Adherence to antidiabetic treatment and impaired hypoglycemia awareness in type 2 diabetes mellitus assessed in Spanish community pharmacies: the ADHIFAC study.

INTRODUCTION: Adherence to treatment and hypoglycemia awareness are strongly linked to glycemic control and hypoglycemia risk in people with type 2 diabetes mellitus (T2DM). Community pharmacies are suitable facilities to detect these conditions, and should be involved in the strategies to minimize the associated risks and burden. RESEARCH DESIGN AND METHODS: This cross-sectional study conducted at community pharmacies across Spain assessed the prevalence of low adherence to antidiabetic treatments, the frequency of impaired hypoglycemia awareness, and their predictive factors. Adherence was measured with the 8-item Morisky Medication Adherence Scale (MMAS-8) and electronic records of dispensed treatments. The Clarke questionnaire was used to assess impaired hypoglycemia awareness. Healthcare counseling provided in the pharmacy was collected. RESULTS: Seventy-nine pharmacists and 618 subjects with T2DM participated in the study. Mean age in the overall T2DM population was 67 years, being the majority (69%) pensioners. Adherence was high in 41% of participants, medium in 35%, and low in 24% according to the MMAS-8. Impaired hypoglycemia awareness was observed in 25% of participants. Main determinants of low adherence were the level of education, the number of treatments per patient, hypoglycemia awareness, and the type of pharmacy. Predictive factors of impaired hypoglycemia awareness were the level of education, information on diabetes-related complications, adherence levels, and the type of pharmacy. The proportion of participants who had healthcare counseling was 71% in the overall population and 100% in subjects with impaired hypoglycemia awareness and low adherence. Healthcare counseling comprised diabetes education (69%), pharmacotherapeutic assessment (20%), and physician referrals (11%). CONCLUSION: Lack of adherence to antidiabetic treatments and impaired hypoglycemia awareness are frequent and correlate in T2DM. Community pharmacies can detect these conditions and should have an active role in the design of strategies to minimize them.

May Measurement Month 2019: an analysis of blood pressure screening results from Spain.

The aim of the May Measurement Month (MMM) is devoted to better understanding the awareness, treatment, and control rates of hypertension in Spain. Presented here are the data corresponding to 2019 campaign. In 2019, a total of 4433 patients (61.5% males) with a mean age of 54.8 years were included. Of all, 96.0% were Caucasian, and 3294 were recruited in pharmacies. The mean values of systolic blood pressure (BP) were 125.6 and of diastolic 76.7 mmHg in the whole population. The most recent previous BP measurement took place more than 1 year before in 27.6% of participants. A total of 1883 were hypertensive (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg or taking antihypertensive medication), of whom 77.2%/were aware and 71.1% were on medication. Of all, 64.9% of those on medication and 46.1% of all hypertensive participants had a BP controlled to <140/90 mmHg. These data from MMM 2019 continue to indicate the need for an improvement in the awareness, treatment, and control of hypertension in Spain.

Percepción de los usuarios de la farmacia comunitaria sobre la COVID-19 / Community pharmacy users' perception of COVID-19

OBJETIVOS: evaluar la percepción de los usuarios de las farmacias sobre la repercusión de la pandemia COVID-19 en su salud, el conocimiento sobre su posible inclusión en grupos de riesgo y su actitud ante una posible vacuna. MATERIAL Y MÉTODOS: estudio observacional transversal aleatorizado, en farmacias de Pontevedra y Ourense, desde marzo a junio de 2020 al comienzo y después de la restricción de movimientos. Sujetos: usuarios ≥ 18 años que acuden a las farmacias participantes en demanda de medicamentos y/o material de higiene y protección. Procedimiento: el usuario cumplimentaba un cuestionario anónimo, depositándolo hasta la noche en una bandeja de plástico desinfectada diariamente. El procedimiento se repetirá tras cesar el confinamiento. Resultados de la primera fase: se realizaron 706 encuestas. 415 (58,8 %) mujeres, edad media 48,9 (DE=16,9) años. 100 participantes (14,2 %) viven solos.637 (90,2 %) creen que la COVID-19 es más peligrosa que la gripe, 189 (26,8 %) desconocen estar en algún grupo de riesgo. 107 (15,1 %) dicen sentirse mal o muy mal con el aislamiento. Los aspectos más afectados son: familiar 350 (49,6 %) y emocional 338 (47,9 %). En 2019/20 se vacunaron de la gripe 172 (24,4 %) y en 2020/21 piensan vacunarse 243 (34,4 %). 448 (63,5 %) se vacunarán frente a la COVID-19 cuando exista vacuna, esté o no financiada por el Sistema Nacional de Salud, 183 (25,9 %) se lo pensarán. CONCLUSIONES: los encuestados consideran la COVID-19 más peligrosa que la gripe estacional. En esta primera fase la afectación sobre bienestar y salud no parece elevada. Un alto porcentaje se vacunará frente a la COVID-19

AIMS: to assess the pharmacy users' perception on the impact of the COVID-19 pandemic on their health, the knowledge of their possible inclusion in risk groups and their attitude towards a potential vaccine. MATERIAL AND METHODS: Randomized, cross-sectional, observational study in pharmacies of Pontevedra and Ourense, from March to June 2020 at the beginning and after movement restrictions. Subjects: users ≥ 18 years old who go to the participating pharmacies to purchase medicines and/or hygiene and protection material. Procedure: the user completed an anonymous questionnaire, which was then placed until night in a plastic tray that was disinfected daily. The procedure will be repeated after the confinement has been terminated. Results of the first phase: 706 surveys were conducted. 415 (58.8%) women, aged 48.9 9 years on average (SD=16.9). 100 participants (14.2%) live alone. 637 (90.2%) believe that COVID-19 is more dangerous than influenza, 189 (26.8%) don't know if they belong to any risk group. 107 (15.1%) say they feel bad or very bad about isolation. The most affected aspects are: familiar 350 (49.6%) and emotional 338 (47.9%). In 2019/20, 172 (24.4%) were vaccinated against influenza and in 2020/21 243 (34.4%) are planning to get vaccinated. 448 (63.5%) will be vaccinated against COVID-19 when the vaccine is available, whether or not it is financed by the National Health System, and 183 (25.9%) will think about it. CONCLUSIONS: respondents consider COVID-19 more dangerous than seasonal influenza. In this first phase, the impact on well-being and health does not seem to be high. A high percentage of people will be vaccinated against COVID-19

Preferencias de formación de los farmacéuticos comunitarios de la provincia de Pontevedra / Training preferences of the community pharmacics of the province of Pontevedra (Spain)

OBJETIVOS: Conocer las preferencias de los farmacéuticos comunitarios (FC) de Pontevedra en relación con la formación continuada, qué materias despiertan mayor interés y posibles relaciones entre preferencias y características demográficas. MÉTODOS: Estudio observacional transversal realizado en diciembre 2017 y enero 2018. Participaron farmacéuticos colegiados en Pontevedra ejercientes en farmacias comunitarias. El tamaño muestral se calculó para una precisión del 10,0%, un intervalo de confianza para poblaciones finitas al 95% bilateral, y una población de 495 titulares y 768 adjuntos, en 72 titulares y 75 adjuntos. Se elaboró una encuesta que se pilotó con seis FC, se hicieron las modificaciones resultantes del pilotaje y se difundió a todos los FC colegiados, que la cumplimentaron en la web del Colegio o impresa. RESULTADOS: Se recibieron 261 cuestionarios (77 titulares, 29,5% y 184, 70,5% adjuntos), correspondientes al 20,7% de los colegiados ejercientes en farmacia comunitaria. El 62,5% cree que no tiene suficiente formación. Las materias formativas más demandadas fueron Farmacología/Farmacoterapia, 206 FC (78,9%), Nutrición, 175 (67,0%) y Servicios Profesionales Farmacéuticos, 161 (61,7). La modalidad semipresencial (contenidos teóricos online y talleres presenciales) (48,3%), frecuencia trimestral (47,9%), duración de 20-30 horas/año (48,7%), y obligatoriedad de un mínimo de créditos anuales (46,0%) son las opciones preferidas. Para el 69,0% la duración de los talleres presenciales debe ser entre 1 y 4 horas. La organización de la formación continuada debe estar a cargo del Colegio. CONCLUSIONES: El estudio permitirá elaborar programas formativos dirigidos a los colegiados ejercientes en farmacias comunitarias mejor adaptados a sus necesidades y preferencias

OBJECTIVES: To know the preferences of the community pharmacists (CP) of Pontevedra in relation to continued education, which subjects arouse the greatest interest and possible relationships between preferences and demographic characteristics. METHODS: Cross-sectional observational study in December 2017 and January 2018. Collegiate community pharmacists participated in Pontevedra. The sample size was calculated for an accuracy of 10.0%, a confidence interval for finite populations at 95% bilateral and a population of 495 holders and 768 attached, in 72 holders and 75 attached. A survey was prepared and piloted with six CPs, the modifications resulting from the piloting were made and disseminated to all collegiate CPs, who completed it on the College website or printed. Outcomes: 261 questionnaires (77 holders, 29.5% and 184, 70.5% attached) were received, corresponding to 20.7% of the collegiate pharmacists working in a community pharmacy. 62.5% think they don't have enough training. The most demanded training subjects were Pharmacology/Pharmacotherapy, 206 CP (78.9%), Nutrition, 175 (67.0%) and Professional Pharmaceutical Services, 161 (61.7). Semi-presencial modality (online theoretical content and face-to-face workshops) (48.3%), quarterly frequency (47.9%), duration of 20-30 hours/year (48.7%), and mandatory minimum annual credits (46.0%) are the preferred options. For 69.0% the duration of the face-to-face workshops should. be between 1 and 4 hours. The organization of the countinuated education must be in charge of the College. Conclussions: The study will allow to develop training programs targeted to the CPs who are members of the College and practice in community pharmacies. These programs will be better adapted to their needs and preferences

Vacunación antigripal en la farmacia comunitaria: opinión de pacientes y farmacéuticos / Influenza vaccination in the community pharmacy: opinion of patients and pharmacists

Objetivos: Conocer la opinión de pacientes y farmacéuticos comunitarios (FC) sobre la posible administración de la vacuna antigripal en farmacias y comprobar si una campaña educativa consigue mejorar la intención de vacunación. Material y métodos: Estudio observacional con intervención educativa. Sujetos: usuarios de la farmacia mayores de 45 años. FC ejercientes en la provincia de Pontevedra. Variables pacientes: Demográficas, pertenencia a grupo de riesgo, intención de vacunación antes/después de la intervención, opinión sobre la vacunación en la farmacia. Variables FC: Demográficas, opinión sobre la vacunación por el FC, necesidad de formación, a quién correspondería la acreditación. Procedimiento: Al participante se le explicaba el propósito del estudio y a los no vacunados se les informaba de los beneficios de vacunarse. A 200 FC de Pontevedra se les envió un cuestionario ad hoc. Resultados: Se entrevistó a 157 usuarios, 134 (85,4%) a favor de la vacunación por el FC. Sin diferencias entre sexos, estudios, ni pertenencia a grupo de riesgo. Tras la intervención, de 92 que no pensaban vacunarse, 27 (29,6%) decidieron acudir a hacerlo. 93 respuestas de FC (46,5%). 63 (67,7%) a favor de la vacunación por el FC, con diferencias significativas entre titulares/adjuntos (p<0,05) y socios/no socios de SEFAC (p<0,05). 82 (88,2%) FC opinan que se necesita formación específica para la actividad. Conclusiones: La opinión de que la farmacia debe ser punto de administración de la vacuna antigripal es mayoritaria entre pacientes y farmacéuticos, significativamente mayor en titulares y socios de SEFAC. La intención de vacunación mejoró en un 29,4%

Objectives: To find out the opinion of patients and community pharmacists (CPs) regarding the possible administration of the influenza vaccine in pharmacies and to verify whether an educational campaign manages to improve vaccination intention. Material and methods: Observational study with educational intervention. Subjects: pharmacy users over 45 years old. Practicing CPs in the province of Pontevedra. Patient variables: demographic, membership of the risk group, vaccination intention before/after the intervention, opinion about being vaccinated at the pharmacy. CP variables: demographic, opinion on vaccination by the CP, need for training, to whom the accreditation would correspond. Procedure: the participant was explained the purpose of the study and those who had not been vaccinated were informed of the benefits of getting vaccinated. Two hundred CPs from Pontevedra were sent an ad hoc questionnaire. Results: One hundred fifty-seven users were interviewed, 134 (85.4%) were in favor of being vaccinated by the CP. No differences between sexes, studies, or belonging to a risk group. After the intervention, of 92 who did not plan to get vaccinated, 27 (29.6%) decided to go and do it.93 responses from CPs (46.5%). 63 (67.7%) in favor of the vaccination by CP, with significant differences between owners/assistants (p<0.05) and members/non-members of SEFAC (p<0.05). 82 (88.2%) CPs think that specific training is needed for the activity. Conclusions: The majority of patients and pharmacists believe that the pharmacy should be the point of administration of the influenza vaccine. This is significantly higher among owners and members of SEFAC. Vaccination intention improved by 29.4%

Uso transitorio de sistemas personalizados de dosificación (SPD): más allá de la polimedicación / Transient use of personalized dosing systems (PDS): beyond polypharmacy

Los pacientes diana del Servicio Personalizado de Dosificación (SPD) han sido habitualmente las personas con enfermedades crónicas polimedicadas con dificultades físicas o cognitivas para manejar adecuadamente su medicación. Sin embargo, existen otros grupos susceptible de beneficiarse igualmente de esta herramienta, como son los pacientes sin deficiencias ni dependencias pero que debido a la complejidad de la pauta del tratamiento a administrar pueden aprovechar este servicio de forma puntual. En este caso veremos una paciente habituada a manejar no sólo su medicación sino también la de su marido pero que debido a una pauta cambiante de medicamentos ansiolíticos y antidepresivos prefiere confiar en la farmacia comunitaria para su correcta administración

The target patients of the Personalized Dosing Service (PDS) have usually been people with chronic polymedicated diseases with physical or cognitive difficulties to properly manage their medication. However, there are other groups likely to equally benefit from this tool, such as patients without deficiencies or dependencies but due to the complexity of the treatment regimen to be administered, they can occasionally take advantage of this service. In this case, we will see a patient used to handling not only her own medication but also that of her husband but due to a changing pattern of anxiolytic and antidepressant medications, she prefers to rely on the community pharmacy for proper administration

Valoración del cumplimiento de los tratamientos hipoglucemiantes y antihipertensivos en Galicia (CumpleGa) / Evaluation of compliance with hypoglycemic and anti-hypertension treatments in Galicia (CumpleGa)

Objetivo: Evaluar en las farmacias comunitarias (FC) gallegas la prevalencia de la no adherencia terapéutica en diabetes e hipertensión arterial, identificando factores relacionados con el incumplimiento y la percepción de los pacientes sobre su tratamiento. Métodos: Estudio transversal descriptivo, aleatorizado, realizado en agosto y septiembre de 2016. Se seleccionaron pacientes mayores de edad, en tratamiento con hipoglucemiantes y/o antihipertensivos que llevaban al menos dos meses con la misma pauta terapéutica. Se midió el incumplimiento mediante la administración de tres cuestionarios: Batalla, Haynes-Sacket y Morisky-Green, en una hoja de recogida de datos que incluía los tres, además de las características demográficas de los pacientes. Resultados: Participaron 31 FC en 27 farmacias, que recogieron 1.588 (muestra necesaria: 1.537) cuestionarios válidos: 778 (49,0%) mujeres y 810 (51,0%) hombres, de edad media 67,6±11,1 años. El número de pacientes incumplidores al menos en uno de los tres tests fue de 1.245 (78,4%). El incumplimiento medio resultó del 42,6%. La percepción de los pacientes sobre su tratamiento fue negativa en el 35,6%. El 51,0% desconoce las complicaciones de su enfermedad, el 33,1% olvida tomar su medicación y el 29,5% no cree que los medicamentos que tienen prescritos sean los adecuados. Conclusiones: El incumplimiento de las pautas terapéuticas de DM y HTA en Galicia es elevado, afectando casi a la mitad de los pacientes. Mal conocimiento sobre la enfermedad, menor nivel de estudios, polimedicación, situación pensionista (mayor edad) y percepción negativa sobre sus medicamentos parecen relacionarse con una peor prevalencia del incumplimiento de los tratamientos (AU)

Objective: To evaluate the prevalence of therapeutic noncompliance in diabetes and arterial hypertension in Galician community pharmacies (FC), identifying the factors associated with patients' non-adherence and perception of their treatment. Methods: A cross-sectional, descriptive, randomized study conducted in August and September 2016 among adult patients receiving treatment with hypoglycemic and/or antihypertensive drugs for at least two months with the same treatment regimen. Noncompliance was assessed with the administration of three questionnaires: Batalla, Haynes-Sacket y Morisky-Green, in one page of data collection that included the three questionnaires, as well as the demographic data of each patient. Results: 31 community pharmacies participated in 27 pharmacies and collected 1,588 (sample size: 1,537) valid questionnaires: 778 (49.0%) females and 810 (51.0%) males, aged 67.6±11.1 years on average. The number of non-compliant patients at least in one of the three tests was 1,245 (78.4%). The average noncompliance was 42.6%. Treatment perception was negative for 35.6% of patients. 51.0% of patients ignore the complications of their illness, 33.1% forget to take their medication, and 29.5% do not believe their prescribed medications are suitable. Conclusions: Noncompliance with the therapeutic guidelines for diabetic and hypertension medication in Galicia is high and affects nearly half the patient population. Poor knowledge of the disease, lower level of education, multiple medication, pensioner age (elderly) and negative perception of medications seem to correlate with a higher prevalence of treatment noncompliance (AU)

Evaluación en farmacias comunitarias del estado nutricional de mayores de 65 años / Assessment of the nutritional condition of over 65s in community pharmacies

Objetivos: Evaluar el estado nutricional de mayores de 65 años con diabetes, que acuden a la farmacia comunitaria y compararlo con el de personas no diabéticas. Método: Estudio observacional-transversal en farmacias españolas por farmacéuticos socios de SEFAC, de 9 de noviembre a 9 de diciembre de 2015. Criterios de Inclusión: ≥65 años, en dos grupos: diabéticos y no diabéticos. Variables: características antropométricas, altura suelo-rodilla (cm), circunferencia braquial (cm), circunferencia de la pantorrilla (cm), diabetes (SÍ/NO) y estado nutricional (cuestionario Mini Nutritional Assessment). Resultados: 1.078 mayores, 652 (60,5%) mujeres de 75,5±7,4 años, 461 (42,8%) diabéticos. 73,4% con sobrepeso/obesidad. IMC=28,6±4,8 sin diferencias significativas entre sexos, mayor en diabéticos (29,0±4,8 vs 28,3±4,8 p=0,0173). 7,5% de diabéticos malnutridos frente al 6,5% de no diabéticos. 39,2% de diabéticos en riesgo de malnutrición frente al 29,8% de no diabéticos. El porcentaje de mujeres en riesgo de malnutrición y/o malnutrición es superior al de hombres (46,3% vs 32,4% p<0,0001). Mayor en mujeres diabéticas frente no diabéticas (52,4% vs 39,3% p=0,0075). 73,1% de diabéticos consideran que tienen problemas de nutrición frente al 80,7% de los no diabéticos p=0,0132. El 30,0% de los diabéticos consideran mejor su estado de salud frente al 45,9% de los no diabéticos. Conclusiones: El 82% de mayores de 65 años presenta malnutrición y/o riesgo de malnutrición, mayor en diabéticos que en no diabéticos y en mujeres que en hombres. 3 de cada 4 mayores de 65 años tienen sobrepeso u obesidad, mayor en hombres que en mujeres, y entre diabéticos que en no diabéticos (AU)

Objectives: To assess the nutritional condition of over 65s with diabetes that go community pharmacies, and compare it to individuals without diabetes. Method: Observational-transversal study in Spanish pharmacies by pharmacists that are SEFAC partners, from November 9 to December 9 2015. Inclusion criteria: ≥65 years old, in two groups: diabetic and non-diabetic. Variables: anthropometric characteristics, floor-knee distance (cm), brachial circumference (cm), calf circumference (cm), diabetes (YES/NO) and nutritional condition (Mini Nutritional Assessment). Results: 1078 elderly; 652 (60.5%) women, 75.5±7.4 years old; 461 (42.8%) diabetic. 73.4% overweight/obese. BMI=28.6±4.8 with no significant differences between genders; higher in diabetics (29.0±4.8 vs. 28.3±4.8 p=0.0173). 7.5% of diabetics presented symptoms of malnutrition vs. 6.5% of non-diabetics. 39.2% of diabetics at risk of malnutrition vs. 29.8% of non-diabetics. There were more women at risk of malnutrition and/or presenting symptoms of malnutrition than men (46.3% vs. 32.4% p>0.0001). Higher in diabetic women than in non-diabetic women (52.4% vs. 39.3% p=0.0075). 73.1% of diabetics believe they suffer from nutritional issues vs. 80.7% of non-diabetics p=0.0132. 30.0% of diabetics believe their health is better vs. 45.9% of non-diabetics. Conclusions: Eighty-two percent of over 65s present symptoms of malnutrition and/or are at risk of malnutrition; the rate is higher among diabetics than non-diabetics and among women than men. Three in every four over 65s are overweight or obese; the rate is higher in men than women and in diabetics than non-diabetics (AU)

Análisis de hábitos nutricionales y actividad física de adolescentes escolarizados. RIVACANGAS / Analysis of nutritio nal habits and physical activity among adolescent students. RIVACANGAS

Fundamentos: El objetivo es conocer el estilo de vida de una muestra de adolescentes respecto a su alimentación y realización de actividad física. Métodos: Estudio observacional, transversal, multicéntrico, realizado en una 630 alumnos (44,8% niñas y 53,2% niños) de la Educación Secundaria Obligatoria (ESO) de Cangas (Pontevedra). Se tuvieron en cuenta variables: 1) Sociodemográficas: edad, sexo, antecedentes personales y familiares de hipertensión arterial y diabetes mellitus; 2) Alimentación: adh erencia a la dieta mediterránea: Cuestionario KIDMED; y 3) Actividad física: Cuestionario PAQ -A. Resultados: Edad media=13,8±1,4. Puntuación KIDMED fue de 4,99±2,18, observándose como disminuye con la edad (r=-0,1761; p<0,001), y en el que el 66,35% present ó una adherencia media (mayor en mujeres), el 21,9% baja y el 11,75% alta. La valoración PAQ -A fue de 2,63±0,67, siendo mayor en niños (2,76±0,66 vs 2,50±0,66; p<0,001), disminuyendo también con la edad (r=-0,1340; p<0,001) y en el que el 79,05% tuvo una a ctividad física moderada, siendo ésta mayor en hombres (p<0,001). Se vio una relación lineal entre la puntuación KIDMED y PAQ -A (r=0,2436; p<0,001). Conclusiones: Casi dos de cada diez alumnos tienen antecedentes familiares de HTA, y poco más del 5% con antecedentes de diabetes en familiares de primer grado. Los hábitos alimentarios, son mejores entre las chicas y empeoran con la edad. Además se vio una moderada ad hesión a la dieta mediterránea y también una moderada actividad física, siendo mayor entre los chicos y a menor edad (AU)

Background: The objective is to know the lifestyle of a sample of adolescents about their diet and physical activity. ethods: Cross-sectional, observational and multicentre study of 630 students of ESO (44.8% of girls and 53.2% of children) in Cangas, Pontevedra. Variables that were taken into account: 1) Sociodemographic: age, sex, personal and family history of hyperte nsion and diabetes mellitus; 2) Food: adherence to the Mediterranean diet: KIDMED questionnaire; and 3) Physical activity: PAQ-A Questionnaire. Results: Mean age=13.8 ± 1.4. The KIDMED score was 4.99±2.18, being observed as decreasing with age (r=-0.1761, p<0.001), and in which 66.35% had an average adherence (greater in women), 21.9% low and 11.75% high adherence. The PAQ-A score was 2.63 ± 0.67, being higher in children (2.76 ± 0.66 vs 2.50±0.66, p<0.001), also decreasing with age (r=-0.1340, p<0.001),and in which 79.05% had moderate physical activity, which was greater in men (p<0.001). A linear relationship was found between the KIDMED score and PAQ -A (r=0.2436, p<0.001). Conclusions: Almost two out of ten students have a family history of hypertension, and little more than 5% have a history of diabetes in first-degree relatives. Food: though eating habits in many studies reviewed, they are better mong girls but worsen with age. Eating habits are better among girls and worsen with age. There was also a moderate adherence to the Mediterranean diet and also a moderate physical activity, being greater among boys and younger (AU)