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1.
Ars pharm ; 62(1): 15-39, ene.-mar. 2021. ilus, tab, graf
Artigo em Espanhol | IBECS-Express | IBECS | ID: ibc-ET6-1766

RESUMO

INTRODUCCIÓN: Los errores de medicación se encuentran entre las 10 principales causas de muerte en el mundo y en su mayoría son prevenibles. Los servicios profesionales farmacéuticos asistenciales (SPFA) tratan de garantizar un uso más seguro, efectivo y eficiente de los medicamentos, y por ello los farmacéuticos comunitarios pueden contribuir a reducir errores de la medicación a nivel de atención primaria. Este trabajo pretender ofrecer un marco de evidencia sobre las iniciativas llevadas a cabo por farmacéuticos comunitarios, a nivel estatal, para identificar, reducir o eliminar los errores de medicación en los diferentes puntos de la cadena terapéutica y plantear una revisión, de los puntos críticos de la cadena terapéutica y clasificar los SPFA. MÉTODO: Revisión sistemática exploratoria de bases de datos internacionales y estatales para obtener estudios publicados sobre la intervención del farmacéutico en la detección, reducción o eliminación de los errores de medicación. RESULTADOS: Se han recopilado 39 iniciativas que se han clasificado en 7 puntos críticos de la cadena terapéutica: (I) 7 en dispensación, (II) 4 en validación o revisión del tratamiento, (III) 3 en transición asistencial, (IV) 18 en monitorización del tratamiento, (V) 4 en educación a pacientes y (VI) 3 en indicación. CONCLUSIONES: Los SPFA llevados a cabo a nivel estatal demuestran que sirven para identificar y resolver los errores de medicación y se plantea una nueva clasificación de los 7 puntos de la cadena terapéutica que se identifican como críticos para la farmacia comunitaria y los relaciona con los SPFA que intervienen en cada uno de los puntos


INTRODUCTION: Medication errors, mostly preventable, are among the top 10 causes of death worldwide. Commu¬nity pharmacists provide professional pharmacy services (PPS) to ensure safer, more effective and efficient use of medications, being professionals who should be included in strategies to reduce medication errors at the primary care level. This work aims to offer an evidence framework on the initiatives carried out by community pharmacists, in Spain, to identify, reduce or eliminate medication errors at different points in the therapeutic chain and propose a classification of the critical points of the therapeutic chain to classify PPS. METHOD: Scoping review of international and national databases to obtain published studies where the community pharmacists provide an intervention to detect, reduce or eliminate of medication errors. RESULTS: 39 records have been compiled and have been classified in 7 critical points of the therapeutic chain: (I) 7 in dispensation, (II) 4 in validation/review of the treatment, (III) 3 in healthcare transition, (IV) 18 in treatment monitor¬ing, (V) 4 in education to patients and (VI) 3 in minor ailments service. CONCLUSIONS: The PPS carried out at the state level demonstrate that they serve to identify and resolve medication errors and a new classification of the critical points of the therapeutic chain that exist in the community pharmacy is proposed, and it relates to the PPS that are involved in each point

2.
Aten. prim. (Barc., Ed. impr.) ; 53(1): 43-50, ene. 2021. tab, graf
Artigo em Inglês | IBECS-Express | IBECS | ID: ibc-ET6-1867

RESUMO

OBJECTIVE: To estimate the effectiveness of a Medication Discrepancy Detection Service (MDDS), a collaborative service between the community pharmacy and Primary Care. DESIGN: Non-controlled before-and-after study. SETTING: Bidasoa Integrated Healthcare Organisation, Gipuzkoa, Spain. PARTICIPANTS: The service was provided by a multidisciplinary group of community pharmacists (CPs), general practitioners (GPs), and primary care pharmacists, to patients with discrepancies between their active medical charts and medicines that they were actually taking. Outcomes: The primary outcomes were the number of medicines, the type of discrepancy, and GPs' decisions. Secondary outcomes were time spent by CPs, emergency department (ED) visits, hospital admissions, and costs. RESULTS: The MDDS was provided to 143 patients, and GPs resolved discrepancies for 126 patients. CPs identified 259 discrepancies, among which the main one was patients not taking medicines listed on their active medical charts (66.7%, n = 152). The main GPs' decision was to withdraw the treatment (54.8%, n = 125), which meant that the number of medicines per patient was reduced by 0.92 (9.12 ± 3.82 vs. 8.20 ± 3.81; p < .0001). The number of ED visits and hospital admissions per patient were reduced by 0.10 (0.61 ± .13 vs 0.52 ± 0.91; p = .405 and 0.17 (0.33 ± 0.66 vs. 0.16 ± 0.42; p = .007), respectively. The cost per patient was reduced by (Euro)444.9 ((Euro)1003.3 ± 2165.3 vs. (Euro)558.4 ± 1273.0; p = .018). CONCLUSION: The MDDS resulted in a reduction in the number of medicines per patients and number of hospital admissions, and the service was associated with affordable, cost-effective ratios


OBJETIVOS: Estimar la efectividad del servicio de detección de discrepancias de la medicación, un servicio de colaboración entre la farmacia comunitaria y la atención primaria. DISEÑO: Estudio de intervención antes-después, sin grupo control. Emplazamiento: Organización Sanitaria Integrada de Bidasoa, Gipuzkoa, España. PARTICIPANTES: El servicio fue ofrecido por un grupo multidisciplinar que incluía farmacéuticos comunitarios (FC), médicos de atención primaria (MAP) y farmacéuticos de atención primaria a pacientes que presentaban discrepancias entre la medicación prescrita en la hoja de tratamiento activo y lo que realmente estaban tomando. Mediciones principales: Las variables principales del estudio fueron el número de medicamentos, tipo de discrepancia y la decisión del MAP. Las variables secundarias fueron tiempo invertido por el farmacéutico, visitas al servicio de urgencias, ingresos hospitalarios y los costes. RESULTADOS: El servicio se ofreció a 143 pacientes, y el MAP resolvió las discrepancias de un total de 126 pacientes. El FC identificó 259 discrepancias de las cuales la mayoría fue que el paciente no estaba tomando un medicamento prescrito (66,7%, n = 152). En la mayoría de los casos, la decisión del MAP fue suspender el tratamiento (54,8%, n = 125); el número de medicamentos que tomaba el paciente se redujo en un 0,92 (9,12 ± 3,82 vs. 8,20 ± 3,81; p < 0,0001). El número de visitas al hospital y los ingresos hospitalarios se redujeron en 0,10 (0,61 ± 0,13 vs. 0,52 ± 0,91; p = 0,405) y 0,17 puntos (0,33 ± 0,66 vs. 0,16 ± 0,42; p = 0,007), respectivamente. El coste por paciente se redujo en 444,9 (Euro) (1.003,3 ± 2.165,3 vs. 558,4 (Euro) ± 1.273,0; p = 0,018). CONCLUSIÓN: El servicio redujo el número de medicamentos que tomaba el paciente e ingresos hospitalarios y esto se relacionó con unos ratios de coste-efectividad positivos

3.
Aten Primaria ; 53(1): 43-50, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32994060

RESUMO

OBJECTIVE: To estimate the effectiveness of a Medication Discrepancy Detection Service (MDDS), a collaborative service between the community pharmacy and Primary Care. DESIGN: Non-controlled before-and-after study. SETTING: Bidasoa Integrated Healthcare Organisation, Gipuzkoa, Spain. PARTICIPANTS: The service was provided by a multidisciplinary group of community pharmacists (CPs), general practitioners (GPs), and primary care pharmacists, to patients with discrepancies between their active medical charts and medicines that they were actually taking. OUTCOMES: The primary outcomes were the number of medicines, the type of discrepancy, and GPs' decisions. Secondary outcomes were time spent by CPs, emergency department (ED) visits, hospital admissions, and costs. RESULTS: The MDDS was provided to 143 patients, and GPs resolved discrepancies for 126 patients. CPs identified 259 discrepancies, among which the main one was patients not taking medicines listed on their active medical charts (66.7%, n=152). The main GPs' decision was to withdraw the treatment (54.8%, n=125), which meant that the number of medicines per patient was reduced by 0.92 (9.12±3.82 vs. 8.20±3.81; p<.0001). The number of ED visits and hospital admissions per patient were reduced by 0.10 (0.61±.13 vs 0.52±0.91; p=.405 and 0.17 (0.33±0.66 vs. 0.16±0.42; p=.007), respectively. The cost per patient was reduced by €444.9 (€1003.3±2165.3 vs. €558.4±1273.0; p=.018). CONCLUSION: The MDDS resulted in a reduction in the number of medicines per patients and number of hospital admissions, and the service was associated with affordable, cost-effective ratios.

4.
J Eval Clin Pract ; 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32881191

RESUMO

INTRODUCTION: Non-adherence is a major problem among patients with chronic diseases. Community pharmacists are ideally positioned to detect non-adherence and to provide patient-centred interventions. OBJECTIVE: To conduct a systematic review of the impact of community pharmacist interventions on patient adherence to lipid lowering medication (LLM) prescriptions and clinical outcomes. SEARCH METHOD: Five databases (MEDLINE, Cochrane Library, Science Direct, Scopus, and Web of Knowledge) were searched systematically to identify relevant reports published by December 2019. Study quality was assessed with the Cochrane risk of bias (RoB 2.0) tool. SELECTION CRITERIA: Controlled trials in which community pharmacists conducted an intervention to improve patient adherence to LLM and clinical outcomes were evaluated. MAIN RESULTS: Five studies (2408 participants) were included in the qualitative analysis. Four studies (n = 2266) were pooled in the meta-analysis. Participants in the intervention group (IG) had better adherence than those in the control group (CG) [odds ratio (OR) = 1.67; 95% confidence interval (CI) 1.38-2.02; P < 0.001; I2 = 54%]. Better adherence rates were obtained when adherence was measured with validated questionnaires than when medication-possession ratio (MPR) measurements were used. Total cholesterol (TC) levels were not included in the meta-analysis due to data variability among the studies. CONCLUSIONS: Pharmacist-led intervention can improve LLM adherence, but its influence on clinical outcomes, including lipid level control, remains to be clarified.

5.
Int J Clin Pharm ; 42(2): 331-335, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32301066

RESUMO

Background Non-adherence is a problem that particularly affects those with chronic diseases. Studying causes for not following the treatment is necessary to choose the best intervention to improve non-adherence. Objective Analyze how the intentionality of non-adherence modulates the effects of professional intervention in patients with hypercholesterolemia. Setting: Community pharmacies and primary care centres in Spain. Methods A 6-month randomized controlled trial was conducted in 46 community pharmacies and 50 primary care centres in Spain. Adherence to statin therapy was measured with the Morisky-Green-Levine test. Non-adherence was classified based on the intentionality. Results 746 Patients were recruited for the study (465 non-adherent and 281 adherent). Of those, 237 were randomly assigned to the intervention group and 228 to the non-intervention group. The 56.5% of non-adherent patients were classified as unintentional non-adherents and 43.5% as intentional non-adherents. More patients in the intervention group finished being adherent compared with the non-intervention group (+ 17.2% for intentional non-adherents and + 27.4% for unintentional non-adherence). The percentage of patients in the intervention group who completed the study as adherent was higher among those who previously had unintentional non-adherence (66.4%) compared to those with intentional non- adherence (55.3%) (p < 0.001). Conclusion Intervention provided to patients with unintentional non-adherence was more effective than intervention provided to patients with intentional non- adherence.

6.
Health Serv Res ; 54(3): 658-668, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30957240

RESUMO

OBJECTIVE: To evaluate the impact of health professionals' intervention on adherence to statins, the influence on total cholesterol levels, and lifestyle patterns in patients with hypercholesterolemia and analyze the differences according to the center of recruitment. STUDY SETTING: Forty-six community pharmacies and 50 primary care centers of Spain. STUDY DESIGN: Randomized controlled trial design (n = 746). Patients were assigned into adherent (ADH) or nonadherent group depending on their initial adherence to statins. Nonadherent patients were randomly assigned to intervention (INT) or nonintervention (NOINT) group. Patients enrolled in the INT group received an intervention depending on the cause of nonadherence. Patients in the ADH and NOINT groups received usual care. Intention-to-treat (ITT) analysis was performed with multiple imputation to replace the missing data. DATA COLLECTION: Adherence, total cholesterol levels, and lifestyle behaviors. FINDINGS: The odds of becoming adherent during the 6 months was higher in the INT group compared to the NOINT group (OR = 1,49; 95% CI: 1.30-1.76; P < 0.001), especially in the community pharmacy group (OR = 2.34; 95% CI: 1.81-3.03; P < 0.001). Adherent patients showed lower values of total cholesterol compared with nonadherent patients at baseline (ADH: 200.3 mg/dL vs NOADH: 216.7 mg/dL; P < 0.001) and at the endpoint (ADH: 197.3 mg/dL vs NOADH: 212.2 mg/dL; P < 0.001). More patients enrolled in the INT group practices exercise at the end of the study (INT: +26.6 percent; P = 0.002), and a greater number of patients followed a diet to treat hypercholesterolemia (+30.2 percent; P < 0.001). CONCLUSIONS: The intervention performed by health professionals, especially by community pharmacists, improved adherence to statins by hypercholesterolemic patients, and this improvement in adherence was accompanied by a reduction in total cholesterol levels and a healthier lifestyle.


Assuntos
Clínicos Gerais/organização & administração , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Farmacêuticos/organização & administração , Idoso , Colesterol/sangue , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Espanha
7.
Int J Pharm Pract ; 27(1): 25-33, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29693292

RESUMO

INTRODUCTION: The Global Network of Age-friendly Cities is a project promoted by the World Health Organization as a response to demographic ageing and urbanization process. San Sebastian, Spain, is one of these Age-friendly Cities and community pharmacies of the city joined the initiative. OBJECTIVE: To define and implement the Age-friendly Pharmacy concept to promote active ageing, optimize the contribution of community pharmacies of San Sebastian to the friendliness of the city and to the improvement of quality of life of the ageing population. METHOD: A bottom-up participative approach was undertaken. A focus group was conducted to determine elderly people's opinions and expectations of community pharmacy. The information obtained was analysed using content analysis and validated for reliability, usefulness and applicability through three expert groups of community pharmacy owners and staff. KEY FINDINGS: Fifteen requirements were agreed, covering four main areas: relationships, pharmacy layout, pharmaceutical services and communication of services. Initially, 18 community pharmacies committed to become Age-friendly Pharmacies by pledging to these requirements and the Official Pharmacist Association of Gipuzkoa supported pharmacies in the implementation of the initiative. CONCLUSION: This study suggests that there is demand for a patient-centred community pharmacy to support older people, in which pharmaceutical care services are required. The 18 Age-friendly Pharmacies together with the Official Pharmacist Association of Gipuzkoa have publicly committed to actively work on social and patient-centred care to meet the needs of the ageing population.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Envelhecimento Saudável , Farmácias/organização & administração , Pesquisa Qualitativa , Qualidade de Vida , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Necessidades e Demandas de Serviços de Saúde/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/organização & administração , Reprodutibilidade dos Testes , Espanha
8.
Mol Nutr Food Res ; 61(6)2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28074613

RESUMO

Methylxanthines (MTXs) are consumed by almost everybody in almost every area of the world. Caffeine, theophylline and theobromine are the most well-known members of this family of compounds; they are present, inter alia, in coffee, tea, cacao, yerba mate and cola drinks. MTXs are readily absorbed in the gastrointestinal tract and are able to penetrate into the central nervous system, where they exert significant psychostimulant actions, which are more evident in acute intake. Coffee has been paradigmatic, as its use was forbidden in many diseases, however, this negative view has radically changed; evidence shows that MTXs display health benefits in diseases involving cell death in the nervous system. This paper reviews data that appraise the preventive and even therapeutic potential of MTXs in a variety of neurodegenerative diseases. Future perspectives include the use of MTXs to advance the understanding the pathophysiology of, inter alia, Alzheimer's disease (AD) and Parkinson's disease (PD), and the use of the methylxanthine chemical moiety as a basis for the development of new and more efficacious drugs.


Assuntos
Doenças Neurodegenerativas/tratamento farmacológico , Xantinas/farmacologia , Animais , Cacau/química , Cafeína/farmacologia , Café/química , Modelos Animais de Doenças , Humanos , Ilex paraguariensis/química , Metanálise como Assunto , Extratos Vegetais/farmacologia , Teobromina/farmacologia , Teofilina/farmacologia
9.
Respir Med ; 112: 1-9, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26880379

RESUMO

Caffeine, theophylline and theobromine are the most known methylxanthines as they are present in coffee, tea and/or chocolate. In the last decades, a huge experimental effort has been devoted to get insight into the variety of actions that these compounds exert in humans. From such knowledge it is known that methylxanthines have a great potential in prevention, therapy and/or management of a variety of diseases. The benefits of methylxanthine-based therapies in the apnea of prematurity and their translational potential in pediatric affections of the respiratory tract are here presented.


Assuntos
Apneia/tratamento farmacológico , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Tosse/tratamento farmacológico , Inibidores de Fosfodiesterase/uso terapêutico , Xantinas/uso terapêutico , Adolescente , Cafeína/uso terapêutico , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Teobromina/uso terapêutico , Teofilina/análogos & derivados , Teofilina/uso terapêutico
10.
Front Pharmacol ; 6: 30, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25750625

RESUMO

Cocoa consumption began in America and in the mid sixteenth Century it quickly spread to Europe. Beyond being considered a pleasant habit due to its rich sweet lingering taste, chocolate was considered a good nutrient and even a medicine. Traditionally, health benefits of cocoa have been related with the high content of antioxidants of Theobroma cocoa beans. However, the direct psychoactive effect due to methylxanthines in cocoa is notable. Theobromine and caffeine, in the proportions found in cocoa, are responsible for the liking of the food/beverage. These compounds influence in a positive way our moods and our state of alertness. Theobromine, which is found in higher amounts than caffeine, seems to be behind several effects attributed to cocoa intake. The main mechanisms of action are inhibition of phosphodiesterases and blockade of adenosine receptors. Further mechanisms are being explored to better understand the health benefits associated to theobromine consumption. Unlike what happens in other mammals -pets- included, theobromine is safe for humans and has fewer unwanted effects than caffeine. Therefore, theobromine deserves attention as one of the most attractive molecules in cocoa.

11.
Nutrients ; 5(10): 4159-73, 2013 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-24145871

RESUMO

One may wonder why methylxanthines are so abundant in beverages used by humans for centuries, or in cola-drinks that have been heavily consumed since their appearance. It is likely that humans have stuck to any brew containing compounds with psychoactive properties, resulting in a better daily life, i.e., more efficient thinking, exploring, hunting, etc., however, without the serious side effects of drugs of abuse. The physiological effects of methylxanthines have been known for a long time and they are mainly mediated by the so-called adenosine receptors. Caffeine and theobromine are the most abundant methylxanthines in cacao and their physiological effects are notable. Their health-promoting benefits are so remarkable that chocolate is explored as a functional food. The consequences of adenosine receptor blockade by natural compounds present in cacao/chocolate are here reviewed. Palatability and health benefits of methylxanthines, in general, and theobromine, in particular, have further contributed to sustain one of the most innocuous and pleasant habits: chocolate consumption.


Assuntos
Bebidas/análise , Cacau/química , Doces/análise , Xantinas/farmacologia , Cafeína/farmacologia , Humanos , Antagonistas de Receptores Purinérgicos P1/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Teobromina/farmacologia
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