Estudio de utilización de nirmatrelvir/ritonavir en tres centros de atención primaria durante 2022 / Drug use evaluation of nirmatrelvir/ritonavir in three primary care centres during 2022

Introducción: Nirmatrelvir/ritonavir (Paxlovid®) es el único tratamiento oral autorizado en Europa para tratar la enfermedad por COVID-19 en adultos que no requieren aporte de oxígeno suplementario y que tienen un riesgo alto de progresar a COVID-19 grave. Está disponible en España previa validación debido al perfil de interacciones y advertencias de uso. El objetivo es determinar efectividad, seguridad y manejo de interacciones. Método: Estudio retrospectivo de todos los pacientes con tratamiento validado de nirmatrelvir/ritonavir en tres centros de salud urbanos durante 2022. La efectividad fue la proporción de participantes sin hospitalización relacionada con COVID-19 o muerte por cualquier causa hasta el día 28. Resultados: Se analizaron 24 pacientes. Se consideró efectivo en 23 (95,8 %). Más del 80 % de pacientes presentaban interacción potencial con la medicación concomitante, recomendándose la suspensión temporal de medicamentos destacando simvastatina y metamizol. Conclusiones: Nirmatrelvir/ritonavir se ha considerado efectivo pero con difícil manejo en pacientes pluripatológicos polimedicados. (AU)

Introduction: Nirmatrelvir/ritonavir (Paxlovid®) is the only oral treatment authorized in Europe to treat COVID-19 disease in adults who do not require supplemental oxygen and who are at high risk for progression to severe COVID-19. It is available in Spain after validation due to the profile of interactions and warnings for use. The objective is to determine effectiveness, safety and management of interactions. Method: Retrospective study of all patients on validated nirmatrelvir/ritonavir treatment at three urban health cen-tres during 2022. Effectiveness was the proportion of participants without COVID-19-related hospitalization or death from any cause through day 28. Results: 24 patients were analyzed. It was considered effective in 23 (95.8 %). More than 80 % of patients presented potential interaction with the concomitant medication, recommending the temporary suspension of medications, highlighting simvastatin and metamizole. Conclusions: Nirmatrelvir/ritonavir has been considered effective but difficult to manage in polymedicated poly-pathological patients. (AU)

Impacto de la pandemia COVID-19 en la prescripción de fármacos en Atención Primaria / Impact of the COVID-19 pandemic on the prescription of drugs in Primary Care

Objetivo: la pandemia por SARS-CoV-2 ha estresado el sistema sanitario y ha producido cambios en la organización de los centros de salud para atender a los pacientes con COVID-19. Como consecuencia, en la Atención Primaria se ha observado una disminución significativa en el seguimiento, control de los pacientes y en el diagnóstico de enfermedades crónicas. Este estudio tiene por objetivo analizar retrospectivamente el impacto de la pandemia de COVID-19 en los tratamientos farmacológicos en tres centros de salud de Atención Primaria urbanos.Métodos: se analizaron las prescripciones farmacológicas realizadas por médicos de familia entre 2017 y 2020. Se registró el número total de tratamientos y los inicios de tratamiento para diferentes grupos farmacológicos. Calculamos las tasas de incidencia anuales de los pacientes tratados y se comparó la ratio de incidencia de 2020 con la media de las ratios del período 2017-2019.Resultados: los grupos farmacológicos con mayor reducción en el porcentaje de pacientes tratados en 2020 en comparación con la media de 2017-2019 fueron los antibióticos (-8,5%), los antinflamatorios no esteroideos (-5,9%) y los antiulcerosos (-2,8%). Se observó una reducción significativa en las tasas de incidencia de 2020 en comparación con la media de 2017-2019 para todos los grupos farmacológicos analizados, excepto para los anticoagulantes orales y los antipsicóticos.Conclusiones: se ha observado una reducción en el consumo global de los fármacos. Se ha producido una disminución significativa en los inicios de tratamiento para la mayoría de grupos farmacológicos analizados.(AU)

Aim: the SARS-CoV-2 pandemic has stressed the health system and led to changes in the organization of health centres to treat COVID-19 patients. As a consequence, in primary care a significant decline has been observed in the follow-up, monitoring of patients and diagnosis of chronic diseases. This study aimed to retrospectively analyse the impact of the COVID-19 pandemic on drug treatments in three urban primary healthcare centres.Methods: we analysed the pharmacological prescriptions issued by general practitioners between 2017 and 2020. We counted total number of treatments and new treatments for different pharmacological groups. We calculated the annual incidence rate of treated patients and compared incidence rate ratios in 2020 with the mean rate in 2017-2019.Results: the pharmacological groups with the greatest reduction in the percentage of patients treated in 2020 compared to the mean of 2017-2019 were antibiotics (-8.5%), non-steroidal anti-inflammatory drugs (-5.9%) and anti-ulcer drugs (-2.8%). There was a significant decrease in incidence rates in 2020 compared to the mean of the 2017-2019 period for all pharmacological groups analysed, except for oral anticoagulants and antipsychotics.Conclusion: a decreased overall consumption of drugs was observed. There has been a significant decline in new patients commencing treatments in most pharmacological groups analysed.(AU)

Efectividad Del Tratamiento De La Hepatitis C En Pacientes Controlados Desde La Consulta De Atención Farmacéutica / Effectiveness of hepatitis C antiviral treatment in attended patients from the outpatient pharmacy consultation

OBJETIVOS: Determinar la efectividad del tratamiento de la hepatitis C crónica definida como la respuesta viral sostenida a las 12 semanas (RVS12) tras la finalización del tratamiento con fármacos antivirales de acción directa (AAD) (glecaprevir/pibrentasvir, sofosbuvir/velpatasvir, sofosbuvir/velpatasvir/voxilaprevir y grazoprevir/elbasvir) en pacientes atendidos en la consulta de farmacia ambulatoria. MÉTODOS: estudio retrospectivo que incluye los pacientes atendidos por farmacia que iniciaron tratamiento con AAD entre el 1 de diciembre de 2017 y el 31 de mayo de 2018. Se registraron datos demográficos, de la enfermedad, grado de adherencia y consultas sobre el tratamiento (interacciones, efectos adversos y otras). RESULTADOS: Se incluyeron 205 pacientes con diferentes genotipos de hepatitis C, estados de fibrosis y grados de morbilidad. La efectividad fue del 99,5%, similar a la reportada en los ensayos clínicos. CONCLUSIONES: Estos resultados se asemejan a los obtenidos en las consultas de farmacia en Estados Unidos, funcionando desde hace más de diez años

OBJECTIVE: To determine the effectiveness of the treatment of chronic hepatitis C determined as the sustained viral response at 12 weeks (SVR12) after the end of treatment with direct-acting antiviral drugs (DAA) (glecaprevir/pibrentasvir, sofosbuvir/velpatasvir, sofosbuvir/velpatasvir/voxilaprevir and grazoprevir/elbasvir) in attended patients from the outpatient pharmacy consultation. METHOD: a retrospective study that includes patients attended by pharmacists who started treatment between December 1, 2017 and May 31, 2018. Demographic data, disease, adherence and treatment consultations were recorded (interactions, adverse effects and others). RESULTS: Two hundred and five patients were included, with different hepatitis C genotypes, fibrosis states and morbidity levels. Effectiveness was 99.5%, similar to that of clinical trials. CONCLUSIONS: These results resemble those obtained in pharmacy consultations in the United States, operating for more than ten years

An Interactive Mobile Phone-Website Platform to Facilitate Real-Time Management of Medication in Chronically ill Patients.

Poor adherence to medication is a prevalent issue that affects 50-60% of chronically ill patients. We present Medplan, a platform for patients/caregivers and healthcare professionals (HCPs) that aims to enhance adherence, increase patient medication knowledge, and facilitate communication between patients and HCPs. The Medplan platform was designed and developed by a multidisciplinary team composed of primary care and hospital physicians, pharmacists, patients, and developers. We questioned 62 patients in order to know their opinion about the different functions the app would incorporate and other possible features that should be taken into consideration. Medplan comprises a website for HCPs and an application (app) that is installed on the patient's phone. The app is available in Spanish, Catalan, and English. The patient's medication plan was introduced by the HCP and interfaced with the app. Each medicine is represented by an icon showing the indication of the treatment, the trade name, active ingredients, dose, and route of administration. Information about special requirements (e.g., need to take medication on an empty stomach), side effects, or lifestyle recommendations can also be provided. Additional functions include a medication reminder alarm system, by which patients can confirm whether or not they have taken the drug. Patients can self-track their adherence, and all data collected are sent automatically to the website for analysis by the HCP. Weekly motivation messages are sent to encourage adherence. A tool enabling interactive communication between patients and HCPs (primary care or hospital care) is also included. The app contains a feature enabling the HCP to verify the suitability of over-the-counter drugs. Medplan has the potential to significantly improve management of medication in chronically ill patients. A pilot study is being conducted to test whether Medplan is useful and effective.

mHealth intervention to improve medication management in chronically ill patients: analysis of the recruitment process.

OBJECTIVES: Mobile phones have been rapidly adopted by the general population and are now a promising technology with considerable potential in health care. However, refusal rates of 24%-75% have been reported in telemedicine studies. We aimed to report the challenges faced when recruiting patients to use Android and iOS smartphone applications aimed at improving medication management and communication between patients and healthcare professionals. METHODS: The patients invited to participate had heart failure and/or hypertension and/or dyslipidemia. After reaching the number of participants required for inclusion, the recruitment process was analyzed, and the study team determined the reasons for refusal. RESULTS: Of the 448 potential participants who were invited to participate, 210 responded. Of these, 37.1% did not use a smartphone, 2.9% owned a mobile phone that was neither iOS nor Android, and 28.6% were smartphone users who refused to participate. In this case, the most common motive was that patients considered their routine healthcare sufficient and had no trouble remembering to take their medicines (81.7%). The final study sample comprised 48 patients. The mean age of the patients enrolled was significantly lower than that of participants who were not included (59.9 ± 10.6 vs. 66.8 ± 11.4 years, respectively; p=0.00). CONCLUSION: We found age to be an important barrier to smartphone use in healthcare. Among smartphone users, good adherence and sufficient routine healthcare were the most common reasons for refusal to participate. Thus, this type of intervention could enhance participation for poor adherers or caregivers. Implementing educational initiatives could play a key role in improving patient perceptions of technology.

Feasibility and Preliminary Outcomes of a Web and Smartphone-Based Medication Self-Management Platform for Chronically Ill Patients.

OBJECTIVE: The aim of this study was to assess the feasibility and preliminary outcomes of a medication self-management platform for chronically ill patients, Medplan. METHODS: We performed a 6-month single-arm prospective pre-post intervention study of patients receiving treatment for hypertension and/or dyslipidemia and/or heart failure and/or human immunodeficiency virus infection. During the pre-intervention phase, participants were followed according to their usual care; during the intervention phase, they used Medplan. We evaluated adherence, health outcomes, healthcare resources and measured the satisfaction of patients and health care professionals. RESULTS: The study population comprised 42 patients. No differences were found in adherence to medication measured by proportion of days covered with medication (PDC). However, when adherence was measured using the SMAQ, the percentage of adherent patients improved during the intervention phase (p < 0.05), and the number of days with missed doses decreased (p < 0.05). Adherence measured using the Medplan app showed poor concordance with PDC. No differences were found in health outcomes or in the use of health care resources during the study period. The mean satisfaction score for Medplan was 7.2 ± 2.7 out of 10 among patients and 7.3 ± 1.7 among health care professionals. In fact, 71.4 % of participants said they would recommend the app to a friend, and 88.1 % wanted to continue using it. CONCLUSION: The Medplan platform proved to be feasible and was well accepted by its users. However, its impact on adherence differed depending on the assessment method. The lack of effect on PDC is mainly because patients were already good adherers at baseline. The study enabled us to validate the platform in real patients using many different mobile devices and to identify potential barriers to scaling up the platform.

[Drug related problems and hospital admissions]. / Problemas relacionados con la medicación que causan ingresos hospitalarios.

OBJECTIVE: Drug related problems (DRP) are health problems associated with the pharmacological treatment of patients and interfere or can interfere with the expected results on their health. The aim of this study is to determine the prevalence of DRP in patients from an urban health centre that lead to hospitalisation, and its prevention. DESIGN: It is a retrospective, observational and descriptive study. SETTING: Les Corts Health Centre (HC), which is an urban health and teaching centre with a reference population of 32,318 inhabitants. PARTICIPANTS: Users of the les Corts HC admitted to the Barcelona Hospital Clinic from August 2005 to January 2006. RESULTS AND MAIN OUTCOME MEASUREMENTS: A pharmacist and a family doctor analysed the clinical histories and determined whether or not there was a DRP. A DRP was present in 13.4% of all hospital discharges, and 12% were implicated in the hospital admission. It was considered that 57.3% of all the discharges with a DRP as the causing factor in the hospital admission were avoidable. Admissions due to DRP were mainly in internal medicine, cardiology and pneumology. The health problems that lead to hospital admission due to DRP are mainly circulatory (38.5%) and respiratory (11.5%). CONCLUSIONS: The number of hospital admissions due to drug related problems is avoidably high.

Problemas relacionados con la medicación que causan ingresos hospitalarios / Drug related problems and hospital admissions

ObjetivoLos problemas relacionados con los medicamentos (PRM) están vinculados al tratamiento farmacológico del paciente e interfieren o pueden interferir con los resultados esperados en su salud. El presente estudio tiene como objetivo determinar la prevalencia de los PRM en los pacientes de un centro de salud urbano que son causa de ingreso en su hospital de referencia, y su evitabilidad.DiseñoEs un estudio observacional de tipo descriptivo y retrospectivo.EmplazamientoCENTRO de Salud Les Corts, que es un centro de salud urbano y docente con una población asignada de 32.318 habitantes.ParticipantesUsuarios del CS Les Corts ingresados en el Hospital Clínico de Barcelona desde agosto de 2005 a enero de 2006.Resultados y mediciones principalesUna pareja de un farmacéutico y un médico de familia analizan las historias clínicas y determinan la presencia o no de PRM. El 13,4% de todas las altas presentan PRM, que en su mayoría están implicados en el ingreso hospitalario (12%). Un 57,3% del total de altas con un PRM como causa del ingreso hospitalario se ha considerado evitable. Los ingresos por PRM se concentran en los servicios de medicina interna, cardiología y neumología. Los problemas de salud motivo de ingreso hospitalario por PRM son mayoritariamente circulatorios (38,5%) y respiratorios (11,5%).ConclusionesEl número de ingresos debidos a problemas relacionados con la medicación es elevado y evitable(AU)

ObjectiveDrug related problems (DRP) are health problems associated with the pharmacological treatment of patients and interfere or can interfere with the expected results on their health. The aim of this study is to determine the prevalence of DRP in patients from an urban health centre that lead to hospitalisation, and its prevention.DesignIt is a retrospective, observational and descriptive study.SettingLes Corts Health Centre (HC), which is an urban health and teaching centre with a reference population of 32,318 inhabitants.ParticipantsUsers of the les Corts HC admitted to the Barcelona Hospital Clinic from August 2005 to January 2006.Results and main outcome measurementsA pharmacist and a family doctor analysed the clinical histories and determined whether or not there was a DRP. A DRP was present in 13.4% of all hospital discharges, and 12% were implicated in the hospital admission. It was considered that 57.3% of all the discharges with a DRP as the causing factor in the hospital admission were avoidable. Admissions due to DRP were mainly in internal medicine, cardiology and pneumology. The health problems that lead to hospital admission due to DRP are mainly circulatory (38.5%) and respiratory (11.5%).ConclusionsThe number of hospital admissions due to drug related problems is avoidably high(AU)

Calidad de la especialidad farmacéutica como causa de problemas relacionados con los medicamentos / Drug quality as a cause of drug related problems

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