ABSTRACT
INTRODUCTION AND OBJECTIVE: In 2015, the Spanish Society of Hospital Pharmacy (SEFH) launched the Strategic Map for Outpatient Pharmaceutical Care (MAPEX), with the purpose of adapting the activity offered in Hospital Pharmacy outpatient clinics to the new healthcare context. The aim of the present study was to analyse the evolution of outpatient pharmaceutical care in Hospital Pharmacy Services in Spain in the period 2016-2021 after the implementation and development of the MAPEX initiative. MATERIAL AND METHOD: The implementation and development of the project was carried out by a group of experts from SEFH and consisted of five phases: creation of the structure, consensus conference, situation analysis, development of strategic initiatives and evolutionary analysis. To analyse the evolutionary development, a specific 43-item questionnaire was developed that addressed aspects related to structure, context, integration, processes, outcomes and research and was answered in 2016 and 2021 (in the latter case by adding 3 additional questions). RESULTS: 141 hospitals participated in the status survey in 2016 and 138 in 2021. Significant differences were found in all dimensions analysed. None of the aspects assessed suffered a setback in this period. The most highly rated aspects at the general level were the improvement of the care model (65.0%) and at the local level, the incorporation of non-face-to-face pharmaceutical care (42.8%). Further progress in the coming years in the expansion and practical application of the methodology proposed in the project was considered a priority. CONCLUSIONS: The implementation and development of the MAPEX initiative has had a positive impact in terms of quality of care for outpatient pharmaceutical care in Hospital Pharmacy services in Spain.
Subject(s)
Pharmacy Service, Hospital , Humans , Outpatients , Spain , Ambulatory Care , Delivery of Health CareABSTRACT
Objetivo Desarrollar una sistemática de manejo de datos que permita estimar comparativamente la eficiencia de los diferentes esquemas de tratamiento antirretroviral (TAR).Método Estudio observacional retrospectivo en pacientes infectados por el VIH con TAR estable. Se determinó para cada paciente su adherencia y el coste unitario de su tratamiento. Se calculó el coste/paciente/día y, multiplicando por un factor de adherencia (fADH), el (coste/paciente/día)ADH. La comparación de ambos permitió obtener el Δcoste/paciente, que estima la desviación de costes originada por la falta de adherencia. Se calculó el coste-efectividad-incremental (CEI) agrupando los resultados en los diferentes fármacos coformulados («combos»). Se realizó un estudio de impacto presupuestario de dichos combos. Resultados Se evaluaron 468 pacientes (62% adherentes). La adherencia media fue de 88±18%. El valor medio del (coste/paciente/día)ADH fue significativamente superior al coste/paciente/día (27,3±9,8 frente 24,3±7,6, p<0 001 al igual que para el f ADH, no se encontraron diferencias en el Δcoste/paciente entre las diferentes combinaciones de TAR. El combo con menor desviación del coste/paciente/día debida a la falta de adherencia fue el constituido por abacavir/zidovudina/lamivudina (ABC/AZT/3TC,Δcoste/paciente=8,72±14,18%), y el de mayor desviación el AZT/3TC (Δcoste/paciente=13,52±17,68%). No se encontraron diferencias significativas en los CEI calculados para ningún combo. Los esquemas de TAR que incluyeron abacavir/lamivudina(ABC/3TC) obtuvieron el menor impacto presupuestario. Conclusiones (..) (AU)
Objective To develop a system of data management that allows us to estimate the comparative effectiveness of the various antiretroviral treatment (ART) regimens. Method Restrospective observational study in patients infected with HIV with stable ART. Adherence to treatment and unit cost for each patient's treatment was determined. The cost/patient/day was calculated and, multiplying by an adherence factor (fADH), the (cost/patient/day)ADH. The comparison of both allowed us to obtain the Δcost/patient, which estimates the additional costs caused by lack of adherence. The incremental cost-effectiveness (iCER), grouping the results by the various coformulated drugs (combos). A study of the budgetary impact of these combos was carried out.Results468 patients were evaluated (62% adherent). Average adherence was 88±18%. The average value of (cost/patient/day) ADH was significantly higher than the cost/patient/day (27.3 ± 9.8 compared to 24.3±7.6. p < 0.001). Just as with the fADH, no differences were found in the Δcost/patient between the different ART combinations. The combo with the least deviation from the cost/patient/day due to lack of adherence was that composed of abacavir/zedovudine/lamivudine (ABC/AZT/3TC,Δcost/patient=8.72±14.18%), and that with the greatest deviation AZT/3TC (Δcost/patient=13.52±17.68%). No significant differences were found in the iCER calcluated for any combo. The ART that included abacavir/lamivudine (ABC/3TC) obtained the least budgetary impact. Conclusions The greatest cost and percentage of adherent patients associated with the combos composed of Tenovovir/Emtricitabine(TDF/FTC) and ABC/3TC, and the least cost and effectiveness of those composed of AZT/#TC and ABC/AZT/3TC, does not allow us to identify any option as significantly dominant. The regimens with ABC/3TC were shown to be the most favourable from the combined point of view of cost and adherence (AU)
Subject(s)
Humans , Male , Female , Adult , Anti-Retroviral Agents/economics , Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , HIV Infections/economics , /statistics & numerical data , Costs and Cost Analysis , Retrospective StudiesABSTRACT
OBJECTIVE: To develop a system of data management that allows us to estimate the comparative effectiveness of the various antiretroviral treatment (ART) regimens. METHOD: Retrospective observational study in patients infected with HIV with stable ART. Adherence to treatment and unit cost for each patient's treatment was determined. The cost/patient/day was calculated and, multiplying by an adherence factor (fADH), the (cost/patient/day)(ADH). The comparison of both allowed us to obtain the Δcost/patient, which estimates the additional costs caused by lack of adherence. The incremental cost-effectiveness (iCER), grouping the results by the various coformulated drugs ("combos"). A study of the budgetary impact of these combos was carried out. RESULTS: 468 patients were evaluated (62% adherent). Average adherence was 88±18%. The average value of (cost/patient/day) (ADH) was significantly higher than the cost/patient/day (27.3±9.8 compared to 24.3±7.6. p<0.001). Just as with the f(ADH), no differences were found in the Δcost/patient between the different ART combinations. The combo with the least deviation from the cost/patient/day due to lack of adherence was that composed of abacavir/zedovudine/lamivudine (ABC/AZT/3TC,Δcost/patient=8.72±14.18%), and that with the greatest deviation AZT/3TC (Δcost/patient=13.52±17.68%). No significant differences were found in the iCER calculated for any combo. The ART that included abacavir/lamivudine (ABC/3TC) obtained the least budgetary impact. CONCLUSIONS: The greatest cost and percentage of adherent patients associated with the combos composed of Tenovovir/Emtricitabine(TDF/FTC) and ABC/3TC, and the least cost and effectiveness of those composed of AZT/#TC and ABC/AZT/3TC, does not allow us to identify any option as significantly dominant. The regimens with ABC/3TC were shown to be the most favourable from the combined point of view of cost and adherence.
Subject(s)
Anti-Retroviral Agents/economics , Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , HIV Infections/economics , Medication Adherence/statistics & numerical data , Adult , Costs and Cost Analysis , Female , Humans , Male , Retrospective StudiesABSTRACT
In the present work we set out to apply pharmacodynamic concepts derived from dose-response curves (Potency and Efficacy) to characterize the gene transfer efficiency of a vector:DNA complex. We employed two widely used vectors, the cationic lipid DOTAP (N,N, N-trimethyl 1-2-3-bis (1-oxo-9-octa-decenyl)oxy-(Z, Z)-1-propanaminium methyl sulfate) and the cationic polymer PEI (polyethylenimine, 800 kDa) to transfect several constructions of the green fluorescent protein cDNA. The analysis of dose-response curves indicated that in all cases the goodness-of-fit was > 0.99. Potency is a measure that provides information on gene activity per amount of DNA. Efficacy is a measure of maximum gene expression achievable using a specific vector:DNA complex, and depends on both the intrinsic efficacy of the gene (evaluated using different vectors to transfer the same gene construct) and on vector efficacy in DNA delivery (evaluated using a single vector to deliver different gene constructs). The results suggest that Potency and Efficacy are objective parameters for describing and comparing the goodness of vectors, as well as the intrinsic efficacy of a given gene construct. Furthermore, they are useful tools that may contribute to a better understanding of the mechanistic gene transfer process of each vector.
Subject(s)
DNA/genetics , Gene Transfer Techniques , Genetic Vectors , Animals , Anti-Bacterial Agents/pharmacology , Dose-Response Relationship, Drug , Fatty Acids, Monounsaturated/administration & dosage , Gentamicins/pharmacology , HeLa Cells , Humans , Mice , Plasmids/genetics , Quaternary Ammonium Compounds/administration & dosage , Tumor Cells, CulturedABSTRACT
1. The effect of the method employed to prepare liposomes and their lipid composition were evaluated in terms of the encapsulation efficiency and pharmacokinetic features of two oligodeoxynucleotides of a 21 mer: the normal (N-Odn) and the phosphorothioate (S-Odn) oligodeoxynucleotide. 2. Liposomes were prepared by the classical method of multilamellar vesicles (MV) and by the dehydration-rehydration method (DR). Two lipid mixtures were used to prepare liposomes--the predominant lipid being phosphatidylcholine (PC) and sphingomyelin (SM) respectively. 3. The DR method for liposome preparation provided the highest encapsulation efficiency, regardless of liposome lipid composition and the type of oligodeoxynucleotide involved (N-Odn or S-Odn). 4. The pharmacokinetics of free and liposome encapsulated oligodeoxynucleotides was studied in mouse following i.v. administration. Liposome encapsulated oligodeoxynucleotides exhibited a significantly lower plasma clearance and longer half-life and residence time than free oligodeoxynucleotides. The method used to obtain the liposomes affected plasma clearance, which was lower for liposomes elaborated by the DR method than for liposomes prepared with the MV method. The use of S-Odn in place of N-Odn decreased the plasma clearance of oligodeoxynucleotide when administered encapsulated in liposomes, regardless of the lipid composition and method used to obtain the liposomes.
