Validated medication adherence questionnaires and associated factors in chronic patients: Systematic review. / Cuestionarios validados de adherencia a la medicación y factores asociados en pacientes crónicos: revisión sistemática.

OBJECTIVE: To identify validated questionnaires to assess medication adherence, and its associated factors, in adult patients with chronic pathologies. METHOD: A systematic review of scientific publications that describe validated medication adherence questionnaires in PubMed and Scopus was carried out during May 2022. The search strategy combined the MeSH Heading "Medication adherence" with the keywords: "Questionnaire" and "Validation"; adding "Spanish" to rescue questionnaires in our language. Systematic reviews, meta-analyses or scientific articles with full text available in Spanish or English were selected; published from January 2000 to April 2022; that present the application and validation of a medication adherence questionnaire in adults with chronic pathologies; and publications of the initial validation of a questionnaire, recovered through bibliographic citations of the previously identified publications, even if they are prior to the year 2000. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to represent the search process, inclusion and exclusion of the retrieved publications. RESULTS: Ninety-seven records in PubMed and 3 adding "Spanish" were retrieved; in Scopus, 334 records were retrieved and 13 with "Spanish". One hundred-eighteen records were retrieved through bibliographic citations identification. From the analysis of the previous publications, 14 validated questionnaires were identified that assess medication adherence and are applied in English and/or Spanish in adult patients with chronic pathologies. For each questionnaire, the following characteristics were described: name, authors, year of publication, dimensions (barriers and facilitators factors), number and wording of the items, response scale, form of administration, language and pathologies of the initial validation. Of the subsequent validations, only those carried out in English and/or Spanish were presented. So far, 6 questionnaires were validated in Spanish and only for certain chronic pathologies. CONCLUSIONS: 14 validated questionnaires were identified, 6 of them were validated in Spanish. They are designed to evaluate medication adherence in a comprehensive manner, being useful to be applied in hospital and community pharmaceutical services. This review provides health professionals with tools to develop and validate their own questionnaire, adapting the wording to the local language and context of the health system.

[Translated article] Validated questionnaires on medication adherence and associated factors in chronic patients: A systematic review.

OBJECTIVE: To identify validated questionnaires to assess medication adherence, and its associated factors, in adult patients with chronic pathologies. METHOD: A systematic review of scientific publications that describe validated medication adherence questionnaires in PubMed and Scopus was carried out during May 2022. The search strategy combined the MeSH heading "Medication adherence" with the keywords: "Questionnaire" and "Validation"; adding "Spanish" to rescue questionnaires in our language. Systematic reviews, meta-analyses, or scientific articles with full text available in Spanish or English were selected; published from January 2000 to April 2022; that present the application and validation of a medication adherence questionnaire in adults with chronic pathologies; and publications of the initial validation of a questionnaire, recovered through bibliographic citations of the previously identified publications, even if they are prior to the year 2000. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to represent the search process, inclusion and exclusion of the retrieved publications. RESULTS: (97) records in PubMed and 3 adding "Spanish" were retrieved; in Scopus, 334 records were retrieved and 13 with "Spanish". 118 records were retrieved through bibliographic citations identification. From the analysis of the previous publications, 14 validated questionnaires were identified that assess medication adherence and are applied in English and/or Spanish in adult patients with chronic pathologies. For each questionnaire, the following characteristics were described: name, authors, year of publication, dimensions (barriers and facilitators factors), number and wording of the items, response scale, form of administration, language, and pathologies of the initial validation. Of the subsequent validations, only those carried out in English and/or Spanish were presented. So far, 6 questionnaires were validated in Spanish and only for certain chronic pathologies. CONCLUSIONS: (14) validated questionnaires were identified, 6 of them were validated in Spanish. They are designed to evaluate medication adherence in a comprehensive manner, being useful to be applied in hospital and community pharmaceutical services. This review provides health professionals with tools to develop and validate their own questionnaire, adapting the wording to the local language and context of the health system.

[Oncology medications prescription in a cancer service: appropriateness to clinical practice guidelines]. / Prescripción de medicamentos oncológicos en un Servicio de Oncología: adecuación a las guías de práctica clínica.

OBJECTIVE: To assess prescription of oncology medications in municipal public health network of Rosario for its appropriateness to clinical practice guidelines. METHODS: Descriptive pharmacoepidemiological study in adult patients in an Oncology Service between January and June 2012. Compliance requirements with clinical practice guidelines were evaluated. RESULTS: 51.8% of diagnoses had at least one prescription medication that did not match recommendation by at least one of the guides considered. Prescriptions of doxorrubicine and ifosfamide did not agree with the recommendation of any reference guides. 5.4% of prescriptions weren´t considered by local guides, nor 7.7% by national on es. Regarding comparison with international guidelines: 4.2% of prescriptions weren ´t considered by the European Society for Medical Oncology guidelines, 2.3% not considered by the American Cancer Society and only 1.9% were not considered by the National Comprehensive Cancer Network ones. CONCLUSIONS: Prescription of oncology treatments is closer to international reference guides. One reason could be that there is still no standard definition in the management of tumor diseases by the National State.

Objetivo: Evaluar la prescripción de medicamentos oncológicos de la Red de Salud Pública Municipal de Rosario según su adecuación las guías de práctica clínica. Método: Estudio farmacoepidemiológico descriptivo en pacientes adultos en un Servicio Oncológico. Enero-junio 2012. Se evaluó la adecuación de las prescripciones a las guías de práctica clínica de referencia. Resultados: El 51,8 % de los diagnósticos tuvo al menos un medicamento prescripto que no coincidía con lo recomendado por al menos una de las guías consideradas. Las prescripciones de doxorrubicina e ifosfamida no coincidieron con lo recomendado por ninguna guía. El 5,4% de las prescripciones no estaban consideradas en las guías locales, el 7,7% no lo estaban en las nacionales y, respecto de las internacionales, el 4,2 % no estaban consideradas en la European Society for Medical Oncology, el 2,3% por el American Cancer Society y solo el 1,9% por la National Comprehensive Cancer Network. Conclusiones: La prescripción de oncológicos se adecúa más a las guías internacionales. Podría deberse a que no existe aún una definición estándar en el manejo de las patologías tumorales por parte del Estado Nacional.

[Validation of cold chain during distribution of parenteral nutrition]. / Validación de la conservación de la cadena de frío durante la distribución de mezclas de nutrición parenteral.

OBJECTIVE: this study aims to demonstrate the suitability of the process used to condition the extemporaneous mixtures of parenteral nutrition for distribution, considering the objective of preserving the cold chain during transport until it reaches the patient, necessary to ensure stability, effectiveness and safety of these mixtures. METHOD: concurrent validation, design and implementation of a protocol for evaluating the process of packaging and distribution of MNPE developed by a pharmaceutical laboratory. Running tests, according to predefined acceptance criteria. It is performed twice, in summer and on routes that require longer transfer time. Evaluation of conservation of temperature by monitoring the internal temperature values of each type of packaging, recorded by data loggers calibrated equipment. RESULTS: the different tests meet the established criteria. The collected data ensure the maintenance of the cold chain for longer than the transfer time to the most distant points. CONCLUSIONS: this study establishes the suitability of the processes to maintaining the cold chain for transfer from the laboratory to the patient pharmacist. Whereas the breaking of cold chain can cause changes of compatibility and stability of parenteral nutrition and failures nutritional support, this study contributes to patient safety, one of the relevant dimensions of quality of care the health.

Objetivo: el presente estudio tiene la finalidad de demostrar la aptitud del proceso empleado para acondicionar las mezclas de nutrición parenteral extemporáneas para su distribución, considerando el objetivo de conservar la cadena de frío durante el traslado hasta que llega al paciente, necesario para asegurar la estabilidad, efectividad y seguridad de estas mezclas. Método: validación concurrente; diseño e implementación de un protocolo de evaluación del proceso de acondicionamiento y distribución de MNPE elaboradas por un laboratorio farmacéutico. Ejecución de test, según criterios de aceptación predefinidos. Se efectúa en dos oportunidades, en verano y en las rutas que requieren un tiempo de traslado más prolongado. Evaluación de la conservación de la temperatura mediante supervisión de los valores de temperatura interna de cada tipo de empaquetado, registrados por equipos data loggers calibrados. Resultados: los diferentes test cumplen con los criterios preestablecidos. Los valores obtenidos permiten asegurar el mantenimiento de la cadena de frío durante un tiempo superior al traslado hasta los puntos más distantes. Conclusiones: este estudio permite mostrar la aptitud del proceso de acondicionamiento de MNPE para su distribución, manteniendo la cadena de frío durante todo el traslado desde el Laboratorio farmacéutico hasta el paciente. Considerando que la rotura de la cadena de frío puede ocasionar alteraciones de la compatibilidad y estabilidad de las nutriciones parenterales, así como fallas en el soporte nutricional, este estudio contribuye a la seguridad del paciente, una de las dimensiones relevantes de la calidad de la atención de la salud.

Antiepileptic drugs in Rett Syndrome.

PURPOSE: We investigated drugs most often used to treat epilepsy in Rett Syndrome and their efficacy in a large cohort of Italian patients. METHODS: This is a multi-centre retrospective study. Data of 165 Rett subjects were collected from the patients' files, and hospital charts. The efficacy of antiepileptic drugs (AEDs) was classified as follows: not effective; decrease in seizure frequency ≥50% for at least 6 months; seizure-free for at least 2 years. Phenotypic and genetic categorization of patients was performed and it was considered in AEDs efficacy evaluation. RESULTS: There were 130 epileptic patients.Sodium valproate (VPA) was the most commonly administered AED (44.3%) at seizure onset, followed by Carbamazepine (CBZ) (25.4%) and Phenobarbital (PB) (13%). Monotherapy was the first treatment option in most patients. VPA and CBZ proved to be equally effective in Rett patients who presented seizures within the typical age range (4-5 years), while Lamotrigine (LTG) was effective for patients in whom epilepsy started later. Overall, the frequency of side effects was low and the most often observed ones were restlessness and somnolence. CONCLUSION: Our study suggests that LTG, VPA and CBZ can be used as drugs of first choice in Rett Syndrome. The association of four drugs should be avoided since it did not result in any significant clinical improvement.

Validation of a patient satisfaction questionnaire for services provided in Spanish community pharmacies.

BACKGROUND: The concept of Pharmaceutical Care (PC) is being gradually developed, and it's impact in health care should be measured using a quality tool. OBJECTIVE: The aim of this study was to describe and assess the psychometric properties of a patient satisfaction questionnaire (PSQ) for PC services in community pharmacies in Seville, Spain. It was based on a previous questionnaire in Spanish. METHODS: The face and content validity were assessed using the items of a validated questionnaire developed by Traverso et al. and adapted to the Seville pharmacy patient population. The PSQ was designed for use in the community pharmacy setting by a panel of seven pharmacists with expertise in both PC and questionnaire design. The result, was a 'draft PSQ' which comprised of 27 multidimensional items, with responses recorded on a five-point 'Likert-type scale'. The validity and reliability of the 'final PSQ' was carried out using a cross-sectional and analytical study. Eighteen community pharmacies agreed to participate in the study. The draft PSQ was a self completion questionnaire distributed to patients by pharmacists following selection criteria. The survey response rate was assessed. The validity was determined by establishing the distribution of the PSQ's items and dimensions of the PSQ through factor analysis, and the reliability was evaluated with Cronbach's alpha coefficient (α). RESULTS: Two-hundred and twenty-three patients took part in the study.The factor analysis with varimax rotation established a 'final PSQ' with 24 items over two dimensions: Medication Therapy Management (MTM) and General satisfaction with the pharmacy/staff and services (GSP/SS) which extracted 63.5% of the variance. The internal consistency by α was 0.964 for the PSQ and 0.959 and 0.916 for the two dimensions, respectively. The median (mode) score for GSP/SS was 5.0 (5.0) and 4.0 (5.0) for MTM. The Wilcoxon-test indicated that the difference between these scores was statistically significant (P < 0.001). CONCLUSION: Our results suggest that the PSQ is a two dimensional instrument with psychometric properties able to assess patient satisfaction in community pharmacies. However, its validity and reliability need to be further confirmed in different PC settings and its sensitivity to measure changes in satisfaction over time also needs to be established.

[Antiretroviral drug supply in Argentina: National Program to Combat Human Retroviruses, AIDS, and STDs]. / Suministro de antirretrovirales en Argentina: Programa Nacional de Lucha contra los Retrovirus del Humano, SIDA y ETS.

OBJECTIVES: To evaluate the supply cycle of antiretroviral (ARV) drugs, overseen by the National Program to Combat Human Retroviruses, AIDS, and STDs, through its order fulfillment indicators, and to obtain input from supply chain stakeholders. METHODS: A study was carried out from April-September 2005 in the pharmacies of two hospitals in Rosario, Argentina, involving both a quantitative analysis of indicators and secondary sources and a qualitative evaluation using semistructured interviews. RESULTS: The indicators reveal the impact that interruptions in ARV supply stream from the Program (central level) have and the overstocking that takes place at the pharmacies (local level) to manage the shortages. Changes in ARV treatment account for over 50% of the prescriptions. Fulfillments fall short of the reference value. The interviewees shared possible strategies for overcoming the communication gaps between levels, for building-up stock, for guaranteeing availability, and for shortening waiting times; reached informal agreements to deal with the lack of policies and the shortage of staff; acknowledged the challenges facing the jurisdictions (central, intermediate, and local/community); and recognized local efforts to improve management. CONCLUSIONS: These challenges could be the starting point for building teams to work on effectively decentralizing the entire supply chain and allowing the Program to fulfill its much-needed oversight role.

Questionnaire to assess patient satisfaction with pharmaceutical care in Spanish language.

OBJECTIVE: To develop and validate a questionnaire, in Spanish, for assessing patient satisfaction with pharmaceutical care received in community pharmacies. DESIGN: Selection and translation of questionnaire's items; definition of response scale and demographic questions. Evaluation of face and content validity, feasibility, factor structure, reliability and construct validity. SETTING: Forty-one community pharmacies of the province of Santa Fe. Argentina. PARTICIPANTS: Questionnaire administered to patients receiving pharmaceutical care or traditional pharmacy services. MAIN OUTCOME MEASURE: Pilot test to assess feasibility. Factor analysis used principal components and varimax rotation. Reliability established using internal consistency with Cronbach's alpha. Construct validity determined with extreme group method. RESULTS: A self-administered questionnaire with 27 items, 5-point Likert response scale and demographic questions was designed considering multidimensional structure of patient satisfaction. Questionnaire evaluates cumulative experience of patients with comprehensive pharmaceutical care practice in community pharmacies. Two hundred and seventy-four complete questionnaires were obtained. Factor analysis resulted in three factors: Managing therapy, Interpersonal relationship and General satisfaction, with a cumulative variance of 62.51%. Cronbach's alpha for the whole questionnaire was 0.96, and 0.95, 0.88 and 0.76 for the three factors, respectively. Mann-Whitney test for construct validity did not showed significant differences between pharmacies that provide pharmaceutical care and those that do not, however, 23 items showed significant differences between the two groups of pharmacies. CONCLUSION: The questionnaire developed can be a reliable and valid instrument to assess patient satisfaction with pharmaceutical care in community pharmacies in Spanish. Further research is needed to deepen the validation process.

Instruments for measuring patient satisfaction with pharmacy services in the spanish language.

AIM OF THE REVIEW: The purpose of this paper is to identify and evaluate instruments used to assess patient satisfaction with pharmacy services available in the Spanish language, and specifically those designed to assess pharmaceutical care provided in community pharmacies. METHOD: A literature search was conducted in seven databases, using keywords: "patient satisfaction" and "Spanish" with and without the term "pharmacy". Publications that described the development or translation and/or adaptation of a questionnaire to assess patient satisfaction with pharmacy services in the Spanish language were retained. Publications were excluded if they were abstracts from conferences, reviews, letters or notes. The criteria used also excluded manuscripts where patient satisfaction was not assessed with a questionnaire. Instruments were evaluated according to evidence of the psychometric properties considered relevant: content validity, reliability and construct validity. RESULTS: While 83 publications describing instruments to measure patient satisfaction with health care services in the Spanish language were identified, only two pertained to satisfaction with pharmacy services. Both assessed patient satisfaction with pharmaceutical care. One questionnaire, developed in Spanish only, includes four dimensions that comprehensively assessed pharmaceutical care practice; however, its reliability was only partially evaluated. The other questionnaire was developed in both Spanish and English. It was considered narrower in scope, assessing satisfaction with the pharmacist only. However, evidence was provided that the two versions of the questionnaire were reliable, valid and linguistically equivalent. CONCLUSION: A comprehensive, reliable, and valid instrument for assessing patient satisfaction with pharmaceutical care in community pharmacies in the Spanish language is not yet available. The two published questionnaires that we have identified are a beginning, further research and development is needed.

Suministro de antirretrovirales en Argentina: Programa Nacional de Lucha contra los Retrovirus del Humano, SIDA y ETS / Antiretroviral drug supply in Argentina: National Program to Combat Human Retroviruses, AIDS, and STDs

OBJETIVOS: Evaluar el circuito de suministro de antirretrovirales (ARV) dentro del Programa Nacional de Lucha contra los Retrovirus del Humano, SIDA y ETS, mediante indicadores de desempeño, y recuperar la perspectiva de actores involucrados en el circuito de provisión. Se busca mejorar las acciones programáticas satisfaciendo las necesidades de los pacientes. MÉTODOS: En el servicio de farmacia de dos hospitales de Rosario, Argentina, de abril a septiembre de 2005 se llevó a cabo una investigación evaluativa con un abordaje cuantitativo, mediante indicadores y basado en fuentes secundarias, y otro cualitativo, con entrevistas semiestructuradas. RESULTADOS: Los indicadores revelan el impacto de las interrupciones en la provisión de ARV desde el Programa (nivel central) y la acumulación de stock en el nivel local para paliar esas faltas. Los cambios de tratamiento con ARV representan más de 50 por ciento de las prescripciones. El cumplimiento en el retiro de ARV se aleja del valor de referencia. Los entrevistados describieron estrategias alternativas para superar dificultades de comunicación entre niveles, acumular stock, garantizar disponibilidad y acortar tiempos de espera; se establecieron acuerdos informales ante la falta de normativas y la escasez de recursos humanos; las instancias jurisdiccionales (central, intermedia y local o municipal) suman dificultades, y se reconocen esfuerzos del nivel local para mejorar la gestión. CONCLUSIONES: Estos hallazgos pueden ser el punto de partida para la construcción de propuestas que involucren equipos de trabajo afectados en el circuito de provisión en su totalidad, a fin de lograr una descentralización efectiva, en congruencia con el papel rector que le corresponde necesariamente al Programa.

OBJECTIVES: To evaluate the supply cycle of antiretroviral (ARV) drugs, overseen by the National Program to Combat Human Retroviruses, AIDS, and STDs, through its order fulfillment indicators, and to obtain input from supply chain stakeholders. METHODS: A study was carried out from AprilSeptember 2005 in the pharmacies of two hospitals in Rosario, Argentina, involving both a quantitative analysis of indicators and secondary sources and a qualitative evaluation using semistructured interviews. RESULTS: The indicators reveal the impact that interruptions in ARV supply stream from the Program (central level) have and the overstocking that takes place at the pharmacies (local level) to manage the shortages. Changes in ARV treatment account for over 50 percent of the prescriptions. Fulfillments fall short of the reference value. The interviewees shared possible strategies for overcoming the communication gaps between levels, for building-up stock, for guaranteeing availability, and for shortening waiting times; reached informal agreements to deal with the lack of policies and the shortage of staff; acknowledged the challenges facing the jurisdictions (central, intermediate, and local/community); and recognized local efforts to improve management. CONCLUSIONS: These challenges could be the starting point for building teams to work on effectively decentralizing the entire supply chain and allowing the Program to fulfill its much-needed oversight role.

HOPE study impact on ACE inhibitors use.

BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors are used to treat cardiovascular diseases, major causes of death in Canada. The HOPE (Heart Outcomes Prevention Evaluation) study showed that ramipril benefits patients at high risk for cardiovascular disease. We analyzed ACE inhibitor use and costs in Canada before and after publication of HOPE. METHODS: We obtained pharmacy and hospital sales data for 1985-2001 from IMS Canada for all ACE inhibitors (Anatomical Therapeutic Category code C09A0) and for the 3 largest provinces (i.e., British Columbia, Quebec, Ontario). Prescription numbers, total costs, cost/prescription, and market share of individual ACE inhibitors were plotted over time and analyzed using regression. Canadian dollars were used to report costs. RESULTS: We examined 10 drugs; captopril was the first, introduced in 1985. Overall, prescriptions increased consistently from 356 000 in 1985 to 11.5 million in 2001, representing an annual increase of 660 000 (y = 661 410x-510 360; r(2) = 0.99). Total costs increased linearly from 1985 (14.5 million US dollars) to 2001 (513 million US dollars): Y = 29.3.10(6)x - 29.9.10(6); r(2) = 0.99. Provincial utilization patterns were also similar. Ramipril's national use increased dramatically from 1999 (822 000 prescriptions, 9.2% of all ACE inhibitors) to 2001 (3.8 million, 32.8% of all ACE inhibitors). National costs for ramipril increased exponentially (y = 1.08e(0.6248x)) to a total of 157 million US dollars in 2001, with the 3 major provinces accounting for 78.9%. Costs per prescription followed no observable trend (range 39.45-46.20 US dollars). CONCLUSIONS: The number of prescriptions and the total cost of ACE inhibitors increased over the period studied. Ramipril use increased in concert with publication of the HOPE trial, while the growth rates of other ACE inhibitors remained constant.