Assuntos
Antivirais , Tratamento Farmacológico da COVID-19 , COVID-19 , Carga Viral , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Administração Oral , Antivirais/administração & dosagem , Antivirais/farmacologia , Antivirais/uso terapêutico , COVID-19/terapia , SARS-CoV-2 , Carga Viral/efeitos dos fármacosRESUMO
INTRODUCTION: previous studies have shown that higher infliximab trough levels are associated with favorable short-term and long-term therapeutic outcomes in inflammatory bowel disease. There is a need to determine which patients could benefit from proactive therapeutic drug monitoring in the induction phase. The aim of this study was to evaluate the pharmacokinetic variability of infliximab, determine the factors associated with achieving target infliximab trough levels in the induction phase and analyze the clinical and biochemical response at week 26 of treatment. PATIENTS AND METHODS: a retrospective observational study was performed of patients with inflammatory bowel disease and data available on serum levels of infliximab during the induction period. The percentage of patients that achieved target infliximab trough levels at week 6 was determined. Clinical remission and response and biochemical remission were evaluated at week 26. RESULTS: thirty patients were included and only 13 (43.3 %) had infliximab trough levels > 15 µg/mL at week 6. A clinical response was observed during the maintenance period in 71.4 % of patients, their infliximab levels were significantly higher than in non-responders (6.3 µg/mL [IQR: 6.7] vs 1.0 µg/mL [IQR: 5.0], respectively; p = 0.016). Likewise, 53.6 % of patients achieved biochemical remission (responders 6.2 µg/mL [IQR: 5.2] vs non-responders 3.2 µg/mL [IQR: 5.0]; p = 0.031). CONCLUSION: less than half of patients had target infliximab levels during the induction period. Therapeutic drug monitoring during this period is related to the achievement of therapeutic levels of infliximab and may lead to a better clinical response in these patients.
Assuntos
Doença de Crohn , Doenças Inflamatórias Intestinais , Doença de Crohn/tratamento farmacológico , Monitoramento de Medicamentos , Fármacos Gastrointestinais/uso terapêutico , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Infliximab/uso terapêutico , Indução de Remissão , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: infliximab is used in inflammatory bowel disease, which has a great inter-individual pharmacokinetic variability. Thus, it is necessary to individualize the therapy in many cases. The main objective of our study was to compare two methods of a dose adjustment strategy using therapeutic drug monitoring: a) based on an algorithm and b) based on Bayesian prediction, to achieve an optimal infliximab trough level in patients with inflammatory bowel diseases. The secondary objective was to evaluate the predictive performance of a population pharmacokinetic model of infliximab in patients with inflammatory bowel diseases and therefore, its clinical utility. Furthermore, the factors associated with a suboptimal adjustment of the model were analyzed. METHODS: a retrospective observational cohort analysis was performed of patients with inflammatory bowel disease and available serum levels of infliximab. The relationship between trough concentration and dosing strategy was compared in both groups. The external validation of a previously published population pharmacokinetic model was performed using the NONMEM software. The mean prediction error and mean absolute prediction error were calculated to evaluate the predictive performance of the model. RESULTS: a total of 94 infliximab serum samples were obtained from 47 patients. After the adjustment, a total of 30 patients (63.8 %) achieved optimal infliximab trough levels. A dosing strategy based on Bayesian was associated with optimal infliximab trough levels that were higher than the strategy based on an algorithm (OR: 8.94 [95 % CI: 2.24 - 35.6], p = 0.001). For the individual predictions, the mean prediction error was 0.118 µg/ml (95 % CI: -0.149-0.384) and the mean absolute prediction error was 0.935 µg/ml (95 % CI: 0.569-1.075). CONCLUSIONS: the application of a population pharmacokinetic model based on Bayesian prediction is an important advance in the optimization of infliximab dosage in the treatment of inflammatory bowel disease.
Assuntos
Doenças Inflamatórias Intestinais , Teorema de Bayes , Monitoramento de Medicamentos , Fármacos Gastrointestinais/uso terapêutico , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Infliximab/uso terapêutico , Estudos RetrospectivosRESUMO
OBJECTIVE: To quantify and to evaluate the reliability of Primary Care (PC) computerised medication records of as an information source of patient chronic medications, and to identify associated factors with the presence of discrepancies. DESIGN: A descriptive cross-sectional study. LOCATION: General Referral Hospital in Murcia. PARTICIPANTS: Patients admitted to the cardiology-chest diseases unit, during the months of February to April 2013, on home treatment, who agreed to participate in the study. MAIN MEASUREMENTS: Evaluation of the reliability of Primary Care computerised medication records by analysing the concordance, by identifying discrepancies, between the active medication in these records and that recorded in pharmacist interview with the patient/caregiver. Identification of associated factors with the presence of discrepancies was analysed using a multivariate logistic regression. RESULTS: The study included a total of 308 patients with a mean of 70.9 years (13.0 SD). The concordance of active ingredients was 83.7%, and this decreased to 34.7% when taking the dosage into account. Discrepancies were found in 97.1% of patients. The most frequent discrepancy was omission of frequency (35.6%), commission (drug added unjustifiably) (14.6%), and drug omission (12.7%). Age older than 65 years (1.98 [1.08 to 3.64]), multiple chronic diseases (1.89 [1.04 to 3.42]), and have a narcotic or psychotropic drug prescribed (2.22 [1.16 to 4.24]), were the factors associated with the presence of discrepancies. CONCLUSIONS: Primary Care computerised medication records, although of undoubted interest, are not be reliable enough to be used as the sole source of information on patient chronic medications when admitted to hospital.
Assuntos
Doença Crônica/tratamento farmacológico , Registros Eletrônicos de Saúde/normas , Atenção Primária à Saúde , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Controle de Qualidade , Reprodutibilidade dos Testes , EspanhaRESUMO
Background Conventional therapy of inflammatory bowel disease with traditional immunosuppressant medication is increasingly being replaced by biological agents. However, the response to these biological agents may be lost over time, with discontinuation being a marker of loss of effectiveness. There are few published reports on the treatment drug survival of infliximab and adalimumab in patients with inflammatory bowel disease. Objective This study compared the drug survival of infliximab versus adalimumab as first- and second-line treatments, identified factors associated with drug survival, and described reasons for treatment withdrawal. Setting A pharmacy department of a university hospital in Spain. Method A retrospective single-centre cohort study of all patients with inflammatory bowel disease treated with biological agents between 2008 and 2017 at a regional referral hospital. The primary outcome was drug survival and associated factors during a follow-up of 52 months. Main outcome measure Drug survival of infliximab versus adalimumab. Results One hundred thirty-four patients with inflammatory bowel disease (73.9% Crohn's disease and 26.1% ulcerative colitis) were treated with biological therapy. The overall mean drug survival of first-line treatment with an anti-tumour necrosis factor agent was 18.6 months (SD 14.9), with mean values of 20.2 months (SD 16.6) for adalimumab and 17.1 months (SD 13.1) for infliximab. As a second-line treatment, the drug survival of anti-tumour necrosis factor agents was 17.9 months (SD 15.6), with mean values of 22.9 months (SD 17.1) for adalimumab and 12.5 months (SD 11.7) for infliximab. The difference in time to discontinuation at 52 months of follow-up between the infliximab and adalimumab subgroups, as either first- or second-line treatment, was not statistically significant (p = 0.547 and p = 0.676, respectively). Therapeutic drug monitoring was the only factor associated with greater drug survival in first-line treatment (HR 0.27; 95% confidence interval, CI 0.15-0.50) and second-line treatment (HR 0.26; 95% CI 0.10-0.65). Secondary failure to treatment was the most frequent reason for withdrawal. Conclusion Infliximab and adalimumab showed similar drug survival as first- and second-line anti-tumour necrosis factor treatments. Therapeutic drug monitoring was associated with higher drug survival for both first- and second-line anti-tumour necrosis factor treatments.
Assuntos
Adalimumab/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Monitoramento de Medicamentos/tendências , Fármacos Gastrointestinais/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Infliximab/uso terapêutico , Adalimumab/sangue , Adulto , Anti-Inflamatórios/sangue , Estudos de Coortes , Feminino , Seguimentos , Fármacos Gastrointestinais/sangue , Humanos , Doenças Inflamatórias Intestinais/sangue , Doenças Inflamatórias Intestinais/epidemiologia , Infliximab/sangue , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Resultado do Tratamento , Fator de Necrose Tumoral alfaRESUMO
OBJECTIVES: To analyze if the hypoglycemic therapy prescribed in the Emergency Department adapts to the consensus recommendations available, as well as to assess its clinical impact. METHODS: A descriptive observational study, which included patients awaiting hospital admission, who were in the Observation Ward of the Emergency Department and had been previously diagnosed with diabetes mellitus, and were receiving treatment with hypoglycemic drugs at home. The management of antidiabetic treatment and its clinical impact were assessed. RESULTS: 78 patients were included. At admission to the Emergency Department, treatment was modified for 91% of patients, and omitted for 9%. The most prescribed treatment was sliding scale insulin (68%). The treatments prescribed coincided in a 16.7% with the recommendations by the Spanish Society of Emergency Medicine. After intervention by the Pharmacist, the omission descended to 1.3%, and the adaptation to the recommendations increased to 20.5%. Comparing patients whose treatment coincided with the recommendations and those who did not, the clinical impact was respectively: mean glycemia at 24 hours: 138.3 } 49.5 mg/dL versus 182.7 } 97.1 mg/dL (p = 0.688); mean rescues with insulin lispro: } 1.6 versus 1.5 } 1.8 (p = 0.293); mean units of insulin lispro administered: 4.6 } 12.7 IU versus 6.6 } 11.3 IU (p = 0.155). CONCLUSIONS: We found antidiabetic prescriptions to have a low adaptation to consensus recommendations. These results are in line with other studies, showing an abuse of sliding scale regimen as single hypoglycemic treatment.
Objetivo: Analizar la adecuacion del tratamiento hipoglucemiante prescrito en el Servicio de Urgencias a las recomendaciones de consenso disponibles, asi como evaluar su repercusion clinica. Método: Estudio observacional descriptivo. Se incluyeron pacientes que se encontraban en la sala de observacion del Servicio de Urgencias pendientes de ingreso hospitalario, con diagnostico previo de diabetes mellitus y en tratamiento domiciliario con farmacos hipoglucemiantes. Se evaluo el manejo del tratamiento antidiabetico y su repercusion clinica. Resultados: Se incluyeron 78 pacientes. Al ingreso en el Servicio de Urgencias se modifico el tratamiento en el 91% de los pacientes, y se omitio en el 9%, siendo el tratamiento mas pautado los rescates con insulina rapida (68%). Los tratamientos prescritos se ajustaron en un 16,7% a las recomendaciones de la Sociedad Espanola de Medicina de Urgencias y Emergencias. Tras la intervencion del farmaceutico, la omision descendio al 1,3% y la adecuacion a las recomendaciones aumento al 20,5%. Comparando los pacientes cuyo tratamiento se ajusto a las recomendaciones y los que no, la repercusion clinica fue, respectivamente: media de glucemia a las 24 horas 138,3 } 49,5 mg/dL versus 182,7 } 97,1 mg/dL (p = 0,688); media de rescates con insulina lispro 1 } 1,6 versus 1,5 } 1,8 (p = 0,293); media de unidades de insulina lispro administradas 4,6 } 12,7 UI frente a 6,6 } 11,3 UI (p = 0,155). Conclusiones: Encontramos una baja adecuacion de las prescripciones de antidiabeticos a las recomendaciones de consenso. Estos resultados van en linea con otros estudios, objetivandose un abuso de las pautas de rescate con insulina rapida como unico tratamiento hipoglucemiante.
Assuntos
Diabetes Mellitus/tratamento farmacológico , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Hipoglicemiantes/uso terapêutico , Conduta do Tratamento Medicamentoso , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Insulina/uso terapêutico , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Collaboration between pharmacists and physicians in the care of patients with chronic kidney disease (CKD) may improve the quality of drug dosage regimens that require adjustment according to the renal function. OBJECTIVE: To demonstrate that the intervention of a pharmacist in a monitoring program for patients with CKD improves the outcome of renal function in these patients. Setting A 330-bed regional referral hospital in the city of Murcia (Spain). METHOD: All patients with CKD and taking nephrotoxic medication admitted to the internal medicine service were included in the study. Depending on the department of the hospital to which the patients were admitted, they were assigned to an intervention or control group. In the control group, the renal function at the time of admission and discharge was measured. In the intervention group, in addition to measuring kidney function at the time of admission and at discharge, the patients were followed daily and recommendation for dose adjustment were made when nephrotoxic drugs were not properly dosed. MAIN OUTCOME MEASURE: Glomerular filtration rate on admission and at discharge. RESULTS: A total of 249 patients were included in the study, 124 in the control group and 125 in the intervention group. Significant differences were noted when comparing creatinine clearance (CrCl) between discharge and admission in both the control and intervention groups (5.1 ± 0.9 vs. 6.4 ± 1.0 p < 0.01). In a comparison of the observed improvement in the two groups, we found significant differences in adjusted relative CrCl according to sex, age and stage (19.9 [1.2-38.5] p < 0.05). When the disease was analyzed by stage, we observed significant differences that favored the intervention group in regards CrCl (3.1 ± 2.1 vs. 7.9 ± 3.8 p < 0.05) and relative CrCl (16.1 ± 10.3 vs. 36.6 ± 16.7) in stages 4-5. The rate of acceptance of the pharmacists' recommendations was 74 %. CONCLUSION: The implementation of a monitoring program for CKD patients was effective in the group in which monitoring was conducted, especially in patients with more advanced stage of CKD.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Monitorização Fisiológica , Avaliação de Processos e Resultados em Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Farmacêuticos , Papel Profissional , Insuficiência Renal Crônica/tratamento farmacológico , Idoso de 80 Anos ou mais , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Estudos Prospectivos , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/psicologiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Acidente Vascular Cerebral/prevenção & controleRESUMO
TARGET: To evaluate the results of the implementation of a therapeutic reconciliation procedure (TRP) at admission by the emergency department (ED). METHODS: Prospective observational study conducted in the ED of a Referral Hospital Area. We collected the results of the implementation of a TRP from September to December 2012. A pharmacist attended daily to emergency department meeting and reviewed medical history to select those patients with high risk of reconciliation error (RE) according TRP. Afterwards, home medication history was elaborated with emergency department and primary care records and interview with the patient or caregiver. Therapeutic reconciliation took place with the emergency physician, considering RE any discrepancies not justified by the doctor. The potential severity of RE was assessed by emergency physicians outside the study using NCCMERP'S categorization. RESULTS: The pharmacist collected an avarage of 1,3±2,2 home medication more than the emergency physician finding 564 discrepancies with the emergency record in 95,8% of the patients. 167 were RE affecting 69 patients (71,9%). Most of the errors were due to omissions of the drugs. Acceptance by emergency physicians of the reconciliation interventions was 73,9%. 58% of the RE were considered clinically relevants. Other interventions were also performed with an acceptance of 97%. Greater compliance with risk criteria, polypharmacy and pluripathology were associated with present RE and prescription of high-risk medications with the need for intervention. CONCLUSIONS: The application of TRP avoided any error in most of the patients. TRP should extend to all patients at risk who admitted by the ED.
Objetivo: Evaluar los resultados de la implantación de un procedimiento de conciliación terapéutica (PCT) al ingreso hospitalario por el Servicio de Urgencias (SU). Método: Estudio prospectivo observacional realizado en el Servicio de Urgencias de un Hospital De Referencia de Área. Se recogieron los resultados de la aplicación del PCT de Septiembre a Diciembre de 2012.Un farmacéutico asistió diariamente al relevo de urgencias y revisó las historias clínicas,para seleccionar aquellos pacientes con mayor riesgo de error de conciliación (EC) según el PCT. Posteriormente, elaboró la historia farmacoterapéutica mediante la realizada en Urgencias, los registros de Primaria y entrevista con el paciente o su cuidador. La conciliación terapéutica se llevó a cabo con el urgenciólogo, considerándose EC cualquier discrepancia no justificada por el médico. La gravedad potencial de los EC fue valorada por urgenciólogos ajenos al estudio utilizando la categorización NCCMERP´S. Resultados: Se incluyeron 125 pacientes de los que 96 fueron conciliados. El farmacéutico recogió de media 1,3±2,2 medicamentos domiciliarios más que el médico encontrando 564 discrepancias con la anamnesis realizada en Urgencias en el 95,8% de los pacientes.167 se tradujeron en EC afectando al 71,9% de los pacientes. La mayoría de los errores fueron por omisión de medicamentos. La aceptación por el urgenciólogo de las intervenciones de conciliación fue del 73,9%. El 58% de los EC se consideraron clínicamente relevantes. Se realizaron también otras intervenciones con una aceptación del 97%.Un mayor cumplimiento de criterios de riesgo, polimedicación y pluripatología estuvieron asociados a presentar EC y la prescripción de Medicamentos Alto Riesgo a la necesidad de intervención. Conclusiones: La aplicación del PCT evitó potenciales errores de medicación clínicamente relevantes en la mayoría de los pacientes incluidos, que se beneficiaron además de otras intervenciones optimizando su farmacoterapia.
Assuntos
Serviço Hospitalar de Emergência , Reconciliação de Medicamentos , Admissão do Paciente , Idoso , Idoso de 80 Anos ou mais , Cuidadores , Feminino , Hospitais Universitários , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Prontuários Médicos , Preparações Farmacêuticas/classificação , Farmacêuticos , Polimedicação , Estudos Prospectivos , Fatores de Risco , Papel (figurativo) , Centros de Atenção TerciáriaAssuntos
Anafilaxia/tratamento farmacológico , Anafilaxia/etiologia , Antirreumáticos/efeitos adversos , Artrite Reumatoide/complicações , Certolizumab Pegol/efeitos adversos , Adulto , Anti-Inflamatórios/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Certolizumab Pegol/uso terapêutico , Hipersensibilidade a Drogas/complicações , Hipersensibilidade a Drogas/tratamento farmacológico , Feminino , Humanos , Hidrocortisona/uso terapêuticoRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Certolizumab Pegol/efeitos adversos , Anafilaxia/tratamento farmacológico , Artrite Reumatoide/complicações , Anticorpos Monoclonais Humanizados , Anafilaxia/diagnósticoRESUMO
OBJECTIVE: To analyze the prevalence of prescription drugs, previously selected, that should be monitored by their analytical test, and the rate of alteration in these tests, with the aim of establishing priorities to facilitate monitoring. METHOD: Prospective observational study in the Internal Medicine department of a referral hospital of 350 beds. In a first phase, we selected some drugs which analytical monitoring is recommended for the medical literature, and after that, we reviewed the pharmacological treatment of all patients admitted with any of these drugs. The study was conducted in the last two month of 2011. RESULTS: We included 271 patients, 128 (47%) were women. The mean age was 74.5 ± 14.4 years and the average stay of 7 ± 5.8 days. These patients accounted for 83% of all patients admitted to Internal Medicine during the study period. There were 828 drugs that must be monitored; each patient had an average of 3.1 ± 2.3. We reviewed 1837 analytical test, of which 401 (22%) were altered and 154 patients (57%) were affected for it. The pairs drug-analytical test altered most frequently found were creatinine increased and nephrotoxic drugs, hypokalemia in patients taking high efficiency diuretics and thrombocytopenia in patients treated with low molecular weight heparins. CONCLUSIONS: Our study highlights the importance of monitoring laboratory test associated with some drugs from the pharmacy department, as it demonstrates a high incidence of warning results. Our proposal for selection of drugs makes monitoring easier, and reaches large numbers of patients.
Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/organização & administração , Monitoramento de Medicamentos/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Departamentos Hospitalares/estatística & dados numéricos , Gestão de Riscos/organização & administração , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Contagem de Células Sanguíneas/estatística & dados numéricos , Análise Química do Sangue/estatística & dados numéricos , Monitoramento de Medicamentos/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Hospitais com 300 a 499 Leitos/estatística & dados numéricos , Departamentos Hospitalares/organização & administração , Humanos , Medicina Interna/organização & administração , Testes de Função Renal/estatística & dados numéricos , Laboratórios Hospitalares/organização & administração , Masculino , Estudos ProspectivosAssuntos
Antibacterianos/uso terapêutico , Dermatopatias Infecciosas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico , Teicoplanina/análogos & derivados , Toxidermias , Feminino , Humanos , Pessoa de Meia-Idade , Teicoplanina/uso terapêutico , Vancomicina/efeitos adversosRESUMO
OBJETIVO: Cuantificar y evaluar la fiabilidad de los registros electrónicos de medicación de Atención Primaria (AP) como fuente de información de la medicación crónica del paciente, así como identificar los factores asociados a la presencia de discordancias. DISEÑO: Estudio transversal descriptivo. EMPLAZAMIENTO: Hospital General de Referencia de un Área de Salud de la Región de Murcia. PARTICIPANTES: Pacientes ingresados en la unidad de Cardio-Neumología durante los meses de febrero a abril del 2013, con tratamiento domiciliario previo, que aceptaron participar en el estudio. MEDICIONES PRINCIPALES: Evaluación de la fiabilidad de los registros de AP analizando la concordancia, mediante la identificación de discrepancias, entre la medicación activa en dichos registros y la registrada mediante entrevista de un farmacéutico con el paciente/cuidador. Identificación de los factores asociados a la presencia de discrepancias analizados mediante una regresión logística multivariante. RESULTADOS: Se incluyó a 308 pacientes con una media ± desviación estándar de 70,9 ± 13,0 años. La concordancia en principios activos fue del 83,7%, disminuyendo al 34,7% al tener en cuenta la posología. Se encontraron discrepancias en el 97,1% de los pacientes, siendo las más frecuentes la omisión de pauta (35,6%), comisión (medicamento añadido injustificadamente) (14,6%) y omisión de medicamentos (12,7%). Ser mayor de 65 años (1,98 [1,08-3,64]), pluripatológico (1,89 [1,04-3,42]) y tener prescrito un estupefaciente o psicótropo (2,22 [1,16-4,24]) fueron los factores asociados a la presencia de discordancias. CONCLUSIONES: Los registros electrónicos de medicación de AP, aunque de indudable interés, pueden no ser lo suficientemente fiables como para poder ser utilizados como fuente única de información sobre la medicación crónica del paciente al ingreso hospitalario
OBJECTIVE: To quantify and to evaluate the reliability of Primary Care (PC) computerised medication records of as an information source of patient chronic medications, and to identify associated factors with the presence of discrepancies. DESIGN: A descriptive cross-sectional study. LOCATION: General Referral Hospital in Murcia. PARTICIPANTS: Patients admitted to the cardiology-chest diseases unit, during the months of February to April 2013, on home treatment, who agreed to participate in the study. MAIN MEASUREMENTS: Evaluation of the reliability of Primary Care computerised medication records by analysing the concordance, by identifying discrepancies, between the active medication in these records and that recorded in pharmacist interview with the patient/caregiver. Identification of associated factors with the presence of discrepancies was analysed using a multivariate logistic regression. RESULTS: The study included a total of 308 patients with a mean of 70.9 years (13.0 SD). The concordance of active ingredients was 83.7%, and this decreased to 34.7% when taking the dosage into account. Discrepancies were found in 97.1% of patients. The most frequent discrepancy was omission of frequency (35.6%), commission (drug added unjustifiably) (14.6%), and drug omission (12.7%). Age older than 65 years (1.98 [1.08 to 3.64]), multiple chronic diseases (1.89 [1.04 to 3.42]), and have a narcotic or psychotropic drug prescribed (2.22 [1.16 to 4.24]), were the factors associated with the presence of discrepancies. CONCLUSIONS: Primary Care computerised medication records, although of undoubted interest, are not be reliable enough to be used as the sole source of information on patient chronic medications when admitted to hospital
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Registros Eletrônicos de Saúde/instrumentação , Registros Eletrônicos de Saúde , Prescrições , Atenção Primária à Saúde , Reprodutibilidade dos Testes , Erros de Medicação/prevenção & controle , Tratamento Farmacológico , Quimioterapia Assistida por Computador/instrumentação , Quimioterapia Assistida por Computador/métodos , Segurança do Paciente , Doença Crônica/terapia , Epidemiologia Descritiva , Estudos Transversais/instrumentação , Estudos Transversais/métodos , Estudos de Avaliação como Assunto , EspanhaRESUMO
Objectives: To analyze if the hypoglycemic therapy prescribed in the Emergency Department adapts to the consensus recommendations available, as well as to assess its clinical impact. Methods: A descriptive observational study, which included patients awaiting hospital admission, who were in the Observation Ward of the Emergency Department and had been previously diagnosed with diabetes mellitus, and were receiving treatment with hypoglycemic drugs at home. The management of antidiabetic treatment and its clinical impact were assessed. Results: 78 patients were included. At admission to the Emergency Department, treatment was modified for 91% of patients, and omitted for 9%. The most prescribed treatment was sliding scale insulin (68%). The treatments prescribed coincided in a 16.7% with the recommendations by the Spanish Society of Emergency Medicine. After intervention by the Pharmacist, the omission descended to 1.3%, and the adaptation to the recommendations increased to 20.5%. Comparing patients whose treatment coincided with the recommendations and those who did not, the clinical impact was respectively: mean glycemia at 24 hours: 138.3 ± 49.5 mg/dL versus 182.7 ± 97.1 mg/dL (p = 0.688); mean rescues with insulin lispro: ± 1.6 versus 1.5 ± 1.8 (p = 0.293); mean units of insulin lispro administered: 4.6 ± 12.7 IU versus 6.6 ± 11.3 IU (p = 0.155). Conclusions: We found antidiabetic prescriptions to have a low adaptation to consensus recommendations. These results are in line with other studies, showing an abuse of sliding scale regimen as single hypoglycemic treatment (AU)
Objetivo: Analizar la adecuación del tratamiento hipoglucemiante prescrito en el Servicio de Urgencias a las recomendaciones de consenso disponibles, así como evaluar su repercusión clínica. Método: Estudio observacional descriptivo. Se incluyeron pacientes que se encontraban en la sala de observación del Servicio de Urgencias pendientes de ingreso hospitalario, con diagnóstico previo de diabetes mellitus y en tratamiento domiciliario con fármacos hipoglucemiantes. Se evaluó el manejo del tratamiento antidiabético y su repercusión clínica. Resultados: Se incluyeron 78 pacientes. Al ingreso en el Servicio de Urgencias se modificó el tratamiento en el 91% de los pacientes, y se omitió en el 9%, siendo el tratamiento más pautado los rescates con insulina rápida (68%). Los tratamientos prescritos se ajustaron en un 16,7% a las recomendaciones de la Sociedad Española de Medicina de Urgencias y Emergencias. Tras la intervención del farmacéutico, la omisión descendió al 1,3% y la adecuación a las recomendaciones aumentó al 20,5%. Comparando los pacientes cuyo tratamiento se ajustó a las recomendaciones y los que no, la repercusión clínica fue, respectivamente: media de glucemia a las 24 horas 138,3 ± 49,5 mg/dL versus 182,7 ± 97,1 mg/dL (p = 0,688); media de rescates con insulina lispro 1 ± 1,6 versus 1,5 ± 1,8 (p = 0,293); media de unidades de insulina lispro administradas 4,6 ± 12,7 UI frente a 6,6 ± 11,3 UI (p = 0,155). Conclusiones: Encontramos una baja adecuación de las prescripciones de antidiabéticos a las recomendaciones de consenso. Estos resultados van en línea con otros estudios, objetivándose un abuso de las pautas de rescate con insulina rápida como único tratamiento hipoglucemiante (AU)
Assuntos
Humanos , Diabetes Mellitus/tratamento farmacológico , Insulina/uso terapêutico , Hipoglicemiantes/uso terapêutico , Tratamento de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Assistência Farmacêutica/métodos , Adesão à Medicação/estatística & dados numéricos , Fatores de Risco , Reconciliação de Medicamentos/métodosRESUMO
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Assuntos
Feminino , Humanos , Masculino , Registros Eletrônicos de Saúde/organização & administração , Registros Eletrônicos de Saúde/tendências , Registros Eletrônicos de Saúde , Prescrição Eletrônica/estatística & dados numéricos , Prescrição Eletrônica/normas , Seguro de Serviços Farmacêuticos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Prescrições de Medicamentos/normas , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendênciasRESUMO
INTRODUCTION: previous studies have shown that higher infliximab trough levels are associated with favorable shortterm and long-term therapeutic outcomes in inflammatory bowel disease. There is a need to determine which patients could benefit from proactive therapeutic drug monitoring in the induction phase. The aim of this study was to evaluate the pharmacokinetic variability of infliximab, determine the factors associated with achieving target infliximab trough levels in the induction phase and analyze the clinical and biochemical response at week 26 of treatment. PATIENTS AND METHODS: a retrospective observational study was performed of patients with inflammatory bowel disease and data available on serum levels of infliximab during the induction period. The percentage of patients that achieved target infliximab trough levels at week 6 was determined. Clinical remission and response and biochemical remission were evaluated at week 26. RESULTS: thirty patients were included and only 13 (43.3 %) had infliximab trough levels > 15 μg/mL at week 6. A clinical response was observed during the maintenance period in 71.4 % of patients, their infliximab levels were significantly higher than in non-responders (6.3 μg/mL [IQR: 6.7] vs 1.0 μg/mL [IQR: 5.0], respectively; p = 0.016). Likewise, 53.6 % of patients achieved biochemical remission (responders 6.2 μg/mL [IQR: 5.2] vs non-responders 3.2 μg/mL [IQR: 5.0]; p = 0.031). CONCLUSION: less than half of patients had target infliximab levels during the induction period. Therapeutic drug monitoring during this period is related to the achievement of therapeutic levels of infliximab and may lead to a better clinical response in these patients
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Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Infliximab/administração & dosagem , Infliximab/farmacocinética , Fármacos Gastrointestinais/administração & dosagem , Fármacos Gastrointestinais/farmacocinética , Doenças Inflamatórias Intestinais/tratamento farmacológico , Estudos Retrospectivos , Indução de Remissão , Ensaio de Imunoadsorção Enzimática , Teorema de Bayes , Fatores de Tempo , Monitoramento de MedicamentosRESUMO
INTRODUCTION: infliximab is used in inflammatory bowel disease, which has a great inter-individual pharmacokinetic variability. Thus, it is necessary to individualize the therapy in many cases. The main objective of our study was to compare two methods of a dose adjustment strategy using therapeutic drug monitoring: a) based on an algorithm and b) based on Bayesian prediction, to achieve an optimal infliximab trough level in patients with inflammatory bowel diseases. The secondary objective was to evaluate the predictive performance of a population pharmacokinetic model of infliximab in patients with inflammatory bowel diseases and therefore, its clinical utility. Furthermore, the factors associated with a suboptimal adjustment of the model were analyzed. METHODS: a retrospective observational cohort analysis was performed of patients with inflammatory bowel disease and available serum levels of infliximab. The relationship between trough concentration and dosing strategy was compared in both groups. The external validation of a previously published population pharmacokinetic model was performed using the NONMEM software. The mean prediction error and mean absolute prediction error were calculated to evaluate the predictive performance of the model. RESULTS: a total of 94 infliximab serum samples were obtained from 47 patients. After the adjustment, a total of 30 patients (63.8 %) achieved optimal infliximab trough levels. A dosing strategy based on Bayesian was associated with optimal infliximab trough levels that were higher than the strategy based on an algorithm (OR: 8.94 [95 % CI: 2.24 - 35.6], p = 0.001). For the individual predictions, the mean prediction error was 0.118 Mug/ml (95 % CI: -0.149-0.384) and the mean absolute prediction error was 0.935 Mug/ml (95 % CI: 0.569-1.075). CONCLUSIONS: the application of a population pharmacokinetic model based on Bayesian prediction is an important advance in the optimization of infliximab dosage in the treatment of inflammatory bowel disease
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