Evaluación del grado de adherencia al tratamiento intravenoso no antineoplásico de pacientes ambulatorios / Evaluation of the degree of adherence to non-antineoplastic intravenous treatment of ambulatory patients

Introducción: La falta de adherencia al tratamiento farmacológico es un problema prevalente y relevante en la evolución clínica.Objetivo: Evaluar el grado de adherencia al tratamiento intravenoso no antineoplásico de pacientes crónicos que acuden al hospital de día (HD), identificar los factores relacionados y analizar los desvíos de programación de la cita previa en el HD y su impacto en el Servicio de Farmacia (SF).Material y métodos: Estudio descriptivo longitudinal retrospectivo de tres años de duración (2017-2019) que incluyó a los pacientes que acudieron al HD a administrarse el tratamiento. Los datos de adherencia se extrajeron de los registros del SF y los datos demográficos-clínicos, de las historias clínicas electrónicas. El grado de adherencia se expresó en porcentaje (adherencia adecuada ≥90%). La asociación entre las variables y el grado de adherencia se estudió mediante test estadísticos de contraste de hipótesis.Resultados: Se incluyeron 300 pacientes, 60% mujeres, edad media 47 años. El 18% presentaron una adherencia inadecuada. La adherencia se asoció con la edad, el medicamento administrado, el intervalo posológico y la persistencia al tratamiento (p<0,05). El 5,6% del trabajo de HD se desvió de la programación suponiendo un trabajo adicional para el SF.Conclusiones: El grado de adherencia al tratamiento era inadecuado en casi una cuarta parte de la población. La edad, el medicamento infundido, el intervalo posológico y la persistencia al tratamiento se asociaron con la adherencia de los pacientes. Los desvíos en la programación de HD se tradujeron en trabajo sobreañadido para el SF. (AU)

Introduction: The lack of adherence to pharmacological treatment of patients with chronic diseases it is a relevant problem.Objective: To assess the degree of adherence to the non-chemotherapy intravenous treatment of chronic patients who came to the outpatient clinic (OC), to identify the possible specific factors related to therapeutic compliance and to analyze the appointment changes in the OC and its impact on the Pharmacy Department (PD).Material and methods: Retrospective longitudinal descriptive study of three years duration (2017-2019). This included patients who went to the OC to receive the treatment. Adherence data were extracted from the PD records and demographic-clinical data from the review of electronic health records. Besides, the degree of adherence was expressed as a percentage (adherence adequate ≥90%). The association between the variables studied and the degree of adherence was estimated by means of statistical tests of hypothesis contrast.Results: A total sample size of 300 patients were included, mean age 47 years, 60% women. Adherence of the treatment was inadequate in 18% of patients. The variables that showed a statistically significant association with adherence were the age, the drug delivered, the dosage interval and the persistence of treatment (p<0.05). 5.6% of OC work deviated from schedule and it meant additional work to the PD.Conclusions: The degree of adherence to the intravenous ambulatory treatment was inadequate in approximately a quarter of the population. The age, the infused drug, the dosage interval and the persistence of treatment were the variables that showed association with the adherence. Changes to OC programming resulted in over-added work for the PD. (AU)

Atención farmacéutica en pacientes ingresados con insuficiencia renal / Pharmaceutical care in renal insufficiency inpatients

Objetivos: Valorar los resultados de un programa de ajuste posológico en pacientes hospitalizados con enfermedad renal, describir los medicamentos mayoritariamente implicados y determinar el grado de aceptación de la intervención farmacéutica realizada. Método: Estudio prospectivo, de intervención no aleatorizada, de 15 meses de duración en pacientes hospitalizados con función renal alterada (Creatinina sérica > 1,4 mg/dL) y en tratamiento con medicamentos que precisan ajuste en insuficiencia renal. La variable principal fue el porcentaje de adecuación posológica según la tasa de filtrado glomerular. También se evaluó la aceptación global por servicio clínico, el grupo farmacoterapéutico más prescrito de forma inadecuada, las monitorizaciones farmacocinéticas que se derivaron de la intervención y el carácter educativo de la misma. Resultados: Se identificaron un total de 384 pacientes de los que 341 presentaban un aclaramiento de creatinina entre 10-50 ml/min. Se revisaron 2.807 medicamentos prescritos, de éstos, 2.052 no requerían ajuste posológico en insuficiencia renal y 508 estaban correctamente ajustados. 247 prescripciones eran susceptibles de un ajuste posológico de las cuales 164 prescripciones era necesario un ajuste posológico concreto. Se realizaron recomendaciones posológicas en 200 ocasiones, y se aceptaron un total de 131. Los fármacos con mayor número de intervenciones fueron la enoxaparina, levofloxacino, amoxicilina-clavulánico y digoxina. Conclusiones: La implantación del programa de atención farmacéutica ha tenido una buena aceptación entre los facultativos prescriptores, siendo los antibióticos el grupo farmacológico más susceptible de realizar un ajuste posológico sobre una mayoría de pacientes con insuficiencia renal moderada (AU)

Background and objective: To asses the outcomes of posological adjust program in renal impairment inpatients, describe the drugs more usually involved, and determine the degree of acceptance of the pharmaceutical intervention made. Material and method: A fifteen months-prospective study, in renal insufficiency inpatients (serum creatinine > 1,4 mg/dL) treated with drugs that needs posological adjustment. The primary outcome was the ratio of adequate dosage of the treatment, according with the glomerular filtration rate. We also evaluated the global acceptation rate, the drugs inadequate prescribed more frequently, phamacokinetic analysis derived from the pharmaceutical intervention and its educative character. Results: 384 patients were identified, and 341 of them presented a glomerular filtration rate between 10-50 ml/min. 2.807 prescribed drugs were reviewed, and 2.052 of them didn’t require posological adjustment in renal insufficiency, 508 prescribed drugs were correctly adjusted. 247 pres - criptions were susceptible of posological adjustment and 164 of them, needed a concrete posological adjustment. We performed 200 posological recommendations, and 131 were accepted. The drugs with a higher number of interventions were enoxaparine, levofloxacin, amoxicillin-clavulanic and digoxin. Conclusions: The implementation of the pharmaceutical care program was accepted between physicians, being antibiotics the group more susceptible of doing a posological adjustment in most patients with renal impairment (AU)

[Pharmaceutical care in renal insufficiency inpatients]. / Atención farmacéutica en pacientes ingresados con insuficiencia renal.

BACKGROUND AND OBJECTIVE: To asses the outcomes of posological adjust program in renal impairment inpatients, describe the drugs more usually involved, and determine the degree of acceptance of the pharmaceutical intervention made. MATERIAL AND METHOD: A fifteen months-prospective study, in renal insufficiency inpatients (serum creatinine > 1,4 mg/dL) treated with drugs that needs posological adjustment. The primary outcome was the ratio of adequate dosage of the treatment, according with the glomerular filtration rate. We also evaluated the global acceptation rate, the drugs inadequate prescribed more frequently, phamacokinetic analysis derived from the pharmaceutical intervention and its educative character. RESULTS: 384 patients were identified, and 341 of them presented a glomerular filtration rate between 10-50 ml/min. 2.807 prescribed drugs were reviewed, and 2.052 of them didn%#39;t require posological adjustment in renal insufficiency, 508 prescribed drugs were correctly adjusted. 247 pres - criptions were susceptible of posological adjustment and 164 of them, needed a concrete posological adjustment. We performed 200 posological recommendations, and 131 were accepted. The drugs with a higher number of interventions were enoxaparine, levofloxacin, amoxicillin-clavulanic and digoxin. CONCLUSIONS: The implementation of the pharmaceutical care program was accepted between physicians, being antibiotics the group more susceptible of doing a posological adjustment in most patients with renal impairment.

[Assessment of quality as perceived by users of an outpatient pharmaceutical care unit]. / Evaluación de la calidad percibida por los usuarios de una unidad de atención farmacéutica a pacientes externos.

OBJECTIVE: To assess quality of care by an Outpatient Pharmaceutical Care Unit (OPCU) from patient satisfaction regarding the unit s premises and activities. METHOD: A transversal study performed at the OPCU using a patient survey. Patient opinions were obtained regarding structural aspects, pharmaceutical care, patient information, overall satisfaction, and preference for care in the OPCU or pharmacy office. The response variable was the presumed choice for the OPCU or traditional pharmacy office. A multivariate analysis using logistic regression was used to evaluate the independent effect of variables. RESULTS: In all, 256 surveys were administered, of which 195 were assessable. Response rate was 76%. Responses with highest scores included communication and interaction with professionals (4.8 points on average) and care received (4.5 points). Worst assessments included OPCU s timetable (3.8 points) and location (3.9 points); 98.4% of patients were satisfied or very satisfied with care received, and only 18.4% would switch to the pharmacy office if allowed to. The multivariate analysis suggested that variables associated with the pharmacy office choice included a negative rating of OPCU s location (OR 9.8, CI 1.3-76.8) and a negative rating of information delivered (OR 4.1, CI 1.7-9.8); p < 0.05. CONCLUSIONS: Information received and OPCU s location had the greatest impact on patient satisfaction. Patient remarks and suggestions were very useful to identify areas of improvement, and to introduce modification suiting their views.

Evaluación de la calidad percibida por los usuarios de una unidad de atención farmacéutica a pacientes externos / Assessment of quality as perceived by users of an outpatient pharmaceutical care unit

Objetivo: Evaluar la calidad de la asistencia prestada en una Unidad de Atención Farmaceútica a Pacientes Externos (UFPE) a partir de la satisfacción de los pacientes con las instalaciones y las actividades desarrolladas en la misma. Método: Estudio transversal realizado en la UFPE, mediante una encuesta. Se recogió la opinión sobre aspectos estructurales, atención farmacéutica, información al paciente, satisfacción general y preferencias a ser atendidos en la UFPE o en la oficina de farmacia. La variable de respuesta fue la elección hipotética de laUFPE o la farmacia tradicional. Se recurrió a un análisis multivariante por medio de la regresión logística para evaluar el efecto independiente de las variables. Resultados: Se entregaron 256 encuestas, de las cuales fueron evaluables 195. El porcentaje de respuesta fue del 76%. Las respuestas con mayor puntuación fueron la comunicación y trato con los profesionales (4,8 puntos sobre 5) y la información recibida (4,5 puntos). Los peores valorados fueron el horario (3,8 puntos) y la ubicación de la UFPE (3,9 puntos). El 98,4% de los pacientes estuvieron satisfechos o muy satisfechos con la atención recibida y sólo el 18,4% cambiarían, si pudieran, a la oficina de farmacia. Del análisis multivariante se dedujo que las variables asociadas a la elección de oficina de farmacia fueron la valoración negativa de la ubicación de la UFPE (OR 9,8, IC 1,3-76,8) y la valoración negativa sobre la información facilitada (OR 4,1, IC1,7-9,8), p < de 0,05. Conclusiones: La información recibida y la ubicación de la UFPE fueron los factores que más peso tuvieron en la satisfacción de los pacientes. Las observaciones y sugerencias aportadas, fueron muy útiles para detectar puntos de mejora e introducir modificaciones según sus opiniones

Objective: To assess quality of care by an Outpatient Pharmaceutical Care Unit (OPCU) from patient satisfaction regarding the unit's premises and activities. Method: A transversal study performed at the OPCU using apatient survey. Patient opinions were obtained regarding structural aspects, pharmaceutical care, patient information, overall satisfaction, and preference for care in the OPCU or pharmacy office.The response variable was the presumed choice for the OPCU ortradicional pharmacy office. A multivariate analysis using logistic regression was used to evaluate the independent effect of variables. Results: In all, 256 surveys were administered, of which 195 were assessable. Response rate was 76%. Responses with highest scores included communication and interaction with professionals (4.8 points on average) and care received (4.5 points). Worst assessments included OPCU's timetable (3.8 points) and location (3.9 points); 98.4% of patients were satisfied or very satisfied with care received, and only 18.4% would switch to the pharmacy office if allowed to. The multivariate analysis suggested that variables associated with the pharmacy office choice included a negative rating of OPCU's location (OR 9.8, CI 1.3-76.8) and a negative rating of information delivered (OR 4.1, CI 1.7-9.8); p <0.05. Conclusions: Information received and OPCU's location had the greatest impact on patient satisfaction. Patient remarks and suggestions were very useful to identify areas of improvement, and to introduce modification suiting their views

[Drug therapy for corneo-conjunctival neoplasm]. / Tratamiento farmacológico de la neoplasia corneal y conjuntival.

BACKGROUND: The goal of therapy for corneo-conjunctival neoplasm is lesion removal, with the most widespread procedure being complete tumor resection with or without associated chemotherapy lines. As this sort of procedure entails a high relapse rate (9-52%) the use of adjuvant therapies to reduce the occurence of relapse becomes a need. The administration of a number of topically administered drugs has been used for adjuvant therapy, including mitomycin C, 5-fluorouracil and interferon a 2b. OBJECTIVE: To determine the clinical experience published regarding the effectiveness of the various drug therapies for cor-neo-conjunctival neoplasm. SEARCH STRATEGY: Information reported on this topic in the Medline database (1966-2004) was searched using corneo-conjunctival neoplasm, 5-fluorouracil, mitomycin C, and interferon ca2b as key words. SELECTION CRITERIA: All papers quoting dosage for drugs used,treatment length, adverse effect development, and clinical response obtained were included. PRIMARY RESULTS: Papers reporting the use of 5-fluorouracil re few when compared to those quoting other drugs, with a response rate of 88% and a relapse rate of 20%. The use of mitomycin C is widely described in the medical literature with a response rate of 90% and a relapse rate of 13%, but in association with the development of adverse effects in a high percentage of patients. Interferon ca 2b is the last drug to be incorporated in the treatment of these ocular lesions, with a response rate of 100% and a low incidence of adverse effects, with a relapse rate of 4%. CONCLUSIONS: Mitomycin C is an effective drug, but its use is associated with a high number of adverse events, some of which may lead to therapy discontinuation. Interferon ct 2b has efficacy outcomes comparable to mitomycin C and a lower incidence of adverse effects, which are mostly mild in nature. The use of 5-fluorouracil is relegated to a second-tier status.

[Acute intoxication with sustained-release lithium carbonate tablets. A propos of a case]. / Intoxicación aguda por comprimidos de liberación sostenida de carbonato de litio. A propósito de un caso clínico.

OBJECTIVE: To describe the case of a patient who ingested 50 sustained release lithium carbonate 400 mg tablets, and reached a late peak concentration above 3 mEq/L. CASE REPORT: A 32-year-old male with bipolar mood disorder ingested 50 sustained-release lithium carbonate tablets. Upon admission to the emergency room, a gastric wash was performed,from which several tablet remnants were obtained, as well as an intestinal lavage using activated carbon. PHYSICAL EXAMINATION: good general status, no fever, blood pressure 160/90 mm Hg, no edemas. Neurologic, pulmonary, and cardiac examinations were normal. CBC and the chemistry panel were normal. The patient's psychopathological examination suggested a stable status with no apparent manifestations arising from a decompensated mood disorder. Five hours after his massive lithium ingestion the drug's plasma levels were 0.75 mEq/L. At 22 hours post-ingestion a chemistry panel was obtained, which showed serum creatinin at 1.38 mg/dL and a lithium plasma concentration of 3.15 mEq/L. A hemodyalisis trial was attempted for 4 hours. At 73 hours post-ingestion, lithium plasma levels were 0.6 mEq/L, that is, within therapeutic range. The patient was hemodynamically stable and serial blood tests were normal; he was discharged. COMMENT: Acute lithium intoxication with plasma levels above 3 mEq/l can be fatal or result in irreversible neurologicsequelae in almost one third of cases, with persistent cerebellar dysfunction in association with dementia of variable degree, andrenal, blood, and liver disturbances. Sustained-release tablets may prolong absorption and delay peak plasma concentrations. In such cases, therefore, it is recommended that drug plasma concentrations be monitored during 48-72 hours post-ingestion.

Tratamiento farmacológico de la neoplasia corneal conjuntival / Drug therapy for corneo-conjunctival neoplasm

Antecedentes: El objetivo del tratamiento de la neoplasia córneo- conjuntival es la eliminación de la lesión, siendo el más extendido la resección quirúrgica completa del tumor asociado o no a varias hileras de crioterapia. Debido a la elevada tasa de recidivas de este tipo de intervención (9-52%), se hace necesaria la utilización de tratamientos adyuvantes que la reduzcan. Para el tratamiento adyuvante se ha empleado la administración de varios fármacos por vía tópica tales como: la mitomicina-C, el 5-fluorouracilo y el interferón alfa 2b. Objetivo: Conocer la experiencia clínica publicada sobre la efectividad de los diferentes tratamientos farmacológicos de la neoplasia córneo-conjuntival. Estrategia de la búsqueda: Se revisó la información publicada sobre este tema en la base de datos Medline (1966-2004), utilizando como palabras clave neoplasia córneo conjuntival, 5- fluorouracilo, mitomicina C e interferón alfa 2b. Criterios de selección: Se incluyeron todos los trabajos en los que se expresaba la dosis de fármaco utilizado, la duración del tratamiento, la aparición de efectos adversos y la respuesta clínica obtenida. Resultados principales: Los artículos publicados en los que se ha utilizado el 5-fluorouracilo son escasos en comparación con los publicados con los otros dos fármacos, presentando una tasa de respuesta del 88% y una tasa de recidivas del 20%. La utilización de mitomicina-C está ampliamente descrita en la literatura médica con una tasa de respuesta del 90% y tasa de recidivas del 13%, pero está asociada a la aparición de efectos adversos en un porcentaje elevado de pacientes. El interferón alfa 2b, ha sido el último fármaco incorporado para el tratamiento de estas lesiones oculares obteniendo unos resultados en cuanto a respuesta del 100% y un bajo número de efectos adversos, con un tasa de recidivas del 4%. Conclusiones: La mitomicina C es un fármaco eficaz, pero que se asocia a la aparición de un gran número de efectos adversos, que en algunos casos obligan a suspender el tratamiento. El interferón alfa 2b presenta unos resultados de eficacia comparables a la mitomicina-C y con un menor número de reacciones adversas, siendo en su mayoría de carácter leve. Queda en un segundo plano la utilización del 5-fluorouracilo

Background: The goal of therapy for corneo-conjunctival neoplasm is lesion removal, with the most widespread procedure being complete tumor resection with or without associated chemotherapy lines. As this sort of procedure entails a high relapse rate (9-52%) the use of adjuvant therapies to reduce the occurence of relapse becomes a need. The administration of a number of topically administered drugs has been used for adjuvant therapy, including mitomycin C, 5-fluorouracil and interferon alpha 2b. Objective: To determine the clinical experience published regarding the effectiveness of the various drug therapies for corneo- conjunctival neoplasm. Search strategy: Information reported on this topic in the Medline database (1966-2004) was searched using corneo-conjunctival neoplasm, 5-fluorouracil, mitomycin C, and interferon alpha 2b as key words. Selection criteria: All papers quoting dosage for drugs used, treatment length, adverse effect development, and clinical response obtained were included. Primary results: Papers reporting the use of 5-fluorouracil are few when compared to those quoting other drugs, with a response rate of 88% and a relapse rate of 20%. The use of mitomycin C is widely described in the medical literature with a response rate of 90% and a relapse rate of 13%, but in association with the development of adverse effects in a high percentage of patients. Interferon alpha 2b is the last drug to be incorporated in the treatment of these ocular lesions, with a response rate of 100% and a low incidence of adverse effects, with a relapse rate of 4%. Conclusions: Mitomycin C is an effective drug, but its use is associated with a high number of adverse events, some of which may lead to therapy discontinuation. Interferon alpha 2b has efficacy outcomes comparable to mitomycin C and a lower incidence of adverse effects, which are mostly mild in nature. The use of 5-fluorouracil is relegated to a second-tier status

Intoxicación aguda por comprimidos de liberación sostenida de carbonato de litio. A propósito de un caso clínico / Acute intoxication with sustained-release lithium carbonate tablets. A propos of a case

Objetivo: Describir el caso de un paciente que ingirió 50 comprimidos de liberación sostenida de carbonato de litio 400 mg, alcanzando una concentración pico tardía superior a 3 mEq/L. Descripción del caso: Varón de 32 años con trastorno afectivo bipolar que ingiere 50 comprimidos de liberación sostenida de carbonato de litio. Al ingreso en urgencias se realiza lavado gástrico, obteniéndose restos de múltiples comprimidos y lavado intestinal con carbón activado. Exploración física: buen estado general, afebril, tensión arterial 160/90 mmHg, no edemas. Exploración neurológica, pulmonar y cardiaca normales. El hemograma y la bioquímica fueron normales. La exploración psicopatológica del paciente indica que presenta una situación estable, sin clínica aparente de descompensación de su trastorno afectivo. A las 5 horas de la ingesta masiva de litio, los niveles plasmáticos del fármaco son de 0,75 mEq/L. A las 22 horas posingesta se practica una bioquímica sanguínea que muestra un valor de creatinina sérica de 1,38 mg/dL y una concentración plasmática de litio de 3,15 mEq/L. Se realiza una sesión de hemodiálisis de 4 horas de duración. A las 73 horas posingesta los niveles plasmáticos de litio son de 0,6 mEq/L dentro del ámbito terapéutico. El paciente se encuentra estable hemodinámicamente con una analítica seriada sin alteraciones y es dado de alta. Comentario: La intoxicación aguda por litio con niveles plasmáticos por encima de 3 mEq/L puede ser letal e incluso dejar secuelas neurológicas irreversibles en cerca de un tercio de los casos, consistente en una disfunción cerebelosa persistente asociada a demencia de grado variable, alteraciones renales, sanguíneas y hepáticas. Cuando el litio se presenta en comprimidos de liberación retardada, se puede prolongar el periodo de absorción y retrasar la consecución de la concentración plasmática pico. Por lo tanto, en estos casos, se recomienda la monitorización de la concentración plasmática del fármaco durante un periodo de tiempo de 48-72 horas posingesta

Objective: To describe the case of a patient who ingested 50 sustained release lithium carbonate 400 mg tablets, and reached a late peak concentration above 3 mEq/L. Case report: A 32-year-old male with bipolar mood disorder ingested 50 sustained-release lithium carbonate tablets. Upon admission to the emergency room, a gastric wash was performed, from which several tablet remnants were obtained, as well as an intestinal lavage using activated carbon. Physical examination: good general status, no fever, blood pressure 160/90 mm Hg, no edemas. Neurologic, pulmonary, and cardiac examinations were normal. CBC and the chemistry panel were normal. The patient's psychopathological examination suggested a stable status with no apparent manifestations arising from a decompensated mood disorder. Five hours after his massive lithium ingestion the drug's plasma levels were 0.75 mEq/L. At 22 hours post-ingestion a chemistry panel was obtained, which showed serum creatinin at 1.38 mg/dL and a lithium plasma concentration of 3.15 mEq/L. A hemodyalisis trial was attempted for 4 hours. At 73 hours postingestion, lithium plasma levels were 0.6 mEq/L, that is, within therapeutic range. The patient was hemodynamically stable and serial blood tests were normal; he was discharged. Comment: Acute lithium intoxication with plasma levels above 3 mEq/l can be fatal or result in irreversible neurologic sequelae in almost one third of cases, with persitent cerebellar dysfunction in association with dementia of variable degree, and renal, blood, and liver disturbances. Sustained-release tablets may prolong absorption and delay peak plasma concentrations. In such cases, therefore, it is recommended that drug plasma concentrations be monitored during 48-72 hours post-ingestion