Líneas de mejora asistencial entre dermatólogos y farmacéuticos hospitalarios para el manejo y seguimiento de la dermatitis atópica: consenso Delphi / Improving the Management and Follow-up of Atopic Dermatitis: A Delphi Process Report of Consensus Between Hospital Dermatologists and Pharmacists

El control de la dermatitis atópica (DA), una de las dermatosis más frecuentes, es en muchas ocasiones un reto terapéutico. En el presente estudio se ha utilizado la metodología Delphi con el objetivo de poner en común las perspectivas del dermatólogo y del farmacéutico hospitalario ante el manejo de la DA y establecer una serie de recomendaciones de actuación adaptadas a las diferentes situaciones que plantea la enfermedad. El cuestionario Delphi ha sido definido por un comité científico y se ha dividido en 2bloques: 1) valoración de la respuesta al tratamiento del paciente con DA, y 2) cooperación entre Dermatología y Farmacia Hospitalaria (FH). Como resultado del estudio, se ha alcanzado un consenso total del 86%. Se concluye que el dermatólogo y el farmacéutico hospitalario deben tener una buena comunicación y trabajar coordinados para conseguir optimizar el manejo del paciente con DA y su respuesta al tratamiento (AU)

Managing atopic dermatitis, one of the most common dermatologic conditions, is often challenging. To establish consensus on recommendations for responding to various situations that arise when treating atopic dermatitis, a group of hospital pharmacists and dermatologists used the Delphi process. A scientific committee developed a Delphi survey with 2 blocks of questions to explore the group's views on 1) evaluating response to treatment in the patient with atopic dermatitis and 2) cooperation between the dermatology department and the hospital pharmacy service. The experts achieved an overall rate of consensus of 86% during the process. Conclusions were that dermatologists and hospital pharmacists must maintain good communication and coordinate their interventions to optimize the management of atopic dermatitis and patients’ responses to treatment (AU)

[Translated article] Improving the Management and Follow-up of Atopic Dermatitis: A Delphi Process Report of Consensus Between Hospital Dermatologists and Pharmacists / Líneas de mejora asistencial entre dermatólogos y farmacéuticos hospitalarios para el manejo y seguimiento de la dermatitis atópica: consenso Delphi

Managing atopic dermatitis, one of the most common dermatologic conditions, is often challenging. To establish consensus on recommendations for responding to various situations that arise when treating atopic dermatitis, a group of hospital pharmacists and dermatologists used the Delphi process. A scientific committee developed a Delphi survey with 2 blocks of questions to explore the group's views on 1) evaluating response to treatment in the patient with atopic dermatitis and 2) cooperation between the dermatology department and the hospital pharmacy service. The experts achieved an overall rate of consensus of 86% during the process. Conclusions were that dermatologists and hospital pharmacists must maintain good communication and coordinate their interventions to optimize the management of atopic dermatitis and patients’ responses to treatment (AU)

El control de la dermatitis atópica (DA), una de las dermatosis más frecuentes, es en muchas ocasiones un reto terapéutico. En el presente estudio se ha utilizado la metodología Delphi con el objetivo de poner en común las perspectivas del dermatólogo y del farmacéutico hospitalario ante el manejo de la DA y establecer una serie de recomendaciones de actuación adaptadas a las diferentes situaciones que plantea la enfermedad. El cuestionario Delphi ha sido definido por un comité científico y se ha dividido en 2bloques: 1) valoración de la respuesta al tratamiento del paciente con DA, y 2) cooperación entre Dermatología y Farmacia Hospitalaria (FH). Como resultado del estudio, se ha alcanzado un consenso total del 86%. Se concluye que el dermatólogo y el farmacéutico hospitalario deben tener una buena comunicación y trabajar coordinados para conseguir optimizar el manejo del paciente con DA y su respuesta al tratamiento (AU)

Improving the Management and Follow-up of Atopic Dermatitis: A Delphi Process Report of Consensus Between Hospital Dermatologists and Pharmacists. / Líneas de mejora asistencial entre dermatólogos y farmacéuticos hospitalarios para el manejo y seguimiento de la dermatitis atópica: consenso Delphi.

Managing atopic dermatitis, one of the most common dermatologic conditions, is often challenging. To establish consensus on recommendations for responding to various situations that arise when treating atopic dermatitis, a group of hospital pharmacists and dermatologists used the Delphi process. A scientific committee developed a Delphi survey with 2 blocks of questions to explore the group's views on 1) evaluating response to treatment in the patient with atopic dermatitis and 2) cooperation between the dermatology department and the hospital pharmacy service. The experts achieved an overall rate of consensus of 86% during the process. Conclusions were that dermatologists and hospital pharmacists must maintain good communication and coordinate their interventions to optimize the management of atopic dermatitis and patients' responses to treatment.

Persistencia y seguridad del apremilast en el tratamiento de la psoriasis en la práctica clínica habitual: experiencia en 30 pacientes / Treatment Persistence and Safety of Apremilast in Psoriasis: Experience With 30 Patients in Routine Clinical Practice

No disponible

Treatment Persistence and Safety of Apremilast in Psoriasis: Experience With 30 Patients in Routine Clinical Practice. / Persistencia y seguridad del apremilast en el tratamiento de la psoriasis en la práctica clínica habitual: experiencia en 30 pacientes.

Apremilast is a phosphodiesterase-4 inhibitor taken orally. Little information about its use in routine clinical practice is available. We aimed to assess treatment safety and persistence rates in patients on apremilast for different forms of plaque psoriasis. This observational retrospective study included 30 patients with psoriasis who were treated with apremilast between January 2016 and December 2017 in our hospital. Twelve patients had palmar-plantar psoriasis, 8 had plaque psoriasis mainly on the scalp, and 10 had plaque psoriasis in other locations. The probable period of treatment persistence in patients in the 50th percentile was 18.5 months according to survival analysis of the series overall. Our experience suggests that apremilast is effective and safe for treating palmar-plantar psoriasis and plaques at other locations but not for treating scalp psoriasis. Adverse effects that compromise treatment occur in nearly two-thirds of the patients.

Hacia una Farmacia Hospitalaria Digital / No disponible

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Expert consensus on the persistence of biological treatments in moderate-to-severe psoriasis.

BACKGROUND: Treatment persistence is becoming a useful measure to evaluate long-term effectiveness and safety of biological therapies in real-world settings. OBJECTIVE: The main objective of this study was to explore the scientific opinion of a panel of dermatologists and hospital pharmacists to reach a consensus about the impact, causes, and best strategies and interventions that might be associated with improved drug persistence in patients with psoriasis in Spain. METHODS: This research was conducted using a modified Delphi method organized in two rounds and involving a panel of 90 dermatologists and 34 hospital pharmacists. A questionnaire of 70 items was developed. The items proposed to reach a consensus included topics such as definitions and measures in the treatment of psoriasis, analysis of treatment persistence, factors that may influence treatment persistence, impact of treatment persistence and economic cost of treatment. RESULTS: Dermatologists reached a consensus on 77.1% of the items proposed, and hospital pharmacists reached a consensus on 71.4%. Both groups agreed that it is important to use standardized measures in the evaluation of treatment maintenance over time. Dermatologists agreed that treatment survival, persistence and retention are synonymous, but hospital pharmacists considered only treatment persistence as a valid term. In addition, panelists agreed that drug persistence is an indicator of success in the treatment of psoriasis that may be influenced by a drug's effectiveness and safety profile, as well as by patient satisfaction. They agreed that the different causes of treatment discontinuation should be considered in Kaplan-Meier analysis of treatment persistence. Moreover, treatment persistence was agreed to decrease the cost of therapy. CONCLUSION: This Delphi consensus highlights the different perspectives of dermatologists and hospital pharmacists regarding the interpretation of treatment persistence, and the challenge of harmonizing the results obtained.

Pilot evaluation of home delivery programme in haemophilia.

WHAT IS KNOWN AND OBJECTIVES: Most of the clotting factor (CF) dispensations to haemophiliac patients are centralized in a few haemophilia treatment centres, necessitating frequent visits and long travel distances. The aim was to evaluate the home delivery programme developed by the Outpatient Pharmaceutical Care Unit (OPCU) through the association of patients (ASHECOVA). METHODS: A specific software programme was designed to communicate the individual CF requirements. Dispensations were prepared in advance, and an ASHECOVA member collected and delivered to patients' homes in optimal conditions. Data regarding the programme were analysed from December 2011 to December 2017. An electronic satisfaction survey with 34 questions was conducted, asking about organizational aspects, education and communication, use of apps and satisfaction level. RESULTS AND DISCUSSION: Forty-nine patients were included and 2464 home deliveries were made, without any reported incident related to dispensation errors, drug preservation, communication or confidentiality problems. This system avoids 11.4 annual dispensation visits per patient to OCPU, and a mean travel distance, time and cost of 1189.1 km, 945.3 minutes and 373.5 euros, respectively. Overall satisfaction with home delivery was 9.7, without any change suggested in the current system. Ninety-five per cent of individuals believed that the programme improves adherence and all patients would recommend it to other patients. The most common benefits reported were less frequent visits to hospital, reducing time and cost spent on transportation. WHAT IS NEW AND CONCLUSION: The home delivery programme guarantees a proper follow-up of treatments with full patient satisfaction. This programme allows OPCU to achieve better pharmaceutical care, traceability of the process and optimization of working times and CF stock management.

[Analysis of the causes leading to withdrawal of the treatment with triple antiviral therapy for hepatitis C patients]. / Análisis de las causas de suspensión de tratamiento con triple terapia antiviral en pacientes con hepatitis C.

OBJECTIVE: To assess causes of suspension of hepatitis C treatment in patients receiving triple antiviral therapy (peginterferon+ ribavirin + protease inhibitor). METHODS: Retrospective observational study of patients who received triple antiretroviral therapy against hepatitis C between January 2012 - March 2013 and discontinued their treatment. RESULTS: Of 156 patients who initiated therapy, 41 discontinued treatment: Nineteen due to adverse events, being dermatological events in seven patients ( 36.8 %), intolerance in six(31.6%) and hematologic toxicity in four (15.8%) . Sixteen patients discontinued treatment for being ineffectiveness.Patients with higher inefficacy failure rate were "null-responders"(32.3% ) while the group of "relapsers" were the one with the highest rate of toxicity suspensions (15.6%). Two patients died during treatment for pneumonia. CONCLUSIONS: Triple therapy with boceprevir and telaprevir is associated with a significant number of treatment failures due to toxicity and ineffectiveness.

Objetivo: Evaluar las causas de suspensión de tratamientofrente a Hepatitis C que reciben triple terapia antiviral (peginterferon+ ribavirina + inhibidor de proteasa).Métodos: Estudio observacional retrospectivo de pacientes queiniciaron triple terapia antiviral entre enero 2012 - marzo 2013y suspendieron el tratamiento antes de completar el mismo.Resultados: De 156 pacientes que iniciaron triple terapia, 41interrumpieron el tratamiento: Diecinueve por toxicidad, siendodermatológica en siete pacientes (36,8%), intolerancia en seis(31,6%) y hematológica en cuatro (15,8%). Dieciséis pacientessuspendieron todo el tratamiento por ineficacia. El grupo depacientes con mayor porcentaje de fracasos por ineficacia fueronlos "no respondedores" (32,3%) mientras que el grupo depacientes "recidivantes" fueron el grupo con mayor porcentajede suspensiones por toxicidad (15,6%). Dos pacientes fallecierondurante el tratamiento por neumonía.Conclusiones: La triple terapia frente a VHC está asociada a unnúmero importante de fracasos terapéuticos tanto por toxicidadcomo por ineficacia.

Experiencia clínica con los cannabinoides en la terapia de la espasticidad en la esclerosis múltiple / Clinical experiences with cannabinoids in spasticity management in multiple sclerosis

Introducción: La espasticidad es un síntoma muy frecuente entre los pacientes con esclerosis múltiple (EM). El objetivo del presente estudio es evaluar la efectividad y la seguridad de la combinación de delta-9-tetrahidrocannabinol (THC) y cannabidiol (CBD) en la práctica clínica del tratamiento de la espasticidad en EM. Métodos: Estudio observacional retrospectivo con los pacientes tratados con THC/CBD inhalado de abril del 2008 a marzo del 2012. Se recogieron variables descriptivas de paciente y tratamiento. La respuesta se evaluó mediante impresión global de respuesta terapéutica analizada por el médico. Resultados: Cincuenta y seis pacientes iniciaron tratamiento, 6 fueron excluidos por falta de datos. Se evaluó a 50 pacientes (42% hombres), mediana de edad 47,8 años, el 38% de ellos diagnosticados de EM primaria progresiva, el 44% de EM secundaria progresiva y el 18% de EM remitente recurrente. El motivo de prescripción fue espasticidad (44%), dolor (10%) o ambos (46%). Se suspendió tratamiento en 16 pacientes por inefectividad (7 pacientes), abandono (4) y efectos adversos (5). La mediana de tiempo de exposición de los pacientes que suspendieron tratamiento fue 30 días y 174 días para los que continuaban tratamiento al final del estudio. THC/CBD fue efectivo en un 80% de pacientes, con dosis mediana de 5 (2-10) pulverizaciones/ día. El perfil de efectos adversos fue: mareo (11 pacientes), somnolencia (6), debilidad muscular (7), molestias bucales (2), diarrea (3), sequedad de boca (2), visión borrosa (2), agitación (1), náuseas (1), ideas paranoides (1). Conclusiones: THC/CBD se muestra como una buena alternativa al tratamiento habitual mejorando la espasticidad refractaria en la EM con perfil de toxicidad aceptable

Introduction: Spasticity is a common symptom among patients with multiple sclerosis (MS). This study aims to assess the effectiveness and safety of the combination of delta- 9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in clinical practice for the treatment of spasticity in MS. Methods: Retrospective observational study with patients treated with inhaled THC/CBD between April 2008 and March 2012. Descriptive patient and treatment variables were collected. Therapeutic response was evaluated based on the doctor’s analysis and overall impression. Results: Of the 56 patients who started treatment with THC/CBD, 6 were excluded because of missing data.We evaluated 50 patients (42% male) with a median age 47.8 years (25.6-76.8); 38% were diagnosed with primary progressive MS, 44% with secondary progressive MS, and 18% with relapsing-remitting MS. The reason for prescribing the drug was spasticity (44%), pain (10%), or both (46%). Treatment was discontinued in 16 patients because of ineffectiveness (7 patients), withdrawal (4), and adverse effects (5). The median exposure time in patients whose treatment was discontinued was 30 days vs 174 days in those whose treatment continued at the end of thestudy. THC/CBD was effective in 80% of patients at a median dose of 5 (2-10) inhalations/day. The adverse event profile consisted of dizziness (11 patients), somnolence (6), muscle weakness (7), oral discomfort (2), diarrhoea (3), dry mouth (2), blurred vision (2), agitation (1), nausea (1), and paranoid ideation (1). Conclusions: THC/CBD appears to be a good alternative to standard treatment as it improves refractory spasticity in MS and has an acceptable toxicity profile

Análisis de las causas de suspensión de tratamiento con triple terapia antivrial en pacientes con hepatitis C / Analysis of the causes leading to withdrawal of the treatment with triple antivial therapy for hepatitis C patients

Objetivo: Evaluar las causas de suspensión de tratamient of rente a Hepatitis C que reciben triple terapia antiviral (pegin-terferon + ribavirina + inhibidor de proteasa).Métodos: Estudio observacional retrospectivo de pacientes que iniciaron triple terapia antiviral entre enero 2012 - marzo 2013y suspendieron el tratamiento antes de completar el mismo. Resultados: De 156 pacientes que iniciaron triple terapia, 41interrumpieron el tratamiento: Diecinueve por toxicidad, siendo dermatológica en siete pacientes (36,8%), intolerancia en seis(31,6%) y hematológica en cuatro (15,8%). Dieciséis pacientes suspendieron todo el tratamiento por ineficacia. El grupo de pacientes con mayor porcentaje de fracasos por ineficacia fueron los "no respondedores" (32,3%) mientras que el grupo de pacientes "recidivantes" fueron el grupo con mayor porcentaje de suspensiones por toxicidad (15,6%). Dos pacientes fallecieron durante el tratamiento por neumonía. Conclusiones: La triple terapia frente a VHC está asociada a un número importante de fracasos terapéuticos tanto por toxicidad como por ineficacia

Objective: To assess causes of suspension of hepatitis C treatment in patients receiving triple antiviral therapy (peginterferon+ ribavirin + protease inhibitor).Methods: Retrospective observational study of patients who recived triple antiretroviral therapy agaisnst hepatitis C between January 2012 - March 2013 and discontinued their treatment. Results: Of 156 patients who initiated therapy, 41 discontinued treatment: Nineteen due to adverse events, being dermatological events in seven patients ( 36.8 %), intolerance in six(31.6%) and hematologic toxicity in four (15.8%) . Sixteen patients discontinued treatment for beeing ineffectiveness. Patients with higher inefficacy failure rate were "null-responders" (32.3% ) while the group of "relapsers" were the one with the highest rate of toxicity suspensions (15.6%). Two patients died during treatment for pneumonia. Conclusions: Triple therapy with boceprevir and telaprevir is associated with a significant number of treatment failures due to toxicity and ineffectiveness (AU)

Recomendaciones para el uso de las redes sociales para farmacéuticos de hospital (12 consejos que deberías tener en cuenta antes de lanzarte a la red) / No disponible

No disponible

Anidulafungin-induced alopecia.

OBJETIVE: To report a case of a woman in whom alopecia appeared after several months of treatment with anidulafungin. CASE SUMMARY: A 34-year-old woman with chronic femoral osteomyelitis with the presence of persistent suppuration, developed a Candida albicans infection, isolated in the fistula exudate cultures. After initial failures of single therapy with azoles, it was decided to administer fluconazole and anidulafungin 100 mg/d. One month after starting the treatment, the patient mentioned a greater hair loss than usual. At 3 months, the patient stopped taking the drug on noting the loss and easy falling out of her hair, with alopecia plaques 1 to 2 cm in size. At 2 months after stopping the anidulafungin, it was decided to restart combined antifungal treatment using micafungin and fluconazole; there was no mention of new or greater loss of hair. It was decided to change micafungin to anidulafungin again 90 days after starting treatment. In the first month of treatment, there appeared to be a reactivation in hair loss that later stabilized and improved. DISCUSSION: Drug-induced hair loss is an adverse reaction that has been identified during different hair growth phases. It has been described for the azoles group and has not been associated with candins until now. Results of the causality analysis, using the probability scale established by Naranjo, found the relationship as probable. CONCLUSIONS: Anidulafungin could be associated with hair loss. Physicians must be aware of this adverse effect in order to approach it properly and to detect possible nonadherence to treatment.

[Recommendations for the use of social networks by hospital pharmacists (12 advises that one should consider before jumping into the network)]. / Recomendaciones para el uso de las redes sociales para farmacéuticos de hospital (12 consejos que deberías tener en cuenta antes de lanzarte a la red).

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[Boceprevir and telaprevir utilization: evaluation for the treatment of chronic hepatitis C]. / Estudio de utilización de boceprevir y telaprevir para el tratamiento de la hepatitis C crónica.

INTRODUCTION: Protease inhibitors, boceprevir and telaprevir, have changed the treatment paradigm of chronic hepatitis C (CHC). The objective is analyzing the degree of compliance with the recommendations for boceprevir and telaprevir use that have been issued for the Spanish Agency for Medicines and Health Products in patients with CHC on a tertiary hospital. METHOD: All patients who started treatment with triple therapy between March and September 2012 were included. Compliance the initiation criteria were assessed and whether the rules of discontinuation due to ineffectiveness were made. RESULTS: 76 patients, 24 treated with boceprevir and 52 with telaprevir were included. In 11 patients (14.5%) triple therapy was initiated without keeping the Spanish Agency criteria, 6 were monoinfected patients and 4 with liver transplantation. In the group of boceprevir viral load (VL) at 12th week of treatment in 19 patients was measured (79.2%) and in 13 patients at 24th week (61.9 %). For telaprevir VL at week 4 the in 48 patients was determined (92.3%), at week 12 in 45 (91.8%) and at week 24 in 42 patients (93.3%). In all patients that the VL was determined its outcome was linked with the treatment continuation or not. CONCLUSIONS: In most patients (80.3%) start and suspension requirements for triple therapy were kept. There is leeway for action and improvement that requires the involvement of all the acting agents.

Estudio de utilización de boceprevir y telaprevir para el tratamiento de la hepatitis C crónica / Boceprevir and telaprevir utilization evaluation for the treatment of chronic hepatitis C

INTRODUCCIÓN: Los inhibidores de la proteasa, boceprevir y tela-previr, han modificado el paradigma del tratamiento de la hepa-titis C crónica (HCC). El objetivo es analizar el grado de cumplimiento de las recomendaciones de la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) para la utilización de boceprevir y telaprevir en pacientes con HCC en un hospital de tercer nivel. MÉTODO: Se incluyeron todos los pacientes que iniciaron tratamiento con triple terapia entre marzo y septiembre de 2012. Seanalizó si se cumplieron los criterios de inicio de tratamientoestablecidos por la AEMPS y se determinó si se efectuaban lasreglas de suspensión del tratamiento por inefectividad. RESULTADOS: Se incluyeron 76 pacientes, 24 tratados con boce-previr y 52 con telaprevir. En 11 pacientes (14,5%) se inició triple terapia sin cumplir los criterios de la AEMPS, 6 monoinfec-tados y 4 trasplantados de hígado. En el grupo de bocepreviren la semana 12 de tratamiento se cuantificó la carga viral (CV)en 19 pacientes (79,2%) y en la 24 en 13 pacientes (61,9%). En el de telaprevir en la semana 4 la CV se determinó en 48 pacientes (92,3%), en la semana 12 a 45 (91,8%) y en la 24 a 42 (93,3%). En todos los que se determinó la CV su resultado vinculó la continuación o no del tratamiento. CONCLUSIONES: En la mayoría de los pacientes (80,3%) se cumplen tanto los requisitos de inicio de triple terapia como los desuspensión. Existe un margen de mejora que necesita la implicación de todos los agentes actuantes

INTRODUCTION: Protease inhibitors, boceprevir and telaprevir, havechanged the treatment paradigm of chronic hepatitis C (CHC). The objective is analyzing the degree of compliance with therecommendations for boceprevir and telaprevir use that havebeen issued for the Spanish Agency for Medicines and HealthProducts in patients with CHC on a tertiary hospital. METHOD: All patients who started treatment with triple therapybetween March and September 2012 were included. Compliance the initiation criteria were assessed and whether the rulesof discontinuation due to ineffectiveness were made. RESULTS: 76 patients, 24 treated with boceprevir and 52 with telaprevir were included. In 11 patients (14.5%) triple therapy was initiated without keeping the Spanish Agency criteria, 6 were monoinfected patients and 4 with liver transplantation. In the group of boceprevir viral load (VL) at 12th week of treatment in 19 patients was measured (79.2%) and in 13 patients at 24th week (61.9 %). For telaprevir VL at week 4 the in 48 patients was determined (92.3%), at week 12 in 45 (91.8%) and at week 24 in 42 patients (93.3%). In all patients that the VL was determined its outcome was linked with the treatment continuation or not. CONCLUSIONS: In most patients (80.3%) start and suspension requirements for triple therapy were kept. There is leeway for action and improvement that requires the involvement of all the acting agents

Clinical experiences with cannabinoids in spasticity management in multiple sclerosis.

INTRODUCTION: Spasticity is a common symptom among patients with multiple sclerosis (MS). This study aims to assess the effectiveness and safety of the combination of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in clinical practice for the treatment of spasticity in MS. METHODS: Retrospective observational study with patients treated with inhaled THC/CBD between April 2008 and March 2012. Descriptive patient and treatment variables were collected. Therapeutic response was evaluated based on the doctor's analysis and overall impression. RESULTS: Of the 56 patients who started treatment with THC/CBD, 6 were excluded because of missing data. We evaluated 50 patients (42% male) with a median age 47.8 years (25.6-76.8); 38% were diagnosed with primary progressive MS, 44% with secondary progressive MS, and 18% with relapsing-remitting MS. The reason for prescribing the drug was spasticity (44%), pain (10%), or both (46%). Treatment was discontinued in 16 patients because of ineffectiveness (7 patients), withdrawal (4), and adverse effects (5). The median exposure time in patients whose treatment was discontinued was 30 days vs 174 days in those whose treatment continued at the end of the study. THC/CBD was effective in 80% of patients at a median dose of 5 (2-10) inhalations/day. The adverse event profile consisted of dizziness (11 patients), somnolence (6), muscle weakness (7), oral discomfort (2), diarrhoea (3), dry mouth (2), blurred vision (2), agitation (1), nausea (1), and paranoid ideation (1). CONCLUSIONS: THC/CBD appears to be a good alternative to standard treatment as it improves refractory spasticity in MS and has an acceptable toxicity profile.

[Quality healthcare and pharmaceutical care practice indicators to HIV+ patient]. / Indicadores para la calidad asistencial y la atención farmacéutica al paciente VIH+

OBJECTIVE: To identify and to promote improvements in the quality of the sanitary attention to the HIV+ patients in the Clinical Units of the hospitals in our country, there being included and reinforcing the perspective of Pharmaceutical Care. METHODS: To carry out the project, during the period January- June 2012, the following phases were defined. First, a bibliographical review was realized and reading criticizes related to the pathology HIV and quality criteria. Later, a presencial qualitative investigation phase was carried out with the expert participants. The first one was carried out by means of two technologies: the nominal group and a variant of groups of discussion. The application of the technologies was supported by an technical support that allowed the codification and valuation organized. The last phase of the project consisted of a meeting presencial, where there were outlined the aims of the first meeting and put jointly all the work that the subgroups of work had elaborated to agree on the contents. Of the first selection of ideas, the equipment of investigation worked and prioritized those elements that describe and give response to the raised aims. Concretely, the correct definition of the safety and quality indicators in the area of the hospital pharmacist, there being elaborated a card that was describing every aspect to bear in mind for the later measurement of the indicator. Finally, a plan of actions was elaborated to improve the clinical practice synthesized according to his level of priority. RESULTS: Across the methodology of the project, the experts identified the quality criterias in pharmaceutical care procedure. The principal barriers identified were: asistencial pressure, personnel management system's, security and ignorance of the pharmacotherapy, lack of quality culture and difficulties of access to the information. Principals clinical risks identified were: mistakes in the guidelines with the changes of treatments, lack of information of the whole medication of the patient, lack in resources and time adapted to realize the processes, lack of communication between professionals, ignorance of interactions or adverse events. The principal results that were extracted from the analysis of situation were that the priority line of action had to happen for a link between patients, specialists and primary care. It should promote the clinical management of the units of HIV, the access to the information for all the professionals who realize pharmacoterapeutical follow-up to these patients and the major implication on the part of these. Finally, 29 quality indicators were defined in the pharmaceutical care to the HIV+ patient distributed in structure, processes and results and the plan of improvement for the attention and his level of priority considered. DISCUSSION: This document gives response to the increasing demand for homogenizing the clinical practice and establishing common criteria of quality that result a benefit for the sanitary system and, in consequence, for the professionals and the patients.

Objetivo: Identificar y promover mejoras en la calidad de la atención sanitaria que reciben los pacientes VIH y SIDA en las Unidades Clínicas de los hospitales en nuestro país, incluyéndose y reforzando la perspectiva de Atención Farmacéutica (AF). Metodología: Para llevar a cabo el proyecto, durante el periodo Enero-Junio de 2012 se definieron las siguientes fases de trabajo. Primero, se realizó una revisión bibliográfica y lectura critica relacionada con la patología VIH-SIDA y criterios de calidad. A continuación, se llevó a cabo una fase de investigación cualitativa presencial con los expertos participantes. La primera se llevó a cabo mediante dos técnicas: el grupo nominal y una variante de grupos de discusión. La aplicación de las técnicas estuvo apoyada por un soporte informático que permitió la codificación y valoración jerarquizada de las propuestas mediante un sistema automatizado de votaciones. La última fase del proyecto consistió en una reunión presencial, donde se perfilaron los objetivos de la primera reunión y se puso en común todo el trabajo que los subgrupos de trabajo habían elaborado para consensuar los contenidos. De la primera selección de ideas, el equipo de investigación trabajó y priorizó aquellos elementos que describen y dan respuesta a los objetivos planteados. Concretamente, la correcta definición de los indicadores de calidad y de seguridad en el ámbito de la farmacia hospitalaria, elaborándose una ficha que describía cada aspecto a tener en cuenta para la posterior medición del indicador. Por último, se elaboró un plan de actuaciones para mejorar la práctica clínica, sintetizada según su nivel de prioridad. Resultados: A través de la metodología del proyecto, los expertos identificaron los criterios de calidad en el procedimiento de AF al paciente. Las principales barreras definidas fueron: presión asistencial, Sistemas de gestión de personal, Seguridad y desconocimiento de la farmacoterapia, falta de cultura de calidad y dificultades de acceso a la información. Entre los principales riesgos clínicos identificados destacaron: errores en las pautas con los cambios de tratamientos, falta de información de toda la medicación del paciente, falta de recursos asistenciales y de tiempo adecuado para realizar los procesos, falta de comunicación entre profesionales, desconocimiento de interacciones o eventos adversos Los principales resultados que se extrajeron del análisis de situación fueron que la línea prioritaria de actuación debía pasar por un enlace entre pacientes, especialistas y atención primaria. Igualmente se debería potenciar la gestión clínica de las unidades de VIH, el acceso a la información por todos los profesionales que realizan seguimiento farmacoterapeutico a estos pacientes y la mayor implicación por parte de estos. Por ultimo, se definieron 29 indicadores de calidad en la AF al paciente VIH distribuidos en estructura, procesos y resultados y el plan de mejora para la atención al paciente VIH y su nivel de prioridad considerado. Discusión: Con este documento se da respuesta a la creciente demanda por homogeneizar la labor asistencial y establecer criterios de calidad comunes que redunden un beneficio para el sistema sanitario y, en consecuencia, para los profesionales y los pacientes.

Indicadores para la calidad asistencial y la atención farmacéutica al paciente VIH+ / Quality healthcare and pharmaceutical care practice indicators to HIV+ patient

OBJETIVO: Identificar y promover mejoras en la calidad de la atención sanitaria que reciben los pacientes VIH y SIDA en las Unidades Clínicas de los hospitales en nuestro país, incluyéndose y reforzando la perspectiva de Atención Farmacéutica (AF). METODOLOGÍA: Para llevar a cabo el proyecto, durante el periodo Enero-Junio de 2012 se definieron las siguientes fases de trabajo. Primero, se realizó una revisión bibliográfica y lectura critica relacionada con la patología VIH-SIDA y criterios de calidad. A continuación, se llevó a cabo una fase de investigación cualitativa presencial con los expertos participantes. La primera se llevó a cabo mediante dos técnicas: el grupo nominal y una variante de grupos de discusión. La aplicación de las técnicas estuvo apoyada por un soporte informático que permitió la codificación y valoración jerarquizada de las propuestas mediante un sistema automatizado de votaciones. La última fase del proyecto consistió en una reunión presencial, donde se perfilaron los objetivos de la primera reunión y se puso en común todo el trabajo que los subgrupos de trabajo habían elaborado para consensuar los contenidos. De la primera selección de ideas, el equipo de investigación trabajó y priorizó aquellos elementos que describen y dan respuesta a los objetivos planteados. Concretamente, la correcta definición de los indicadores de calidad y de seguridad en el ámbito de la farmacia hospitalaria, elaborándose una ficha que describía cada aspecto a tener en cuenta para la posterior medición del indicador. Por último, se elaboró un plan de actuaciones para mejorar la práctica clínica, sintetizada según su nivel de prioridad. RESULTADOS: A través de la metodología del proyecto, los expertos identificaron los criterios de calidad en el procedimiento de AF al paciente. Las principales barreras definidas fueron: presión asistencial, Sistemas de gestión de personal, Seguridad y desconocimiento de la farmacoterapia, falta de cultura de calidad y dificultades de acceso a la información. Entre los principales riesgos clínicos identificados destacaron: errores en las pautas con los cambios de tratamientos, falta de información de toda la medicación del paciente, falta de recursos asistenciales y de tiempo adecuado para realizar los procesos, falta de comunicación entre profesionales, desconocimiento de interacciones o eventos adversos. Los principales resultados que se extrajeron del análisis de situación fueron que la línea prioritaria de actuación debía pasar por un enlace entre pacientes, especialistas y atención primaria. Igualmente se debería potenciar la gestión clínica de las unidades de VIH, el acceso a la información por todos los profesionales que realizan seguimiento farmacoterapeutico a estos pacientes y la mayor implicación por parte de estos. Por ultimo, se definieron 29 indicadores de calidad en la AF al paciente VIH distribuidos en estructura, procesos y resultados y el plan de mejora para la atención al paciente VIH y su nivel de prioridad considerado. DISCUSIÓN: Con este documento se da respuesta a la creciente demanda por homogeneizar la labor asistencial y establecer criterios de calidad comunes que redunden un beneficio para el sistema sanitario y, en consecuencia, para los profesionales y los pacientes

OBJECTIVE: To identify and to promote improvements in the quality of the sanitary attention to the HIV+ patients in the Clinical Units of the hospitals in our country, there being included and reinforcing the perspective of Pharmaceutical Care. METHODS: To carry out the project, during the period January-June 2012, the following phases were defined. First, a bibliographical review was realized and reading criticizes related to the pathology HIV and quality criteria. Later, a presencial qualitative investigation phase was carried out with the expert participants. The first one was carried out by means of two technologies: the nominal group and a variant of groups of discussion. The application of the technologies was supported by an technical support that allowed the codification and valuation organized. The last phase of the project consisted of a meeting presencial, where there were outlined the aims of the first meeting and put jointly all the work that the subgroups of work had elaborated to agree on the contents. Of the first selection of ideas, the equipment of investigation worked and prioritized those elements that describe and give response to the raised aims. Concretely, the correct definition of the safety and quality indicators in the area of the hospital pharmacist, there being elaborated a card that was describing every aspect to bear in mind for the later measurement of the indicator. Finally, a plan of actions was elaborated to improve the clinical practice synthesized according to his level of priority. RESULTS: Across the methodology of the project, the experts identified the quality criterias in pharmaceutical care procedure. The principal barriers identified were: asistencial pressure, personnel management system's, security and ignorance of the pharmacotherapy, lack of quality culture and difficulties of access to the information. Principals clinical risks identified were: mistakes in the guidelines with the changes of treatments, lack of information of the whole medication of the patient, lack in resources and time adapted to realize the processes, lack of communication between professionals, ignorance of interactions or adverse events. The principal results that were extracted from the analysis of situation were that the priority line of action had to happen for a link between patients, specialists and primary care. It should promote the clinical management of the units of HIV, the access to the information for all the professionals who realize pharmacoterapeutical follow-up to these patients and the major implication on the part of these. Finally, 29 quality indicators were defined in the pharmaceutical care to the HIV+ patient distributed in structure, processes and results and the plan of improvement for the attention and his level of priority considered. DISCUSSION: This document gives response to the increasing demand for homogenizing the clinical practice and establishing common criteria of quality that result a benefit for the sanitary system and, in consequence, for the professionals and the patients