Treatment patterns and factors associated with adherence in pulmonary arterial hypertension.

OBJECTIVE: Improving understanding of actual pulmonary hypertension (PH) treatment adherence patterns is crucial to properly treating these patients. We aimed to primarily assess adherence to treatments used for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) specific therapies, identify potential factors related to it and secondly describe its treatment patterns. METHODS: A 6-month observational cross-sectional study in a tertiary care hospital was conducted. Patients with PH-targeted therapy who picked it up in the ambulatory hospital pharmacy and who had been on treatment with the same drug for at least 1 year were included. Adherence was assessed as: 1) Proportion of days covered (PDC); and 2) Simplified Medication Adherence Questionnaire (SMAQ). PDC ≥80% was considered adherent. Statistical analyses were performed to evaluate the study outcomes. Logistic regressions were estimated to identify the association between baseline characteristics and factors associated with adherence. P < 0.05 indicated statistical significance. RESULTS: A total of 63 patients with 127 different treatments were included, 71.4% were females with a mean age (SD) of 59 (15) years. PAH was the most common diagnosis (74.6%). Double therapy was used in 39.7% of patients, being the combination of Macitentan + Tadalafil and Ambrisentan + Tadalafil the most prescribed. Endothelin receptor antagonists were the most used treatment (40.2%). Adherence according to PDC was 93.7%, showing no great differences depending on the targeted drug used, and according to SMAQ 61.9%. The agreement degree of both methods was slight (65.1%; Kappa 0.12). Only female sex (OR: 0.23, 95% CI: 0.06-0.90; p = 0.035) was associated with worse adherence in the SMAQ method but not in the PDC. Adverse events were reported by a 55.6% of participants and the perception of effective treatment was high (95.2%). CONCLUSIONS: Adherence to PH therapy differs depending on the assessment method; PDC showed greater adherence rate than SMAQ. According to SMAQ, female sex may have a negative impact on adherence in this cohort, but PDC revealed no factors influencing it. No notable differences in adherence between treatment types were found and generally patients felt the treatments were effective in controlling their disease.

[Impact of a primary care pharmacy unit on the optimization of pharmacological treatment of type 2 diabetic patients]. / Impacto de una unidad de farmacia de atención primaria en la optimización del tratamiento farmacológico de pacientes diabéticos tipo 2.

OBJECTIVE: To evaluate the impact of a pharmaceutical intervention on treatment optimization in patients with type 2 diabetes mellitus. DESIGN: Before-after intervention study. SITE: Health centers of the Primary Care Department of Camp de Tarragona. PARTICIPANTS: Patients aged ≥ 18 years, diagnosed with type 2 diabetes mellitus and under treatment with antidiabetic drugs. INTERVENTIONS: Review of pharmacological treatment for type 2 diabetes mellitus and issuance of proposals for its adequacy. MAIN MEASUREMENTS: Demographic and clinical variables were collected to assess the adequacy of antidiabetic treatment. A consensus meeting was arranged with the patients' primary care physician to evaluate the proposals for improvement. The implementation of the proposals and the variation in postintervention glycemic control were assessed. RESULTS: A total of 907 patients (59% men) were included. A total of 782 proposals for intervention were made in 65.8% of the patients reviewed. Of the proposals, 43.5% corresponded to drug discontinuation, 16% to intensification of dosing and 12.6% to exchange for a therapeutic equivalent. Of the consensual proposals, 54.7% were implemented. HbA1c was reduced by 0.2% after the intervention (7.4 vs 7.2%). CONCLUSIONS: Review of the pharmacological treatment of patients with type 2 diabetes mellitus by a pharmacist or pharmacologist facilitates its optimization.

XI Congreso SEFAC: fortaleciendo la atención primaria y reivindicando el valor clínico de la farmacia comunitaria / XI SEFAC Congress: strengthening primary care and vindicating the clinical value of community pharmacy

Para seguir dando soluciones a los grandes retos de presente y futuro de la sanidad y a las necesidades cambiantes de los pacientes, debemos tener una atención primaria reforzada y coordinada, que cuente con el apoyo decidido de la Administración, y que abrace los avances tecnológicos y digitales sin renunciar a la presencialidad. Ahora más que nunca, la farmacia comunitaria debe reivindicar su compromiso con los pacientes y su vocación de fortalecer la atención primaria, apostando por su valor clínico. Son estos precisamente los dos puntos sobre lo que descansa el lema del XI Congreso Nacional de Farmacéuticos Comunitarios y IV Reunión Internacional de Farmacéuticos Comunitarios, que SEFAC celebra del 16 al 18 de mayo en Las Palmas con la colaboración del Colegio Oficial de Farmacéuticos de Las Palmas; tres intensas jornadas científico-profesionales en las que ponentes de primer nivel nacional e internacional impartirán contenidos basados en la evidencia científica, la práctica profesional y la actualidad sanitaria de la farmacia comunitaria.(AU)

23 Congreso Nacional Farmacéutico / [23rd National Pharmaceutical Congress]

Bajo el lema Transformando la sanidad con el farmacéutico, el 23 Congreso Nacional Farmacéutico ha reunido en Valencia a más de 2.000 farmacéuticos de todos los ámbitos de la profesión, desde la óptica y la ortopedia, a la dermofarmacia, la investigación, la industria, la distribución, la alimentación, los análisis clínicos, la salud pública, la farmacia hospitalaria y, por supuesto, la farmacia comunitaria. (AU)

Effect of a clinical pharmacist on 30-day revisits following discharge from an emergency department: a randomized controlled clinical trial. / Efecto del farmacéutico clínico en las reconsultas a los 30 días posalta del servicio de urgencias: ensayo clínico controlado.

OBJECTIVES: To evaluate a clinical pharmacist's inclusion in emergency department (ED) care in terms of the effect on on 30-day revisits after discharge from the ED and patient satisfaction. MATERIAL AND METHODS: Randomized, controlled parallel-group pragmatic trial in a university hospital ED. Recruited patients were randomly assigned to a control group for standard care only or an intervention group to receive standard care plus the attention of a clinical pharmacist integrated into the care team to optimize the selection and evaluation of medications and provide pharmacotherapeutic education on the patient's discharge. The primary outcome was unplanned revisits within 30 days after discharge because of the same complaint that led to the initial ED visit. Between-group differences were analyzed with Kaplan-Meier survival curves and log-rank tests. The association between the intervention and time to the outcome event was explored with multivariate Cox proportional hazard regression analysis. RESULTS: A total of 1001 patients were enrolled (intervention, 500; control, 501). Patients in both groups were similar. A majority were women (61.5%), and the median age (interquartile range) was 51 years (33-65 years). The pharmacist's intervention significantly reduced the number of 30-day revisits to any ED: 25 (6.3%) revisited vs 66 (16.7%) in the control group. The adjusted hazard ratio (aHR) was 0.29 (95% CI, 0.17-0.50). Fifteen patients (3.0%) from the intervention group revisited the same ED vs 32 (6.5%) from the control group (aHR, 0.46 [95% CI, 0.24-0.87]). More patients expressed satisfaction in the intervention group (87.2%) than in the control group ( 83.2%) (P .05). CONCLUSION: Including a clinical pharmacist in ED care substantially reduces the number of 30-day revisits and increases patient satisfaction.

OBJETIVO: Determinar el efecto de la inclusión del farmacéutico clínico en el servicio de urgencias (SU) en las reconsultas durante 30 días posalta y la satisfacción de los pacientes. METODO: Ensayo clínico controlado, aleatorizado, paralelo y pragmático, realizado en el SU de un hospital universitario. Los pacientes reclutados fueron asignados aleatoriamente al grupo control (GC) que recibió la atención habitual o al grupo intervenido (GI) que recibió además la atención de un farmacéutico clínico, el cual se integró al equipo clínico para optimizar la selección, evaluación y educación farmacoterapéutica en el SU y al alta. El desenlace primario fue reconsultas no programadas 30 días posaltarelacionadas con la atención inicial al SU. Las diferencias entre grupos se analizaron por curvas de supervivencia de Kaplan-Meier y prueba de log-rank. La asociación entre intervención y tiempo al evento fue analizada mediante regresión multivariada de riesgos proporcionales de Cox y se expresó como hazard ratio ajustada (HRa). RESULTADOS: Un total de 1.001 pacientes ingresaron al estudio (GI = 500 y GC = 501). Ambos grupos eran similares, predominaron las mujeres (61,5%), edad 51 años (RIC: 33-65). La intervención redujo significativamente las reconsultas a cualquier centro durante 30 días posalta comparado con GC [25 (6,3%) vs 66 (16,7%); HRa: 0,29 (IC 95%: 0,17-0,50)] y para el mismo centro [15 (3,0%) vs 32 (6,5%); HRa: 0,46 (IC 95%: 0,24-0,87)]. La satisfacción del usuario fue mayor en el GI que GC (87,2% vs 83,2%; p 0,05). CONCLUSIONES: La inclusión del farmacéutico clínico en un SU reduce sustancialmente las reconsultas durante 30 días posalta y mejora la satisfacción de los usuarios.

El farmacéutico clínico en el abordaje del paciente con sospecha de alergia a beta-lactámicos: una revisión sistemática / The role of clinical pharmacists in patients with suspected allergy to B-lactams: A systematic review

Objetivo analizar el papel desempeñado por el farmacéutico clínico y su impacto en el ámbito de los programas de optimización de antimicrobianos ante la sospecha de alergia a antibióticos beta-lactámicos.Método se realizaron 2 búsquedas bibliográficas independientes. Se encontraron un total de 35 artículos incluyéndose 12. Se analizaron los artículos incluidos y se recogieron variables de eficacia, seguridad y aplicabilidad de herramientas de evaluación a pacientes con sospecha de alergia a beta-lactámicos. Además, se analizó la variación en el consumo y en el perfil de prescripción de antibióticos alternativos. Resultados los estudios seleccionados analizaron cuestionarios, desetiquetado, test intradérmicos y pruebas de provocación oral realizados por farmacéuticos. Se hallaron diferencias significativas en la variable principal de eficacia en 4 estudios incluidos a favor de la intervención farmacéutica. En un estudio cuasi experimental, la utilización de cefazolina aumentó tras la intervención farmacéutica (65 vs. 28%; p < 0,01). En otro estudio cuasi experimental, la dosis diaria definida media de aztreonam y la media de días de terapéutica por 1.000 pacientes/día disminuyeron (21,23 vs. 9,05; p < 0,01) y (8,79–4,24; p = 0,016), pre y postintervención, respectivamente, aumentando las desescaladas antibióticas (p ≤ 0,01). En otro estudio, disminuyó la prescripción de antibióticos de uso restringido (42,5 vs. 17,9%; p < 0,01) y en otro, la utilización de antibióticos profilácticos prequirúrgicos alternativos a cefazolina (81,9 vs. 55,9%; p < 0,01). En otro estudio, el tiempo medio por entrevista fue de 5,2 minutos por paciente. No se reportaron eventos adversos en ningún estudio. Conclusiones la intervención del farmacéutico en la evaluación del paciente con sospecha de alergia a beta-lactámicos resulta eficaz, segura y aplicable a la práctica clínica (AU)

Objective To analyze the role played by the clinical pharmacist and its impact in antibiotic stewardship facing suspected allergy to beta-lactam antibiotics. Method We performed two different independent bibliographic searches. A total of 35 articles were found, and the final number included in the study was 12. We analysed the articles and collected variables of efficacy, safety and applicability of evaluation tools applied to patients with suspected allergy to beta-lactams. Also, the variation in the consumption and prescription profile of alternative antibiotics was analyzed. Results The selected studies analysed questionnaires, allergy delabeling, intradermal tests and oral challenge tests performed by pharmacists. Significant differences in the efficacy endpoint were found in 4 studies in favour of pharmaceutical intervention. In the study of Kwiatkowski et al, cefazolin use increased in surgical patients after pharmacist intervention (65 vs. 28%; p < 0.01). In a quasi-experimental study, the mean defined daily dose of aztreonam and the mean days of therapy per 1000 patients/day decreased (21.23 vs 9.05, p <0.01) and (8.79–4.24, p = 0.016), pre and post-intervention, respectively, increasing antibiotic de-escalations (p ≤ 0.01). In another quasi-experimental study, the prescription of restricted-use antibiotics decreased (42.5% vs. 17.9%, p < 0.01) and the use of pre-surgical prophylactic antibiotics alternative to cefazolin (81.9% vs 55.9%, p<0.01) in another study. Other study showed that the mean time per interview was 5.2 minutes per patient. No adverse events were reported in any study. Conclusion The pharmacist intervention in the evaluation of the patient with suspected allergy to beta-lactams is effective, safe and feasible to implement on daily clinical practice (AU)

Efecto del farmacéutico clínico en las reconsultas a los 30 días posalta del servicio de urgencias: ensayo clínico controlado / Effect of a clinical pharmacist on 30-day revisits following discharge from an emergency department: a randomized controlled clinical trial

Objetivos. Determinar el efecto de la inclusión del farmacéutico clínico en el servicio de urgencias (SU) en las reconsultas durante 30 días posalta y la satisfacción de los pacientes. Métodos. Ensayo clínico controlado, aleatorizado, paralelo y pragmático, realizado en el SU de un hospital universitario. Los pacientes reclutados fueron asignados aleatoriamente al grupo control (GC) que recibió la atención habitual o al grupo intervenido (GI) que recibió además la atención de un farmacéutico clínico, el cual se integró al equipo clínico para optimizar la selección, evaluación y educación farmacoterapéutica en el SU y al alta. El desenlace primario fue reconsultas no programadas 30 días posaltarelacionadas con la atención inicial al SU. Las diferencias entre grupos se analizaron por curvas de supervivencia de Kaplan-Meier y prueba de log-rank. La asociación entre intervención y tiempo al evento fue analizada mediante regresión multivariada de riesgos proporcionales de Cox y se expresó como hazard ratio ajustada (HRa). Resultados. Un total de 1.001 pacientes ingresaron al estudio (GI=500 y GC=501). Ambos grupos eran similares, predominaron las mujeres (61,5%), edad 51 años (RIC: 33-65). La intervención redujo significativamente las reconsultas a cualquier centro durante 30 días posalta comparado con GC [25 (6,3%) vs 66 (16,7%); HRa: 0,29 (IC 95%: 0,17-0,50)] y para el mismo centro [15 (3,0%) vs 32 (6,5%); HRa: 0,46 (IC 95%: 0,24-0,87)]. La satisfacción del usuario fue mayor en el GI que GC (87,2% vs 83,2%; p<0,05). Conclusiones. La inclusión del farmacéutico clínico en un SU reduce sustancialmente las reconsultas durante 30 días posalta y mejora la satisfacción de los usuarios. (AU)

Objectives. To evaluate a clinical pharmacist’s inclusion in emergency department (ED) care in terms of the effect on on 30-day revisits after discharge from the ED and patient satisfaction. Methods. Randomized, controlled parallel-group pragmatic trial in a university hospital ED. Recruited patients were randomly assigned to a control group for standard care only or an intervention group to receive standard care plus the attention of a clinical pharmacist integrated into the care team to optimize the selection and evaluation of medications and provide pharmacotherapeutic education on the patient’s discharge. The primary outcome was unplanned revisits within 30 days after discharge because of the same complaint that led to the initial ED visit. Between-group differences were analyzed with Kaplan-Meier survival curves and log-rank tests. The association between the intervention and time to the outcome event was explored with multivariate Cox proportional hazard regression analysis. Results. A total of 1001 patients were enrolled (intervention, 500; control, 501). Patients in both groups were similar. A majority were women (61.5%), and the median age (interquartile range) was 51 years (33-65 years). The pharmacist’s intervention significantly reduced the number of 30-day revisits to any ED: 25 (6.3%) revisited vs 66 (16.7%) in the control group. The adjusted hazard ratio (aHR) was 0.29 (95% CI, 0.17-0.50). Fifteen patients (3.0%) from the intervention group revisited the same ED vs 32 (6.5%) from the control group (aHR, 0.46 [95% CI, 0.24-0.87]). More patients expressed satisfaction in the intervention group (87.2%) than in the control group ( 83.2%) (P<.05). Conclusions. Including a clinical pharmacist in ED care substantially reduces the number of 30-day revisits and increases patient satisfaction. (AU)

Efecto del farmacéutico clínico en las reconsultas a los 30 días posalta del servicio de urgencias: ensayo clínico controlado / Effect of a clinical pharmacist on 30-day revisits following discharge from an emergency department: a randomized controlled clinical trial

Objetivos. Determinar el efecto de la inclusión del farmacéutico clínico en el servicio de urgencias (SU) en las reconsultas durante 30 días posalta y la satisfacción de los pacientes. Métodos. Ensayo clínico controlado, aleatorizado, paralelo y pragmático, realizado en el SU de un hospital universitario. Los pacientes reclutados fueron asignados aleatoriamente al grupo control (GC) que recibió la atención habitual o al grupo intervenido (GI) que recibió además la atención de un farmacéutico clínico, el cual se integró al equipo clínico para optimizar la selección, evaluación y educación farmacoterapéutica en el SU y al alta. El desenlace primario fue reconsultas no programadas 30 días posaltarelacionadas con la atención inicial al SU. Las diferencias entre grupos se analizaron por curvas de supervivencia de Kaplan-Meier y prueba de log-rank. La asociación entre intervención y tiempo al evento fue analizada mediante regresión multivariada de riesgos proporcionales de Cox y se expresó como hazard ratio ajustada (HRa). Resultados. Un total de 1.001 pacientes ingresaron al estudio (GI=500 y GC=501). Ambos grupos eran similares, predominaron las mujeres (61,5%), edad 51 años (RIC: 33-65). La intervención redujo significativamente las reconsultas a cualquier centro durante 30 días posalta comparado con GC [25 (6,3%) vs 66 (16,7%); HRa: 0,29 (IC 95%: 0,17-0,50)] y para el mismo centro [15 (3,0%) vs 32 (6,5%); HRa: 0,46 (IC 95%: 0,24-0,87)]. La satisfacción del usuario fue mayor en el GI que GC (87,2% vs 83,2%; p<0,05). Conclusiones. La inclusión del farmacéutico clínico en un SU reduce sustancialmente las reconsultas durante 30 días posalta y mejora la satisfacción de los usuarios. (AU)

Objectives. To evaluate a clinical pharmacist’s inclusion in emergency department (ED) care in terms of the effect on on 30-day revisits after discharge from the ED and patient satisfaction. Methods. Randomized, controlled parallel-group pragmatic trial in a university hospital ED. Recruited patients were randomly assigned to a control group for standard care only or an intervention group to receive standard care plus the attention of a clinical pharmacist integrated into the care team to optimize the selection and evaluation of medications and provide pharmacotherapeutic education on the patient’s discharge. The primary outcome was unplanned revisits within 30 days after discharge because of the same complaint that led to the initial ED visit. Between-group differences were analyzed with Kaplan-Meier survival curves and log-rank tests. The association between the intervention and time to the outcome event was explored with multivariate Cox proportional hazard regression analysis. Results. A total of 1001 patients were enrolled (intervention, 500; control, 501). Patients in both groups were similar. A majority were women (61.5%), and the median age (interquartile range) was 51 years (33-65 years). The pharmacist’s intervention significantly reduced the number of 30-day revisits to any ED: 25 (6.3%) revisited vs 66 (16.7%) in the control group. The adjusted hazard ratio (aHR) was 0.29 (95% CI, 0.17-0.50). Fifteen patients (3.0%) from the intervention group revisited the same ED vs 32 (6.5%) from the control group (aHR, 0.46 [95% CI, 0.24-0.87]). More patients expressed satisfaction in the intervention group (87.2%) than in the control group ( 83.2%) (P<.05). Conclusions. Including a clinical pharmacist in ED care substantially reduces the number of 30-day revisits and increases patient satisfaction. (AU)

Detección de personas en riesgo de padecer diabetes en la farmacia comunitaria con el test de Findrisc en los años 2014-2021 / Detection of people at risk of diabetes in the community pharmacy with the Findrisc test in the years 2014-2021

Objetivo: analizar los resultados de las campañas de SEFAC de cribado del riesgo de padecer diabetes, realizados en las farmacias comunitarias españolas desde 2014. Métodos: estudio descriptivo acumulativo de los resultados de las campañas del Día Mundial de la Diabetes, en 2014, 2016-2018, 2020 y 2021. Pacientes: usuarios ≥18 años no diagnosticados de diabetes con consentimiento firmado. Variables: puntuación del test de Findrisc, media (m) y desviación estándar (DE) y participantes en intervalos de riesgo, n (%). Variables demográficas (sexo, edad) y antropométricas, índice de masa corporal (IMC) (kg/m2), perímetro de cintura (cm), glucemia capilar m (DE) (mg/dl). Resultados: participaron 1.146 farmacéuticos, 12402 usuarios. 8.799 (70,9 %) tenían IMC ≥25 kg/m2. 7366 (59,4 %) tomaban antihipertensivos. 6047 (48,8 %) con perímetro abdominal excesivo. 5962 (48,0 %) tenían antecedentes familiares de diabetes. El riesgo medio (puntuación Findrisc) fue de 11,3 (4,6), sin diferencias entre sexos (p>0,05). El número de participantes con riesgo alto/muy alto (F≥15) fue 3107 (25,0 %) sin diferencias entre sexos (p>0,05). El riesgo alto/muy alto aumenta con la edad, de 282 (15,1 %) personas de 45-54 años hasta 1695 (40,1 %) personas >64 años. Se derivaron al médico 1762 (14,2 %), sin datos de resultado. Tiempo medio de entrevista: 10,3 (5,3) minutos, sin diferencias entre sexos (p>0,05). Conclusiones: la cuarta parte de los encuestados tenían riesgo alto/muy alto y fueron derivados al médico uno de cada siete. Los factores de riesgo más prevalentes fueron IMC, hipertensión arterial, perímetro abdominal y antecedentes familiares de diabetes. Debe mejorarse la comunicación interprofesional, pues no se obtuvo resultado de las derivaciones al médico. (AU)

Aim: To analyze diabetes risk screening using the Findrisc questionnaire, performed in Spanish community pharmacies (CP) since 2014. Methods: Cumulative descriptive study of the results of the World Diabetes Day campaigns, in 2014, 2016-2018, 2020 and 2021. Subjects: users ≥18 years not diagnosed with diabetes with signed consent. Variables: Findrisc test score m (SD) and participants in risk intervals, n (%). Demographic (sex, age) and anthropometric variables, body mass index (BMI) (kg/m2), waist circumference (cm), capillary glycemia m (SD) (mg/dl). Results: 1146 pharmacists, 12402 users. 8799 (70.9 %) had BMI ≥25 Kg/m2. 7366 (59.4 %) were taking antihypertensive drugs. 6047 (48.8 %) with unhealthy abdominal perimeter. 5962 (48.0 %) had a family history of diabetes. The mean risk (F score) was 11.3 (4.6), with no differences between sexes (p<0.05). The number of participants with high/very high risk (F≥15) was 3107 (25.0%) with no differences between sexes (p<0.05). High/very high risk increased with age, from 282 (15.1%) persons aged 45-54 years to 1695 (40.1%) persons >64 years. A total of 1762 (14.2% of the total) were referred to a physician.Mean interview time: 10.3 (5.3) minutes, with no differences between sexes (p<0.05). Conclusions: One quarter of the respondents were at high/very high risk and one in seven were referred to a physician. The most prevalent risk factors were BMI, hypertension, abdominal circumference and family history of diabetes. Interprofessional communication should be improved, as no results were obtained from referrals to the physician. (AU)

Exploración sobre la situación profesional y laboral de los farmacéuticos comunitarios de Gipuzkoa / Exploration of professional and working conditions among community pharmacists in Gipuzkoa

El presente estudio aborda la situación profesional y laboral de los farmacéuticos comunitarios de Gipuzkoa. Se han realizado las siguientes acciones: 1) Grupo de discusión entre farmacéuticos titulares y adjuntos, 2) Encuesta sobre satisfacción y conciliación de los farmacéuticos colegiados ejercientes en farmacia comunitaria y 3) Análisis de los motivos de las bajas de colegiación de los últimos 3 años. Se han realizado análisis cuantitativos y cualitativos. Se observa una problemática multifactorial que incluye dificultad de contratación de farmacéutico adjuntos, conciliación, falta de satisfacción y desarrollo profesional, horarios y otras condiciones laborales. La satisfacción profesional y la conciliación de los farmacéuticos titulares es mayor que la de los farmacéuticos adjuntos (p<0,001), aunque la conciliación no sea favorable para ninguno de los dos colectivos profesionales. La conciliación se percibe como mejor en farmacias de horario continuado, frente a farmacias con horario partido. El 70,5 % (n=67) de los farmacéuticos que se han dado de baja del colegio en los últimos 3 años, lo han hecho para cambiar de ámbito profesional, siendo educación e industria las opciones más frecuentes. La situación profesional y laboral del farmacéutico ejerciente en farmacia comunitaria requiere de una reflexión profunda para poder plantear estrategias globales que mejoren la satisfacción profesional y conciliación. (AU)

The purpose of this study is to explore the professional and working conditions of community pharmacists in the province of Gipuzkoa. The methodology employed involved: 1) A discussion with owner pharmacists and associate pharmacists, 2) A survey on satisfaction and work-life balance of pharmacists working in community pharmacies, and 3) Analysis of the reasons for cancelling membership of the association of pharmacists in the last 3 years. Data were analysed qualitatively and quantitatively. There was evidence of a range of issues including difficulty in recruiting associate pharmacists, unfavourable work-life balance, low job satisfaction and lack of professional development, poor business hours and other working conditions. Owner pharmacists reported a higher level of job satisfaction and work-life balance than associate pharmacists (p<0.001). However, both groups had a poor work-life balance. The issue of work-life balance is seen as being better in pharmacies with continuous business hours, as opposed to those with split (morning/afternoon) hours. Seventy percent (n=67) of pharmacists who cancelled their membership of the association over the last three years moved to another professional domain, particularly education and industry. In-depth deliberation is required into the professional and working situation of pharmacists working in community pharmacies, with a view to positing global strategies to improve job satisfaction and work-life balance. (AU)

The role of clinical pharmacists in patients with suspected allergy to ß-lactams: A systematic review. / El farmacéutico clínico en el abordaje del paciente con sospecha de alergia a beta-lactámicos: una revisión sistemática.

OBJECTIVE: To analyze the role played by the clinical pharmacist and its impact in antibiotic stewardship facing suspected allergy to beta-lactam antibiotics. METHOD: We performed two different independent bibliographic searches. A total of 35 articles were found, and the final number included in the study was 12. We analysed the articles and collected variables of efficacy, safety and applicability of evaluation tools applied to patients with suspected allergy to beta-lactams. Also, the variation in the consumption and prescription profile of alternative antibiotics was analyzed. RESULTS: The selected studies analysed questionnaires, allergy delabeling, intradermal tests and oral challenge tests performed by pharmacists. Significant differences in the efficacy endpoint were found in 4 studies in favour of pharmaceutical intervention. In the study of Kwiatkowski et al, cefazolin use increased in surgical patients after pharmacist intervention (65 vs. 28%; p < 0.01). In a quasi-experimental study, the mean defined daily dose of aztreonam and the mean days of therapy per 1000 patients/day decreased (21.23 vs 9.05, p <0.01) and (8.79-4.24, p = 0.016), pre and post-intervention, respectively, increasing antibiotic de-escalations (p ≤ 0.01). In another quasi-experimental study, the prescription of restricted-use antibiotics decreased (42.5% vs. 17.9%, p < 0.01) and the use of pre-surgical prophylactic antibiotics alternative to cefazolin (81.9% vs 55.9%, p<0.01) in another study. Other study showed that the mean time per interview was 5.2 minutes per patient. No adverse events were reported in any study. CONCLUSION: The pharmacist intervention in the evaluation of the patient with suspected allergy to beta-lactams is effective, safe and feasible to implement on daily clinical practice. The standardization of protocols to clarify the history of allergies and development of evaluation tools represent simple screenings to perform delabelling or refer to the Immunoallergology service, improving penicilins use and reducing the need for second line antibiotics. More studies are needed to standardize the desensitization tests made by pharmacists. However, despite these results, the involvement and leadership of the pharmacist in this area is limited and constitutes a future challenge for the profession.

[Translated article] The role of clinical pharmacists in patients with suspected allergy to ß-lactams: A systematic review.

OBJECTIVE: To analyze the role played by the clinical pharmacist and its impact in antibiotic stewardship facing suspected allergy to beta-lactam antibiotics. METHOD: We performed 2 different independent bibliographic searches. A total of 35 articles were found, and the final number included in the study was 12. We analyzed the articles and collected variables of efficacy, safety, and applicability of evaluation tools applied to patients with suspected allergy to beta-lactams. Also, the variation in the consumption and prescription profile of alternative antibiotics was analyzed. RESULTS: The selected studies analyzed questionnaires, allergy delabeling, intradermal tests, and oral challenge tests performed by pharmacists. Significant differences in the efficacy endpoint were found in 4 studies in favor of pharmaceutical intervention. In the study of Kwiatkowski et al., cefazolin use increased in surgical patients after pharmacist intervention (65% vs 28%; P < .01). In a quasi-experimental study, the mean defined daily dose of aztreonam and the mean days of therapy per 1000 patients/day decreased (21.23 vs 9.05, P <.01) and (8.79-4.24, P = .016), pre- and post-intervention, respectively, increasing antibiotic de-escalations (P = < .01). In another quasi-experimental study, the prescription of restricted use antibiotics decreased (42.5% vs 17.9%, P < .01)and the use of pre-surgical prophylactic antibiotics alternative to cefazolin (81.9% vs 55.9%, P < .01)in another study. Other study showed that the mean time per interview was 5.2 min per patient. No adverse events were reported in any study. CONCLUSION: The pharmacist intervention in the evaluation of the patient with suspected allergy to beta-lactams is effective, safe, and feasible to implement on daily clinical practice. The standardization of protocols to clarify the history of allergies and development of evaluation tools represent simple screenings to perform delabeling or refer to the Immunoallergology service, improving penicilins use and reducing the need for second-line antibiotics. More studies are needed to standardize the desensitization tests made by pharmacists. However, despite these results, the involvement and leadership of the pharmacist in this area is limited and constitutes a future challenge for the profession.

Concordancia entre las listas de medicamentos esenciales y las guías para diabetes en América Latina y el Caribe / Concordance between essential medicines lists and diabetes guidelines in Latin America and the Caribbean / Concordância entre as listas de medicamentos essenciais e diretrizes para diabetes na América Latina e no Caribe

RESUMEN Objetivo. Analizar la existencia y actualización de las listas de medicamentos nacionales (LMN) y guías de práctica clínica (GPC) para el tratamiento de la diabetes en América Latina y el Caribe (ALC). Comparar los fármacos incluidos en las listas y guías de cada país, entre sí y con los de la Organización Mundial de la Salud (OMS). Métodos. Estudio de corte transversal. Se identificaron las LMN y GPC para diabetes en los sitios web de la Organización Panamericana de la Salud y de las autoridades sanitarias nacionales. Se relevaron los fármacos y se analizaron por grupo farmacológico según el cuarto nivel de la nomenclatura ATC. Se utilizó el puntaje F1 para evaluar la proximidad de las LMN con la lista modelo de medicamentos esenciales (LMME) de la OMS. Resultados. Del total de países, 87,2% cuentan con LMN, y 91% con GPC (78% y 45% actualizadas en los últimos 5 años, respectivamente). En comparación con los 6 grupos de hipoglucemiantes de la LMME, las LMN tenían una mediana (rango) de 6 (4-13) y un puntaje F1 de 0,80; esto indica una consonancia adecuada. Las GPC tenían una mediana (rango) de 12 (1-12) hipoglucemiantes frente a los 8 de las guías de la OMS. Las GPC tuvieron una mediana de 15 fármacos más que las respectivas LMN. Conclusiones. Si bien la mayoría de los países de ALC cuentan con LMN y GPC para diabetes, la falta de concordancia entre ellas limita su eficacia. Es necesario alinear los procesos y criterios de elaboración de estas dos herramientas de la política de medicamentos.

ABSTRACT Objective. Conduct an analysis to determine the existence and updating of national essential medicines lists (EMLs) and clinical practice guidelines (CPGs) for the treatment of diabetes in Latin America and the Caribbean (LAC); and compare the medicines included in each country's list and guidelines both with each other and with those of the World Health Organization (WHO). Methods. Cross-sectional study. EMLs and CPGs for diabetes were found on the websites of the Pan American Health Organization and national health authorities. Medicines were noted and analyzed according to pharmacological group, based on the fourth level of nomenclature of the Anatomical Therapeutic Chemical (ATC) classification system. F1 scoring was used to assess the proximity of EMLs to the WHO Model List of Essential Medicines (MLEM). Results. Of the total number of countries, 87.2% have EMLs, and 91% have CPGs (78% and 45% updated in the last five years, respectively). Compared to the six hypoglycemic groups of the MLEM, the EMLs had a median (range) of 6 (4-13) and an F1 score of 0.80; This indicates proper alignment. CPGs had a median (range) of 12 (1-12) hypoglycemic drugs compared to eight in the WHO guidelines. CPGs had a median of 15 more drugs than their respective EMLs. Conclusions. While most LAC countries have EMLs and CPGs for diabetes, the lack of concordance among them limits their effectiveness. It is necessary to align the processes and criteria for the development of these two tools for policymaking on medicines.

RESUMO Objetivos. Analisar a existência e a atualização das listas nacionais de medicamentos (LNMs) e guias de prática clínica (GPCs) para o tratamento do diabetes na América Latina e no Caribe (ALC). Comparar os medicamentos incluídos nas listas e nas diretrizes de cada país entre si e com as da Organização Mundial da Saúde (OMS). Métodos. Estudo transversal. Foram identificadas LMNs e GPCs para o diabetes nos sites da Organização Pan-Americana da Saúde e das autoridades sanitárias nacionais. Os medicamentos foram pesquisados e analisados por grupo farmacológico de acordo com o quarto nível da classificação ATC. A pontuação F1 foi utilizada para avaliar o grau de proximidade das LMNs com a lista-modelo de medicamentos essenciais (LMME) da OMS. Resultados. Do total de países, 87,2% dispõem de uma LNM e 91%, de GPCs (78% e 45%, respectivamente, atualizadas nos últimos 5 anos). Em comparação com os seis grupos de agentes hipoglicemiantes da LMME, as LMNs tinham uma mediana (intervalo) de 6 (4 a 13) e uma pontuação F1 de 0,80, o que indica uma conformidade adequada. As GPCs tinham uma mediana (intervalo) de 12 (1 a 12) agentes hipoglicemiantes, em comparação com 8 nos guias da OMS. As GPCs tinham uma mediana de 15 medicamentos a mais do que as respectivas LNMs. Conclusões. Embora a maioria dos países da América Latina e do Caribe disponha de LNMs e GPCs para o diabetes, a falta de concordância entre elas limita sua eficácia. É necessário alinhar os processos e os critérios de desenvolvimento dessas duas ferramentas da política de medicamentos.

Implementación del Proceso Estandarizado de Evaluación Farmacoterapéutica en pacientes hospitalizados y ambulatorios / Implementation of the standardized process of Pharmacotherapeutic evaluation in inpatients and outpatients

Objetivos el seguimiento farmacoterapéutico (SFT) realizado por el farmacéutico clínico puede enmarcarse dentro de 3 actividades: la identificación, la resolución y la prevención de eventos adversos a medicamentos. Estas deben ajustarse a los requerimientos y los recursos de cada institución, generando la necesidad de desarrollar procedimientos que aumenten la eficiencia del SFT y garanticen la seguridad del paciente. Los farmacéuticos clínicos de la Red de Salud UC-CHRISTUS Chile desarrollamos un Proceso Estandarizado de Evaluación Farmacoterapéutica (PEEF). El objetivo principal del estudio fue evaluar el impacto de esta herramienta en términos del número de evaluaciones e intervenciones de los farmacéuticos clínicos y secundariamente determinar el ahorro de costos potenciales y directos asociados a las intervenciones en la Unidad de Cuidados Intensivos (UCI). Método estudio cuasi-experimental que evaluó la frecuencia y tipo de evaluaciones e intervenciones realizadas por los farmacéuticos clínicos en unidades de pacientes adultos de la Red UC-CHRISTUS, previo y posterior a la utilización del PEEF. La distribución de variables se evaluó mediante el test Shapiro–Wilk, la asociación entre el uso del PEEF y el número de evaluaciones e intervenciones fue realizada mediante el test Chi cuadrado. La evaluación de costos asociados a las intervenciones del farmacéutico clínico en UCI se realizó utilizando la metodología propuesta por Hammond et al.10. Resultados el total de pacientes evaluados pre- y pos-PEEF fue de 1.781 y 2.129, respectivamente. Las evaluaciones e intervenciones en el periodo pre-PEEF fueron 5.209 y 2.246, en el periodo pos-PEEF fueron 6.105 y 2.641, respectivamente. El aumento de las evaluaciones como de las intervenciones fue significativo solo en las unidades de mayor complejidad. La reducción potencial de costos estimados en el periodo pos-PEEF en UCI fue de 492.805 dólares americanos. ... (AU)

Objectives The Pharmacotherapeutic follow-up program (PFU) carried out by the clinical pharmacist can be categorized within 3 fundamental activities; identification, resolution and prevention of adverse drug events. These must be adjusted to the requirements and resources of each institution, developing procedures to increase PFU efficiency and to guarantee patient safety. The clinical pharmacists of UC-CHRISTUS Healthcare Network developed a Standardized Pharmacotherapeutic Evaluation Process (SPEP). The main goal of our study is to evaluate the impact of this tool through the pharmacist evaluation number and pharmacist interventions number. Secondarily to determine the potential and direct cost savings associated with the pharmacist interventions in an Intensive care unit (ICU). Methods A quasi-experimental study evaluated the frequency and type of pharmacist evaluation and pharmacist interventions performed by clinical pharmacists in adult patients units of UC-CHRISTUS Healthcare Network, before and after the implementation of SPEP. The distribution of variables was evaluated using the Shapiro–Wilk test and the association between the use of SPEP and the pharmacist evaluation and pharmacist interventions number was performed using the Chi-square test. The cost evaluation associated with pharmacist interventions in the ICU was carried out using methodology proposed by Hammond et al. Results A total number of 1,781 patients was evaluated before and 2,129 after the SPEP. The pharmacist evaluation and pharmacist interventions number in the before-SPEP period were 5,209 and 2,246. In the after-SPEP period were 6,105 and 2,641, respectively. The increase in both the pharmacist evaluation and pharmacist interventions number was significant only in critical care patients. The potential cost saving in after-SPEP period in the ICU was USD 492,805.... (AU)

[Translated article] Implementation of the standardized process of drug therapy evaluation in inpatients and outpatients.

OBJECTIVES: The Pharmacotherapeutic follow-up program (PFU) carried out by the clinical pharmacist can be categorized within 3 fundamental activities; identification, resolution and prevention of adverse drug events. These must be adjusted to the requirements and resources of each institution, developing procedures to increase PFU efficiency and to guarantee patient safety. The clinical pharmacists of UC-CHRISTUS Healthcare Network developed a Standardized Pharmacotherapeutic Evaluation Process (SPEP). The main goal of our study is to evaluate the impact of this tool through the pharmacist evaluation number and pharmacist interventions number. Secondarily to determine the potential and direct cost savings associated with the pharmacist interventions in an Intensive care unit (ICU). METHODS: A quasi-experimental study evaluated the frequency and type of pharmacist evaluation and pharmacist interventions performed by clinical pharmacists in adult patients units of UC-CHRISTUS Healthcare Network, before and after the implementation of SPEP. The distribution of variables was evaluated using the Shapiro-Wilk test and the association between the use of SPEP and the pharmacist evaluation and pharmacist interventions number was performed using the Chi-square test. The cost evaluation associated with pharmacist interventions in the ICU was carried out using methodology proposed by Hammond et al. RESULTS: A total number of 1781 patients was evaluated before and 2129 after the SPEP. The pharmacist evaluation and pharmacist interventions number in the before-SPEP period were 5209 and 2246. In the after-SPEP period were 6105 and 2641, respectively. The increase in both the pharmacist evaluation and pharmacist interventions number was significant only in critical care patients. The potential cost saving in after-SPEP period in the ICU was USD 492,805. Major adverse drug events prevention was the intervention that generated the most savings with a reduction of 60.2%. The total direct savings for sequential therapy was USD 8072 in the study period. CONCLUSIONS: This study shows a clinical pharmacist developed tool called SPEP that increased the pharmacist evaluation and pharmacist interventions number in multiple clinical scenarios. These were significant only in critical care patients. Future investigations should make effort to evaluate the quality and clinical impact of these interventions.

Estrategias para detectar necesidades farmacoterapéuticas y educacionales de pacientes con riesgo cardiovascular en farmacia comunitaria / Strategies for detecting pharmacotherapeutic and educational needs of patients with cardiovascular risk in community pharmacy

Introducción. Las enfermedades cardiovasculares son la principal causa de mortalidad.Desde la farmacia comunitaria (FC) es posible ayudar a los pacientes a mejorar los factores de riesgo cardiovascular (FRCV) modificables: hipertensión arterial (HTA), dislipemia, diabetes mellitus (DM), tabaquismo y obesidad. Entre los servicios profesionales farmacéuticos relacionados con la salud comunitaria se incluyen este tipo de actuaciones. El objetivo de este estudio ha sido determinar el perfil sociosanitario y farmacoterapéutico de los pacientes con RCV atendidos en la FC española, con el fin de diseñar la intervención más efectiva para ellos. Método: Se realizó un estudio descriptivo de corte transversal entre enero 2017 y febrero 2018. Utilizando un formulario de recogida de datos se registraron los correspondientes a los pacientes de cuatro FC, dos en Sevilla y dos en Badajoz (España) mediante entrevistas individualizadas. Resultados: La muestra inicial (n=100) quedó reducida a 98 pacientes, mayores (61,5±10,1 años), 51,0 % varones, con bajo nivel educativo (53,1 %) y la mayoría de ellos viviendo acompañados (87,8 %). El 74,5 % eran pacientes en prevención primaria y su nivel de RCVmoderado (2,51±1,89). HTA (83,7 %), dislipemia (64,39 %), diabetes II (38,8 %) y obesidad (52,0 %) fueron los factores más prevalentes. Casi la mitad de los pacientes (48,5 %) realizaban ejercicio físico regularmente y el 23,5 % eran fumadores. Los fármacos más consumidos fueron los modificadores de lípidos (59,4 %), antidiabéticos orales (37,5 %), antitrombóticos (32,2 %) y betabloqueantes (28,1 %), Conclusiones: La utilización de formularios encaminados a detectar las necesidades educacionales y farmacoterapéuticas de pacientes con RCV, permitirá establecer diferentes estrategias para mejorar la capacidad de gestionar su enfermedad. (AU)

Introduction: Cardiovascular diseases are the leading cause of mortality, and community pharmacy (CP) can help patients improve modifiable cardiovascular risk factors (CVRF): hypertension (HT), dyslipidaemia, diabetes mellitus (DM), smoking, and obesity. Professional pharmaceutical services related to community health include this type of action. The aim of this study was to determine the socio-health and pharmacotherapeutic profile of patients with CVR treated in Spanish CP, to design the most effective intervention for them.Method: A descriptive cross-sectional study was conducted between January 2017 and February 2018. Using a data collection form, data from patients in four CP, two in Seville and two in Badajoz (Spain) were recorded through individualised interviews.Results: The initial sample (n=100) was reduced to 98 patients, older (61.5±10.1 years), 51.0 % male, with low edu-cational level (53.1 %) and most of them living accompanied (87.8 %). 74.5 % were patients in primary prevention and their CVR level was moderate (2.51±1.89). Hypertension (83.7 %), dyslipidaemia (64.39 %), diabetes II (38.8 %) and obesity (52.0 %) were the most prevalent factors. Almost half of the patients (48.5 %) exercised regularly and 23.5 % were smokers. The drugs most commonly used were lipid modifiers (59.4 %), oral antidiabetics (37.5 %), antithrombotics (32.2 %) and beta-blockers (28.1 %).Conclusions: The use of forms aimed at detecting the educational and pharmacotherapeutic needs of CVR patients will allow one to establish different strategies to improve their ability to manage their disease. (AU)

Atención farmacéutica y asma: protocolo de una revisión de revisiones sistemáticas / Pharmaceutical care and asthma: Protocol of an umbrella review of systematic reviews

Introducción las revisiones sistemáticas y metaanálisis recientes sugieren que las intervenciones por parte de farmacéuticos en pacientes asmáticos tienen un impacto positivo en resultados en salud. Sin embargo, la asociación no está bien establecida y el papel de los farmacéuticos clínicos está pobremente representado, así como el de los pacientes con asma grave. El objetivo de esta revisión de revisiones es identificar revisiones sistemáticas publicadas que evalúen el impacto de las intervenciones farmacéuticas en resultados en salud medidos en pacientes asmáticos, así como describir los componentes clave de las intervenciones, los resultados medidos y cualquier asociación entre las intervenciones farmacéuticas y los resultados en salud medidos. Métodos se hará una busqueda en PubMed, Embase, Scopus y la Cochrane Library desde el primer registro hasta diciembre de 2022. Se considerará la inclusión de revisiones sistemáticas de todo tipo de estudios primarios, severidad del asma o nivel asistencial que midan resultados en salud. La calidad metodológica se medirá usando A Measurement Tool to Assess Systematic Reviews 2. Dos investigadores independientes realizarán la selección de los estudios, la evaluación de la calidad y la extracción de datos. Cualquier discrepancia será solventada por un tercer investigador. Ambos resultados, narrativos y metaanálisis, de los estudios primarios incluidos en las revisiones sistemáticas serán sintetizados. Si los datos son apropiados para un análisis cuantitativo, las medidas de asociación se expresarán como cociente de riesgos y diferencia de medias. Discusión los primeros resultados del establecimiento de una red multidisciplinar para el manejo de los pacientes asmáticos mostraron beneficios en integrar los diferentes niveles asistenciales en el control de la enfermedad y la reducción de la morbilidad...(AU)

Introduction Recent systematic reviews and meta-analyses suggest that pharmacists' interventions in asthma patients have a positive impact on health-related outcomes. Nevertheless, the association is not well established and the role of clinical pharmacists is poorly represented, as well as severe asthma patients. The aim of this overview of systematic reviews is to identify published systematic reviews assessing the impact of pharmacists' interventions on health-related outcomes measured in asthma patients, as well as to describe key components of the interventions, the outcomes assessed and any associations between pharmacists' interventions and health-related outcomes. Methods PubMed, Embase, Scopus and the Cochrane Library will be searched from inception to December 2022. Systematic reviews of all study designs, severity of asthma and level of care that measured health-related outcomes will be considered. Methodological quality will be assessed using A Measurement Tool to Assess Systematic Reviews 2. Two independent investigators will perform the study selection, quality assessment and data collection, any discrepancy will be solved by a third investigator. Both narrative findings and meta-analysis of primary study data included in the systematic reviews will be synthesized. If data are appropriate for quantitative synthesis, the measures of association will be expressed as the risk ratio and difference in means. Discussion The first results on the establishment of a multidisciplinary network for the management of asthmatic patients have shown the benefits of integrating different levels of care in disease control and morbidity reduction. Further studies showed benefits in hospital admissions, patients' basal oral corticosteroid dose, exacerbations and quality of life of asthma patients...(AU)

ADHEFAP: ensayo clínico para evaluar una intervención telefónica educacional-conductual por el farmacéutico de atención primaria en la mejora de la adherencia terapéutica / ADHEFAP: Clinical trial to evaluate an educational-behavioral telephone intervention by the primary care pharmacist to improve therapeutic adherence

Objetivo: Evaluar la mejora en la adherencia terapéutica (AT) de una intervención basada en el seguimiento telefónico por parte del farmacéutico de atención primaria (FAP).Diseño: Ensayo clínico abierto aleatorizado con grupo control. Emplazamiento: Este estudio se realizó en el ámbito de la atención primaria por un equipo multidisciplinar de 13 centros de salud pertenecientes a 4 direcciones asistenciales de la Comunidad de Madrid durante el año 2021. Participantes: Pacientes polimedicados (60-74 años) que aceptasen participar y fueran clasificados como no adherentes según el test Morisky-Green. Se captaron 224 pacientes, de los cuales 87 fueron no adherentes. De estos se perdieron 15, aleatorizándose finalmente 72. Terminaron el estudio 71 pacientes, 33 en el grupo intervención y 38 en el grupo control. Intervenciones: Al grupo intervención se le incluyó en un programa de seguimiento telefónico que consistía en una entrevista para mejorar la adherencia en los meses 1, 2 y 3. Para evaluar la mejora se repetía el test Morisky-Green al 4.° mes. En el control únicamente se realizó el test de AT al 4.° mes. Mediciones principales: Adherencia, medida por el Morisky-Green al inicio y a los 4 meses. Resultados: En el grupo intervención el 72,7% de los pacientes pasaron a ser adherentes, mientras que en el grupo control el 34,2%, siendo la diferencia del 38,5% (IC 95%: 17,1-59,9) estadísticamente significativa (p=0,001). Conclusiones: Tras la intervención de seguimiento telefónico educacional-conductual a pacientes no adherentes por parte del FAP se mejora la AT de forma estadísticamente significativa en el grupo intervención respecto al grupo control.(AU)

Objective: Evaluate the improvement in therapeutic adherence of an intervention based on telephone monitoring by the primary care pharmacist. Design: Randomized open controlled trial. Location: This study was carried out in 2021 by a multidisciplinary team working with health professionals of thirteen health centers belonging to four health districts in Community of Madrid, Spain. ParticipantsThese were patients (60-74 years) with polipharmacy classified as non-adherent according to the Morisky-Green test. Two hundred and twenty-four patients were originally enrolled, 87 of them were non-adherents. Of these, 15 were lost and 72 were finally randomized. Seventy-one patients completed the study (33 intervention group and 38 control group). Interventions: Patients randomized to the intervention arm were included in a follow-up telephone program consisting of an interview at months 1, 2, and 3 to improve adherence. The Morisky-Green test was repeated at month 4 to assess improvement. In the control group this test was only performed at month 4. Main measurements: Adherence measured by Morisky-Green at baseline and at 4th month. Results: The 72.7% of patients in the intervention group became adherent while only 34.2% did in the control arm, being the difference 38.5% (95% CI: 17.1-59.9), statistically significant (P=.001). Conclusions: After a follow-up educational-behavioral telephone intervention in non-adherent patients by the primary care pharmacist, therapeutic adherence was improved statistically significantly in the intervention group compared with the control group.(AU)

Pharmaceutical care and asthma: Protocol of an umbrella review of systematic reviews. / [Artículo traducido] Atención farmacéutica y asma: protocolo de una revisión de revisiones sistemáticas.

INTRODUCTION: Recent systematic reviews and meta-analyses suggest that pharmacists' interventions in asthma patients have a positive impact on health-related outcomes. Nevertheless, the association is not well established and the role of clinical pharmacists is poorly represented, as well as severe asthma patients. The aim of this overview of systematic reviews is to identify published systematic reviews assessing the impact of pharmacists' interventions on health-related outcomes measured in asthma patients, as well as to describe key components of the interventions, the outcomes assessed and any associations between pharmacists' interventions and health-related outcomes. METHODS: PubMed, Embase, Scopus and the Cochrane Library will be searched from inception to December 2022. Systematic reviews of all study designs, severity of asthma and level of care that measured health-related outcomes will be considered. Methodological quality will be assessed using A Measurement Tool to Assess Systematic Reviews 2. Two independent investigators will perform the study selection, quality assessment and data collection, any discrepancy will be solved by a third investigator. Both narrative findings and meta-analysis of primary study data included in the systematic reviews will be synthesized. If data are appropriate for quantitative synthesis, the measures of association will be expressed as the risk ratio and difference in means. DISCUSSION: The first results on the establishment of a multidisciplinary network for the management of asthmatic patients have shown the benefits of integrating different levels of care in disease control and morbidity reduction. Further studies showed benefits in hospital admissions, patients' basal oral corticosteroid dose, exacerbations and quality of life of asthma patients. A systematic review is the most appropriate design in order to summarize the literature and identify the evidence of the benefits of interventions performed by clinical pharmacists in asthma patients, especially those with severe uncontrolled asthma, and encourage future studies to stablish the role of clinical pharmacists in asthma units. REGISTRATION DETAILS: Systematic review registration number: CRD42022372100.

Farmacovigilancia de las vacunas frente a la COVID-19 en farmacias comunitarias. Resultados tras la segunda dosis y comparación entre ambas / Pharmacovigilance of vaccines against COVID-19 in community pharmacies. Results after the second dose and comparison between both

Objetivos: detección y seguimiento de sospechas de reacciones adversas (RA) en farmacias comunitarias tras la segunda dosis de vacunas frente a la COVID-19. Comparación entre dosis.Material y métodos: diseño: estudio observacional prospectivo.Sujetos: vacunados frente a la COVID-19, mayores de edad, que consintieron participar.Variables: número y porcentaje de participantes con RA. Su número, tipo y frecuencia. Repercusión en su vida diaria. Relaciones entre variables.Aprobado por CEIm-G.Resultados: 693 participantes con la 2ª dosis, 63,6 % mujeres. Edad media 56,8 años. 312 (45,0 %) vacunados, 49,4 % de mujeres y 37,3 % de hombres (p<0,0001), refirieron al menos una RA: 43,9 % con Comirnaty®, 37,7 % con Vaxzevria®, 63,0 % con Spikevax®.Se registraron 972 RA, 75,2 % en mujeres y 24,8 % en hombres (p<0,0001). Media 1,4/vacunado (máximo 11). Las más prevalentes: dolor en punto de inyección 197 (28,4 %), cansancio/fatiga 141 (20,3 %), mialgia 112 (16,2 %), cefalea 95 (13,7 %), fiebre 84 (12,1 %).51 encuestados con RA necesitaron ayuda profesional: 10 del médico, 6 en urgencias, 3 en hospital (1 derivado), 33 en la farmacia. A 70 (15,1 %) les impidió su actividad diaria. Se comunicaron RA de 201 vacunados.Los vacunados con RA y su número fueron menos tras la administración de la 2ª dosis (p<0,05).Relación inversa (p<0,05) entre “edad” y “número de vacunados con RA”, “necesidad de atención profesional” e “impidió la actividad diaria”.Conclusiones: el número de vacunados con RA y su número fue alto también con la segunda dosis, aunque menor que tras la primera. Mujer y menor edad son predictores de riesgo de sufrir RA tras la vacunación frente a COVID-19.(AU)