ABSTRACT
Measuring biological drugs' trough concentrations and the concentrations of anti-drug antibodies is a valuable practice for treatment optimization. ELISA techniques are the gold standard for biological drug concentration quantification, but new techniques such as chemiluminescence immunoassays present some advantages. The aim of this unicentric prospective observational study is to compare the infliximab, adalimumab, vedolizumab and ustekinumab trough levels and anti-adalimumab and anti-infliximab antibodies concentrations obtained when using a chemiluminescent instrument (i-TRACK®, Theradiag, Croissy-Beaubourg, France) and an ELISA instrument (TRITURUS®, Griffols, Barcelona, Spain). Linear regression, Pearson or Spearman tests, Bland-Altman plots and the Cohen kappa test were applied for every sample. The correlation was excellent for both assays in the measurement of all drug concentrations. In general, values were lower when measured using i-TRACK than when using TRITURUS, especially when the values were high. Both techniques proved valuable in clinical practice for monitoring adalimumab and infliximab drug concentration. However, the results were modest for ustekinumab and vedolizumab, so caution is recommended and further research is needed. The limited number of anti-drug antibody-positive samples precluded a comparison between the techniques.
ABSTRACT
OBJECTIVE: To report our experience with Telemedicine projects: a Telepharmacy Hospital Pharmacy/Primary Care Pharmacy Coordination Program and a Hospital Pharmacy/Primary Care Pharmacy Electronic Cross-consultation Program. Results are reported in terms of medication adherence, perceived quality and satisfaction, and economic impact. METHOD: A) Telepharmacy Hospital Pharmacy/Primary Care Pharmacy Coordination Program: Phases of development: 1) Creation of a work group; 2) definition of patient inclusion criteria; 3) selection of medicines; 4) integration of hospital and primary care pharmaceutical care; 5) setting up of facilities in primary care; 6) logistics design; 7) creation of the Telemedicine system; 8) provision of training to primary care pharmacists; 9) establishment of a pharmaceutical care protocol; 10) obtaining patient informed consent. Medication adherence was evaluated using dispensing records. Results were assessed based on a quality questionnaire. Pharmacist evaluation was performed using a satisfaction questionnaire. The economic impact of the programs was assessed from patient's perspective from the estimated 1-year avoided direct costs of traveling from home to the hospital. B) Webbased cross-consultation system: mining was performed of web data from August 2018-June 2019. Analyzed items: hospital pharmacoterapeutic area, reasons, and results of consultation in primary and hospital care. RESULTS: A) Telepharmacy Hospital Pharmacy / Primary Care Pharmacy Coordination Program: sample: 51 patients, 58% male. Mean age 62.8 ± 18.0 years. 83.0% were pensioners; 69% were involved in an enteral nutrition program. Baseline and post-intervention medication adherence, 95.82 ± 8.03 vs 85.23 ± 23.02 (p = 0.007). Patients took 3.3 ± 1.4 hours to travel to the hospital; all patients assumed traveling costs. Average avoided cost per patient per year, 76.08 ± 38.77. Average score on the satisfaction questionnaire, 9.4 ± 1.3 over 10. The most valued items were work/family reconciliation and cost savings. No items were identified as negative in the program. Pharmacist satisfaction was 9.0 ± 1.2 over 10. B) Electronic cross-consultation program: 458 consultations, 190 from secondary to primary care, and 268 from primary to secondary care. CONCLUSIONS: The Telemedicine programs enabled coordination of drug therapy monitoring between the hospital and the primary care pharmacy. Patients and professionals reported a high level of satisfaction with the Telepharmacy Hospital Pharmacy/Primary Care Pharmacy Coordination Program, which had a very positive economic impact. Finally, the two Telepharmacy programs integrate humanization strategies.
OBJETIVO: Analizar estrategias de Telemedicina y colaboración entre atención primaria y atención hospitalaria: programa de Telefarmacia de Coordinación entre los Equipos Asistenciales de Farmacia Hospitalaria y Atención Primaria y la plataforma e-interconsulta. Describir la implantación del programa Telefarmacia de Coordinación entre los Equipos Asistenciales de Farmacia Hospitalaria y Atención Primaria y evaluar los resultados sobre adherencia terapéutica, calidad percibida y satisfacción y económicos, así como las e- interconsultas realizadas entre atención hospitalaria y atención primaria.Método: A) Telefarmacia de Coordinación entre los Equipos Asistenciales de Farmacia Hospitalaria y Atención Primaria: fases de implantación: 1) creación del grupo de trabajo; 2) establecimiento de criterios de inclusión de pacientes; 3) selección de medicamentos; 4) integración de la documentación de la atención farmacéutica; 5) acondicionamiento hospide la consulta de atención primaria; 6) diseño logístico; 7) creación del sistema de Telemedicina; 8) formación a farmacéuticos de atención primaria; 9) protocolización de la atención farmacéutica; 10) información al paciente y consentimiento informado. La adherencia se evaluó por registro de dispensaciones. Evaluación de los resultados mediante cuestionario de calidad percibida. Evaluación por farmacéuticos mediante encuesta de satisfacción. Análisis del impacto económico según costes directos estimados de los desplazamientos evitados desde el domicilio hasta el hospital durante un año. B) Plataforma e- interconsulta: explotación de los datos de la plataforma web de agosto de 2018 a junio de 2019. Se analizó: área farmacoterapéutica en atención hospitalaria, motivos y resultados de las mismas en atención primaria y atención hospitalaria. RESULTADOS: A) Telefarmacia de Coordinación entre los Equipos Asistenciales de Farmacia Hospitalaria y Atención Primaria: 51 pacientes incluidos, 58% varones. 62,8 ± 18,0 años de media de edad. 83,0% pensionistas; 69% adscritos al programa de nutrición enteral domiciliaria. Adherencia previa y tras la implantación del programa: 95,82 ± 8,03 versus 85,23 ± 23,02 (p = 0,007). Los pacientes emplearon una media de 3,3 ± 1,4 horas en el desplazamiento al servicio de farmacia del hospital; el 100% asumió el gasto de los desplazamientos. Coste medio evitado por paciente/año: 76,08 ± 38,77 . Media de valoración de la encuesta de satisfacción: 9,4 ± 1,3 sobre 10. Resultado de la encuesta de satisfacción a farmacéuticos: 9,0 ± 1,2. B) Plataforma e-interconsulta: 458 consultas realizadas: 190 desde atención hospitalaria a atención primaria, y 268 desde atención primaria a atención hospitalaria. CONCLUSIONES: Estos programas de Telemedicina permiten un seguimiento farmacoterapéutico coordinado del paciente externo entre farmacia hospitalaria y atención primaria. El programa Telefarmacia de Coordinación entre los Equipos Asistenciales de Farmacia Hospitalaria y Atención Primaria cuenta con una alta valoración de calidad percibida por pacientes y farmacéuticos y un elevado impacto económico para el paciente. Ambos proyectos integran estrategias de humanización que facilitan proporcionar una atención farmacéutica más cercana al paciente, evitándole desplazamientos innecesarios al hospital.
Subject(s)
Pharmaceutical Services , Telemedicine , Humans , Male , Adult , Middle Aged , Aged , Aged, 80 and over , Female , Pharmacists , Hospitals , Primary Health CareABSTRACT
Background: adalimumab dose escalation is often recommended for inflammatory bowel disease (IBD) patients incases of loss of response (LOR). The usual adalimumabintensification regimen was 40 mg every week. Recently,the pharmaceutical companies commercialized the 80 mginjection pen. In the biosimilars era, this pen was sold atthe same price as the 40 mg pen. Due to this and for patientcomfort, we proposed that our stable intensified adalimumab patients on a 40 mg every-week (ew) regimen change toa dose of 80 mg every-other-week (eow).Aim and methods: an observational study was performedto monitor outcome through this posologic change. Clinical,analytic parameters and adalimumab trough levels wereprospectively obtained at baseline, four and 12 monthsafter posologic change. The evolution of this cohort andcalculates savings were described.Results: thirteen patients were included in the study and themedian time of adalimumab intensification prior to posologic change to 80 mg eow was 32 months (IQR 29-63). Atfour months, all patients maintained adalimumab 80 mgeow. After month 4, two patients returned to the previousregimen after mild worsening, without significant changes in C-reactive protein (CRP), calprotectin or adalimumab-trough-levels. At one year, adalimumab was stoppedin one patient in remission with undetectable levels andpositive adalimumab-antibodies. No significant differencesin adalimumab-trough-levels were noted before and afterthe posologic change. Costs fell from 16,276 /patient/yearof treatment to 8,812.15 /patient/year of treatment.Conclusion: in IBD patients with stable response to adalimumab intensification regimen of 40 mg ew, changingto 80 mg eow seems to maintain response and similaradalimumab-trough-levels. Furthermore, it is cost-saving,although some patients may perceive mild symptoms. (AU)
Subject(s)
Humans , Adalimumab , Inflammatory Bowel Diseases , Biosimilar Pharmaceuticals , PharmaciesABSTRACT
Objetivo: Analizar estrategias de Telemedicina y colaboración entreatención primaria y atención hospitalaria: programa de Telefarmacia deCoordinación entre los Equipos Asistenciales de Farmacia Hospitalariay Atención Primaria y la plataforma e-interconsulta. Describir la implantación del programa Telefarmacia de Coordinación entre los EquiposAsistenciales de Farmacia Hospitalaria y Atención Primaria y evaluar losresultados sobre adherencia terapéutica, calidad percibida y satisfaccióny económicos, así como las e-interconsultas realizadas entre atenciónhospitalaria y atención primaria.Método: A) Telefarmacia de Coordinación entre los Equipos Asistenciales de Farmacia Hospitalaria y Atención Primaria: fases de implantación: 1) creación del grupo de trabajo; 2) establecimiento de criteriosde inclusión de pacientes; 3) selección de medicamentos; 4) integración dela documentación de la atención farmacéutica; 5) acondicionamiento. de la consulta de atención primaria; 6) diseño logístico; 7) creación delsistema de Telemedicina; 8) formación a farmacéuticos de atención primaria; 9) protocolización de la atención farmacéutica; 10) información alpaciente y consentimiento informado. La adherencia se evaluó por registro de dispensaciones. Evaluación de los resultados mediante cuestionariode calidad percibida. Evaluación por farmacéuticos mediante encuestade satisfacción. Análisis del impacto económico según costes directosestimados de los desplazamientos evitados desde el domicilio hasta elhospital durante un año. B) Plataforma e-interconsulta: explotación delos datos de la plataforma web de agosto de 2018 a junio de 2019. (AU)
Objective: To report our experience with Telemedicine projects: aTelepharmacy Hospital Pharmacy/Primary Care Pharmacy CoordinationProgram and a Hospital Pharmacy/Primary Care Pharmacy ElectronicCross-consultation Program. Results are reported in terms of medicationadherence, perceived quality and satisfaction, and economic impact.Method: A) Telepharmacy Hospital Pharmacy/Primary Care PharmacyCoordination Program: Phases of development: 1) Creation of a workgroup; 2) definition of patient inclusion criteria; 3) selection of medicines;4) integration of hospital and primary care pharmaceutical care; 5) setting up of facilities in primary care; 6) logistics design; 7) creation of theTelemedicine system; 8) provision of training to primary care pharmacists;9) establishment of a pharmaceutical care protocol; 10) obtaining patientinformed consent. Medication adherence was evaluated using dispensingrecords. Results were assessed based on a quality questionnaire. Pharmacist evaluation was performed using a satisfaction questionnaire. Theeconomic impact of the programs was assessed from patients perspectivefrom the estimated 1-year avoided direct costs of traveling from home tothe hospital. B) Webbased cross-consultation system: mining was performed of web data from August 2018-June 2019. Analyzed items: hospitalpharmacoterapeutic area, reasons, and results of consultation in primaryand hospital care.Results: A) Telepharmacy Hospital Pharmacy / Primary Care Pharmacy Coordination Program: sample: 51 patients, 58% male. Meanage 62.8 ± 18.0 years. 83.0% were pensioners; 69% were involved inan enteral nutrition program. Baseline and post-intervention medicationadherence, 95.82 ± 8.03 vs 85.23 ± 23.02 (p = 0.007). Patients took3.3 ± 1.4 hours to travel to the hospital; all patients assumed travelingcosts. Average avoided cost per patient per year, 76.08 ± 38.77. Average score on the satisfaction questionnaire, 9.4 ± 1.3 over 10. (AU)
Subject(s)
Humans , Telemedicine , Pharmacy , Pharmaceutical Services , Primary Health Care , Treatment Adherence and ComplianceABSTRACT
BACKGROUND: Adalimumab dose escalation is often recommended for inflammatory bowel disease patients in cases of loss of response. The usual adalimumab intensification regimen was 40 mg every week. Recently the pharmaceutical companies commercialized the 80mg injection pen. In the biosimilars era, this pen was sold at the same price as the 40mg pen. Due to this and for patient comfort, we proposed that our stable intensified adalimumab patients on a 40mg every-week regimen, change to a dose of 80mg every-other-week. AIM AND METHODS: an observational study was performed to monitor outcome through this posologic change. Clinical, analytic parameters and adalimumab trough levels were prospectively obtained at baseline, 4 and 12 months after posologic change. The evolution of this cohort and calculates savings were described. RESULTS: 13 patients were included in the study and the median time of adalimumab intensification prior to posologic change to 80mg eow was 32 months (IQR 29-63). At 4 months, all patients maintained adalimumab 80mg every-other-week. After month 4, two patients returned to the previous regimen after mild worsening, without significant changes in CRP, calprotectin or adalimumab-trough-levels. At 1 year, adalimumab was stopped in one patient in remission with undetectable levels and positive adalimumab-antibodies. No significant differences in adalimumab-trough-levels were noted before and after the posologic change. Costs fell from 16276 /patient/year of treatment to 8812.15 /patient/year of treatment. CONCLUSION: In IBD patients with stable response to adalimumab intensification regimen of 40 mg every-week, changing to 80mg every-other-week seems to maintain response and similar adalimumab-trough-levels. Furthermore, it is cost-saving, although some patients may perceive mild symptoms.
Subject(s)
Biosimilar Pharmaceuticals , Crohn Disease , Humans , Adalimumab/therapeutic use , Crohn Disease/drug therapy , Anti-Inflammatory Agents/therapeutic use , Biosimilar Pharmaceuticals/therapeutic use , Treatment OutcomeABSTRACT
Objetivo: Describir el desarrollo del simulador conversacional Antidotos_bot, para facilitar la búsqueda de información en la Guía de Administración de Antídotos y realizar cálculos útiles en el uso de antídotos.Método: En enero de 2019 planteamos el desarrollo de un simuladorconversacional de libre acceso en Telegram®, empleando la plataformaXenioo®. En el desarrollo del software se definió la forma de interaccióncon el usuario y se incorporaron funcionalidades de cálculo. Se realizóuna validación interna y en junio de 2019 se presentó Antidotos_bot.Resultados: Antidotos_bot incorporó información en castellano sobre49 antídotos en 57 intoxicaciones, permitiendo realizar tres tipos decálculos y consultar dos algoritmos de tratamiento. La consulta fue posible mediante 332 preguntas. La validación interna precisó cinco entrenamientos diferentes durante 2 meses. En julio 2020, Antidotos_bot tenía415 usuarios y los antídotos más consultados fueron glucagón, penicilinaG, protamina, n-acetilcisteína y flumazenilo. Mensualmente fueron realizados 29 cálculos, el número medio de nuevos usuarios fue de 3 y elnúmero medio de consultas por usuario fue de 3.Conclusiones: Antidotos_bot es una herramienta de apoyo en la tomade decisiones en intoxicaciones, que proporciona información actualizada de forma ágil, y podría contribuir a mejorar la calidad y seguridadasistencial en situaciones de emergencia. (AU)
Objective: To describe the development of the Antidotos_bot chatbottool, which is used to facilitate the search for information in the AntidoteAdministration Guide and to perform useful calculations in the use of antidotes.Method: In January 2019, we proposed developing a freely accessiblechatbot on Telegram® using Xenioo®. Software development defined theway it interacts with users and incorporated calculation functionalities.Internal validation was conducted and it was presented as Antidotos_botin June 2019.Results: Antidotos_bot included information in Spanish on 49 antidotes and 57 poisonings. Three types of calculations were provided andtwo treatment algorithms could be consulted. Consultation was possiblethrough 332 questions. Internal validation needed five sets of training over2 months. By July 2020, it had 415 users. The most frequently consultedantidotes were glucagon, penicillin G, protamine, n-acetylcysteine andflumazenyl. Regarding monthly activity, there was an average of 29 calculations and an average of three new users and three queries per user.Conclusions: Antidotos_bot is a poisoning management decisionmaking tool that provides up-to-date information in a user-friendly manner.It could contribute to improving the quality and safety of care in emergency situations. (AU)
Subject(s)
Humans , Antidotes/therapeutic use , Referral and Consultation , Software , Poisoning/therapyABSTRACT
OBJECTIVE: To describe the development of the Antidotos_bot chatbot tool, which is used to facilitate the search for information in the Antidote Administration Guide and to perform useful calculations in the use of antidotes. METHOD: In January 2019, we proposed developing a freely accessible chatbot on Telegram® using Xenioo®. Software development defined the way it interacts with users and incorporated calculation functionalities. Internal validation was conducted and it was presented as Antidotos_bot in June 2019. RESULTS: Antidotos_bot included information in Spanish on 49 antidotes and 57 poisonings. Three types of calculations were provided and two treatment algorithms could be consulted. Consultation was possible through 332 questions. Internal validation needed five sets of training over 2 months. By July 2020, it had 415 users. The most frequently consulted antidotes were glucagon, penicillin G, protamine, n- acetylcysteine and flumazenyl. Regarding monthly activity, there was an average of 29 calculations and an average of three new users and three queries per user. CONCLUSIONS: Antidotos_bot is a poisoning management decisionmaking tool that provides up-to-date information in a user-friendly manner. It could contribute to improving the quality and safety of care in emergency situations.
Objetivo: Describir el desarrollo del simulador conversacional Antidotos_bot, para facilitar la búsqueda de información en la Guía de administración de Antídotos y realizar cálculos útiles en el uso de antídotos.Método: En enero de 2019 planteamos el desarrollo de un simulador conversacional de libre acceso en Telegram®, empleando la plataforma Xenioo®. En el desarrollo del software se definió la forma de interacción con el usuario y se incorporaron funcionalidades de cálculo. Se realizó una validación interna y en junio de 2019 se presentó Antidotos_bot.Resultados: Antidotos_bot incorporó información en castellano sobre 49 antídotos en 57 intoxicaciones, permitiendo realizar tres tipos de cálculos y consultar dos algoritmos de tratamiento. La consulta fue posible mediante 332 preguntas. La validación interna precisó cinco entrenamientos diferentes durante 2 meses. En julio 2020, Antidotos_bot tenía 415 usuarios y los antídotos más consultados fueron glucagón, penicilina G, protamina, n-acetilcisteína y flumazenilo. Mensualmente fueron realizados 29 cálculos, el número medio de nuevos usuarios fue de 3 y el número medio de consultas por usuario fue de 3.Conclusiones: Antidotos_bot es una herramienta de apoyo en la toma de decisiones en intoxicaciones, que proporciona información actualizada de forma ágil, y podría contribuir a mejorar la calidad y seguridad asistencial en situaciones de emergencia.