[Factors associated with adherence in HIV patients]. / Factores relacionados con la adherencia en pacientes infectados por el virus de la inmunodeficiencia humana.

OBJECTIVE: To establish the relationship between the adherence to ARVT and the clinical situation and detect those factors which relate to the lack of adherence. METHOD: Observational study on HIV patients who had attended the Pharmacy Service in Navarra Hospital between February and May 2005. The SMAQ questionnaire and pharmacy dispensing records were used to assess adherence to treatment. Socio-demographic variables and other factors which could influence adherence were recorded. Statistical analysis was carried out using the SPSS programme, version 14.0. RESULTS: No concordance was noted between the two measurements of adherence, although there was an association between the viral load and compliance, irrespective of the method used. The questionnaire recorded a higher percentage of non-adhering female patients, substance users and psychiatric patients. Non-adhering patients indicated more frequently factors which made taking the medication difficult. The multivariate analysis showed that the lack of a suitable social-familial environment negatively influenced the adherence level, according to the SMAQ questionnaire, and that the high number of tablets per dose was related to the lack of adherence according to the pharmacy dispensing records. CONCLUSIONS: Patients who adhere to ARVT have a lesser risk of virological failure. An unsuitable social-familial environment and the complexity of treatment are associated with a lack of adherence. The method of using dispensing records should be combined with a patient interview to define the factors which reduce adherence and to propose intervention strategies.

Factores relacionados con la adherencia en pacientes infectados por el virus de la inmunodeficiencia humana / Factors associated with adherence in HIV patients

Objetivo: Establecer la relación entre adherencia al tratamiento antirretroviral (TARV) y situación clínica, y detectar los factores que se relacionan con la falta de adherencia. Método: Estudio observacional en el que se incluyó a pacientes infectados por el virus de la inmunodeficiencia humana que acudieron al Servicio de Farmacia del Hospital de Navarra entre febrero y mayo de 2005. Para evaluar la adherencia al tratamiento, se utilizó el cuestionario SMAQ (Simplified Medication Adherence Questionnaire) y el registro de las dispensaciones. Se recogieron variables sociodemográficas y otros factores que podrían influir en el cumplimiento. El análisis estadístico se realizó mediante el programa SPSS versión 14.0. Resultados: No se observó concordancia entre las 2 medidas de adherencia, aunque sí asociación entre carga viral y cumplimiento, independientemente del método utilizado. Se obtuvo un porcentaje mayor de pacientes no adherentes según el cuestionario, en mujeres, consumidores de sustancias y pacientes psiquiátricos. Los pacientes no adherentes señalaron con más frecuencia factores que dificultan la toma de la medicación. En el análisis multivariante, se observó que la carencia de un entorno sociofamiliar adecuado influye de forma negativa en la adherencia medida según el SMAQ y que el elevado número de comprimidos por toma se relaciona con la falta de adherencia según el método de registros de dispensación. Conclusiones: Los pacientes adherentes al TARV tienen un riesgo menor de presentar fallo virológico. Un entorno sociofamiliar inadecuado y la complejidad del tratamiento se asocian con la falta de adherencia. El método de registros de dispensación se debe combinar con la entrevista al paciente para detectar factores que disminuyen la adherencia y proponer estrategias de intervención (AU)

Objective: To establish the relationship between the adherence to ARVT and the clinical situation and detect those factors which relate to the lack of adherence. Method: Observational study on HIV patients who had attended the Pharmacy Service in Navarra Hospital between February and May 2005. The SMAQ questionnaire and pharmacy dispensing records were used to assess adherence to treatment. Socio-demographic variables and other factors which could influence adherence were recorded. Statistical analysis was carried out using the SPSS programme, version 14.0. Results: No concordance was noted between the two measurements of adherence, although there was an association between the viral load and compliance, irrespective of the method used. The questionnaire recorded a higher percentage of non-adhering female patients, substance users and psychiatric patients. Non-adhering patients indicated more frequently factors which made taking the medication difficult. The multivariate analysis showed that the lack of a suitable social-familial environment negatively influenced the adherence level, according to the SMAQ questionnaire, and that the high number of tablets per dose was related to the lack of adherence according to the pharmacy dispensing records. Conclusions: Patients who adhere to ARVT have a lesser risk of virological failure. An unsuitable social-familial environment and the complexity of treatment are associated with a lack of adherence. The method of using dispensing records should be combined with a patient interview to define the factors which reduce adherence and to propose intervention strategies (AU)

[Pharmaceutical care in a social-healthcare center]. / Atención farmacéutica en un centro socio-sanitario.

OBJECTIVE: To reflect the activity of the pharmacy department within the nursing home s multidisciplinary team, and to assess care improvements received by residents, including a better use of drugs. METHOD: In addition to pharmacotherapeutical guidelines and a standardized work procedure listing generic and therapeutic replacements to be implemented, selected procedures were specified in order to ensure a rational use of drugs and to increase the quality of care received by residents in our center. Such procedures will be performed by the center s multidisciplinary team and will focus on caring the caring for so-called geriatric syndromes. RESULTS: After an assessment of treatments for 125 patients and a 3-month follow-up, 10 interventions per patient were performed, out of which 4.74 were pharmacist interventions and 5.26 were to increase quality of care. CONCLUSIONS: The presence of the pharmacy department within the multidisciplinary team ensures a better use of drugs and a safe delivery system. Its activity contributes to improve quality of care, most notably procedures regarding nutritional status, and the prevention and treatment of pressure ulcers.

Atención farmacéutica en un centro socio-sanitario / Pharmaceutical care in a social-healthcare center

Objetivo: Reflejar la actuación del servicio de farmacia, dentrodel equipo multidisciplinar de la residencia, evaluando la mejoraasistencial que reciben los residentes, incluyendo una mejor utilizaciónde los medicamentos.Método: Además de una guía farmacoterapéutica y un procedimientonormalizado de trabajo en el que se enumeran las sustitucionesgenéricas y terapéuticas que se van a realizar, se concretandeterminadas intervenciones para asegurar el uso racional delos medicamentos e incrementar la calidad de los cuidados recibidospor los residentes de nuestro centro. Estas intervencionesserán realizadas por el equipo multidisciplinar del centro y se centranen el cuidado de los llamados síndromes geriátricos.Resultados: Después de valorar los tratamientos de 125pacientes y realizar un seguimiento de tres meses, se efectúan 10intervenciones por paciente, diferenciando 4,74 intervencionesfarmacéuticas y 5,26 enfocadas a incrementar la calidad asistencial.Conclusiones: La presencia del servicio de farmacia en elequipo multidisciplinar asegura una mejor utilización de medicamentosy un sistema seguro de distribución. Su actuación contribuyea mejorar la calidad asistencial, destacando las intervencionessobre el estado nutricional y la prevención y tratamiento deúlceras por presión

Objective: To reflect the activity of the pharmacy departmentwithin the nursing home's multidisciplinary team, and to assesscare improvements received by residents, including a better use ofdrugs.Method: In addition to pharmacotherapeutical guidelines anda standardized work procedure listing generic and therapeuticreplacements to be implemented, selected procedures were specifiedin order to ensure a rational use of drugs and to increase thequality of care received by residents in our center. Such procedureswill be performed by the center’s multidisciplinary team andwill focus on caring the caring for so-called geriatric syndromes.Results: After an assessment of treatments for 125 patientsand a 3-month follow-up, 10 interventions per patient were performed,out of which 4.74 were pharmacist interventions and5.26 were to increase quality of care.Conclusions: The presence of the pharmacy departmentwithin the multidisciplinary team ensures a better use of drugs anda safe delivery system. Its activity contributes to improve quality ofcare, most notably procedures regarding nutritional status, andthe prevention and treatment of pressure ulcers