[Translated article] Medication experience and clinical interventions in patients receiving pharmaceutical care: A scoping review of pharmaceutical care practice.

OBJECTIVE: Analyze scientific literature on qualitative research that studies the medication experience-MedExp-and related pharmaceutical interventions that bring changes in patients' health. Through the content analysis of this scoping review, we intend to: (1) understand how pharmacists analyze the MedExp of their patients who receive Comprehensive Medication Management CMM and (2) explain which categories they establish and how they explain the individual, psychological, and cultural dimensions of MedExp. METHODS: The scoping review followed recommendations from PRISMA Extension for Scoping Reviews. Medline (Pubmed), SCOPUS, Web of Science, and Psycinfo were used to identify research on MedExp from patients attended by pharmacists; and that they comply with quality standards, Standards for Reporting Qualitative Research. Articles published in English and Spanish were included. RESULTS: 395 qualitative investigations were identified, 344 were excluded. In total, 19 investigations met the inclusion criteria. Agreement between reviewers, kappa index 0.923, 95% CI (0.836-1.010). The units of analysis of the patients' speeches were related to how they were progressing in their medications and how it was built through MedExp, the influence it has on the experience of becoming ill, the connection with socioeconomic aspects, and beliefs. Based on MedExp, the pharmacists raised cultural proposals, support networks, health policies, and provide education and information about medication and disease. Additionally, characteristics of the interventions were identified, such as a dialogic model, therapeutic relationship, shared decision-making, comprehensive approach, and referrals to other professionals. CONCLUSIONS: The MedExp is an extensive concept, which encompasses people's life experience who use medications based on their individual, psychological, and social qualities. This MedExp is corporal, intentional, intersubjective, and relational, expanding to the collective because it implies beliefs, culture, ethics, and the socioeconomic and political reality of each person located in their context.

Experiencia con la medicación e intervenciones clínicas en pacientes valorados por farmacéuticos: revisión de alcance / Medication experience and clinical interventions in patients cared for by pharmacist: Scoping review of pharmaceutical care practice

Objetivo: analizar la literatura científica sobre investigaciones cualitativas que estudian la experiencia con la medicación (MedExp) y las intervenciones farmacéuticas relacionadas que aportan cambios en la salud de los pacientes. A través del análisis de contenido de esta revisión de alcance se pretende: 1) comprender cómo analizan los farmacéuticos la MedExp de sus pacientes que reciben Comprehensive Medication Management (CMM) y 2) explicar cuáles categorías establecen y cómo explican las dimensiones individuales, psicológicas y culturales de MedExp. Métodos: la revisión de alcance siguió las recomendaciones PRISMA Extension for Scoping Reviews. Se hizo una búsqueda en Medline (Pubmed), SCOPUS, Web of Science y Psycinfo para identificar investigaciones sobre MedExp de pacientes atendidos por farmacéuticos y que cumplieran con estándares de calidad, Standards for Reporting Qualitative Research. Se incluyeron artículos publicados en inglés y español. Resultados: se identificaron 395 investigaciones cualitativas, se excluyeron 344. En total 19 investigaciones cumplieron con los criterios de inclusión. Concordancia entre los revisores, índice de kappa 0,923; IC 95% (0,836-1,010). Las unidades de análisis de los discursos de los pacientes se relacionaron con una construcción de la MedExp en el transitar de las personas con sus medicamentos, la influencia que tiene en la experiencia de enfermar, la conexión con aspectos socioeconómicos y las creencias. A partir de la MedExp, los farmacéuticos plantearon propuestas culturales, redes de apoyo, a nivel de políticas sanitarias, y brindar educación e información acerca de la medicación y la enfermedad. Adicionalmente, se identificaron características de las intervenciones como modelo dialógico, relación terapéutica, toma de decisiones compartidas, abordaje integral y derivaciones a otros profesionales. Conclusiones ... (AU)

Objective: Analyze scientific literature on qualitative research that studies the medication experience -MedExp- and related pharmaceutical interventions that bring changes in patients’ health. Through the content analysis of this scoping review, we intend to: 1) understand how pharmacists analyze the MedExp of their patients who receive Comprehensive Medication Management and 2) explain which categories they establish and how they explain the individual, psychological and cultural dimensions of MedExp. Methods: The scoping review followed recommendations from PRISMA Extension for Scoping Reviews. Medline (Pubmed), SCOPUS, Web of Science, and Psycinfo were used to identify research on MedExp from patients attended by pharmacists; and that they comply with quality standards, Standards for Reporting Qualitative Research. Articles published in English and Spanish were included. Results: 395 qualitative investigations were identified, 344 were excluded. In total, 19 investigations met the inclusion criteria. Agreement between reviewers, kappa index 0.923 95% CI (0.836-1.010). The units of analysis of the patients' speeches were related to how they were progressing in their medications and how it was built through MedExp, the influence it has on the experience of becoming ill, the connection with socioeconomic aspects, and beliefs. Based on MedExp, the pharmacists raised cultural proposals, support networks, health policies, and provide education and information about medication and disease. Additionally, characteristics of the interventions were identified, such as a dialogic model, therapeutic relationship, shared decision-making, comprehensive approach, and referrals to other professionals. Conclusions ... (AU)

Medication experience and clinical interventions in patients cared for by pharmacist: Scoping review of pharmaceutical care practice. / Experiencia con la medicación e intervenciones clínicas en pacientes valorados por farmacéuticos: revisión de alcance.

OBJECTIVE: Analyze scientific literature on qualitative research that studies the medication experience -MedExp- and related pharmaceutical interventions that bring changes in patients' health. Through the content analysis of this scoping review, we intend to: 1) understand how pharmacists analyze the MedExp of their patients who receive Comprehensive Medication Management and 2) explain which categories they establish and how they explain the individual, psychological and cultural dimensions of MedExp. METHODS: The scoping review followed recommendations from PRISMA Extension for Scoping Reviews. Medline (Pubmed), SCOPUS, Web of Science, and Psycinfo were used to identify research on MedExp from patients attended by pharmacists; and that they comply with quality standards, Standards for Reporting Qualitative Research. Articles published in English and Spanish were included. RESULTS: 395 qualitative investigations were identified, 344 were excluded. In total, 19 investigations met the inclusion criteria. Agreement between reviewers, kappa index 0.923 95% CI (0.836-1.010). The units of analysis of the patients' speeches were related to how they were progressing in their medications and how it was built through MedExp, the influence it has on the experience of becoming ill, the connection with socioeconomic aspects, and beliefs. Based on MedExp, the pharmacists raised cultural proposals, support networks, health policies, and provide education and information about medication and disease. Additionally, characteristics of the interventions were identified, such as a dialogic model, therapeutic relationship, shared decision-making, comprehensive approach, and referrals to other professionals. CONCLUSIONS: The MedExp is an extensive concept, which encompasses people's life experience who use medications based on their individual, psychological and social qualities. This MedExp is corporal, intentional, intersubjective and relational, expanding to the collective because it implies beliefs, culture, ethics and the socioeconomic and political reality of each person located in their context.

Case report: Serotoninergic and cholinergic syndromes induced by self-medication.

Self-medication is a part of the self-care practices carried out by the elderly in their environment. The aim of this case report is to show how the self-medication of fluoxetine and dimenhydrinate in an older adult can induce serotoninergic and cholinergic syndromes, showing symptoms such as nausea, tachycardia, tremor, loss of appetite, memory loss, decreased vision, falls, and increased urination. An older adult who has been diagnosed with arterial hypertension, dyslipidemia, diabetes mellitus, and a recent diagnosis of essential thrombosis is the subject of this case report. After the analysis of the case, cessation of fluoxetine was recommended to avoid withdrawal symptoms, therefore decreasing the need for dimenhydrinate and the medicines used for dyspepsia. After the recommendation, the patient showed an improvement in the symptoms. Finally, the comprehensive evaluation process of the medication in the Medicines Optimization Unit achieved the detection of the problem and improved the patient's health condition.

Experiencia Farmacoterapéutica en pacientes con enfermedad renal crónica atendidos en el Servicio de Nefrología de un hospital en Costa Rica. Estudio Piloto / Medication experience in patients with chronic kidney disease treated by the Nephrology Service of a hospital in Costa Rica. A pilot study

OBJETIVO: Describir la experiencia farmacoterapéutica en pacientes con enfermedad renal crónica que asisten al Programa de Atención Farmacéutica del Hospital Dr. R.A. Calderón Guardia en Costa Rica. MÉTODOS: Estudio cualitativo en pacientes con enfermedad renal crónica que asisten al Programa de Atención Farmacéutica del Servicio Farmacéutico del Hospital. Las categorías de análisis se obtuvieron de los discursos de los pacientes sobre su experiencia farmacoterapéutica y de las notas del diario de campo de la farmacéutica del programa. El análisis cualitativo y la triangulación se realizaron incorporando la reflexividad a la revisión por pares de los datos cualitativos. RESULTADOS: Sobre la experiencia farmacoterapéutica 5 de los 11 pacientes comentaron sobre la cantidad de medicamentos que deben tomar, 5 pacientes se refirieron a falta de conocimiento y/o compresión de la medicación, 4 manifestaron su temor a reacciones adversas. DISCUSIÓN: Al describir la experiencia farmacoterapéutica la mayoría de los participantes mencionaron la gran cantidad de medicamentos que debían tomar. Esta polimedicación provocó una actitud aversiva en algunos pacientes que tenían enfermedad renal crónica en fases avanzada, pero de forma contraria en los pacientes trasplantados renales produjo una actitud favorable. Otros pacientes indicaban falta de comprensión de la medicación, probablemente asociada al modelo paternalista de atención en el ámbito costarricense. Como principal preocupación, los pacientes dicen que sienten miedo a las reacciones adversas. En estas situaciones, el acompañamiento y disponibilidad del farmacéutico para resolver dudas y aportarle opciones terapéuticas para afrontar estas reacciones ha contribuido a la confianza en usar los medicamentos con mayor tranquilidad

OBJECTIVE: Describe the medication experience of patients with chronic kidney disease included in the Pharmaceutical Care Program of a Hospital Calderón Guardia in Costa Rica. METHODS: Qualitative study in patients with chronic kidney disease that were treated by the Pharmaceutical Care Program. Analytical categories were defined based on patients' feedback on their medication experiences as well as the pharmacist's field notebook. Qualitative analysis and triangulation were obtained by incorporating reflexivity into the peer review of qualitative data. RESULTS: As part of the medication experience, 5 of 11 patients shared feedback on medications quantities to be taken, 5 patients did not have sufficient knowledge and/or understanding of it, and finally, 4 expressed their fear to adverse reactions. DISCUSSION: Most of the feedback received was related to number of medications that each patient was prescribed. Polymedication caused an averse attitude in some of them, especially on those who had chronic kidney disease. Kidney transplant recipient patients did not display the same behavior. Other participants described a general lack of understanding on the use of medication, probably derived from Costa Rica's paternalistic model of care. Overall, most of the patients expressed their worry and fear towards adverse reactions. In these situations, the availability of the pharmacist to answer questions and provide therapeutic options to deal with these reactions, as a care support strategy, contributed to increasing confidence towards medication use