Impacts of a multipurpose outpatient hospital pharmacy in the framework of 3P medicine.

Challenge in the framework of Predictive Preventive and Personalised Medicine: In recent years, we have been witnessing a change in the performance of hospital pharmacists, aimed at increasing their participation in the pharmacotherapeutic process of patients. The drug cycle, characterised as multidisciplinary, is very complex. It is essential for the multidisciplinary team to have a broad vision of the medication system in order to guarantee safety and quality.Considering the challenges of current healthcare systems and paradigm shift from reactive to predictive medicine, a new professional environment should be created to promote the implementation of Predictive, Preventive and Personalised Medicine in healthcare. Objectives and study design: To optimise care times in multipurpose outpatient hospital both in the preparation of ready-to-use medications and in the dispensing of medications for home treatment.To increase the confidence and value of hospital pharmacists in the process of patient and family care.The design of the study was carried out by the following:-Coordinating the schedules of the multi-pathology day hospital with the software and records of Medication Preparation in the pharmacy service.-Opening a Pharmacy Outpatient Clinic associated with the multi-pathology day hospital.-Planning and scheduling patient treatments. Achievements: With the implementation of this programme, the visibility of hospital pharmacists in the multidisciplinary team was increased.This Pharmacy Outpatient Clinic allowed the coordination of the pharmaceutical care process in the day hospital.This project increased the credibility of the Pharmacy Service in the improvement of the integral process of the medicine. Predictive approach: The presence of pharmacists in the multi-pathology day hospital has a predictive approach. A change is made in the workflow that allows to generate a speed of intervention by acting before prescribing, dispensing and administering the treatment to the patient. Targeted prevention: The presence of pharmacists in the multipurpose day hospital unit and their collaboration with other professionals and the patient bring about a selective prevention that decreases the possibility of medication errors occurring. Personalisation of medical services: With the individualised dispensing of treatments, a step forward is taken in the personalisation of medical services, which avoids medication errors in labelling and administration and improves safety in the overall medication circuit in the hospital.

Baricitinib y tofacitinib en pacientes con artritis reumatoide: resultados de práctica clínica habitual / Baricitinib and tofacitinib in patients with rheumatoid arthritis: results of regular clinical practice

Objetivo: Objetivo principal: describir la efectividad y seguridad debaricitinib y tofacitinib en pacientes diagnosticados de artritis reumatoideen nuestro centro. Objetivo secundario: analizar si existen diferenciasentre ambos fármacos en práctica clínica real.Método: Estudio observacional retrospectivo de 2 años de duraciónque incluyó pacientes diagnosticados de artritis reumatoide en tratamientocon baricitinib o tofacitinib en nuestro centro durante al menos 6 meses.Bases de datos: historia clínica electrónica, aplicativo informático dedispensación a pacientes externos. Variables recogidas: demográficas,factores de mal pronóstico, tratamiento previo, duración de tratamiento,tratamiento concomitante, escala DAS28, número de articulaciones inflamadas y dolorosas, escala visual analógica del dolor, suspensión deltratamiento y reacciones adversas. Evaluación de la efectividad: disminución en la escala DAS28, articulaciones inflamadas y dolorosas y escalavisual analógica del dolor a los 6 y 12 meses de iniciado el tratamiento.Evaluación de la seguridad: detección de reacciones adversas. Análisisestadístico: prueba t-student.Resultados: Se evaluaron 44 pacientes, 20 (70% mujeres) recibierontratamiento con baricitinib, 24 (95,8% mujeres) con tofacitinib. Baricitinibredujo la puntuación en la escala DAS28 en 2,3 y 1,7 a los 6 y 12 meses.Tofacitinib en 2 y 1,9 respectivamente. Baricitinib redujo el número de articulaciones inflamadas y dolorosas en 7 a los 6 y 12 meses, tofacitinib en 4 las inflamadas y 6 las dolorosas. Baricitinib redujo la puntuación en la escala visual analógica del dolor en 7,8 y 6,8; tofacitinib en5 y 6 a los 6 y 12 meses. El 40% de los pacientes con baricitinib y el62,5% con tofacitinib precisaron tratamiento con corticoides. El 10% delos pacientes con baricitinib y el 25% de los pacientes con tofacitinibsuspendieron el tratamiento por ineficacia. (AU)

Objective: Main objective: Describe the effectiveness and safety ofbaricitinib and tofacitinib in patients diagnosed with rheumatoid arthritis inour hospital. Secondary objective: Analyse whether there are differencesbetween the two drugs in routine clinical practice.Method: Two-year retrospective study of patients diagnosed with rheumatoid arthritis treated in our hospital with baricitinib and tofacitinib forat least 6 months. Databases: Electronic medical record and outpatientmedication dispensing software. Variables collected: Demographic variables, poor prognosis factors, previous treatment, duration of treatment,concomitant treatment, DAS28, number of swollen and painful joints, painvisual analogy scale, treatment discontinuation, and adverse reactions.Effectiveness evaluation: Decreases in the DAS28 scale, the number ofswollen and painful joints, and the pain Visual Analogy Scale at 6 monthsand 12 months after starting treatment. Safety evaluation: Detection ofadverse reactions. Statistical analysis: Student t-test.Results: A total of 44 patients were evaluated. Of these, 20 (70% women)received treatment with baricitinib and 24 (95.8% women) received tofacitinib. Baricitinib reduced the DAS28 by 2.3 and 1.7 at 6 months and12 months, respectively, and tofacitinib reduced the scale by 2 and 1.9 at6 months and 12 months, respectively. Baricitinib reduced the numberof swollen and painful joints by 7 at both 6 months and 12 months, and tofacitinib reduced the number of swollen and painful joints by 4 and 6at 6 months and 12 months, respectively. Baricitinib reduced the VisualAnalogy Scale score by 7.8 and 6.8 at 6 months and 12 months, respectively, and tofacitinib reduced the score by 5 and 6 at 6 months and12 months, respectively. (AU)

Baricitinib and tofacitinib in patients with rheumatoid arthritis: results of regular clinical practice.

OBJECTIVE: Main objective: Describe the effectiveness and safety of baricitinib and tofacitinib in patients diagnosed with rheumatoid arthritis in our hospital. SECONDARY OBJECTIVE: Analyse whether there are  differences between the two drugs in routine clinical practice. METHOD: Two-year retrospective study of patients diagnosed with  rheumatoid arthritis treated in our hospital with baricitinib and tofacitinib  for at least 6 months. Databases: Electronic medical record and outpatient medication dispensing software. Variables collected:  Demographic variables, poor prognosis factors, previous treatment,  duration of treatment, concomitant treatment, DAS28, number of swollen  and painful joints, pain visual analogy scale, treatment discontinuation,  and adverse reactions. Effectiveness evaluation: Decreases in the DAS28  scale, the number of swollen and painful joints, and the pain Visual  Analogy Scale at 6 months and 12 months after starting treatment. Safety evaluation: Detection of adverse reactions. STATISTICAL ANALYSIS: Student t- test. RESULTS: A total of 44 patients were evaluated. Of these, 20 (70%  women) received treatment with baricitinib and 24 (95.8% women)  received tofacitinib. Baricitinib reduced the DAS28 by 2.3 and 1.7 at 6  months and 12 months, respectively, and tofacitinib reduced the scale by 2 and 1.9 at 6 months and 12 months, respectively. Baricitinib reduced the  number of swollen and painful joints by 7 at both 6 months and 12  months, and tofacitinib reduced the number of swollen and painful joints  by 4 and 6 at 6 months and 12 months, respectively. Baricitinib reduced  the Visual Analogy Scale score by 7.8 and 6.8 at 6 months and 12 months, respectively, and tofacitinib reduced the score by 5 and 6 at 6 months and 12 months, respectively. Corticosteroid treatment was needed in 40% of patients treated with baricitinib and 62.5% of patients treated with  rofacitinib. Treatment was discontinued due to loss of effectiveness in 10% of patients receiving baricitinib and 25% of patients treated with  tofacitinib. Adverse reactions were experienced by 10% of patients treated with baricitinib and 12.5% of patients treated with tofacitinib. Adverse  reactions led to treatment discontinuation in only 1 patient in each group.  No statistically significant differences were observed between the two  drugs. CONCLUSIONS: The results show that baricitinib and tofacitinib were  effective and safe in relation to all the variables analysed. Moreover, both drugs were similar in terms of effectiveness and safety for the  treatment of rheumatoid arthritis in real-world clinical practice.

Objetivo: Objetivo principal: describir la efectividad y seguridad de baricitinib y tofacitinib en pacientes diagnosticados de artritis  reumatoide en nuestro centro. Objetivo secundario: analizar si existen  diferencias entre ambos fármacos en práctica clínica real.Método: Estudio observacional retrospectivo de 2 años de duración que  incluyó pacientes diagnosticados de artritis reumatoide en tratamiento con  baricitinib o tofacitinib en nuestro centro durante al menos 6 meses. Bases de datos: historia clínica electrónica, aplicativo informático de dispensación a pacientes externos. Variables recogidas: demográficas, factores de mal  pronóstico, tratamiento previo, duración de tratamiento, tratamiento  concomitante, escala DAS28, número de articulaciones inflamadas y  dolorosas, escala visual analógica del dolor, suspensión del tratamiento y  reacciones adversas. Evaluación de la efectividad: disminución en la escala DAS28, articulaciones inflamadas y dolorosas y escala visual analógica del  dolor a los 6 y 12 meses de iniciado el tratamiento. Evaluación de la  seguridad: detección de reacciones adversas.Análisis estadístico: prueba t-student.Resultados: Se evaluaron 44 pacientes, 20 (70% mujeres) recibieron tratamiento con baricitinib, 24 (95,8% mujeres) con tofacitinib.  Baricitinib redujo la puntuación en la escala DAS28 en 2,3 y 1,7 a los 6 y  12 meses. Tofacitinib en 2 y 1,9 respectivamente. Baricitinib redujo el  número de articulaciones inflamadas y dolorosas en 7 a los 6 y 12 meses,  tofacitinib en 4 las inflamadas y 6 las dolorosas. Baricitinib redujo la  puntuación en la escala visual analógica del dolor en 7,8 y 6,8; tofacitinib  en 5 y 6 a los 6 y 12 meses. El 40% de los pacientes con baricitinib y el 62,5% con tofacitinib precisaron tratamiento con corticoides. El 10% de los pacientes con baricitinib y el 25% de los pacientes con tofacitinib suspendieron el tratamiento por ineficacia. El 10% de los pacientes de baricitinib y el 12,5% de tofacitinib experimentaron reacciones adversas. Sólo un paciente de cada grupo suspendió el tratamiento por reacciones adversas. No se observaron diferencias estadísticamente significativas entre ambos fármacos.Conclusiones: Según nuestros resultados, baricitinib y tofacitinib han demostrado ser efectivos y seguros en todas las variables analizadas. Además, ambos fármacos resultaron similares en efectividad y  seguridad en la práctica clínica habitual del tratamiento de la artritis  reumatoide.