[Evaluation of patient satisfaction in outpatient pharmacy]. / Evaluación de la satisfacción y de la insatisfacción de pacientes atendidos en la unidad de atención farmacéutica a pacientes externos.

OBJECTIVE: To establish the level of satisfaction and dissatisfaction with the service received by patients attending the Outpatient Pharmacy regarding the care received. METHOD: Two-month long cross-sectional study. The study included all patients who had attended the Outpatient Pharmacy (OP) and had given their consent. Satisfaction was measured using a previously validated survey (Likert-type scale), with 5 possible closed answers (1: Disagree and 5: Strongly agree) and the Satisfaction Index established by the Regional Ministry of Health for the Autonomous Community of Valencia. Dissatisfaction was assessed via the complaints received by the Patient Service Department over the last 10 years. RESULTS: Patient satisfaction survey (nfinal=138). Overall Satisfaction Index (SI): 76% (95% CI: 72-80%). Greatest satisfaction: Pharmacists Skills (SI: 88%; 95% CI: 87-88%). Lowest satisfaction: dispensing area (SI: 63%; 95% CI: 60-66%) and dispensing process (SI: 68%; 95% CI: 67-70%). Complaints (n=22). Reasons for dissatisfaction: dispensing process (72%) and dispensing area (10%). CONCLUSIONS: Although the Satisfaction Index is a useful indicator for identifying improvements, the reasons for dissatisfaction are also required as a complement to this information. Those aspects in need of improvement are the dispensing area and process and increased structural and human resources are required.

Evaluación de la satisfacción y de la insatisfacción de pacientes atendidos en la unidad de atención farmacéutica a pacientes externos / Evaluation of patient satisfaction in outpatient pharmacy

Objetivo: Conocer tanto el grado de satisfacción como los motivosde insatisfacción de los pacientes que acuden a la Unidad deAtención Farmacéutica a Pacientes Externos (UFPE) respecto a laatención recibida.Método: Estudio transversal de dos meses de duración. Se incluyerontodos los pacientes atendidos por la UFPE que dieron su consentimiento.La satisfacción se midió con una encuesta previamente validada,de tipo Likert, con 5 posibles respuestas cerradas (1: endesacuerdo, y 5: muy de acuerdo), utilizándose el indicador índice desatisfacción establecido por la Conselleria de Sanitat de la ComunidadValenciana. La insatisfacción se evaluó a través de las quejas formuladasen el Servicio de Atención e Información al Paciente en losúltimos 10 años.Resultados: encuesta de satisfacción (nfinal = 138). Índice de satisfacción(IS) global: 76% (IC 95%: 72-80%). Mayor satisfacción: habilidadesdel farmacéutico (IS: 88%; IC 95%: 87-88%). Menor satisfacción:zona de dispensación (IS: 63%; IC 95%: 60-66%) y proceso dedispensación (IS: 68%; IC 95%: 67-70%). Reclamaciones (n = 22).Motivos de insatisfacción: proceso de dispensación (72%) y zona dedispensación (10%).Conclusiones: Aunque el índice de satisfacción es un indicador útilpara poder establecer mejoras, es necesario conocer también losmotivos de insatisfacción como complemento a esta información.Los aspectos a mejorar son la zona y el proceso de dispensación,siendo necesario un aumento de los recursos estructurales y humanos

Objective: To establish the level of satisfaction and dissatisfactionwith the service received by patients attending the Outpatient Pharmacyregarding the care received.Method: Two-month long cross-sectional study. The study includedall patients who had attended the Outpatient Pharmacy (OP) andhad given their consent. Satisfaction was measured using a previouslyvalidated survey (Likert-type scale), with 5 possible closedanswers (1: Disagree and 5: Strongly agree) and the Satisfaction Indexestablished by the Regional Ministry of Health for the AutonomousCommunity of Valencia. Dissatisfaction was assessed via thecomplaints received by the Patient Service Department over the last10 years.Results: Patient satisfaction survey (nfinal=138). Overall SatisfactionIndex (SI): 76% (95% CI: 72-80%). Greatest satisfaction: Pharmacist’sSkills (SI: 88%; 95% CI: 87-88%). Lowest satisfaction: dispensingarea (SI: 63%; 95% CI: 60-66%) and dispensing process (SI: 68%;95% CI: 67-70%). Complaints (n=22). Reasons for dissatisfaction:dispensing process (72%) and dispensing area (10%).Conclusions: Although the Satisfaction Index is a useful indicator foridentifying improvements, the reasons for dissatisfaction are also requiredas a complement to this information. Those aspects in need ofimprovement are the dispensing area and process and increasedstructural and human resources are required

[Identifying improvement opportunities in the management of hepatitis C]. / Identificación de oportunidades de mejora del tratamiento de la hepatitis C.

OBJECTIVE: Hepatitis C represents a public health concern with more than 170 million carriers. The goal of this study was to identify improvement opportunities in the management of hepatitis C, and the pharmaceutical actions performed for the prevention and solution of medication-related problems in patients seen at the Pharmaceutical Care Outpatient Unit. METHOD: A longitudinal study (January to October 2005) with patients monoinfected by hepatitis C virus receiving ribavirin and peginterferon alfa (2a or 2b). Data collection took place during the interview at the time of antiviral dispensation. Adverse reactions were classified according to CTCEA v3.0 criteria. Iaser methodology was used to identify patients with improvement opportunities regarding treatment. RESULTS: In all 109 patients and 201 improvement opportunities were identified. Pharmacotherapeutic morbidity was identified from adverse events (blood toxicity, pseudoflu syndrome, etc.) in 425 occasions; 388 pharmaceutical actions were performed, 41.23% to prevent adverse effects and 39.95% to provide patients or carers with information. CONCLUSIONS: In all, 99.01% of patients had safety problems. Pharmacotherapeutic morbidity from adverse effects was less common than reported in clinical trials of these drugs. Most pharmaceutical actions were preventive in nature. Iaser methodology allows to identify patients with improvement opportunities regarding hepatitis C treatment and the prevention of pharmacotherapeutic morbidity.

Identificación de oportunidades de mejora del tratamiento de la hepatitis C / No disponible

Objetivo: El objetivo de este estudio es identificar las oportunidadesde mejora del tratamiento de la hepatitis C y las actuacionesfarmacéuticas realizadas para la prevención y resolución deproblemas relacionados con la medicación en los pacientes atendidosen la unidad de atención farmacéutica a pacientes externos.Método: Estudio longitudinal (enero a octubre de 2005) conpacientes monoinfectados por el virus de la hepatitis C en tratamientocon ribavirina y peginterferón alfa (2a o 2b). La recogidade datos se realizó durante la entrevista con el paciente en elmomento de la dispensación de los antivirales. Las reaccionesadversas se clasificaron según los criterios CTCEA v3.0. Para laidentificación de pacientes con oportunidades de mejora en sutratamiento se empleó la metodología Iaser®.Resultados: Se incluyeron 109 pacientes con 201 oportunidadesde mejora. Se identificó morbilidad farmacoterapéutica porefectos adversos (toxicidad hematológica, síndrome pseudogripal,etc.) en 425 ocasiones. Se realizaron 388 actuaciones farmacéuticas,el 41,23% para prevenir efectos adversos y el 39,95% paraproveer de información al paciente o cuidador.Conclusiones: El 99,01% de pacientes presentaba problemasde seguridad. La morbilidad farmacoterapéutica por efectosadversos es de menor frecuencia que la publicada en ensayos clínicoscon estos medicamentos. Las principales actuaciones farmacéuticasrealizadas fueron de tipo preventivo. La metodologíaIaser® permite la identificación de pacientes con oportunidades demejora del tratamiento de la hepatitis C y la prevención de morbilidadfarmacoterapéutica

Objective: Hepatitis C represents a public health concernwith more than 170 million carriers. The goal of this study was toidentify improvement opportunities in the management of hepatitisC, and the pharmaceutical actions performed for the preventionand solution of medication-related problems in patients seenat the Pharmaceutical Care Outpatient Unit.Method: A longitudinal study (January to October 2005) withpatients monoinfected by hepatitis C virus receiving ribavirin andpeginterferon alfa (2a or 2b). Data collection took place duringthe interview at the time of antiviral dispensation. Adverse reactionswere classified according to CTCEA v3.0 criteria. Iaser®methodology was used to identify patients with improvementopportunities regarding treatment.Results: In all 109 patients and 201 improvement opportunitieswere identified. Pharmacotherapeutic morbidity was identifiedfrom adverse events (blood toxicity, pseudoflu syndrome, etc.) in425 occasions; 388 pharmaceutical actions were performed,41.23% to prevent adverse effects and 39.95% to providepatients or carers with information.Conclusions: In all, 99.01% of patients had safety problems.Pharmacotherapeutic morbidity from adverse effects was lesscommon than reported in clinical trials of these drugs. Most pharmaceuticalactions were preventive in nature. Iaser® methodologyallows to identify patients with improvement opportunities regardinghepatitis C treatment and the prevention of pharmacotherapeuticmorbidity

[Pharmacy Department standard procedures for clinical trial development]. / Procedimientos normalizados del Servicio de Farmacia para el desarrollo de los ensayos clínicos.

INTRODUCTION: Regulations on good clinical practice in the execution of clinical trials require the establishment and compliance of normalised working procedures by the hospital Pharmacy Department. These procedures must indicate precisely each one of the processes involved in their development, e.g. the reception, custody, storage, preparation and dispensing of research samples. OBJECTIVE: The aim of the present study is to analyse the information included in clinical trial protocols involved in the circulation of drug samples during the research stage and, based on the results obtained, to develop normalised working procedures for our hospital Pharmacy Department in order to carry out these clinical trials. MATERIAL AND METHODS: Eleven items were defined in order to describe key processes involved in identification, storage, receipt, preparation, dispensation, administration, maintenance and return of research samples, as well as those related to the beginning and end or closing of a clinical trial. Information included in 39 clinical trial protocols that had been sent to the Hospital Ethics Committee for evaluation between January and August of 2002 and was analysed in terms of the items previously defined. RESULTS: 46% of the protocols included data from the monitor or person representing the sponsor. 64% adequately described conservation and storage conditions of the research samples; but in 39% of the studied cases external labelling descriptions did not comply with legislation. Only 15% of the cases included clear instructions on research sample reception and its acknowledgement. 25.6% reported correct handling and/or preparation instructions for research samples with parenteral administration. Sample dispensation procedures were correctly described in no more than 5.1% of the protocols analyzed. 41% included information for patients, relatives or nurses on administration and handling of research samples, but none of them included specific information pamphlets or three-page leaflets. Procedures for either returning research samples to the sponsor or for their maintenance and replacement were not specified in the 71.8 and 100% of the cases, respectively. Likewise, trial ending or closing dates as well as procedures that must be followed by the Hospital Pharmacy Department during these processes were not stated in 89.7% of the protocols. Finally, only 30.8% of the cases explicitly cite the hospital Pharmacy Department. CONCLUSION: These results support and justify the need to improve clinical trial protocols in order for them to be performed in a secure, effective and efficient way. Besides, they have been the starting point to devise the normalised working procedures of the hospital Pharmacy Department for the development of the clinical trials.

Análisis y predicción de cargas de trabajo en un sistema de dispensación de medicamentos por dosis unitarias en un hospital general / Workload analysis and prediction in a unitary dose drug distribution system within a general hospital

Objetivo: Caracterizar la temporalidad de la carga de trabajo mensual en un sistema de dispensación individualizada de medicamentos en dosis unitarias y desarrollar un modelo matemático para su predicción. Material y métodos: Tipo de hospital: hospital general universitario de 573 camas. Extracción de datos: estadísticas mensuales de dispensación de medicamentos por el sistema de dosis unitarias. Periodo de estudio: enero 1994 - diciembre 1999. Grupos: los datos disponibles hasta diciembre de 1998 se utilizan para identificar el modelo estadístico (grupo de identificación) y los datos de 1999 se utilizan para validar el mismo (grupo de validación). Modelos estadísticos: la variable dependiente es el número de dosis unitarias dispensadas/mes. El modelo de regresión lineal múltiple utiliza como variables independientes, el tiempo transcurrido desde el inicio del estudio (años), el mes y el año en que se efectúan las dispensaciones. El desarrollo del modelo ARIMA se realiza mediante la metodología de Box-Jenkins. Evaluación de la capacidad predictiva: media del error relativo de predicción (exac titud) y raíz cuadrada de la media del error cuadrático de predicción (precisión) de las predicciones realizadas durante 1999 mediante el modelo ARIMA desarrollado. Resultados : Durante el periodo de tiempo estudiado, se dispensaron mensualmente 98.760 ñ 9.074 dosis unitarias. En el modelo de regresión lineal desarrollado (r2 = 0,78) se observa una tendencia lineal anual que incrementa en 3.392 (IC 95 por ciento: 2.609 a 4.175) el número de dosis unitarias dispensadas/mes. Asimismo, respecto al mes de enero, las dispensaciones del mes de marzo se incrementan en 6.783 (IC95 por ciento: 138 a 13.429) unidades y, las dispensaciones de los meses de agosto y septiembre disminuyen en 17.762 (IC 95 por ciento: 11.386 a 24.137) y 11.115 (IC 95 por ciento: 4.740 a 17.490) unidades, respectivamente. El modelo desarrollado puede ser empleado con fines predictivos, ya que posee la exactitud, -3,06 por ciento (IC 95 por ciento: 0,91 a -5,20), y precisión, 3,37 por ciento (inferior al 15 por ciento) adecuadas. Conclusión: La disponibilidad de un modelo matemático para predecir la carga de trabajo en el sistema de dispensación en dosis unitarias es una herramienta eficaz para planificar la adecuación de recursos humanos en el Área de Dispensación del Servicio de Farmacia (AU)

Metodologías para la selección de medicamentos en el hospital / Methods of selecting medications in the hospital

La selección de medicamentos constituye una de las actividades del farmacéutico de hospital con mayor variabilidad en los criterios y métodos aplicados. Esta circunstancia se traduce en diferencias en la calidad del tratamiento farmacoterapéutico y del cuidado que recibe el paciente. En el presente trabajo se analizan las ventajas y desventajas de los diferentes métodos de selección de medicamentos utilizados en la actualidad en los hospitales españoles: el método tradicional, el sistema de guía farmacoterapé utica y el procedimiento basado en criterios objetivos y validados (metodología SOJA). Finalmente se definen y validan criterios para la Comisión de Farmacia y Terapéutica a fin de garantizar la selección de medicamentos basada en la evidencia (AU)

[Simultaneous administration of drugs and artificial nutrition: practical aspects]. / Administración concomitante de medicamentos con nutrición artificial: aspectos prácticos.

Most patients on artificial nutrition, both parenteral or enteral, are also taking drugs. This means that factors covering pharmacokinetic, physico-chemical (stability) and mechanical (use of tubes) considerations have to be taken into account. Description of the pharmacokinetic processes of drugs and the influence of the nutritive state, nutrients and drugs on these processes. The simultaneous administration of drugs and Parenteral Nutrition may be done in two ways: by adding the drugs to the Parenteral Nutrient Units (PNU) and by administering the drugs using "Y equipment". The adding of drugs to PNU is mainly indicated in patients with restricted liquid intake, restricted venous access, patients subject to parenteral nutrition at home and the administering of drugs by continuous perfusion. With regard to enteral nutrition, factors such as the administration method, approach and galenic properties of the preparations should be taken into account.

[The development of an enteral nutrition program (I): an analysis of the degree of compliance]. / Desarrollo de un programa de nutrición enteral (I): análisis del grado de cumplimiento.

Preparation of a working plan for enteral nutrition consisting of: the application of the Heimburger criteria for including in the drug therapy guide enteral diets existing on the market, their indications in enteral nutrition, data on the extent of non-compliance and level of information of the patient in order to bring the enteral nutrition programme closer to the rational standards established in literature. The study concludes with the application of an algorithm for prescribing the diet based on the pathology and the preparation of an "informative leaflet" for the patient.