral (SU), así como en la frecuencia de infección del tracto urinario asociada al SU (ITU-SU) en pacientes hospitalizados. Material y métodos. Estudio cuasi-experimental. En el periodo preintervención se midieron indicadores basales de uso del SU. La intervención consistió en educación sobre el SU y en la implementación de recordatorios para su retirada. En el periodo postintervención se evaluaron las mismas variables. Resultados. Se incluyeron 197 pacientes durante el periodo preintervención y 194 durante el periodo postintervención. La prevalencia (17,3% versus 15,3%) y los días de SU (4,8 ± 5,8 versus 4,3 ± 4,2) experimentaron un descenso no significativo. Se incrementaron las sondas correctamente prescritas (41,1% versus 61,9%; p < 0,001) y fijadas (0% versus 38,1%; p < 0,001) y descendieron las bolsas de diuresis en el suelo (26,4% versus 6,2%; p < 0,001). El incremento en la adecuación de la indicación del SU (86,8% versus 92,3%) y el descenso en la densidad de incidencia de ITU-SU (2,1 versus 1,2 episodios/1.000 días de SU) no fueron significativos, aunque superaron los estándares. Conclusiones. Tras la intervención se incrementó de forma significativa el número de SU correctamente prescritas y fijadas, y disminuyó las bolsas de diuresis en el suelo. La mejora en la indicación del SU y en la frecuencia de ITU-SU alcanzaron los estándares de calidad. Las actividades formativas y el uso de recordatorios mejoran la seguridad del paciente ingresado con SU (AU)

Objective. To evaluate the impact of an intervention regarding the adequate use and improvement in the care of indwelling urinary catheters (IUC) and the frequency of catheter-associated urinary tract infections (CAUTI) in hospitalised patients. Material and methods. A quasi-experimental study was performed. Basic data on the use of IUC were recorded before and after the intervention, which consisted of training on IUC use and the implementation of reminders for their removal. Results. There were 197 patients in the pre-intervention period and 194 in the post-intervention period. There was a non-significant decrease in the prevalence (17.3% versus 15.3%) and days with IUC (4.8 ± 5.8 versus 4.3 ± 4.2). There was an increase in adequately prescribed (41.1% versus 61.9%; P < .001) and attached IUC (0% vs 38.1%; P < .001), and a decrease in the urine collection bags on the floor (26.4% vs 6,2%; P < .001). The increase in the appropriate indications for IUC (86.8% vs 92.3%) and the decrease in CAUTI incidence density (2.1 vs 1.2 episodes/1,000 catheter days) were not significant, although above the standards. Conclusions. After the intervention there was a significant increase in the number of adequately prescribed and attached IUC, and a decrease in the number of urine collection bags on the floor. Improvement in IUC indication and frequency of CAUTI reached the quality standards. Educational activities and the use of reminders improve safety of hospitalised patients with IUC (AU)

[Impact of an intervention to improve indwelling urinary catheter use and reduce urinary tract infections]. / Impacto de una intervención para mejorar el uso del sondaje uretral y reducir las infecciones del tracto urinario.

OBJECTIVE: To evaluate the impact of an intervention regarding the adequate use and improvement in the care of indwelling urinary catheters (IUC) and the frequency of catheter-associated urinary tract infections (CAUTI) in hospitalised patients. MATERIAL AND METHODS: A quasi-experimental study was performed. Basic data on the use of IUC were recorded before and after the intervention, which consisted of training on IUC use and the implementation of reminders for their removal. RESULTS: There were 197 patients in the pre-intervention period and 194 in the post-intervention period. There was a non-significant decrease in the prevalence (17.3% versus 15.3%) and days with IUC (4.8±5.8 versus 4.3±4.2). There was an increase in adequately prescribed (41.1% versus 61.9%; P<.001) and attached IUC (0% vs 38.1%; P<.001), and a decrease in the urine collection bags on the floor (26.4% vs 6,2%; P<.001). The increase in the appropriate indications for IUC (86.8% vs 92.3%) and the decrease in CAUTI incidence density (2.1 vs 1.2 episodes/1,000 catheter days) were not significant, although above the standards. CONCLUSIONS: After the intervention there was a significant increase in the number of adequately prescribed and attached IUC, and a decrease in the number of urine collection bags on the floor. Improvement in IUC indication and frequency of CAUTI reached the quality standards. Educational activities and the use of reminders improve safety of hospitalised patients with IUC.

Usos del micofenolato de mofetilo en condiciones distintas de las autorizadas: nefritis lúpica / Off-lable uses of mycophenolate mofetil: lupus nephritis

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