Pharmaceutical pictograms to improve textual comprehension: A systematic review.

INTRODUCTION: Written instructive information for the patient is key in pharmaceutical care. However, the preexisting literature agrees on the discordance between the readability of written medication messages intended for patients. The aim of our work was to systematically review the available evidence on the effect of pharmaceutical pictograms as elements that facilitate understanding of the text in primary or secondary medication packaging. METHODS: A parallel systematic search was conducted of the literature covering evidence of the effect of including pictograms in primary or secondary packaging on comprehension by potential users or caregivers up to April 9, 2023. The databases consulted were Scopus, MEDLINE and Web of Science. Only randomized controlled studies, whose main outcome measure was comprehension, were included. RESULTS: Only 8 papers met our search criteria. In most of the included studies, the intervention of including pictograms improved participants' performance in comprehending instructions. A debatable methodological quality, and differences in the target population, textual complexity of the materials or the cultural affinity of the pictograms with the target population in each study, could have had a decisive influence on the results. CONCLUSION: The heterogeneity in the design of each study poses a significant barrier to establishing commonalities and generalizing the results. This heterogeneity also prevented us from conclusively confirming the usefulness of pictograms complementary to instructional text in improving the comprehension of instructions for the rational use of medicines.

Impacto de la adición de pictogramas farmacéuticos como ayuda visual sobre la comprensión de prospectos en estudiantes de educación secundaria / Impact of the addition of pharmaceutical pictograms as visual aids on the comprehension of package inserts in students completing secondary education

Introducción: La Atención Farmacéutica requiere que los pacientes comprendan la información brindada. La inclusión de ayudas visuales podría mejorar la comprensión de textos complejos como son los prospectos de los medicamentos. Nuestro objetivo fue evaluar los efectos de la inclusión de pictogramas farmacéuticos sobre la comprensión de instrucciones elementales para el uso de medicamentos por estudiantes que finalizan la enseñanza básica. Método: De un total de 309 alumnos participantes, se aleatorizaron 160 para leer tres prospectos de medicamentos de uso frecuente (ibuprofeno, amoxicilina/ácido clavulánico y omeprazol), mientras que 149 recibieron pictogramas junto a los prospectos. La aleatorización fue alterna según la posición de los alumnos en el aula. La comprensión fue estimada mediante cuestiones básicas del uso de medicamentos. Resultados: En el grupo control solo el 38.75% de los alumnos contestaron correctamente cuándo tomar el ibuprofeno en relación a las comidas el 32.25% acertaron cual es la dosis habitual del antibiótico y el 61.88% identificó la indicación del omeprazol. En los tres casos, se encontraron diferencias significativas en favor de la comprensión en el grupo experimental (OR = 1.93; 95% IC, 1.23 – 3.05; p = 0.0041, OR = 3.87; 95% IC, 2.43 – 6.25; p = 10-7 y OR = 3.55; 95% IC, 2.07 – 6.29; p = 3.67x10-5 respectivamente). Conclusiones: La inclusión de pictogramas farmacéuticos en los prospectos es una estrategia sencilla que podría potencialmente favorecer el uso racional del medicamento. (AU)

Introduction: Pharmaceutical Care requires that patients understand the information provided. The inclusion of visual aids could improve the comprehension of complex texts such as drug package inserts. Our objective was to evaluate the effects of the inclusion of pharmaceutical pictograms on the comprehension of elementary instructions for the use of drugs by students completing basic education. Methods: Among a total of 309 participating students, 160 were randomized to read three frequently used drug package inserts (ibuprofen, amoxicillin/clavulanic acid and omeprazole), while 149 received pictographs together with the package inserts. Randomization was alternated according to the position of the students in the classroom. Comprehension was estimated by means of basic questions on the use of drugs. Results: In the control group only 38.75% of the students answered correctly when to take ibuprofen in relation to meals, 32.25% were right about the usual dose of the antibiotic and 61.88% identified the indication for omeprazole. In all three cases, significant differences in favor of understanding were found in the experimental group (OR = 1.93; 95% CI, 1.23 - 3.05; p = 0.0041, OR = 3.87; 95% CI, 2.43 - 6.25; p = 10-7 and OR = 3.55; 95% CI, 2.07 - 6.29; p = 3.67x10-5 respectively). Conclusions: The inclusion of pharmaceutical pictograms in package inserts is a simple strategy that could favor potentially the rational use of drugs. (AU)

Uso de Anticonceptivos Orales y Percepción del Papel del Farmacéutico Comunitario entre Adolescentes: un estudio observacional / Oral Contraceptive Use and Perception of the Role of the Community Pharmacist among Adolescents: an observational study

Introducción: Los embarazos no deseados en adolescentes tienen graves consecuencias tanto para las propias adolescentes y sus bebés como para el uso de los recursos del sistema sanitario. Una de las razones es el escaso uso de píldoras anticonceptivas orales (ACO) entre esta población, debido principalmente a la falta de información o a la no adherencia a los medicamentos. El objetivo de este estudio fue describir la información que reciben las adolescentes sobre los ACO y su uso, así como su percepción del papel del farmacéutico comunitario en este campo. Método: Se realizó un estudio observacional transversal mediante encuesta, aplicada a mujeres entre 12-19 años residentes en España, independientemente de si habían utilizado o no ACO, durante abril de 2021. Para la difusión de esta encuesta se utilizaron diferentes redes sociales. Asimismo, se contactó con diferentes asociaciones españolas dedicadas a la orientación de la planificación familiar y la salud sexual en adolescentes. Resultados: El 81,7% (n=76) de los encuestados no había tomado ACO, aunque el 35,5% (n=33) sí había mantenido relaciones sexuales. El 6% (n=1) que tomaba o había tomado ACO informó que eran adherentes. El 88% (n=82) pensaba que el farmacéutico tiene conocimientos sobre medicamentos; sin embargo, sólo el 19,4% (n=18) les consultaría para resolver dudas sobre ACO. Conclusiones: Para resolver los problemas de falta de información sobre ACO y de adherencia en mujeres adolescentes, el farmacéutico comunitario es un profesional accesible que puede contribuir a ello adoptando una actitud activa y utilizando diferentes formas de material educativo. (AU)

Introduction: Unintended pregnancies in adolescents have serious consequences both for the adolescents themselves and their babies and for the use of health system resources. One of the reasons is the low use of oral contraceptive pills (OCPs) among this population, mainly due to lack of information or non-adherence to the medication. The aim of this study was to describe the information adolescents receive about OCPs and their use, as well as their perception of the role of the community pharmacist in this field. Method: A cross-sectional observational study was carried out by means of a survey applied to women aged 12-19 years living in Spain, regardless of whether or not they had used OCPs, during April 2021. Different social networks were used to disseminate the survey. Different Spanish associations dedicated to family planning and adolescent sexual health counselling were also contacted. Results: 81.7% (n=76) of respondents had not taken OCPs, although 35.5% (n=33) had had sex. The 6% (n=1) who were taking or had taken OCPs reported adherence. 88% (n=82) thought that the pharmacist is knowledgeable about medicines; however, only 19.4% (n=18) would consult them for OCP questions. Conclusions: To solve the problems of lack of information about OCPs and adherence in adolescent women, the community pharmacist is an accessible professional who can contribute to this by taking an active role and using different forms of educational materials. (AU)

Protocolo de autocuidado para pacientes con psoriasis desde la farmacia comunitaria / Self-care protocol for patients with psoriasis from community pharmacy

Introducción: Debido a la baja calidad de vida y ad-herencia al tratamiento de los pacientes con psoria-sis se plantea desarrollar un protocolo de empode-ramiento que conduzca a un mayor conocimiento del autocuidado en pacientes con esta patología, acorde a sus necesidades, siendo importante el papel del farmacéutico para la mejora de ambos. Método: Se administró el test Morisky Green-4 items y el cuestionario Dermatology Life Quality Index a 40 pacientes con psoriasis que acudían a una farmacia comunitaria. Con estos datos, la información de las guías clínicas y la colaboración con un dermatólogo, se diseñó un protocolo de autocuidado.Resultados: Se observó falta de adherencia en el 100% de los pacientes y una calidad de vida leve/moderada (5,3±4,2), en las preguntas relacionadas con: los síntomas cutáneos afectan mucho/muy al 50% de los pacientes y la sensación de vergüenza y dificultad con su tratamiento entre poco y mucho en el 60%. Con estos resultados se diseñaron dos dípticos. A los 3 meses la calidad de vida mejoró a 3,98±2,05, p=0,048, y se observó falta de adheren-cia en el 70% de los pacientes.Conclusiones: Los protocolos de autocuidado son necesarios para mejorar la calidad de vida de los pacientes crónicos. El papel del farmacéutico es importante a través de un protocolo de autocuida-do en pacientes con psoriasis, ayudando a mejorar la adherencia al tratamiento y la calidad de vida. (AU)

Introduction: Due to the low quality of life and adherence to treatment of patients with psoriasis, it is proposed to develop an empowerment protocol that leads to greater knowledge of self-care in pa-tients with this pathology, according to their needs, with the role of the pharmacist being important for the improvement of both.Method: The Morisky Green-4 items test and the Dermatology Life Quality Index questionnaire were administered to 40 patients with psoriasis who attended a community pharmacy. With these data, information from clinical guidelines and collabora-tion with a dermatologist, a self-care protocol was designed.Results: Lack of adherence was observed in 100% of the patients and a mild/moderate quality of life (5.3±4.2), in questions related to: skin symptoms af-fect a lot/very much 50% of the patients and feeling of embarrassment and difficulty with their treat-ment between a little and a lot in 60%. With these results, two diptychs were designed. Three months later, the quality of life improved to 3.98±2.05, p=0.048, and non-adherence was observed in 70% of the patients.Conclusions: Self-care protocols are necessary to improve quality of life of chronic patients. The role of the pharmacist is important through a self-care protocol in patients with psoriasis, helping to im-prove adherence to treatment and quality of life. (AU)

[Analysis of the legal framework on food supplements for menopause in Spanish community pharmacies]. / Análisis del marco legal sobre complementos alimenticios para la menopausia en farmacias comunitarias españolas.

OBJECTIVE: To analyze the legal framework for the marketing of specific food supplements prescribed and indicated for menopause symptoms, so that it is verified if according to the effects on health that they produce, should be considered in the category of food supplements, or in others included in our legal system. METHOD: An exhaustive review of the legal frameworks applicable to food supplements used both in Spain and in Europe, collecting those aspects that are related to legal concepts such as the definition of medicine for human use, medicine based on medicinal plants, or the so-called "frontier products". RESULTS: There is a large number of products that can be called "frontier products", they can fit into different product categories, they can fit into different product categories, since some of the plants in their formulation are also authorized for use as industrial medicines or medicines based on traditional medicinal plants. CONCLUSIONS: There are currently specific food supplements for menopause that raise reasonable doubts about their inclusion in other legal categories, both as medicines for human use, or as herbal medicines, so the legislator would need to enable more agile mechanisms and more frequent reviews of the new certainties that science finds, and that can change the status of these products.

Análisis del marco legal sobre complementos alimenticios para la menopausia en farmacias comunitarias españolas / Analysis of the legal framework on food supplements for menopause in Spanish community pharmacies

Objetivo: Realizar un análisis sobre el marco legal de los complementos alimenticios prescritos e indicados para la sintomatología de la menopausia, verificando si de acuerdo con los efectos sobre la salud que producen deben ser considerados como complementos alimenticios o bien en otras categorías recogidas en el ordenamiento jurídico español. Método: Se realiza una revisión de los marcos jurídicos aplicables a los complementos alimenticios utilizados en España y Europa, recogiendo aquellos aspectos que resulten aplicables o relevantes para los utilizados durante la menopausia, y la relación que guarden con conceptos jurídicos como la definición de medicamento de uso humano, medicamento a base de plantas medicinales o los denominados «productos frontera». Resultados: Existe una gran cantidad de productos que pueden ser considerados «productos frontera» y pueden encajar en categorías de productos diferentes, ya que algunas de las plantas en su formulación también se encuentran autorizadas para su uso como medicamentos industriales o medicamentos de plantas medicinales tradicionales. Conclusiones: Existen complementos alimenticios para la menopausia que suscitan dudas razonables sobre su inclusión en otras categorías legales, tanto como medicamentos de uso humano o como medicamentos a base de plantas, por lo que el legislador necesitaría habilitar mecanismos más agiles y revisiones más frecuentes de las nuevas certezas que la ciencia encuentre, y que pueda cambiar la consideración de estos productos. (AU)

Objective: To analyze the legal framework for the marketing of specific food supplements prescribed and indicated for menopause symptoms, so that it is verified if according to the effects on health that they produce, should be considered in the category of food supplements, or in others included in our legal system. Method: An exhaustive review of the legal frameworks applicable to food supplements used both in Spain and in Europe, collecting those aspects that are related to legal concepts such as the definition of medicine for human use, medicine based on medicinal plants, or the so-called “frontier products”. Results: There is a large number of products that can be called “frontier products”, they can fit into different product categories, they can fit into different product categories, since some of the plants in their formulation are also authorized for use as industrial medicines or medicines based on traditional medicinal plants. Conclusions: There are currently specific food supplements for menopause that raise reasonable doubts about their inclusion in other legal categories, both as medicines for human use, or as herbal medicines, so the legislator would need to enable more agile mechanisms and more frequent reviews of the new certainties that science finds, and that can change the status of these products. (AU)

Pictogramas farmacéuticos: ¿una oportunidad para la Alfabetización en Salud? / Pharmaceutical Pictograms: an opportunity for Health Literacy?

Introducción: El material educativo para el uso del medicamento frecuentemente es poco legible para el paciente, especialmente si es poco Alfabetizado en Salud. Ello pone en relieve la necesidad de alternativas al prospecto tradicional. El objetivo de este trabajo fue revisar la evidencia disponible sobre los pictogramas como herramienta conducente al uso racional del medicamento. Método: Se realizó una búsqueda de los artículos que consistieran en estudios de la eficacia comunicativa de los pictogramas farmacéuticos en Scopus, Web of Science y Medline a través de PubMed. Resultados: Se identificaron 24 estudios con los criterios de inclusión aplicados. 10 de los 12 estudios controlados aleatorizados obtuvieron resultados favorables a la inclusión de pictogramas. Los estudios transversales exploraron la importancia del contexto cultural o educativo. Todos los estudios longitudinales obtuvieron resultados positivos tras el seguimiento, que podrían explicarse gracias a una explicación previa. Conclusiones: Los pictogramas son una herramienta simple, económica y con un elevado potencial para mejorar el uso del medicamento. (AU)

Introduction: Instructional material for the use of medicines is often unreadable by the patient, especially if he or she is poorly literate in Health. This alleviates the need for alternatives to the traditional leaflets. The aim of this work was to review the available evidence on the pictograms as a tool leading to the rational use of medicines. Method: A search was carried out for articles that considered studies of the communicative efficacy of pharmaceutical pictograms from Scopus, Web of Science and Medline through PubMed. Results: 24 studies were identified with the inclusion criteria applied. 10 of the 12 randomized controlled studies obtained results favorable to the inclusion of pictograms. Cross-sectional studies explored the importance of cultural or educational context. All longitudinal studies obtained positive results after follow-up, which could be explained by prior knowledge. Conclusions: Pictograms are a simple, economical tool with a high potential to improve the use of medication. (AU)

Situación legal de la atención farmacéutica en residencias de ancianos en España / Legal Situation of Pharmaceutical Care in Nursing Homes in Spain

ntroducción: La mayor esperanza de vida está pro-duciendo un aumento de la población de personas mayores de 65 años. Este grupo de población se caracteriza por un elevado consumo de medica-mentos y de asistencia sanitaria, permaneciendo muchos de ellos en centros residenciales donde son cubiertas todas sus necesidades. El perfil farmacoterapéutico de estos pacientes suele ser complejo debido a la polimedicación y a las pato-logías crónicas que padecen. Es aquí donde entra en juego el papel del farmacéutico a través de servicios asistenciales. El objetivo de esta revisión es analizar la situación legal, a través del estudio de la normativa específica española que regula la atención farmacéutica en centros sociosanitarios.Método: Revisión de la situación legal de la aten-ción farmacéutica en centros sociosanitarios en EspañaResultados: En España, el marco legal básico se encuentra en el Real Decreto Ley 16/2012 que esta-blece la obligación de tener un servicio de farmacia para los centros sociosanitarios que tengan cien o más camas en régimen de asistidos, mientras que aquellos con menos camas tendrán que tener-lo vinculado a un hospital o a una farmacia. Sin embargo, cada Comunidad Autónoma establece un régimen propio de funcionamiento, a través de su normativa específica.Conclusiones: Existen diferencias en la regulación de los centros sociosanitarios en cuanto a presta-ciones, funciones y servicios farmacéuticos corres-pondiente a cada Comunidad Autónoma (AU)

Introduction: Longer life expectancy is producing an increase among the population of people over the age of 65. This population group is charac-terized by a high consumption of medicines and healthcare, living many of them in residential facili-ties where all their needs are covered.The pharmacotherapeutic profile of these patients is usually complex due to their polymedication and the chronic pathologies they suffer. Here is where the role of the pharmacist comes into play with healthcare services. The aim of this review is to analyze the legal situation by studying the specific Spanish regulations that rule the pharmaceutical care in social and health care centers.Method: Review of the legal situation of pharma-ceutical care in social-health centers in Spain.Results: In Spain, the basic legal framework is found in Royal Decree Law 16/2012, which estab-lishes the obligation to have a pharmacy service for social care centers with one hundred beds or more in assisted care, while those with fewer beds must be linked to a hospital or pharmacy. However, each Autonomous Community establishes its own oper-ating regime through its specific regulations.Conclusions: There are differences in the regula-tion of social and healthcare centers in terms of benefits, functions and pharmaceutical services corresponding to each Autonomous Community (AU)

Influence of Genetic Polymorphisms on Clinical Outcomes of Glatiramer Acetate in Multiple Sclerosis Patients.

Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of autoimmune origin, in which inflammation and demyelination lead to neurodegeneration and progressive disability. Treatment is aimed at slowing down the course of the disease and mitigating its symptoms. One of the first-line treatments used in patients with MS is glatiramer acetate (GA). However, in clinical practice, a response rate of between 30% and 55% is observed. This variability in the effectiveness of the medication may be influenced by genetic factors such as polymorphisms in the genes involved in the pathogenesis of MS. Therefore, this review assesses the impact of genetic variants on the response to GA therapy in patients diagnosed with MS. The results suggest that a relationship exists between the effectiveness of the treatment with GA and the presence of polymorphisms in the following genes: CD86, CLEC16A, CTSS, EOMES, MBP, FAS, TRBC1, IL1R1, IL12RB2, IL22RA2, PTPRT, PVT1, ALOX5AP, MAGI2, ZAK, RFPL3, UVRAG, SLC1A4, and HLA-DRB1*1501. Consequently, the identification of polymorphisms in these genes can be used in the future as a predictive marker of the response to GA treatment in patients diagnosed with MS. Nevertheless, there is a lack of evidence for this and more validation studies need to be conducted to apply this information to clinical practice.

Therapeutic Value of Single Nucleotide Polymorphisms on the Efficacy of New Therapies in Patients with Multiple Sclerosis.

The introduction of new therapies for the treatment of multiple sclerosis (MS) is a very recent phenomenon and little is known of their mechanism of action. Moreover, the response is subject to interindividual variability and may be affected by genetic factors, such as polymorphisms in the genes implicated in the pathologic environment, pharmacodynamics, and metabolism of the disease or in the mechanism of action of the medications, influencing the effectiveness of these therapies. This review evaluates the impact of pharmacogenetics on the response to treatment with new therapies in patients diagnosed with MS. The results suggest that polymorphisms detected in the GSTP1, ITGA4, NQO1, AKT1, and GP6 genes, for treatment with natalizumab, ZMIZ1, for fingolimod and dimethyl fumarate, ADA, for cladribine, and NOX3, for dimethyl fumarate, may be used in the future as predictive markers of treatment response to new therapies in MS patients. However, there are few existing studies and their samples are small, making it difficult to generalize the role of these genes in treatment with new therapies. Studies with larger sample sizes and longer follow-up are therefore needed to confirm the results of these studies.