ABSTRACT
BACKGROUND: Interdisciplinary collaboration between general practitioner, nurses and pharmacists can favour the control of patients treated with vitamin K antagonists (VKA), increasing their safety and effectiveness. The aim of the study was to evaluate the impact of pharmaceutical interventions on patients treated with VKA within the framework of a Pharmacotherapeutic Follow-up service on clinical, economic and humanistic outcomes. METHODS: Controlled and randomized study in patients from two health areas of Zaragoza in treatment with VKA with Time in Therapeutic Range (TTR) according to the Rosendaal method less than 70% in the last 6 months. Patients were recruited at the pharmacy and assigned to two groups: control and intervention. A Pharmacotherapeutic Follow-up Program was established for the intervention group for 6 months. The outcome variables were INR stability, pharmacological adherence, vitamin K intake, knowledge about the use of acenocoumarol, quality of life, satisfaction with treatment, associated costs and avoided costs. A descriptive analysis was performed, and the Students' T test or Mann-Whitney U test was used for the association between quantitative variables and Chi-square or Fisher's test for qualitative variables. RESULTS: A total of 123 patients were included, 65 in the intervention group (IG) and 58 in the control group (CG). A total of 108 interventions were conducted (1.7 interventions/patient) and the most common were those related to the proper taking of medications (41.0%). In IG, TTR (p = 0.019), adherence to treatment (p = 0.038) and knowledge about acenocoumarol (p = 0.031) improved, compared to CG. A higher proportion of patients in IG achieved a TTR>65% (p = 0.024). In addition, patients whose interventions were accepted by the physician (p = 0.027) and those who received vitamin K optimization interventions (p = 0.003) achieved TTR>65% in greater proportion. CONCLUSIONS: Community pharmacist medication review, in collaboration with general practitioners improve knowledge and adherence of patients treated with oral anti-vitamin K agents and enhances the achievement of their therapeutic INR ranges. Investment needed to achieve this clinical impact is low and patient satisfaction is high. TRIAL REGISTRATION: This study has been registered with Clinical Trials.gov dated 25/05/2017: NCT03154489.
ABSTRACT
Se ofreció el Servicio de Seguimiento Farmacoterapéutico (SFT) a una mujer de 66 años, exfumadora, diagnosticada de hipertensión arterial, hipercolesterolemia, asma, ansiedad y migraña, que presentaba prurito y urticaria. Tomaba 5 medicamentos. Tras revisión de la farmacoterapia y realización de una entrevista en profundidad, se determinó la presencia de prurito y urticaria como Resultados Negativos asociados a la Medicación (RNM) de inseguridad derivado del uso de rosuvastatina/ezetimiba por posibles Problemas Relacionados con los Medicamentos (PRM) y, de probabilidad de efecto adverso y de error en la prescripción del fármaco. Se propuso a la paciente suspender el tratamiento y se realizó derivación al Médico de Atención Primaria (MAP) mediante informe de derivación que fue entregado por la paciente en cita médica, para valorar alternativa farmacológica para tratar la hipercolesterolemia. La propuesta fue aceptada por el MAP. Se realizó un seguimiento del caso, que permitió constatar la resolución de los PRM y RNM detectados, logrando una mejora en la salud del paciente y favoreciendo la adherencia al tratamiento (AU)
A 66-year-old woman, ex-smoker, diagnosed with hypertension, hypercholesterolemia, asthma, anxiety and migraine, who presented pruritus and urticaria, was given Medication Review with Follow-Up Service (MRF). She was taking 5 medications. After the review of the pharmacotherapy and conducting an in-depth interview, the presence of pruritus and urticaria was determined as a Negative Outcomes Releated to Medicines (NOM) and a Drug Related Problem (DRP) derived from the use of Rosuvastatin/Ezetimibe, and a possible DRPs of probability of adverse effects and prescription error. It was proposed to the patient to suspend the treatment and a referral was made to the Primary Care Physician (PCP) by means of a referral report that was submitted by the patient at the medical appoint ment to assess a pharmacological alternative to treat hypercholesterolemia. The proposal was accepted by the PCP. A follow-up of the case was carried out, which allowed verifying the resolution of the DRPs and NOMs detected, achieving an improvement in the patients health and favoring adherence to treatment (AU)
Subject(s)
Humans , Female , Aged , Drug-Related Side Effects and Adverse Reactions , Community Pharmacy Services , Urticaria/chemically induced , Urticaria/prevention & control , Pruritus/chemically induced , Pruritus/prevention & control , Follow-Up Studies , Process OptimizationABSTRACT
Introducción: La Farmacia comunitaria vasca tiene una larga tradición de colaboración con la Dirección de Farmacia del Departamento de Salud del Gobier-no Vasco. En mayo de 2017 se firmó un Convenio de colaboración entre el Departamento de Salud y los tres colegios de farmacéuticos vascos para la puesta en marcha de un Programa piloto de Segui-miento Farmacoterapéutico Integral a pacientes crónicos polimedicados en el que el farmacéutico comunitario realizaría seguimiento farmacotera-péutico a pacientes con Diabetes tipo2. Método: Se realizó el servicio de seguimiento farmacoterapéutico en farmacias de tres organi-zaciones sanitarias integradas de Alava, Bizkaia y Gipuzkoa. Participaron 18 farmacias con 7 pacien-tes cada una. Criterios de inclusión: paciente con diabetes tipo2 que tomaban 8 o más principios activos de forma continuada. Durante los 12 meses de estudio se analizaron tres puntos: inicio (V1), 6 meses (V2) y al finalizar el estudio (V3).Resultados: De los 127 pacientes inicialmente previstos finalizaron el estudio 87. No se obtuvie-ron diferencias significativas en el valor de HbA1c entre inicio y final. Por el contrario, el número de problemas de salud no controlados disminuyó en un 47% (p=0,001) sin que se modificase el número de medicamentos. Los PRM más frecuentes en V3 fueron el conocimiento insuficiente del medicamen-to (34%) y la falta de adherencia (19%). Mejoraron tanto el conocimiento y la adherencia (p<0,001) como la calidad de vida (p<0,05). Conclusiones: Aunque el programa no ha tenido impacto en el valor de la HbA1c, sí ha contribuido a controlar otros problemas de salud, así como la adherencia, el conocimiento sobre los medicamen-tos y la calidad de vida de los pacientes. (AU)
Introduction: Basque community pharmacy has a long tradition of collaborating with Basque health authorities. In May 2017, a collaboration agreement was signed between the Department of Health and the three Basque Pharmaceutical Associations "for the implementation of a Pilot Program for Medi-cation review with follow up service for chronic polymedicated patients". Method: The medication review with follow up service was carried out in pharmacies of three integrated health organizations in Alava, Bizkaia and Gipuzkoa. 18 pharmacies participated with 7 patients each. Inclusion criteria: patients with type 2 diabetes who were taking 8 or more medicines. During the 12 months of the study, three points were analyzed: baseline (V1), 6 months (V2) and at the end of the study (V3).Results: Of the 127 initially planned patients, 87 completed the study. No significant differences were obtained in the HbA1c value between baseline and the end. In contrast, the number of uncontro-lled health problems decreased by 47% (p=0.001) without changing the number of medications. The most frequent DRPs in V3 were insufficient knowle-dge of the medication (34%) and lack of adherence (19%). Both, knowledge and adherence (p<0.001) and quality of life (p<0.05) improved.Conclusions: Although the program has not had an impact on the value of HbA1c, it has contributed to controlling other health problems, as well as adher-ence, knowledge about medications and the quality of life of patients. (AU)
