ABSTRACT
Objetivo: Evaluar la mejora en la adherencia terapéutica (AT) de una intervención basada en el seguimiento telefónico por parte del farmacéutico de atención primaria (FAP).Diseño: Ensayo clínico abierto aleatorizado con grupo control. Emplazamiento: Este estudio se realizó en el ámbito de la atención primaria por un equipo multidisciplinar de 13 centros de salud pertenecientes a 4 direcciones asistenciales de la Comunidad de Madrid durante el año 2021. Participantes: Pacientes polimedicados (60-74 años) que aceptasen participar y fueran clasificados como no adherentes según el test Morisky-Green. Se captaron 224 pacientes, de los cuales 87 fueron no adherentes. De estos se perdieron 15, aleatorizándose finalmente 72. Terminaron el estudio 71 pacientes, 33 en el grupo intervención y 38 en el grupo control. Intervenciones: Al grupo intervención se le incluyó en un programa de seguimiento telefónico que consistía en una entrevista para mejorar la adherencia en los meses 1, 2 y 3. Para evaluar la mejora se repetía el test Morisky-Green al 4.° mes. En el control únicamente se realizó el test de AT al 4.° mes. Mediciones principales: Adherencia, medida por el Morisky-Green al inicio y a los 4 meses. Resultados: En el grupo intervención el 72,7% de los pacientes pasaron a ser adherentes, mientras que en el grupo control el 34,2%, siendo la diferencia del 38,5% (IC 95%: 17,1-59,9) estadísticamente significativa (p=0,001). Conclusiones: Tras la intervención de seguimiento telefónico educacional-conductual a pacientes no adherentes por parte del FAP se mejora la AT de forma estadísticamente significativa en el grupo intervención respecto al grupo control.(AU)
Objective: Evaluate the improvement in therapeutic adherence of an intervention based on telephone monitoring by the primary care pharmacist. Design: Randomized open controlled trial. Location: This study was carried out in 2021 by a multidisciplinary team working with health professionals of thirteen health centers belonging to four health districts in Community of Madrid, Spain. ParticipantsThese were patients (60-74 years) with polipharmacy classified as non-adherent according to the Morisky-Green test. Two hundred and twenty-four patients were originally enrolled, 87 of them were non-adherents. Of these, 15 were lost and 72 were finally randomized. Seventy-one patients completed the study (33 intervention group and 38 control group). Interventions: Patients randomized to the intervention arm were included in a follow-up telephone program consisting of an interview at months 1, 2, and 3 to improve adherence. The Morisky-Green test was repeated at month 4 to assess improvement. In the control group this test was only performed at month 4. Main measurements: Adherence measured by Morisky-Green at baseline and at 4th month. Results: The 72.7% of patients in the intervention group became adherent while only 34.2% did in the control arm, being the difference 38.5% (95% CI: 17.1-59.9), statistically significant (P=.001). Conclusions: After a follow-up educational-behavioral telephone intervention in non-adherent patients by the primary care pharmacist, therapeutic adherence was improved statistically significantly in the intervention group compared with the control group.(AU)
Subject(s)
Humans , Male , Female , Aged , Primary Health Care/methods , Treatment Adherence and Compliance , Pharmacists , Telemedicine , Remote Consultation , SpainABSTRACT
Objetivo: Se planteó un estudio cuyo objetivo principal fue cuantificar el cambio en el número de pacientes con edad ≥74 años en tratamiento cróni-co con dosis altas de ácido acetilsalicílico (AAS) (> 150 mg), después de una estrategia de intervención del farmacéutico de atención primaria (FAP). Método: estudio transversal de intervención en pa-cientes ≥74 años con AAS >150 mg, dispensados en un periodo de 6 meses (enero-julio 2021), en 40 centros de salud. Resultados: 731 pacientes ≥74 años con dosis al-tas de AAS (3,6%). 56,6% mujeres, edad media=85,0 años (IC 95% 84,6-85,5); media de años con AAS > 150 mg = 6,5 (IC 95% 6,2-6,8). Se consiguió una reducción de la dosis en 394 pacientes (53,9%; IC 95% 50,2 -57,6). El número total de pacientes y porcentaje en el que la aceptación de la interven-ción fue mayor del 50% según el diagnóstico fue: insuficiencia venosa (n=8; 87,5%), enfermedad trombótica venosa (n=4; 75,0%), diagnóstico incier-to (n=56; 69,6%), fibrilación auricular (n=25; 64,0%), prevención primaria de enfermedad cardiovascular (n=102; 62,7%), arteriopatía periférica (n=22; 54,5%) y accidente cerebrovascular (n= 362; 51,7%). Un 17,2% (IC 95% 14,57-20,17) no estaban en trata-miento concomitante con un IBP. Conclusiones: a pesar de la evidencia científica, se siguen encontrando prescripciones de AAS a dosis altas en mayores, exponiéndoles a un mayor riesgo de hemorragias. Esta estrategia ha sido eficaz ya que ha permitido adecuar la dosis a más de la mi-tad de los pacientes. Los FAP pueden desempeñar una importante labor en la detección y resolución de potenciales reacciones adversas. (AU)
Objective: A study was proposed whose main ob-jective was to evaluate the variation in the number of patients aged ≥74 years in chronic treatment with high doses of acetylsalicylic acid (ASA) (> 150 mg), after a primary care pharmacist intervention strategy. Methods: It was carried out a cross-sectional and interventional study in ≥74 years old patients treat-ed with ASA >150 mg, dispensed in a period of 6 months (January-July 2021), in 40 health centers.Results: the total number of patients was 731. 56.6% women, mean age=85.0 years (95% CI 84.6-85.5); mean years on treatment with ASA > 150 mg = 6.5 (95% CI 6.2-6.8). A dose reduction was achieved in 394 patients (53.9%; 95% CI 50.2-57.6). The total number of patients and percentage in which the acceptance of the intervention was great-er than 50% according to the diagnosis was: ve-nous insufficiency (n=8; 87.5%), venous thrombotic disease (n=4; 75.0%), uncertain diagnosis (n=56; 69.6%), atrial fibrillation (n=25; 64.0%), primary pre-vention of cardiovascular disease (n=102; 62.7%), peripheral artery disease (n=22 54.5%), stroke (n= 362, 51.7%). 17.2% were not receiving concomitant treatment with a PPI. (IC)Conclusions: despite of the scientific evidence, prescription of a high dose of ASA is still occurring in older patients, increasing bleeding risk without any benefit. This strategy was effective since ASA dose was adjusted in more than half of the affected patients. Primary Care Pharmacists can play an important role in the detection and resolution of potential adverse effects. (AU)
Subject(s)
Humans , Male , Female , Aged , Aspirin , Pharmacists , Primary Health Care , Cross-Sectional StudiesABSTRACT
OBJECTIVE: Evaluate the improvement in therapeutic adherence of an intervention based on telephone monitoring by the primary care pharmacist. DESIGN: Randomized open controlled trial. LOCATION: This study was carried out in 2021 by a multidisciplinary team working with health professionals of thirteen health centers belonging to four health districts in Community of Madrid, Spain. PARTICIPANTS: These were patients (60-74 years) with polipharmacy classified as non-adherent according to the Morisky-Green test. Two hundred and twenty-four patients were originally enrolled, 87 of them were non-adherents. Of these, 15 were lost and 72 were finally randomized. Seventy-one patients completed the study (33 intervention group and 38 control group). INTERVENTIONS: Patients randomized to the intervention arm were included in a follow-up telephone program consisting of an interview at months 1, 2, and 3 to improve adherence. The Morisky-Green test was repeated at month 4 to assess improvement. In the control group this test was only performed at month 4. MAIN MEASUREMENTS: Adherence measured by Morisky-Green at baseline and at 4th month. RESULTS: The 72.7% of patients in the intervention group became adherent while only 34.2% did in the control arm, being the difference 38.5% (95% CI: 17.1-59.9), statistically significant (P=.001). CONCLUSIONS: After a follow-up educational-behavioral telephone intervention in non-adherent patients by the primary care pharmacist, therapeutic adherence was improved statistically significantly in the intervention group compared with the control group.
Subject(s)
Pharmacists , Treatment Adherence and Compliance , Humans , Telephone , Primary Health Care , Spain , Medication AdherenceABSTRACT
The aim of this study was to know the prevalence and severity of COVID-19 in patients treated with long-term macrolides and to describe the factors associated with worse outcomes. A cross-sectional study was conducted in Primary Care setting. Patients with macrolides dispensed continuously from 1 October 2019 to 31 March 2020, were considered. Main outcome: diagnosis of coronavirus disease-19 (COVID-19). Secondary outcomes: symptoms, severity, characteristics of patients, comorbidities, concomitant treatments. A total of 3057 patients met the inclusion criteria. Median age: 73 (64-81) years; 55% were men; 62% smokers/ex-smokers; 56% obese/overweight. Overall, 95% of patients had chronic respiratory diseases and four comorbidities as a median. Prevalence of COVID-19: 4.8%. This was in accordance with official data during the first wave of the pandemic. The most common symptoms were respiratory: shortness of breath, cough, and pneumonia. Additionally, 53% percent of patients had mild/moderate symptoms, 28% required hospital admission, and 19% died with COVID-19. The percentage of patients hospitalized and deaths were 2.6 and 5.8 times higher, respectively, in the COVID-19 group (p < 0.001). There was no evidence of a beneficial effect of long-term courses of macrolides in preventing SARS-CoV-2 infection or the progression to worse outcomes in old patients with underlying chronic respiratory diseases and a high burden of comorbidity.
ABSTRACT
Introducción: Tras la reciente publicación de la alerta de la Food and Drug Administration (FDA) que advierte sobre la posible aparición de dificultades respiratorias en pacientes con fármacos gabapentinoides y factores de riesgo respiratorio, se plantea un estudio cuyo objetivo principal es conocer la prevalencia de patología respiratoria crónica en mayores de 75 años, en tratamiento concomitante con gabapentinoides y opioides potentes. Material y métodos: Estudio transversal descriptivo realizado en pacientes >75 años con prescripción concomitante de gabapentinoides y opioides potentes, y al menos 3 envases dispensados en un periodo de 6 meses (julio-diciembre 2019), en 40 centros de salud. Resultados: Tras realizar muestreo, se analizaron 57 pacientes. Edad media=84,1 (DE 5,0) años; 82,5%mujeres. Un 25,3% de la población presentaba patología respiratoria crónica asociada. El promedio del Índice de comorbilidad Charlson fue=6,4 (DE 1,88). La indicación para patología lumbar se detectó en el 50,9% de la prescripción con gabapentinoides y 47,3% con opioides. Un 68,4% tenían incluido en su tratamiento otro depresor. Conclusiones: Los resultados muestran una población mayor frágil, con una elevada carga de comorbilidad. Alrededor de un cuarto de la muestra analizada ya presentaba patología respiratoria crónica, con lo que en estos pacientes el riesgo se incrementa notablemente. El uso de gabapentinoides y de opioides fue para la indicación de dolor lumbar en casi la mitad de los pacientes. La evidencia disponible en esta indicación es cuestionable y limitada. Por otro lado, el abordaje de tratamiento para dolor de tipo lumbar es complejo, y requiere un planteamiento global.(AU)
Introduction: following the recent publication of the Food and Drug Administration (FDA) alert, which warns about the possible occurrence of respiratory depression in patients with gabapentinoid drugs and respiratory risk factors, we present a study whose main objective is to know the prevalence of chronic respiratory diseases in patients over 75 years in concomitant treatment with gabapentinoids and potent opioids. Material and methods: it was carried out a descriptive cross-sectional study in patients >75 years with concomitant prescription of gabapentinoids and potent opioids, and at least three dispensed containers over a 6-month period (July-December 2019), in 40 primary health-care centers. Results: after sampling, 57 patients were analyzed. Average age=84.1 (SD 5.0) years; 82.5% women. 25.3% of the population had associated chronic respiratory pathology. The average of Charlson Comorbidity Index was=6.4 (SD 1.88). The indication for lumbar pathology was detected in 50.9% of the gabapentinoid prescription and 47.3% of opioid. Another depressant was included in their treatment, in 68.4% of patients. Conclusions: the results show a fragile population with a high burden of comorbidity. About a quarter of the sample analyzed had chronic respiratory pathology, which increases the risk significantly in these patients. Gabapentinoids and opioids were used for the indication of lumbar pain in almost half of the patients. The evidence available in this indication is questionable and limited. On the other hand, the treatment approach for lumbar-type pain is complex, and requires a global management.(AU)
