Acceso a medicamentos en pacientes del Seguro Integral de Salud (SIS) con diabetes mellitus y/o hipertensión arterial en Perú / Access to medications in patients of the Seguro Integral de Salud (SIS) with diabetes mellitus and/or arterial hypertension in Peru

Objetivos: Investigar el acceso a medicamentos en pacientes afiliados al Seguro Integral de Salud (SIS) con diabetes mellitus (DM) y/o hipertensión arterial (HTA) en tres regiones de Perú.Material y métodos: Estudio descriptivo transversal realizado mediante dos encuestas adaptadas métodos desarrollados por la OMS. Se encuestaron pacientes afiliados al SIS con DM y/o HTA a la salida de farmacia de establecimientos de salud públicos, y se visitaron instalaciones de establecimientos farmacéuticos públicos y privados en las provincias de Cajamarca y Trujillo, y región Callao.Resultados: 46% de los pacientes recibió todos los productos prescritos. La disponibilidad promedio en oficinas farmacéuticas privadas fue de 53% y en la públicas de 36%. En las oficinas farmacéuticas privadas la mediana de precios en promedio fue 7,7 veces mayor al precio de referencia y en las públicas fue de 1,5. A pesar de la diferencia de precios los tratamientos orales son asequibles y el tratamiento con insulina no lo es. El 30% de los pacientes tardó más de 30 minutos en llegar a los establecimientos de salud públicos y pagaron en promedio 13,45 nuevos soles. En las farmacias de los establecimientos de categorías II-2 y III-1 el 29% los pacientes son atendidos en 30 minutos o más. El 44% de pacientes están de acuerdo con la frase “el SIS cubre todos los medicamentos y yo no tengo que pagarlos”.Conclusión: Existen barreras que limitan el acceso a medicamentos de los pacientes afiliados al SIS con DM y/o HTA en los establecimientos de salud públicos y oficinas farmacéuticas privadas en Perú. (AU)

Objectives: To investigate access to medicines in patients affiliated with the Seguro Integral de Salud (SIS) with diabetes mellitus (DM) and/or arterial hypertension (HT) in three regions of Peru.Material and methods: Cross-sectional descriptive study carried out through two surveys adapted methods developed by WHO. Patients affiliated to the SIS with DM and/or HTA were surveyed at the exit of a pharmacy from public health facilities, and facilities of public and private pharmaceutical establishments were visited in the provinces of Cajamarca and Trujillo, and Callao region.Results: 46% of patients received all prescribed products. The average availability in private pharmaceutical offices was 53% and in the public 36%. In private pharmaceutical offices the median price on average was 7.7 times higher than the reference price and in public offices it was 1.5. Despite the difference in prices, oral treatments are affordable and insulin treatment is not. 30% of the patients took more than 30 minutes to reach public health facilities and paid an average of 13.45 nuevos soles. In pharmacies in establishments of categories II-2 and III-1, 29% of patients are treated in 30 minutes or more. 44% of patients agree with the phrase «the SIS covers all medications and I don’t have to pay for them».Conclusion: There are barriers that limit access to medicines for patients affiliated with SIS with DM and/or HTA in public health facilities and private pharmaceutical offices in Peru. (AU)

Reacciones Adversas a Medicamentos reportadas como resultado de la implementación de Atención Farmacéutica en la Farmacia Institucional DIGEMID - Ministerio de Salud de Perú / Adverse drug reactions reported as a result of the implementation of pharma- ceutical care in the Institutional Pharmacy DIGEMID - Ministry of Health

Objetivos: Determinar el resultado de la implementación de la Atención Farmacéutica en las notificaciones de sospechas de reacciones adversas de medicamentos (RAM) en los pacientes ambulatorios de la Farmacia Institucional de la DIGEMID. Material y métodos: Se realizó un estudio retrospectivo, descriptivo, observacional y transversal del año 2013. Se emplearon las fichas farmacoterapéuticas de los pacientes atendidos en el año 2013. Se seleccionaron las fichas de los pacientes que tuvieron notificación de sospecha de RAM. Resultados: Se recolectó las notificaciones de sospecha de RAM de 44 pacientes ambulatorios de la Farmacia Institucional de DIGEMID y se procedió a analizar las notificaciones de la RAM. Se notificaron 77 sospecha de RAM y el mayor porcentaje fueron los de trastorno gastrointestinal (26,0%). El medicamento causante del mayor porcentaje de RAM fue carbamazepina (6,7%), siendo los medicamentos relacionados con el sistema nervioso los que presentaron más RAM (28,9%), Según la gravedad la RAM más frecuente fueron las serias (61%) y en cuanto a la categoría de la causalidad el más frecuente fue "probable" (43,1%). Conclusión: La implementación de la atención farmacéutica tuvo un resultado positivo en las notificaciones de las sospechas de RAM en la Farmacia Institucional de DIGEMID

Objectives: To determine the result of the implementation of Pharmaceutical Care in the notifications of suspected adverse drug reactions (ADRs) in the outpatients of the institutional pharmacy DIGEMID. Methods: A retrospective, descriptive, observational and cross-sectional study was conducted in 2013. The pharmacotherapeutic records of the patients that have been seen in 2013 were taken to carry out this study. Particularly, the patients who were reporting suspected ADRs were selected. Results: 44 Notifications of suspected ADR of outpatients from the Institutional Pharmacy of DIGEMID were collected and analyzed. PRM was the most common adverse reaction detected (PRM 5) with 35%. 77 suspected ADRs were related to gastrointestinal disorders (26.0%); this represented the highest percentage. The drug which caused the biggest percentage of the ADRs was nervous system one (28.9%). Regarding the gravity, the serious ADR’s were the most common ones (61%) and taking into account the category of the most frequent ones, causality was "likely" (43.1%). Conclusion: The implementation of pharmaceutical care had a positive result in the notifications of suspected ADR in the institutional pharmacy DIGEMID

Campaña de atención farmacéutica como estrategia de implementación de los servicios farmacéuticos: experiencia Perú / Pharmaceutical care campaign as a strategy for implementation of pharmaceutical services: experience Peru

Introducción: Se necesita mostrar las actividades farmacéuticas enfocadas en el cuidado de los pacientes, logrando un uso efectivo y seguro del medicamento y, finalmente, alcanzar las metas terapéuticas de los pacientes. Objetivo: Describir las actividades realizadas en una campaña de atención farmacéutica como estrategia para la implementación de servicios farmacéuticos. Material y métodos: Estudio observacional, descriptivo, transversal, que incluyó a pacientes que asistieron a la farmacia institucional el día de la campaña, quienes recibieron al menos uno de los 3 servicios siguientes: 1. Información sobre medicamentos usando un atril con láminas; 2. Medición de la presión arterial; 3. Seguimiento farmacoterapéutico. Resultados: Se desarrollaron las tres actividades programadas. Un total de 815 personas estuvieron interesadas en la información brindada con el atril con láminas. Un total de 96 personas acudieron para que se les midiera la presión arterial (un 62,5% varones y el resto mujeres). El promedio de edad fue de 67,83 años (desviación estándar [DE]: 13,624). El 25% de los pacientes presentó valores de presión arterial por encima del objetivo terapéutico. El servicio de SFT fue solicitado por 39 pacientes (un 66,66% mujeres y el resto varones). El promedio de edad fue de 64,7 años (DE: 19,7). En 33 se detectaron problemas reales relacionados con los medicamentos, y en 7 problemas potenciales habiéndose tomado el Segundo Consenso de Granada como referencia para la clasifi cación. Se notificaron 12 reacciones adversas a medicamentos, el 50% graves. Conclusión: El desarrollo de la campaña farmacéutica ha permitido obtener datos sobre el uso de medicamentos en enfermedades crónicas y las reacciones adversas, así como valorar en qué medida los pacientes alcanzan sus objetivos terapéuticos. En definitiva, se muestra la urgente necesidad de que los pacientes ambulatorios reciban de modo sistemático servicios farmacéuticos que logren optimizar sus tratamientos farmacológicos(AU)

Introduction: It needs to show pharmaceutical activities focused on patient care, achieving safe and effective use of medication and finally achieve the therapeutic goals of patients. Objective: To describe the activities carry out in a pharmaceutical care campaign as strategy for pharmaceutical service implementation. Material and methods: An observational, descriptive, transversal, which included patients who attended institutional pharmacy day of the campaign, who received at least one of the three following services: 1) drug information using a music stand with sheet; 2) pressure measurement blood, and 3) pharmaceutical care. Results: We developed the 3 programmed activities. 815 people were interested in the information provided with the flip chart. A total of 96 people came for blood pressure measured, 62.5% being male and the other women. The mean (standard deviation) age was 67.83 (13,624). 25% of patients had values greater than 140/90 mmHg. Pharmacotherapy follow up service was requested by 39 patients, 66.66% women and other men. The mean (SD) age was 64.7 (19.7). 33 real DRP and 7 potential DRP were detected. It was notifi ed 12 reports of adverse drug reactions, with 50% of serious gravity. Conclusion: The development of pharmaceutical campaign has yielded data on medication use in chronic diseases, adverse reactions and to what extent patients reach their therapeutic goals, which shows the urgent need for patients to receive services in a systematic achieve optimized pharmaceutical drug treatments for outpatients(AU)

House-level risk factors for triatomine infestation in Colombia.

BACKGROUND: Chagas disease, transmitted domestically by triatomine bugs, is the most important vector-borne disease in Latin America. The association between triatomine infestation and housing characteristics was investigated based on a standardized survey in 41 971 houses in 15 Departments in Colombia. METHODS: Multivariate logistic regression was used to test for associations of two highly correlated infestation measures of infestation (householders reporting having seen triatomines inside the house, and sending triatomines to the survey team), with 15 household-level risk factors. Risks were measured relative to a reference category of houses with up to three inhabitants, area up to 50 m(2), unplastered adobe walls, thatch roof and no outbuildings or domestic animals. RESULTS: The probability of seeing triatomines was highest for households with over seven inhabitants (OR = 1.24, 95% CI 1.11-1.39), overhead storage space (OR = 1.16, 95% CI 1.03-1.32), grain shed (OR = 1.25, 95% CI 1.02-1.52), cats (OR = 1.27, 95% CI 1.14-1.42) and pigs (OR = 1.16, 95% CI 1.03-1.30). Lowest risks were in houses with wooden walls (OR = 0.46, 95% CI 0.34-0.61), fully plastered walls (OR = 0.78, 95% CI 0.68-0.88), roofs made of tiles (OR = 0.51, 95% CI 0.33-0.78) and flagstone floors (OR = 0.57, 95% CI 0.42-0.76). Results for householders returning triatomines support this set of risk factors, but with wider confidence intervals. CONCLUSIONS: Surveillance of a few easily assessed household characteristics provides an accurate, rapid assessment of house-level variation in risk. Measured effect sizes for specific structural characteristics could be used to maximize the cost-effectiveness of programmes to reduce vector infestation and interrupt Chagas disease transmission by improving house quality.

Comparison of four serological tests for the diagnosis of Chagas disease in a Colombian endemic area.

The performance of 4 serological tests for the diagnosis of Chagas disease was evaluated in Santander, Colombia, a region still presenting active transmission. Serum samples from 638 individuals were submitted to an enzyme immunoassay test (EIA), using total lysate of a local Trypanosoma cruzi strain and 52.5% were positive (335/638). A subset of this group (94 positive individuals and 90 seronegatives) was randomly selected for further serological confirmation. Three additional tests were used--indirect immunofluorescence (IIF) and 2 distinct enzyme-linked immunosorbent assays using total lysate of the Y strain (EIA BM) and a mixture of 2 recombinant antigens (EIA RA). Seventy-nine patients were seropositive in all tests (84.0%-79/94). The number of positive sera with the IIF, EIA RA and EIA BM was 84/94 (89.4%), 80/94 (85.1%) and 79/94 (84.0%), respectively. In 15 out of the 94 EIA seropositive patients (16.0%), 10 individuals were negative in all 3 tests (10.6%-10/94). One was negative in the EIA BM and positive in the other two tests (1.1%-1/94) and 4 patients were positive, solely, in the IIF assay (4.3%-4/94). Relative to the 90 EIA negative individuals, 89 were confirmed in all other tests (98.9%-89/90). One individual, although seronegative in the IIF, was positive in both confirmatory EIA tests (1.1%-1/90). In addition, 120 blood specimens were submitted to PCR amplification. This group consisted of 79 confirmed seropositive cases, 16 individuals with discordant serological results and 25 validated seronegative individuals. The PCR was able to detect the presence of parasite DNA in 67 out of the 79 seropositive patients (84.8%), in 8 individuals with discordant serology (50.0%) and in only one seronegative individual (4.0%). The results pointed to the necessity for performing more than one serological test, preferentially with antigens from autochthonous strains, to achieve a reliable diagnosis of Chagas disease in Colombia.