[Multidisciplinary approach as a model for detection and monitoring of psychiatric morbidity in patients treated with interferon and ribavirin]. / Abordaje multidisciplinar como modelo de detección y seguimiento de la moribilidad psiquiátrica en pacientes en tratamiento con interferón de la moribilidad psiquiátrica en pacientes en tratamiento con interferón y ribavirina.

PURPOSE: We aimed to describe the incidence of psychiatric disorders in a cohort of HCV infected patients treated with interferon and ribavirin, and their impact on treatment adherence and viral response rate (SVR). MATERIALS AND METHODS: Retrospective analysis of a cohort of HCV patients visited at an outpatient pharmacy service (OPS). We included all adult patients monoinfected with HCV who had initiated treatment in 2010. Monitoring of psychiatric disorders was assessed at weeks 0, 4, 12, 24, 48, and 72 through the self-administered questionnaires Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (Goldberg).Adherence to treatment was assessed by counting of drug dispensations and patient reporting and drug exposure with the 80/80/80 rule. Virologic response was determined by the physician according to standard definitions. RESULTS: Among 76 included patients, 19 (25%) had a preexisting psychiatric disorder. The incidence of confirmed psychiatric disorders was 33% (n=25),with a peak of abnormal results in the tests by week 12. Overall, 43% of patients achieved an SVR. There were not significant differences between strict adherence and SVR in patients with or without medically confirmed disorders(96.0% vs 96,8%; p = NS) and SVR (39% vs 52%; p = NS], respectively. CONCLUSIONS: Psychiatric side effects had no effect on adherence to treatment nor on attainment of SVR. Multidisciplinary monitoring provided during the treatment of hepatitis C can contribute to early detection and management of psychiatric disorders and to improve integrated patient care.

Objetivo: Describir la experiencia recogida durante el programa multidisciplinar,y en particular describir la incidencia de los trastornos psiquiátricosen pacientes con hepatitis C crónica (HCC) durante el tratamiento coninterferón y ribavirina, y determinar la adherencia al tratamiento antiviraly la respuesta viral sobtenida (RVS).Material y métodos: Estudio observacional, descriptivo y retrospectivo realizadoa partir de los datos recogidos durante el programa de dispensaciónambulatoria de tratamiento antiviral.Se incluyó a todos los pacientes monoinfectados por el virus hepatitis C(VHC) que iniciaron tratamiento durante el 2010. El cribaje de lostrastornos psiquiátricos se realizó mediante el Hospital Anxiety-DepressionScale (HADS) y el General Health Questionnaire (Goldberg) las semanas 0,4, 12, 24, 48 y 72. La adherencia se evaluó mediante el recuento de dispensacionesy de la medicación sobrante del paciente y la exposición al fármacosegún la regla 80/80/80. La respuesta virológica se determinó por elmédico responsable de acuerdo a las definiciones estándar.Resultados: Se incluyeron 76 pacientes, 19 (25%) de los cuales teníanantecedentes psiquiátricos. La incidencia de trastornos psiquiátricos fue del33% (n = 25). El pico de resultados anormales en los test fue en la semana12. El 43% alcanzó RVS, sin diferencias entre ambos grupos (p > 0,05). Laadherencia (96,0% y 96,8%, p > 0,05) y RVS (39% y 52%, p > 0,05)fueron similares en ambos subgrupos con y sin trastornos.Conclusiones: Los trastornos psiquiátricos no tuvieron impacto en la adherenciay la RVS. El seguimiento multidisciplinar durante el tratamiento de la hepatitisC crónica (HCC) puede contribuir a la detección precoz y manejo de lostrastornos psiquiátricos y a mejorar la atención integral del paciente.

Programa de atención farmacéutica integrada en pacientes con enfermedades crónicas / Integrated pharmaceutical care programme in patients with chronic diseases

Objetivo: Valorar si un programa de atención farmacéutica integrada (PAFI) en pacientes crónicos mejora la evolución clínica, la calidad de vida de los pacientes y disminuye el consumo de recursos sanitarios. Material y métodos Ensayo clínico, paralelo, abierto y multicéntrico de un PAFI en pacientes con insuficiencia cardiaca (IC) y/o enfermedad pulmonar obstructiva crónica (EPOC) en 8 áreas de salud de Cataluña. Al paciente en intervención le realizaban seguimiento farmacoterapéutico los farmacéuticos de hospital, atención primaria y farmacia comunitaria. Al control, seguimiento habitual. Todos los pacientes fueron seguidos 12 meses y se les realizó un test de calidad de vida al inicio y final del seguimiento. Resultados Participaron 8 hospitales, 8 centros de atención primaria y 109 farmacias comunitarias. Finalizaron el estudio 238 pacientes con un porcentaje de pérdidas del 2,9%. No hubo diferencias significativas en reingresos, visitas al médico o urgencias. Se detectaron 50 problemas relacionados con medicamentos (PRM) en 37 pacientes, siendo estadísticamente significativa la diferencia de PRM entre el grupo intervención y control en pacientes con IC y casi significativa en pacientes con EPOC. El 36% de los PRM fueron moderados-graves. El 94% PRM fueron evitables y el farmacéutico los resolvió en el 90% de los casos. No hubo diferencias entre la calidad de vida al inicio y final del estudio ni en el consumo de recursos sanitarios. Conclusiones Los programas de atención farmacéutica integrada permiten la mejora de la calidad asistencial al paciente, no obstante es necesaria la utilización de registros electrónicos que faciliten la comunicación entre niveles asistenciales (AU)

Objectives: To assess whether an integrated pharmaceutical care programme (IPCP) improvesclinical evolution, patient quality of life, and reduces health costs in chronic patients. Material and methods: A parallel, open, and multi-centre clinical trial of an IPCP in patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) in 8 different health areas in Cataluña. The intervened patient was monitored for pharmacotherapeutic evolution by hospital pharmacists, primary care physicians, and community pharmacists. Controls received normal follow-up. All patients were monitored for 12 months, with quality of life tests administered at the beginning and end of follow-up. Results: We had the participation of 8 different hospitals, 8 primary care centres, and109 community pharmacies. 238 patients completed the study, with 2.9% of participants lost during the study period. There were no significant differences in terms of readmissions, visits to the doctors, or to emergency services. We detected 50 different medication-related problems(MRP) in 37 patients, with a statistically significant difference in terms of MRP between the control and treatment groups of patients with HF, and almost significant differences in COPD patients. MRP were moderate-severe in 36% of cases. MRP were avoidable in 94% of cases, and the pharmacist resolved the issue in 90% of cases. There were no differences in terms of patient quality of life or health costs between the start and end of the study. Conclusions: Integrated pharmaceutical care programs facilitate an improvement in the quality of patient care, but electronic registries are necessary to promote communication between sections of the health care network (AU)

[Integrated pharmaceutical care programme in patients with chronic diseases]. / Programa de atención farmacéutica integrada en pacientes con enfermedades crónicas.

OBJECTIVES: To assess whether an integrated pharmaceutical care programme (IPCP) improves clinical evolution, patient quality of life, and reduces health costs in chronic patients. MATERIAL AND METHODS: A parallel, open, and multi-centre clinical trial of an IPCP in patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) in 8 different health areas in Cataluña. The intervened patient was monitored for pharmacotherapeutic evolution by hospital pharmacists, primary care physicians, and community pharmacists. Controls received normal follow-up. All patients were monitored for 12 months, with quality of life tests administered at the beginning and end of follow-up. RESULTS: We had the participation of 8 different hospitals, 8 primary care centres, and 109 community pharmacies. 238 patients completed the study, with 2.9% of participants lost during the study period. There were no significant differences in terms of readmissions, visits to the doctors, or to emergency services. We detected 50 different medication-related problems (MRP) in 37 patients, with a statistically significant difference in terms of MRP between the control and treatment groups of patients with HF, and almost significant differences in COPD patients. MRP were moderate-severe in 36% of cases. MRP were avoidable in 94% of cases, and the pharmacist resolved the issue in 90% of cases. There were no differences in terms of patient quality of life or health costs between the start and end of the study. CONCLUSIONS: Integrated pharmaceutical care programs facilitate an improvement in the quality of patient care, but electronic registries are necessary to promote communication between sections of the health care network.

[Detecting adverse drug events during the hospital stay]. / Detección de acontecimientos adversos producidos por medicamentos durante la estancia hospitalaria.

INTRODUCTION: The principal objective was to determine the incidence rate of adverse drug events (ADEs) in hospitalised patients and evaluate the event prevention percentage. METHODS: Multi-centre, prospective observational study lasting four months, performed in five hospitals providing different levels of care. We included all adult patients who were admitted to one of the selected centres for longer than 48 hours and who required pharmacological treatment. ADEs were identified by direct observation and the use of previously defined alarm signals. The Karch-Lasagna scale was used to determine the causality relationship, and the Schumock and Thornton questionnaire adapted by Otero was used to evaluate ADE preventability. Preventable drug-induced adverse events were classified according to the taxonomy that the Ruiz-Jarabo 2000 group defined, and coordinated by ISMP-Spain. RESULTS: We included 1,550 patients, 159 of whom experienced at least one ADE (10.3 %). The preventability percentage was 51.6 %, which represented 5.3 % of the total sample. The endocrine system (34.8 %) and the cardiovascular system (20.7 %) were the most affected by preventable ADEs. Antibiotics were responsible for 16.5 % of all ADEs. 9.3 % of all preventable ADEs were triggered by use of opiates. The vast majority of preventable ADEs (36.3 %) resulted from omitting a necessary medication. Only 4.4 % of preventable ADEs are considered to be serious. CONCLUSIONS: There is a high incidence rate of ADEs during patients' hospital stay (10.3 %), and half of them (51.6 %) could have been prevented. Implementation of an automatic alarm system and certain best practices for problem spots along the care circuit will help detect and avoid preventable ADEs.

Estudio de incidencia de los errores de medicación en los procesos de utilización del medicamento: prescripción, transcripción, validación, preparación, dispensación y administración en el ámbito hospitalario / Incident study of medication errors in drug use processes: prescription, transcription, validation, preparation, dispensing and administering in the hospital environment

Objetivo: Determinar la incidencia global y por etapas de los errores de medicación en 6 hospitales de Cataluña, así como los tipos de error y las consecuencias. Método: Diseño prospectivo, cuya variable global es el error de medicación. Se han excluido los errores potenciales. En cada hospital se estudiaron los ingresados en 2 unidades hasta 300 pacientes y se observaron 1.500 administraciones. Se aplicó la taxonomía del National Coordinating Council for Medication Error Reporting and Prevention. El error de prescripción se detectó mediante la revisión de las prescripciones, en la que se comprobaron paciente, medicamento, adherencia a protocolos, interacciones, contraindicaciones, omisión, duplicidad terapéutica, dosis, frecuencia, vía y falta de seguimiento. En la transcripción/validación se comprobó la coincidencia con la orden médica original. En la dispensación, antes de enviar los carros de unidosis, se revisó el contenido de los cajetines, y se contrastó con el listado generado informáticamente. En planta, los observadores comprobaron transcripción, preparación y administración. En todos los procesos se registraron los datos en una hoja específica. La concordancia entre revisores fue moderada (kappa = 0,525). Resultados: Se detectaron 16,94 errores por 100 pacientes-día y 0,98 por paciente: 16 % en prescripción, 27 % en transcripción/validación, 48 % en dispensación y 9 % en administración. El 84,47 % pertenecía a la categoría B (no se alcanzó al paciente), y menos del 0,5 % causaron daño. La población, de 65 años de media, se distribuyó en una relación varón/mujer de 60/40. Los principales grupos terapéuticos fueron: agentes contra la úlcera péptica y el reflujo gastroesofágico, antitrombóticos, y otros analgésicos y antipiréticos, en los que predominaba la forma farmacéutica (..) (AU)

Objective: To determine both the global Incident, and the Incident for stages of medication errors in six Catalonian hospitals, the types of error and the consequences. Method: A prospective design, with the global variable of the medication error. Potential errors have been excluded. The patients admitted to each hospital were studied in 2 groups of up to 300 patients and 1,500 administrations were observed. The NCCMERP taxonomy was applied. The prescription error was detected through the review of prescriptions, checking the patient, medication, adherence to protocols, interactions, contraindications, omission, duplicated therapy, doses, frequency, method, and lack of follow-up. During the transcription/validation, it was verified that the prescription matched the original order. In the dispensing process, the content of the drawers was checked, comparing it to the computer generated list, before sending out the single dose trolley. The transcription, preparation and administration were observed on the wards. The information for all the procedures was registered in a specific data sheet. There was moderate concordance amongst the inspectors (kappa = 0.525). Results: 16.94 errors were detected per 100 patients-day and 0.98 errors per patient: 16 % in prescription, 27 % in transcription/validation, 48 % in dispensing, and 9 % in administration. 84.47 % were category B errors (they did not reach the patient), and < 0.5 % of the errors were harmful. The population, with an average age of 65, had a male/female ratio of 60/40. The principal therapeutic groups were: agents against peptic ulcer and GERD, antithrombotic agents, and other analgesics and antipyretics, (..) (AU)

[Incident study of medication errors in drug use processes: prescription, transcription, validation, preparation, dispensing and administering in the hospital environment]. / Estudio de incidencia de los errores de medicación en los procesos de utilización del medicamento: prescripción, transcripción, validación, preparación, dispensación y administración en el ámbito hospitalario.

OBJECTIVE: To determine both the global Incident, and the Incident for stages of medication errors in six Catalonian hospitals, the types of error and the consequences. METHOD: A prospective design, with the global variable of the medication error. Potential errors have been excluded. The patients admitted to each hospital were studied in 2 groups of up to 300 patients and 1,500 administrations were observed. The NCCMERP taxonomy was applied. The prescription error was detected through the review of prescriptions, checking the patient, medication, adherence to protocols, interactions, contraindications, omission, duplicated therapy, doses, frequency, method, and lack of follow-up. During the transcription/validation, it was verified that the prescription matched the original order. In the dispensing process, the content of the drawers was checked, comparing it to the computer generated list, before sending out the single dose trolley. The transcription, preparation and administration were observed on the wards. The information for all the procedures was registered in a specific data sheet. There was moderate concordance amongst the inspectors (kappa = 0.525). RESULTS: 16.94 errors were detected per 100 patients-day and 0.98 errors per patient: 16 % in prescription, 27 % in transcription/validation, 48 % in dispensing, and 9 % in administration. 84.47 % were category B errors (they did not reach the patient), and < 0.5 % of the errors were harmful. The population, with an average age of 65, had a male/female ratio of 60/40. The principal therapeutic groups were: agents against peptic ulcer and GERD, antithrombotic agents, and other analgesics and antipyretics, principally in a solid oral drug form (58 %). The medications per patient-day were 5.5 and the units of medication were on average 11.21, varying greatly among the institutions. The adjustment of 10 units made the results more uniform. In all the stages, omission was the most frequent error. DISCUSSION: The different methods used and different areas of the investigations make comparisons difficult. This is evident in the harmful errors, the proportion of which is affected by the detection procedure. The number of mistakes avoided during the execution of this project demonstrates the need to improve the planning of the work systems and to establish safety measures.

[The participation of the pharmacist in the design and follow-up of the drug treatment plan for patients with a cardiovascular condition]. / Diseño y seguimiento del plan farmacoterapéutico del paciente con enfermedad cardiovascular.

OBJECTIVES: To systemise the pharmaceutical care provided to patients with chronic diseases. To evaluate the pharmacist's participation in the drug treatment plan, studying their intervention in the reconciliation of the patient's habitual treatment and the detection and resolution of drug-related problems. METHOD: A multicentre study based on the comparison of two cohorts: one with the intervention of the pharmacist and one without. Inclusion criteria were as follows: patients over the age of 70 with chronic cardiovascular conditions being treated with more than 6 drugs. They were selected between 24-48 hours from admittance; a control patient was chosen for each patient in the intervention group. The pharmaceutical intervention consisted of medication reconciliation on admittance, drug treatment monitoring and reconciliation on discharge. Drug-related problems, their seriousness, the pharmaceutical intervention, the degree of resolution and the clinical outcomes on discharge were all recorded. A total of 24 hospitals participated, with a total of 356 patients: 180 in the intervention cohort and 176 in the control one. RESULTS: A total of 602 drug-related problems were identified: 66.9% belonging to the intervention group and 33% to the control group. Interventions were made in 359 (89%) patients belonging to the intervention group, 66% were resolved after the pharmaceutical intervention, producing a total or partial improvement in the patient in 36.3% of cases. CONCLUSIONS: Pharmaceutical care has been systematised, providing an instrument that enables all the hospitals to work in a standardised manner. The active participation of the pharmacist in the healthcare team contributes to preventing and resolving drug-related problems.

Diseño y seguimiento del plan farmacoterapéutico del paciente con enfermedad cardiovascular / The participation of the pharmacist in the design and follow-up of the drug treatment plan for patients with a cardiovascular condition

Objetivos: Sistematizar la atención farmacéutica al paciente con unaenfermedad crónica. Evaluar la participación del farmacéutico en elplan farmacoterapéutico mediante el estudio de su intervención enla conciliación del tratamiento habitual del paciente y en la deteccióny resolución de problemas relacionados con los medicamentos.Método: Estudio multicéntrico basado en la comparación de dos cohortes,una con intervención del farmacéutico y la otra no. Los criteriosde inclusión fueron: pacientes mayores de 70 años con enfermedadcardiovascular crónica y tratamiento con más de 6 fármacos. Seseleccionaban a las 24-48 h de su ingreso; por cada paciente del grupointervención se seleccionaba uno de control. La intervención farmacéuticaconsistía en la conciliación del tratamiento en el momentodel ingreso, el seguimiento farmacoterapéutico y la conciliación enel momento del alta. Se registraban los problemas relacionados conlos medicamentos, su gravedad, la intervención farmacéutica, el gradode resolución y los resultados clínicos en el momento del alta.Han participado 24 hospitales con un total de 356 pacientes: 180 dela cohorte de intervención y 176 de la de control.Resultados: Se ha identificado un total de 602 problemas relacionadoscon los medicamentos, el 66,9% perteneciente al grupo de intervencióny el 33% al de control. Se ha intervenido en 359 (89%) deellos pertenecientes al grupo intervención; un 66% se resolvió tras laintervención farmacéutica, que en el 36,3% de los casos produjo unamejoría total o parcial en el paciente.Conclusiones: Se ha sistematizado la atención farmacéutica y se haproporcionado un instrumento que permite trabajar de forma homogéneaen todos los hospitales. La participación activa del farmacéuticoen el equipo de salud contribuye a prevenir y resolver problemasrelacionados con los medicamentos

Objectives: To systemise the pharmaceutical care provided to patientswith chronic diseases. To evaluate the pharmacist’s participation inthe drug treatment plan, studying their intervention in the reconciliationof the patient’s habitual treatment and the detection and resolutionof drug-related problems.Method: A multicentre study based on the comparison of two cohorts:one with the intervention of the pharmacist and one without.Inclusion criteria were as follows: patients over the age of 70 withchronic cardiovascular conditions being treated with more than 6drugs. They were selected between 24-48 hours from admittance; acontrol patient was chosen for each patient in the intervention group.The pharmaceutical intervention consisted of medication reconciliationon admittance, drug treatment monitoring and reconciliation on discharge. Drug-related problems, their seriousness, the pharmaceuticalintervention, the degree of resolution and the clinical outcomeson discharge were all recorded. A total of 24 hospitals participated,with a total of 356 patients: 180 in the intervention cohort and 176 inthe control one.Results: A total of 602 drug-related problems were identified: 66.9%belonging to the intervention group and 33% to the control group.Interventions were made in 359 (89%) patients belonging to the interventiongroup, 66% were resolved after the pharmaceutical intervention,producing a total or partial improvement in the patient in36.3% of cases.Conclusions: Pharmaceutical care has been systematised, providingan instrument that enables all the hospitals to work in a standardisedmanner. The active participation of the pharmacist in the healthcareteam contributes to preventing and resolving drug-related problems

[Pharmaceutical care for drug-related problems in inpatients]. / Atención farmacéutica en los problemas relacionados con los medicamentos en enfermos hospitalizados.

UNLABELLED: Drug therapy-induced high morbidity results in pharmacists participating in the prevention and solution of drug-related problems (DRPs). OBJECTIVE: To assess DRP prevalence amongst inpatients, and the clinical results derived from pharmaceutical intervention. METHODS: DRPs detected during 6 months at Hospital Comarcal de Sant Bernabé were recorded and classified, and their severity established. Pharmaceutical intervention was evaluated by using two codes: impact and clinical significance. Interventions were reassessed by another pharmacist and a physician, and the degree of agreement was calculated. RESULTS: The prevalence of DRPs amongst inpatients was 10.8%. A total of 425 DRPs was detected, with a mean of 1.51 DRPs/patient. The highest percentage involved inappropriate drugs (26%), overdosing (22%), and inadequate dosing (22%). Eighty-four percent of DRPs were a severity level 2. Drugs mainly involved were antibiotics (21.6%), anti-ulcer agents (21.8%), and analgesic-anti-inflammatory compounds (8.1%). In all, 58% of interventions impacted on treatment effectiveness, and 42% on toxicity. Intervention acceptance was 91%. Seventy percent of interventions were appropriate and highly significant. The percentage of agreements in reassessments exceeded 88%. CONCLUSIONS: Pharmaceutical care allows DRPs to be prevented and solved. Methodology validation makes it safer in daily practice.

Atención farmacéutica en los problemas relacionados con los medicamentos en enfermos hospitalizados / Pharmaceutical care for drug-related problems in inpatients

La elevada morbilidad de la farmacoterapia implica que el farmacéutico participe en la prevención y resolución de problemas relacionados con medicamentos (PRM). Objetivo: Valorar la prevalencia de PRMs en enfermos hospitalizados y los resultados clínicos de la intervención farmacéutica realizada. Metodología: Durante 6 meses, en el Hospital Comarcal de Sant Bernabé, se registraron y clasificaron los PRMs detectados y se determinó su gravedad. La intervención farmacéutica se evaluó mediante dos códigos; impacto y significación clínica. Las intervenciones se reevaluaron por otro farmacéutico y un médico y se calculó el grado de concordancia. Resultados: La prevalencia de pacientes hospitalizados con PRM fue del 10,8 por ciento. Se detectaron 425 PRMs, con una media de 1,51 PRM/paciente. El mayor porcentaje fueron medicamentos inadecuados (26 por ciento), sobredosificaciones (22 por ciento) e infradosificaciones (22 por ciento). Un 84 por ciento de PRMs eran de nivel de gravedad 2. Los principales medicamentos implicados fueron antiinfecciosos (21,6 por ciento), antiulcerosos (21,8 por ciento), y analgésicos-antiinflamatorios (8,1 por ciento). Un 58 por ciento de las intervenciones incidieron en la efectividad del tratamiento y un 42 por ciento en la toxicidad. La aceptación de la intervención fue del 91 por ciento. Un 70 por ciento de las intervenciones fueron apropiadas y muy significativas. El porcentaje de coincidencia en las reevaluaciones fue superior al 88 por ciento. Conclusiones: La atención farmacéutica permite prevenir y resolver PRMs. La validación de la metodología da seguridad para utilizarla en la práctica diaria (AU)