Free software to analyse the clinical relevance of drug interactions with antiretroviral agents (SIMARV®) in patients with HIV/AIDS.

BACKGROUND: Highly active antiretroviral therapy has extended the expected lifespan of patients with HIV/AIDS. However, the therapeutic benefits of some drugs used simultaneously with highly active antiretroviral therapy may be adversely affected by drug interactions. OBJECTIVE: The goal was to design and develop a free software to facilitate analysis, assessment, and clinical decision making according to the clinical relevance of drug interactions in patients with HIV/AIDS. METHODS: A comprehensive Medline/PubMed database search of drug interactions was performed. Articles that recognized any drug interactions in HIV disease were selected. The publications accessed were limited to human studies in English or Spanish, with full texts retrieved. Drug interactions were analyzed, assessed, and grouped into four levels of clinical relevance according to gravity and probability. Software to systematize the information regarding drug interactions and their clinical relevance was designed and developed. RESULTS: Overall, 952 different references were retrieved and 446 selected; in addition, 67 articles were selected from the citation lists of identified articles. A total of 2119 pairs of drug interactions were identified; of this group, 2006 (94.7%) were drug-drug interactions, 1982 (93.5%) had an identified pharmacokinetic mechanism, and 1409 (66.5%) were mediated by enzyme inhibition. In terms of clinical relevance, 1285 (60.6%) drug interactions were clinically significant in patients with HIV (levels 1 and 2). With this information, a software program that facilitates identification and assessment of the clinical relevance of antiretroviral drug interactions (SIMARV®) was developed. CONCLUSIONS: A free software package with information on 2119 pairs of antiretroviral drug interactions was designed and developed that could facilitate analysis, assessment, and clinical decision making according to the clinical relevance of drug interactions in patients with HIV/AIDS.

Investigación y conocimiento en Atención Farmacéutica: un binomio inseparable / No disponible

No disponible

Common health problems management uncertainties in heart failure: a qualitative study

Background: Medicine review with follow up quantitative studies conducted on heart failure (HF) outpatients detected health problems that were frequently treated insufficiently: hyperuricemia, gastric injury prevention, anemia, and diabetes mellitus. Objective: The aim of this qualitative study was to explore experiences in the pharmacological management of these health problems, and to contribute with strategies to overcome the identified obstacles. Methods: The internal medicine specialists and cardiologists of a tertiary hospital HF clinic underwent in-depth semi-structured interviews and a constant comparative approach was used. Results: Interviewees highlighted there is a lack of guidelines concerning the treatment of asymptomatic hyperuricemia in HF, thus in routine practice it is often not treated. Interviewees said that preventive strategies to avoid gastric injury in at-risk patients taking prophylactic low-dose aspirin are needed, but the most appropriate strategy is not well defined. Interviewees thought that structural support is needed for the management of HF patients with anemia, and proper clinic pathways should be created to identify which service patients should be referred to. The same lack of communication with other services appeared with diabetes mellitus. Conclusion: HF specialists demand a closer interaction with other specialists for a comprehensive approach to these polymedicated patients with multiple co-morbidities. And suggest that specific recommendations in HF guidelines to manage these co-morbidities specifically in HF would be helpful to shed light upon the existing confusing evidence (AU)

Antecedentes: Estudios de seguimiento farmacoterapéutico realizados en insuficiencia cardiaca (IC) detectaron problemas de salud insuficientemente tratados de manera frecuente: hiperuricemia, gastroprotección, anemia y diabetes mellitus. Objetivo: El objetivo de este estudio cualitativo fue explorar las experiencias de los médicos en el manejo farmacológico de estos problemas de salud, y contribuir con estrategias para solventar los obstáculos identificados. Métodos: Los especialistas en medicina interna y cardiología de la unidad de IC de un hospital terciario fueron entrevistados en profundidad con entrevistas semi-estructuradas utilizándose para su análisis el método de comparación constante. Resultados: Los entrevistados destacaron que hay una falta de guías sobre el tratamiento de la hiperuricemia asintomática en IC, por lo que en la práctica clínica generalmente no se trata. Los otros servicios apareció al hablar de la diabetes. Conclusión: Los especialistas en IC piden una interacción más cercana con otros especialistas para un abordaje más completo de estos pacientes polimedicados con múltiples comorbilidades. Y sugieren que sería de ayuda para aportar algo de luz en la confusa evidencia que existe el tener recomendaciones especí- ficas en las guías de IC para manejar estas comorbilidades en pacientes con IC en concreto (AU)

Efecto del seguimiento farmacoterapéutico en pacientes con hiperparatiroidismo secundario tratados con cinacalcet / Effect of pharmaceutical follow-up in patients with secondary hyperparathyroidism treated with cinacalcet

Objetivos: Evaluar el efecto de la intervención farmacéutica en la identificación de los problemas relacionados con medicamentos y en la mejora de los resultados clínicos deseados; evaluar la efectividad del cinacalcet para alcanzar los objetivos clínicos recomendados por la Guía Clínica KDOQI. Método Estudio cuasi experimental pre-post intervención. Pacientes con hiperparatiroidismo secundario a enfermedad renal crónica, con edad ≥ 18 años y en tratamiento con cinacalcet han sido seleccionados en la farmacia externa hospitalaria entre 2007-2009. El Método Dáder de Seguimiento Farmacoterapéutico y los cuestionarios de SMAQ y Moriski, para evaluar la adherencia, han sido usados en la primera entrevista. Tras el análisis de cada caso, el farmacéutico diseñaba la intervención adecuada. Los parámetros clínicos han sido consultados en la base de datos del laboratorio del hospital. Resultados Se incluyeron 34 pacientes, detectándose al inicio 29 problemas relacionados con medicamentos, entre ellos, la no adherencia ha sido el más común (15). Tras la intervención, restaron 9 problemas relacionados con medicamentos, lo que significa que 68,9% de ellos han sido resueltos (p < 0,001), alcanzando una adherencia del 80%. Los valores séricos de parathormona, calcio y CaxP disminuyeron significativamente tras 3 meses de tratamiento (p < 0,001, < 0,001 y 0,045, respectivamente), alcanzando las recomendaciones de la Guía Clínica KDOQI. Conclusión Esta intervención farmacéutica, simple y de fácil aplicabilidad, es efectiva en prevenir y resolver los problemas relacionados con medicamentos en estos pacientes, además de mejorar la adherencia al tratamiento y confirmar que cinacalcet es efectivo para lograr los resultados terapéuticos recomendados por la guía clínica KDOQI (AU)

Objectives: To assess the effect of pharmaceutical intervention in the identification of drug related problems, to improve desired clinical outcomes, and to evaluate the effectiveness of cinacalcet in achieving clinical outcomes recommended by the KDOQI Clinical Guidelines. Method: Quasi-experimental pre-post intervention study. Patients with Secondary Hyperparathyroidism due to Chronic Kidney Disease, aged ≥18 years and under treatment with cinacalcet were recruited at the hospital outpatient pharmacy between 2007 and 2009. Dáder follow-up method and SMAQ and Moriski questionnaires were used to verify adherence at the first interview. Then, the pharmacist analyzed each case and designed an adequate intervention. Clinical parameters were consulted in the hospital laboratory data base. Results: Thirty four patients were included, 29 drug-related problems were found before pharmacist intervention, and among these, non-adherence was the most common (15). After the intervention, 9 drug-related problems remained, which means that 68.9% of them were resolved (P<0.001), reaching an adherence of 80%. Parathyroid hormone, calcium and calcium phosphorus product serum levels decreased significantly after 3 months of treatment (P<0.001,<0.001 and 0.045, respectively), achieving the KDOQI Clinical Guideline recommendations. Conclusion: These results suggest that this simple and easy-to-apply intervention was effective in preventing and resolving drug-related problems in these patients. Moreover, it improved patient adherence and confirmed that cinacalcet treatmentis effective for achieving the clinical outcomes recommended by KDOQI clinical guidelines (AU)

Factores que influyen en la participación de farmacéuticos comunitarios en un servicio de atención farmacéutica para pacientes asmáticos / Factors affecting community pharmacists’ participation in a Pharmaceutical care service for asthmatic patients

Objetivo: Identificar, mediante el modelo PRECEDE, los factores predisponentes, facilitadores y reforzantes que influían en la participación de un grupo de farmacéuticos en el proyecto AFasma. Método: Estudio cualitativo mediante entrevistas semiestructuradas y observación participante de los farmacéuticos incluidos en el grupo de intervención del estudio AFasma. Resultados: Los factores predisponentes motivantes para el farmacéutico fueron: formación en asma, realización profesional, fidelización del paciente y valoración de la farmacia. Los factores desmotivantes fueron: dedicación de tiempo, ausencia de relación farmacéutico-médico, falta de personal y de publicidad, y dificultades para ofrecer el servicio. Los factores facilitadores presentes fueron: habilidades de comunicación farmacéuticopaciente, cumplimentación correcta de las hojas de recogida de datos, uso correcto del inhalador y pago por servicio. Por el contrario, se detectó: baja capacidad para ofertar el servicio, ausencia de una zona de atención personalizada, dudas con la valoración de la técnica de inhalación y educación en asma, y ausencia de implicación de todo el personal de la farmacia. Los factores reforzantes identificados con mayor frecuencia a favor de la realización del estudio fueron: satisfacción personal y profesional, mejora de la relación farmacéutico-paciente y actualización en farmacología, mientras que entre los identificados en contra el más frecuente fue la alta dedicación de tiempo requerida. Conclusiones: La utilización del modelo PRECEDE logró identificar los factores predisponentes, facilitadores y reforzantes que condicionaron la participación de un grupo de farmacéuticos en el estudio AFasma. Con los resultados obtenidos se podría diseñar un conjunto de estrategias para apoyar la realización de estudios similares y facilitar una posible implantación del servicio (AU)

Objective: Identify trough the PRECEDE model those factors predisposing, reinforcing and enabling the participation of a group of pharmacists in the AFasma project. Methods: Qualitative study through semi-structured interviews and participant observation of the pharmacists included in the intervention group of the AFasma project. Results: Predisposing factors motivating the pharmacist were: asthma training, professional satisfaction, patient loyalty and increase pharmacy value. Those desmotivating were: lack of time, lack of physician-pharmacist collaborative working relationship, lack of staff and marketing and difficulties in offering the service. Facilitating factors were: pharmacist-patient communication skills, ability to complete data forms, correct inhaler technique and payment for the service. In contrast, there was a lack of skills to offer the service to the patient, lack of a patient counseling area, doubts with the inhaler technique assessment and asthma non-pharmacological advice, and pharmacy staff not working as a team. Reinforcing factors supporting the service were: professional and personal satisfaction, improvement of the pharmacist-patient relationship, pharmacology training. The reinforcing factor against the service was the time spent during the project. Conclusions: Using the PRECEDE model we were able to identify the factors predisposing, facilitating and enabling the participation of a group of pharmacist in the AFasma project. With the factors identifi ed a number of strategies could be developed in order to support further studies and facilitate a potential implementation of the service (AU)

Common health problems management uncertainties in heart failure: a qualitative study.

BACKGROUND: Medicine review with follow up quantitative studies conducted on heart failure (HF) outpatients detected health problems that were frequently treated insufficiently: hyperuricemia, gastric injury prevention, anemia, and diabetes mellitus. OBJECTIVE: The aim of this qualitative study was to explore experiences in the pharmacological management of these health problems, and to contribute with strategies to overcome the identified obstacles. METHODS: The internal medicine specialists and cardiologists of a tertiary hospital HF clinic underwent in-depth semi-structured interviews and a constant comparative approach was used. RESULTS: Interviewees highlighted there is a lack of guidelines concerning the treatment of asymptomatic hyperuricemia in HF, thus in routine practice it is often not treated. Interviewees said that preventive strategies to avoid gastric injury in at-risk patients taking prophylactic low-dose aspirin are needed, but the most appropriate strategy is not well defined. Interviewees thought that structural support is needed for the management of HF patients with anemia, and proper clinic pathways should be created to identify which service patients should be referred to. The same lack of communication with other services appeared with diabetes mellitus. CONCLUSION: HF specialists demand a closer interaction with other specialists for a comprehensive approach to these polymedicated patients with multiple co-morbidities. And suggest that specific recommendations in HF guidelines to manage these co-morbidities specifically in HF would be helpful to shed light upon the existing confusing evidence.

[Effect of pharmaceutical follow-up in patients with secondary hyperparathyroidism treated with cinacalcet]. / Efecto del seguimiento farmacoterapéutico en pacientes con hiperparatiroidismo secundario tratados con cinacalcet.

OBJECTIVES: To assess the effect of pharmaceutical intervention in the identification of drug-related problems, to improve desired clinical outcomes, and to evaluate the effectiveness of cinacalcet in achieving clinical outcomes recommended by the KDOQI Clinical Guidelines. METHOD: Quasi-experimental pre-post intervention study. Patients with Secondary Hyperparathyroidism due to Chronic Kidney Disease, aged ≥18 years and under treatment with cinacalcet were recruited at the hospital outpatient pharmacy between 2007 and 2009. Dáder follow-up method and SMAQ and Moriski questionnaires were used to verify adherence at the first interview. Then, the pharmacist analyzed each case and designed an adequate intervention. Clinical parameters were consulted in the hospital laboratory data base. RESULTS: Thirty four patients were included, 29 drug-related problems were found before pharmacist intervention, and among these, non-adherence was the most common (15). After the intervention, 9 drug-related problems remained, which means that 68.9% of them were resolved (P<0.001), reaching an adherence of 80%. Parathyroid hormone, calcium and calcium-phosphorus product serum levels decreased significantly after 3 months of treatment (P<0.001, <0.001 and 0.045, respectively), achieving the KDOQI Clinical Guideline recommendations. CONCLUSION: These results suggest that this simple and easy-to-apply intervention was effective in preventing and resolving drug-related problems in these patients. Moreover, it improved patient adherence and confirmed that cinacalcet treatment is effective for achieving the clinical outcomes recommended by KDOQI clinical guidelines.

Effect of pharmaceutical intervention on medication adherence and blood pressure control in treated hypertensive patients: Rationale, design and methods of the AFenPA pilot study

Objective: To assess the effect of a protocol-based pharmacist intervention on blood pressure control and medication adherence among treated hypertensive patients who are users of community pharmacies.Methods: A quasi experimental study design with control group has been designed to compare the effect of pharmaceutical intervention (intervention group) versus the standard healthcare procedure (control group) on blood pressure and medication adherence among hypertensive patients receiving drug therapy in community pharmacies. The patients will be allocated evenly between the two groups (ncontrol = nintervention), with a 6-month follow-up. The pharmaceutical intervention program will comprise three main parts: 1) patient education / information on issues relating to hypertension and medication adherence; 2) self-monitoring of blood pressure; and 3) interaction with the physician through personalized reports when the mean blood pressure values recorded at home exceed the treatment goal according to the clinical condition of the patient. In order to evaluate the effect of the pharmaceutical intervention upon medication adherence and blood pressure, blood pressure recordings will be made in the pharmacy, while percent medication adherence will be established based on pill count in both groups at the start and end of the study.Discussion: To our knowledge, this is the first study in the community pharmacy setting in Spain to evaluate the effectiveness of pharmaceutical intervention in combination with home blood pressure monitoring on blood pressure control. In addition, the pharmaceutical intervention has been designed for inclusion as standard practice in the context of Pharmaceutical Care(AU)

Objetivo: Evaluar el efecto de una intervención farmacéutica protocolizada sobre el control de la presión arterial y la adherencia al tratamiento farmacológico en pacientes usuarios de farmacias comunitarias.Material y métodos: Estudio cuasi-experimental con grupo control en el que se comparará el efecto de una intervención farmacéutica (grupo intervención) con el proceso de atención habitual (grupo control), sobre la presión arterial y la adherencia al tratamiento de pacientes hipertensos tratados farmacológicamente en farmacias comunitarias. Los pacientes serán distribuidos de forma equitativa en ambos grupos (n control = n intervención) y serán seguido durante 6 meses. El programa de la intervención farmacéutica constará de tres partes fundamentales: 1) educación/información al paciente sobre aspectos relacionados con la hipertensión y adherencia al tratamiento farmacológico, 2) automonitorización de la presión arterial y, 3) interacción con el médico mediante informes personalizados cuando la media de las cifras de presión arterial realizadas en el domicilio superen el objetivo terapéutico acorde con la situación clínica del paciente. Para evaluar el efecto de la intervención farmacéutica sobre la adherencia terapéutica y la presión arterial se obtendrán medidas de presión arterial en la farmacia y porcentaje de cumplimiento terapéutico mediante recuento de comprimidos en ambos grupos al principio y al final del estudio.Discusión: Según nuestros conocimientos, éste es el primer estudio que se realiza en farmacia comunitaria en España para probar la efectividad de una intervención farmacéutica conjuntamente con la automedida de la presión arterial sobre el control de la presión arterial. Además, la intervención farmacéutica se ha diseñado de forma que pueda integrase como práctica habitual enmarcada dentro de la Atención Farmacéutica(AU)

Métodos de medida de la presión arterial disponibles en la farmacia comunitaria para el cribado y seguimiento de la hipertensión arterial / Available measurement methods of blood pressure at the community pharmacy for the screening and follow up of hypertension

La medida de la presión arterial (PA) en la consulta médica (PAC) ha sido durante muchos años el método de referencia para realizar el diagnóstico, seguimiento y tomar las decisiones clínicas en el manejo de la hipertensión arterial (HTA). Por otra parte, la medida de la PA en la farmacia comunitaria es un método poco estudiado y su utilidad en la práctica clínica es, cuando menos, desconocida. La aparición de la automedida domiciliaria de la PA (AMPA) y de la monitorización ambulatoria de la PA (MAPA) ha permitido superar muchas de las limitaciones inherentes a la medida de la PAC, principalmente al proporcionar múltiples medidas de PA exentas del efecto de bata blanca. Además, estos métodos han demostrado relacionarse más estrechamente que la medida de la PAC con el pronóstico cardiovascular y la lesión de órganos diana. En defi nitiva, la AMPA y la MAPA proporcionan una evaluación más precisa (p. ej., del riesgo cardiovascular o del efecto de los tratamientos antihipertensivos) y un mejor manejo del paciente con HTA. El presente artículo ofrece una visión actualizada sobre el interés de los distintos métodos de medida de la PA disponibles en la farmacia para el cribado y seguimiento del paciente hipertenso(AU)

The blood pressure (BP) measurement in the physician’s office has been for many years the gold standard for diagnosis, monitoring and making clinical decisions in the management of hypertension. On the other hand, few studies analyze the usefulness of the community pharmacy BP measurement method, which remains unknown in clinical practice. Home and ambulatory BP monitoring (HBPM and ABPM, respectively) have overcome many of the inherent limitations of the BP measurement at the physician’s office, mainly providing multiple BP readings exempt from the white coat effect. Additionally, these methods have shown to be better predictors of end-organ damage and cardiovascular outcome than BP measured in the physician’s offi ce. Finally, the use of HBPM or ABPM enables a more accurate assessment and an improved management of hypertension. This article provides an overview update on the interest of the different BP measurement methods available in the community pharmacy for the screening and monitoring of hypertensive patients(AU)

Implantación de un protocolo Farmacogenético del polimorfismo del GENE CYP3A5 y la respuesta a Tacrolimus en el trasplante renal / Implementation of a pharmacogenetics protocol of the CYP3A5 GENE polymorphisms and Tacrolimus response in kidney transplantation

Introducción: La monitorización de fármacos revela una gran variabilidad interindividual en la farmacocinética del Tacrolimus, principalmente en la dosis requerida para atingir los niveles sanguíneos terapéuticos y evitar la nefrotoxicidad tras el trasplante renal. La presencia del polimorfismo genético rs776746 del gene CYP3A5 resulta en la reducción de la actividad enzimática y, consecuentemente en la disminución del aclaramiento renal, aumentando su biodisponibilidad, la posibilidad de toxicidad y rechazo agudo del riñón. Objetivo: Generar una base de datos farmacogenéticos personalizada y complementaria a los datos clínicos estándares de los pacientes. Pacientes y método: Estudio observacional descriptivo transversal, pacientes mayores de 18 años en la lista de espera para el trasplante renal en el periodo de Enero a Mayo de 2010 en el Hospital Virgen de las Nieves de Granada. El ADN ha sido extraído de una muestra de sangre total y el polimorfismo del gen e CYP3A5 ha sido determinado por PCR seguida por secuenciación. Resultados: Setenta y nueve pacientes fueron genotipados, edad media de 57±13.4, 60% hombres. Los resultados del genotipado fueron: 77.2% CYP3A5 *3/*3 (homocigoto mutado) y 22.8% *1/*3(heterocigoto). Discusión: El 77.2% de los pacientes en la lista de espera para el trasplante de riñón en este hospital van a necesitar una dosis inicial de Tacrolimus cerca de 2 veces menor que los demás pacientes. Por lo tanto, con la traslación de este protocolo farmacogenético a la práctica clínica, se espera optimizar la terapia con Tacrolimus, así como contribuir al aumento de casos de éxito en los trasplantes renales(AU)

INTRODUCTION: drug monitoring reveals a great variability in the pharmacokinetics of tacrolimus, mainly in order to reach the required dose therapeutic blood levels and prevent nephrotoxicity after renal transplantation. The genetic polymorphism rs776746 of the CYP3A5 gene results in reduced enzymatic activity and consequently in decreased renal clearance, increasing its bioavailability, the possibility of toxicity and kidney acute rejection. OBJECTIVE: To create a personalized pharmacogenetic data base to complement the patient's standard clinical data. METHOD: Descriptive study, patients over 18 years in the waiting list for renal transplantation in the period from January to May 2010 at the Hospital Virgen de las Nieves de Granada. The DNA was extracted from a sample of whole blood and CYP3A5 gene polymorphism was determined by PCR followed by sequencing. RESULTADOS: Seventy-nine patients were genotyped, mean age 57±13.4, 60% men. The results of the genotyping were: 77.2% CYP3A5 *3/*3 (homozygous mutant) and 22.8% *1/*3 (heterozygous). DISCUSSION: The 77.2% of patients on the waiting list for kidney transplantation in this hospital will need an initial dose of tacrolimus about 2 times lower than other patients. Therefore, the translation of this protocol pharmacogenetics into clinical practice, is expected to optimize therapy with Tacrolimusand contribute to increased cases of successful kidney transplants(AU)

Revision sistemática sobre la implantación y la evaluación del seguimiento farmacoterapéutico en pacientes hospitalizados / Systematic review of the implementation and evaluation of Pharmaceutical Care in hospitalized patients(Pharmaceutical Care implementation in hospitalised patients. Systematic review)

Introducción: La persistencia de la morbimortalidad relacionada con la farmacoterapia del paciente ingresado hace necesario identificar evidencia científica sobre la implantación y evaluación del seguimiento farmacoterapéutico (SFT) a nivel hospitalario. Objetivo Realizar una revisión sistemática de la literatura para localizar, seleccionar y analizar estudios sobre la implantación y evaluación del SFT en pacientes hospitalizados. Material y métodos Se realizó una búsqueda de artículos relacionados con la farmacia clínica (FC) y el SFT publicados entre 1990 y 2006, mediante una estrategia de búsqueda restringida combinando todos los descriptores. Las bases de datos consultadas fueron Medline, Embase-Drug & Pharmacology y Cochrane Library. Se seleccionaron artículos originales y revisiones que describían un programa de SFT y de FC, que contaban con la participación del farmacéutico, que se hubieran efectuado en pacientes hospitalizados y que estuvieran disponibles en inglés o español. Resultados Se localizaron 66 publicaciones, incluyendo 49 (74,2%) y excluyendo 17 (25,8%). Se seleccionaron 15 (22,7%) sobre la integración entre la FC y el SFT en el ámbito hospitalario, 18 (27,3%) respecto a la implantación del SFT y 16 (24,2%) relacionadas con la evaluación de programas de SFT. Conclusiones En los estudios descritos, los farmacéuticos han logrado incorporar el SFT a las actividades asistenciales de los servicios de farmacia. Aunar esfuerzos para unificar los criterios de la FC y el SFT debe ser un plan para un futuro común en esta profesión. Del SFT, los pacientes atendidos deben obtener resultados en salud concretos y las instituciones hospitalarias deben reconocer sus efectos beneficiosos respecto a unos costes razonables (AU)

Introduction: The persistent morbidity and mortality related (..)(AU)

[Systematic review of the implementation and evaluation of Pharmaceutical Care in hospitalised patients(Pharmaceutical Care implementation in hospitalised patients. Systematic review)]. / Revision sistemática sobre la implantación y la evaluación del seguimiento farmacoterapéutico en pacientes hospitalizados.

INTRODUCTION: The persistent morbidity and mortality related to pharmaceutical treatment for hospitalised patients mean that it is necessary to identify scientific criteria for implementing and evaluating Pharmaceutical Care (phC) on the hospital setting. OBJECTIVE: The purpose of the study is to perform a systematic literature review in order to locate, select and analyse studies on implementing and evaluating phC in hospitalised patients. MATERIAL AND METHODS: We searched for articles having to do with clinical pharmacy (CP) and phC published between 1990 and 2006, using a restricted search technique combining all descriptors. The databases we searched were Medline, Embase-Drug & Pharmacology and Cochrane Library. We selected original articles and reviews in English or Spanish describing a phC and clinical pharmacy programme having a participating pharmacist and used in hospitalised patients. RESULTS: We located 66 publications, of which 49 (74.2%) were included and 17 (25.8%) were excluded. We selected 15 (22.7%) on integrating CP and phC in the hospital environment, 18 (27.3%) on implementing phC and 16 (24.2%) relating to evaluating phC programmes. CONCLUSIONS: In the listed studies, pharmacists have managed to incorporate phC programmes in pharmacy divisions' treatment activities. Joining efforts in order to unify CP and phC criteria should be a plan for a common future in this profession. Patients under care should obtain concrete health benefits from phC use, and hospitals should recognise that they create beneficial effects at a reasonable cost.

Aproximación para establecer y evaluar la relevancia clínica de las interacciones medicamentosas en pacientes infectados con virus de la inmunodeficiencia humana: actualización 2009 / Approach to establishing and evaluating clinical relevance of drugs interactions in HIV patients: 2009 update

Objetivo Actualizar información sobre interacciones medicamentosas en pacientes con VIH/sida. Método Se realizó una revisión en PubMed de artículos publicados en inglés y español entre el 1 de julio de 2007 y el 30 de abril de 2009 sobre interacciones de antirretrovirales en humanos. La búsqueda fue complementada con la revisión de interacciones de medicamentos utilizados frecuentemente en pacientes con VIH/sida y de referencias de artículos considerados relevantes. Resultados Se encontraron 52 nuevas interacciones relacionadas con el metabolismo por el CYP3A4 y la competencia por la absorción intestinal, también se encontraron nuevas interacciones de tipo farmacocinético para medicamentos que ya estaban en el mercado, y se reportaron interacciones para medicamentos recientemente comercializados: tipranavir, fosamprenavir, darunavir, raltegravir, maraviroc y etravirina. Conclusiones Hay evidencia de 52 nuevas interacciones, encontrándose medicamentos que utilizan vías metabólicas en el sistema enzimático CYP450, y se aclaran otras del proceso de absorción intestinal (AU)

Objective To update information on drug interactions in patients with HIV/AIDS. Method PubMed was used to review English and Spanish articles published between 1 July 2007 and 30 April 2009 on antiretroviral drug interactions in humans. The search included a review of interactions between commonly-used medications in patients with HIV/AIDS and references from articles considered to be relevant.Results52 new interactions were identified having to do with CYP3A4 metabolism and competition for intestinal absorption. New pharmacokinetic interactions were identified for medications that were already on the market, and we report interactions for drugs that were recently introduced: Tipranavir, Fosamprenavir, Darunavir, Raltegravir, Maraviroc and Etravirine. Conclusions There is evidence of 52 new interactions between medications using metabolic routes in the CYP450 enzymatic system, and an explanation is given for others in the intestinal absorption process (AU)

[Approach to establishing and evaluating clinical relevance of drug interactions in HIV patients: 2009 update]. / Aproximación para establecer y evaluar la relevancia clínica de las interacciones medicamentosas en pacientes infectados con virus de la inmunodeficiencia humana: actualización 2009.

OBJECTIVE: To update information on drug interactions in patients with HIV/AIDS. METHOD: PubMed was used to review English and Spanish articles published between 1 July 2007 and 30 April 2009 on antiretroviral drug interactions in humans. The search included a review of interactions between commonly-used medications in patients with HIV/AIDS and references from articles considered to be relevant. RESULTS: 52 new interactions were identified having to do with CYP3A4 metabolism and competition for intestinal absorption. New pharmacokinetic interactions were identified for medications that were already on the market, and we report interactions for drugs that were recently introduced: Tipranavir, Fosamprenavir, Darunavir, Raltegravir, Maraviroc and Etravirine. CONCLUSIONS: There is evidence of 52 new interactions between medications using metabolic routes in the CYP450 enzymatic system, and an explanation is given for others in the intestinal absorption process.

Enfermedades crónicas de alta prevalencia en una población asistida por la Seguridad Social / Highly prevalent chronic diseases in a population with Social Security coverage

Objetivo: Una de las prioridades sanitarias de las políticas europeas es la obtención de información sobre enfermedades crónicas y de alta prevalencia; ésta se encuentra limitada por la calidad de los datos disponibles. El objetivo del estudio fue describir el comportamiento de las enfermedades crónicas más prevalentes a través de bases de datos de gestión administrativa. Método: Estudio transversal retrospectivo sobre medicamentos fabricados industrialmente, dispensados y financiados total o parcialmente con fondos públicos por el Servicio de Salud deCastilla-La Mancha, a través de farmacias. El estudio se realizó durante 2003 y 2004 en el área de salud de Albacete y en él se aplicó la metodología recomendada por la Organización Mundial de la Salud para los estudios de utilización de medicamentos. El valor de la dosis diaria definida permitió conocer el número que contenía cada envase y el utilizado por 1.000 usuarios y por día, variable cuantitativa asimilable al concepto de tasa poblacional. Mediante la variable cualitativa, principio activo identificado por su código ATC, se agruparon medicamentos por indicación principal y se relacionaron con la variable cuantitativa. Resultados: La mayor prevalencia se observó en la hipertensión (27,3%: 24,2-36,7), las alteraciones del metabolismo lipídico (7,4%: 5,9-10,7) y la diabetes (6,8%: 5,9-9,7); se constató un incremento en todos los casos (del 8,9, el 27,5 y el 9,2%, respectivamente). Ambas situaciones destacan en los distritos dela sierra. Conclusiones: Es posible conocer cuál es la situación de las enfermedades crónicas de alta prevalencia, con bases de datos de gestión, mediante estudios de utilización de medicamentos. Su aplicación a ámbitos y periodos diferentes requiere la adopción de criterios metodológicos similares (AU)

Objective: One of the sanitary priorities in Europe is the obtaining of information about the high prevalence and chronic diseases, which is limited by the quality of the available information. The aim of the present study was to describe the behavior of the most prevalent chronic diseases using databases of administrative management. Method: We performed a retrospective, cross-sectional study of drugs made industrially, dispensation and financed, whole or partially with public funds, by the Health Service of Castilla-La Mancha, through pharmacies. The study was conducted between the years 2003 and 2004 in the health area of Albacete; in the study the methodology recommended by the World Health Organization WHO for conducting drug utilization studies was applied. The value of the defined daily dose allowed knowing the number contained in each package and the number of them used per thousand users and per day, quantitative assimilable variability to the population rate concept. Through the qualitative variable, active drug substance identified by ATC code, drugs with the same composition and principal indication were grouped, and they were related to the quantitative variable. Results: The greater prevalence was seen in hypertension(27.3%: 24.2-36.7), lipid metabolism alterations (7.4%: 5.9-10.7) and diabetes (6.8%: 5.9-9.7); an increase was established in all the cases (of 8.9%, of 27.5% and of 9.2%, respectively). Both situations stand out in the districts of the mountain range. Conclusions: It is possible to know the status of chronic diseases and high prevalence, with management databases, by means of studies of medication use. Its application to different areas and periods requires the adoption of similar methodological criteria (AU)

Adherence: a review of education, research, practice and policy in Spain / Cumplimiento: revisión de la educación, investigación, práctica y política en España

Aims: To describe medication adherence education, practice, research and policy efforts carried out by pharmacists in Spain in the last decade. Methods: A literature review using Medline and Embase was conducted covering the last ten years. Additional pharmaceutical bibliographic sources in Spain were consulted to retrieve articles of interest from the last decade. Articles were included if a pharmacist was involved and if medication adherence was measured or there was any direct or indirect pharmacist intervention in monitoring and/or improving adherence. Articles focusing on the development of tools for adherence assessment were collected. Pre- and post-graduate pharmacy training programs were also reviewed through the Spanish Ministry of Education and Science website. Information regarding policy issues was gathered from the Spanish and Autonomous Communities of Education and Health Ministries websites. Results: Pharmacists receive no specific training focused on adherence. There is no specific government policies for pharmacists in Spain related to medication adherence regardless of their practice setting. A total of 24 research studies met our inclusion criteria. Of these, 10 involved pharmacist intervention in monitoring and/or improving adherence and 14 assessed only adherence. Ten studies involved hospital pharmacists working in collaboration with another healthcare professional. Conclusions: At present in Spain, the investigative role of the pharmacist is not well developed in the area of medication adherence. Adherence improvement services provided to patients by pharmacists are not implemented in a systematic way. However, recent efforts to implement new initiatives in this area may provide the basis for offering new cognitive services aimed at improving patient adherence in the near future (AU)

Objetivo: Describir la educación, práctica e investigación sobre adherencia farmacológica llevadas a cabo en la última década por farmacéuticos en España. Métodos: Se hizo una revisión de la bibliografía de los últimos 10 años en Medline y Embase. Además, se consultaron otras fuentes bibliográficas farmacéuticas españolas para recuperar artículos de interés publicados en la última década. Los artículos se incluyeron si contaban con la participación de un farmacéutico y se medía la adherencia a la medicación, o si existía una intervención farmacéutica para monitorizar y/o mejorar la adherencia, de forma directa o indirecta. Se seleccionaron también los artículos que desarrollaban herramientas para la evaluación de la adherencia. También, se revisaron los programas de formación impartidos en pre y postgrado de farmacia. La evaluación de las políticas sobre este asunto se realizó analizando las páginas web de los Ministerios de Educación y de Sanidad y Política Social a nivel estatal, así como sus homólogos a nivel autonómico. Resultados: Los farmacéuticos no reciben formación ninguna enfocada específicamente a la adherencia. Tampoco existe política ni práctica sanitaria obligatoria que deban seguir los farmacéuticos independientemente del ámbito sanitario donde ejerzan su profesión. Respecto a la investigación, se encontraron 24 estudios que cumplieron con los criterios de inclusión. De ellos, 10 trataban de alguna intervención farmacéutica para monitorizar y/o mejorar la adherencia y 14 sólo pretendían evaluar la adherencia. En diez de los estudios, participaron farmacéuticos hospitalarios en colaboración con otro profesional de la salud. Conclusiones: Actualmente en España, la actividad investigadora del farmacéutico está poco desarrollada en el campo de la adherencia farmacológica. Los servicios que proporcionan los farmacéuticos a los pacientes para mejorar la adherencia no se implementan de forma generalizada. No obstante, parece ser que los esfuerzos que se están realizando últimamente para implantar nuevas iniciativas pueden constituir una base para que en un futuro cercano se comiencen a prestar servicios cognitivos encaminados a mejorar la adherencia de los pacientes (AU)

[Negative results related to drugs required in hospitalisation]. / Resultados negativos asociados con medicamentos como causa de ingreso hospitalario.

OBJECTIVE: To assess the prevalence of negative clinical outcomes associated with medication as a cause of hospital admission and to determine their characteristics (types, categories, avoidability, severity and the drug groups involved.) To determine possible risk factors related to the appearance of this problem. METHOD: An observational study carried out over a three month period in a department of the university hospital, 163 patients were selected at random. The information obtained from the patient interview, the revision of clinical records and clinical sessions were used to then identify negative clinical outcomes using the Dader method. RESULTS: In 27 cases (16.6 %; 95 % confidence interval [CI], 1.6 to 23.0), negative clinical outcomes associated with medication were considered to be the main cause of hospital admission. The most frequent negative clinical outcomes associated with medication were untreated health problems, non-quantitative ineffectiveness and quantitative safety problems respectively. The overall prevalence of preventable admissions due to negative clinical outcomes associated with medication was 88.9 %; (95 % CI, 71.9 to 96.1 %.) With regards to severity, 74.1 % (95 % CI, 55.3 to 86.1 %) of the total admissions were moderate. The most common drugs implicated in hospital admissions were: antibacterial for systemic use, cardiovascular and non steroidal anti-inflammatory agents. Apart from age, no other factors were found for hospital admissions due to negative results associated with medication. CONCLUSIONS: Negative clinical outcomes associated with medication as cause of hospital admission are a prevalent problem and most of them are avoidable with pharmacotherapeutic follow-up.

Resultados negativos asociados con medicamentos como causa de ingreso hospitalario / Negative results related to drugs required in hospitalisation

Objetivo: Estimar la prevalencia de resultados negativos asociados a medicamentos como causa de ingreso hospitalario y determinar sus características (dimensiones, tipos, evitabilidad, gravedad y grupos terapéuticos implicados). Buscar posibles factores asociados a la aparición de este problema. Método: Estudio observacional transversal, durante 3 meses, en una unidad del hospital universitario, seleccionando al azar mediante el método de extracción de bolas de una urna a 163 pacientes. La información obtenida de la entrevista con el paciente, de la revisión de historias clínicas y la procedente de las sesiones clínicas se empleaba para la identificación posterior de los resultados negativos asociados con medicamentos mediante el método Dáder. Resultados: En 27 de los 163 pacientes estudiados (16,6 %; intervalo de confianza [IC] del 95 %, 1,6-23,0), el ingreso fue causado principalmente por un resultado negativo asociado con los medicamentos. Los pacientes ingresaron por problemas de salud no tratados, inefectividades no cuantitativas e inseguridades cuantitativas respectivamente. Un 88,9 % (IC del 95 %, 71,9-96,1) de los ingresos por resultados negativos asociados con medicamentos fueron evitables. En cuanto a la gravedad, el 74,1 % (IC del 95 %, 55,3-86,1) fueron moderados. Los principales grupos farmacológicos implicados en los ingresos fueron antiinfecciosos sistémicos, fármacos relacionados con el aparato cardiovascular y antiinflamatorios no esteroideos. A excepción de la edad, no se encontraron factores asociados a la aparición de ingresos por resultados negativos asociados con medicamentos. Conclusiones: Los ingresos por resultados negativos asociados con medicamentos son un problema de elevada prevalencia y la mayoría son evitables mediante seguimiento farmacoterapéutico (AU)

Objective: To assess the prevalence of negative clinical outcomes associated with medication as a cause of hospital admission and to determine their characteristics (types, categories, avoidability, severity and the drug groups involved.) To determine possible risk factors related to the appearance of this problem. Method: An observational study carried out over a three month period in a department of the university hospital, 163 patients were selected at random. The information obtained from the patient interview, the revision of clinical records and clinical sessions were used to then identify negative clinical outcomes using the Dader method. Results: In 27 cases (16.6 %; 95 % confidence interval [CI], 1.6 to 23.0), negative clinical outcomes associated with medication were considered to be the main cause of hospital admission. The most frequent negative clinical outcomes associated with medication were untreated health problems, non-quantitative ineffectiveness and quantitative safety problems respectively. The overall prevalence of preventable admissions due to negative clinical outcomes associated with medication was 88.9 %; (95 % CI, 71.9 to 96.1 %.) With regards to severity, 74.1 % (95 % CI, 55.3 to 86.1 %) of the total admissions were moderate. The most common drugs implicated in hospital admissions were: antibacterial for systemic use, cardiovascular and non steroidal anti-inflammatory agents. Apart from age, no other factors were found for hospital admissions due to negative results associated with medication. Conclusions: Negative clinical outcomes associated with medication as cause of hospital admission are a prevalent problem and most of them are avoidable with pharmacotherapeutic follow-up (AU)

Application of the SCORE and Wilson-Grundy methods for the assessment of cardiovascular risk in community pharmacies.

BACKGROUND: The assessment and follow-up of patients with risk factors, or with cardiovascular disease (CVD), involves estimating and monitoring their CVD risk (CVDR). There are different opinions about the most appropriate method for this. OBJECTIVE: To compare the SCORE system and the Wilson-Grundy system (based on Framingham's study). METHODS: A descriptive, observational study over 15 days in six pharmacies, with patients aged between 25 and 74 years, and with a prescription for medications related to hypertension, dyslipidaemia, CVD prevention or type-2 diabetes. Results of patients' absolute CVDR were assessed and compared using the SCORE system and the Wilson-Grundy method, adapted for Spain. The Chi-square test was used to compare proportions, and the Student t-test was used to compare mean values, including odds ratios (OR) and 95% confidence intervals (95%CI). RESULT: A total of 257 patients [165 women, 92 men; mean (SD) age, 60.9 (10.8) years; percentage of previous medical history of hypertension (70.0%), dyslipidaemia (42.4%), type-2 diabetes (19.5%) and CVD (22.6%)] participated. With the CVDR assessed with SCORE, the distribution was as follows: low 35.8%, intermediate 21.0% and high 43.2%. The corresponding values using the Wilson-Grundy system was low 60.7%, intermediate 8.2% and high 31.1%. CONCLUSION: The cardiovascular risk of patients that attend community pharmacies with prescriptions for cardiovascular medications is significantly higher when assessed using the SCORE system than with the Wilson-Grundy method.