Conciliación e información de medicación al alta hospitalaria en un servicio de urología / Conciliation and medication information at the moment of hospital discharge in a service of urology

Analizar los resultados de un programa de conciliación e información de medicación al alta hospitalaria en un servicio de urología. Material y Método: Fueron incluidos los pacientes ingresados en el servicio de urología durante 2009 con mayor complejidad en su tratamiento domiciliario. Éste fue registrado, confirmándose previamente mediante una entrevista con el paciente la adherencia al mismo, así como problemas relacionados con la medicación habitual (PRMs). A partir de la epicrisis, se concilió la medicación prescrita con el tratamiento ambulatorio, resolviendo las discrepancias con el facultativo responsable. Por último, se entregó al paciente un cronopictograma con el listado completo de su medicación a partir del episodio asistencial y recomendaciones sobre su tratamiento con la explicación verbal del mismo. Realizamos una encuesta de satisfacción a los facultativos para conocer el conocimiento del programa y su valoración. Resultados: Se seleccionaron 260 pacientes, de los cuales en 102 (39 por ciento) se detectaron PRMs. Las discrepancias más frecuentes fueron: prescripción incompleta (28 por ciento), administración inadecuada (22 por ciento), medicamento no indicado (18 por ciento) y duplicidad (16 por ciento). Los PRM’s se clasificaron en orden a la severidad, de las 102 discrepancias: el 68 por ciento no habrían causado daño al paciente y el 32 por ciento habría requerido monitorización. La valoración global del programa fue muy positiva para los facultativos. Conclusión: La conciliación de medicación reduce los PRM’s, sobre todo en las transiciones asistenciales de los pacientes. Creemos que esta actividad asistencial debería realizarse de manera habitual en los hospitales, para aumentar la seguridad de los pacientes, en el marco de un sistema de reducción de riesgos para la salud y mejora de la calidad asistencial.

To analyze the results of a medication reconciliation and drug information program at discharge, in an urology department. Materials and Methods: Patients with more complexity in their home treatment, admitted in this facility during 2009, were included in the study. Preadmission regimens were recorded and the patients were asked about drug-related problems (DRP) and drug adherence. On the day of discharge, prescribed medication was reconciled with the outpatient treatment, resolving discrepancies with the prescribers. Finally, the patients were given a complete list of their medications and oral recommendations. We conducted a survey with physicians to enquire about their reconciliation program knowledge and their assessment. Results: 260 patients were selected, of which in 102 (42 percent) DRP were detected. The most frequent discrepancies were: incomplete prescription (28 percent), incorrect administration (22 percent), inappropriate medication (18 percent) and therapeutic duplication (16 percent ). The DRP were classified according to their severity, of the 102 discrepancies, 68 percent would not have caused harm to the patient and 32 percent would require monitoring. On the survey, about the overall evaluation of the program, it was highly regarded for the most of the physicians. Conclusion: Medication reconciliation reduces the DRP, especially at transition in healthcare of patients. We believe that activity should be carried out routinely in hospitals, to increase the patients safety, as part of a system to reduce health risks and improving the quality of care.

[Correlation, in previously treated HIV-1 positive patients, between hypersensitivity reaction to abacavir and the presence of the HLA-B*5701 allele]. / Correlación, en pacientes infectados por el VIH-1 y previamente tratados, entre la reacción de hipersensibilidad a abacavir y el alelo HLA-B*5701.

INTRODUCTION: Hypersensitivity reaction to abacavir (a powerful inverse transcriptase inhibitor) is a serious adverse effect that limits its use in antiretroviral treatment and requires a high level of clinical surveillance. Certain haplotypes of the primary histocompatibility complex proteins (HLA-B*5701) are very significant predictors of the risk of hypersensitivity to this drug. The purpose of this study is to identify the cases where a probable hypersensitivity reaction to abacavir presented the HLA-B*5701 allele. METHOD: A retrospective study was conducted in all HIV-1 positive adult patients infected treated with abacavir between January 2000 and December 2007, in Department 6 of the Agencia Valenciana de Salud (Valencia Health Agency). The adverse effects developed by the patients were collected to determine which cases presented a probable clinically diagnosed hypersensitivity reaction. Finally, these 39 patients were screened for HLA-B*5701. RESULTS: In total, 323 patients were treated with abacavir between 2000 and 2007. The treatment was discontinued in 12.1 % (n = 39 patients) presenting a hypersensitivity reaction. Nine (23.1 %) of these were HLA-B*5701 positive. Eight patients presented skin rash and positivity was observed in only single patient with gastrointestinal symptoms and fever. CONCLUSIONS: The administration of the HLA-B*5701 gene test may be of benefit in clinical practice, because it prevents diagnostic errors of the hypersensitivity reaction and enables more accurate interpretation of the symptoms.

Correlación, en pacientes infectados por el VIH-1 y previamente tratados, entre la reacción de hipersensibilidad a abacavir y el alelo HLA-B*5701 / Correlation, in previously treated HIV-1 positive patients, between hypersensitivity reaction to abacavir and the presence of the HLA-B*5701 allele

Introducción: La reacción de hipersensibilidad a abacavir (un potente inhibidor de la transcriptasa inversa) es un efecto adverso importante que limita su uso en la terapia antirretroviral y precisa un elevado grado de vigilancia clínica. Determinados haplotipos de las proteínas del complejo principal de histocompatibilidad (HLA-B*5701) predicen, de forma muy significativa, el riesgo de hipersensibilidad a este fármaco. El objetivo del estudio es identificar los casos que, después de desarrollar una probable reacción de hipersensibilidad a abacavir, presentaban el alelo HLA-B*5701. Métodos: Se ha realizado un estudio retrospectivo a todos los pacientes adultos infectados por el virus de la inmunodeficiencia humana 1 (VIH-1) que recibieron tratamiento con abacavir entre enero de 2000 y diciembre de 2007, en el Departamento 6 de la Agencia Valenciana de Salud. Se recogieron los efectos adversos desarrollados por los pacientes para identificar los casos con probable reacción de hipersensibilidad diagnosticada clínicamente. Finalmente, se realizó la tipificación de HLA-B*5701 a estos 39 pacientes. Resultados: En total, 323 pacientes recibieron tratamiento con abacavir entre 2000 y 2007. Se retiró el tratamiento por reacción de hipersensibilidad a 39 pacientes (12,1 %); 9 (23,1 %) de ellos resultaron HLA-B*5701 positivo; 8 pacientes manifestaron exantema y únicamente se observó positividad en un paciente con síntomas gastrointestinales y fiebre. Conclusiones: La realización del test genético HLA-B*5701 podría ser favorable para la práctica clínica habitual, ya que evita errores en el diagnóstico de la reacción de hipersensibilidad y permite interpretar los síntomas con más seguridad (AU)

Introduction: Hypersensitivity reaction to abacavir (a powerful inverse transcriptase inhibitor) is a serious adverse effect that limits its use in antiretroviral treatment and requires a high level of clinical surveillance. Certain haplotypes of the primary histocompatibility complex proteins (HLA-B*5701) are very significant predictors of the risk of hypersensitivity to this drug. The purpose of this study is to identify the cases where a probable hypersensitivity reaction to abacavir presented the HLA-B*5701 allele. Method: A retrospective study was conducted in all HIV-1 positive adult patients infected treated with abacavir between January 2000 and December 2007, in Department 6 of the Agencia Valenciana de Salud (Valencia Health Agency). The adverse effects developed by the patients were collected to determine which cases presented a probable clinically diagnosed hypersensitivity reaction. Finally, these 39 patients were screened for HLA-B*5701. Results: In total, 323 patients were treated with abacavir between 2000 and 2007. The treatment was discontinued in 12.1 % (n = 39 patients) presenting a hypersensitivity reaction. Nine (23.1 %) of these were HLA-B*5701 positive. Eight patients presented skin rash and positivity was observed in only single patient with gastrointestinal symptoms and fever. Conclusions: The administration of the HLA-B*5701 gene test may be of benefit in clinical practice, because it prevents diagnostic errors of the hypersensitivity reaction and enables more accurate interpretation of the symptoms (AU)

[Results of a medication reconciliation project in routine medical treatment after surgical discharge]. / Resultados de un proyecto de control y adecuación del tratamiento médico habitual tras el alta quirúrgica.

OBJECTIVE: To reduce the number of medication-related problems by ensuring reconciliation between ambulatory treatment and surgical prescription and to increase patients' understanding of drug therapy and treatment adherence. MATERIAL AND METHOD: Information on ambulatory medication was obtained through a personal interview and a review of the patient's personal and pharmacotherapeutic history. A dossier was created that included detailed information on each medication and a chronopictogram with all doses. On the day of discharge, a second interview with the patient was performed in which information was obtained orally and in writing about all treatment. The process was evaluated through a satisfaction questionnaire. Two weeks after discharge a telephone interview was carried out to detect post-discharge medication-related problems. RESULTS: During the study period (April-December 2006) 544 patients were included. There were 658 pharmaceutical interventions: 87% educational, 8% safety, 5% efficiency. A total of 346 satisfaction questionnaires were properly completed (63% of those distributed). Responses to questionnaires were evaluated from 0 (completely dissatisfied) to 5 (highly satisfied). Interest in the information received was scored 4.75, understanding of the information 4.67, and satisfaction with the intervention 4.59. CONCLUSIONS: Including the pharmacist in the surgical team ensures reconciliation between ambulatory treatment and surgical prescription and reduces medication errors. Providing information to patients about their medication at discharge increases their understanding of drug treatment and adherence.

Resultados de un proyecto de control y adecuación del tratamiento médico habitual tras el alta quirúrgica / Results of a medication reconciliation project in routine medical treatment after surgical discharge

Objetivos. Reducir el número de problemas relacionados con la medicación asegurando la conciliación del tratamiento. Aumentar la comprensión y el cumplimiento del tratamiento del paciente. Material y método. Se obtiene la medicación ambulatoria del paciente mediante una entrevista personal y la revisión de su historia clínica y farmacoterapéutica. Se elabora un dossier que incluye información detallada de cada medicamento y un cronopictograma con las pautas posológicas. El día del alta se realiza una segunda entrevista con el paciente, donde se le informa oralmente y por escrito sobre todo su tratamiento. El proceso se valora mediante un cuestionario de satisfacción. A las 2 semanas del alta se realiza una encuesta telefónica para detectar problemas relacionados con la medicación posteriores al alta hospitalaria. Resultados. Durante el período de estudio (abril-diciembre de 2006) se incluyó a 544 pacientes. Se realizaron 658 intervenciones farmacéuticas; el 87%, educativas; el 5%, de eficacia, y el 8%, de seguridad. Se recuperaron 346 cuestionarios de satisfacción debidamente cumplimentados (el 63% de los repartidos). Las respuestas del cuestionario se puntúan de 0 (nada satisfecho) a 5 (muy satisfecho). Interés por la información recibida, 4,75; grado de comprensión de la información, 4,67; satisfacción con la intervención, 4,59. Conclusiones. La inclusión del farmacéutico en el equipo quirúrgico asegura la conciliación entre el tratamiento ambulatorio del paciente y el prescrito por el cirujano y disminuye los errores de medicación. Proporcionar información al paciente sobre su medicación en el momento del alta aumenta su comprensión del tratamiento farmacológico y su cumplimiento (AU)

Objective. To reduce the number of medication-related problems by ensuring reconciliation between ambulatory treatment and surgical prescription and to increase patients' understanding of drug therapy and treatment adherence. Material and method. Information on ambulatory medication was obtained through a personal interview and a review of the patient's personal and pharmacotherapeutic history. A dossier was created that included detailed information on each medication and a chronopictogram with all doses. On the day of discharge, a second interview with the patient was performed in which information was obtained orally and in writing about all treatment. The process was evaluated through a satisfaction questionnaire. Two weeks after discharge a telephone interview was carried out to detect post-discharge medication-related problems. Results. During the study period (April-December 2006) 544 patients were included. There were 658 pharmaceutical interventions: 87% educational, 8% safety, 5% efficiency. A total of 346 satisfaction questionnaires were properly completed (63% of those distributed). Responses to questionnaires were evaluated from 0 (completely dissatisfied) to 5 (highly satisfied). Interest in the information received was scored 4.75, understanding of the information 4.67, and satisfaction with the intervention 4.59. Conclusions. Including the pharmacist in the surgical team ensures reconciliation between ambulatory treatment and surgical prescription and reduces medication errors. Providing information to patients about their medication at discharge increases their understanding of drug treatment and adherence (AU)