RESUMO
ANTECEDENTES: La eficacia de las estatinas para reducir los niveles de LDL-colesterol es elevada, aunque sus costes son importantes y su efectividad en ámbitos reales, limitada. OBJETIVO: Analizar la eficiencia y la efectividad de las prescripciones de estatinas y su relación con características del paciente en un estudio piloto en una farmacia comunitaria. DISEÑO: Estudio transversal. Emplazamiento: Farmacia comunitaria. Prescripciones procedentes de 2 Centros de Salud de Lorca (Área III del Sistema Murciano de Salud). PARTICIPANTES: Ciento cuarentaiún pacientes y 32 médicos. MEDICIONES PRINCIPALES: Se recogieron variables sociodemográficas y clínicas de los pacientes, e información sobre el tipo y la dosis de estatina. En cada paciente se determinó: efectividad del tratamiento, en función del RCV y niveles de LDL-colesterol previos al tratamiento, y eficiencia, comparando el coste de la estatina prescrita con el de aquellas de igual potencia famacológica. RESULTADOS: El 57,4% de las prescripciones fueron de atorvastatina. El 63,9% de las prescripciones se consideraron ineficientes y el 17,3% inefectivas. En el análisis bivariado, los pacientes con eventos cardiovasculares previos (8/38; 21% vs.41/103; 39,8%, p = 0,040) y los fumadores (42/114; 36,8% vs.4/23; 17,4%, p = 0,047) tenían más riesgo de recibir una prescripción ineficiente. En el análisis multivariable, los fumadores tenían más probabilidad de recibir prescripciones ineficientes comparados con los no fumadores (OR ajustada 3,76; IC del 95%, 1,03-0,77; p = 0,012). CONCLUSIONES: Los pacientes alcanzaron mayoritariamente los objetivos de LDL-colesterol propuestos, aunque más de la mitad de las prescripciones se consideraron ineficientes
BACKGROUND: The efficacy of statins to reduce LDL-cholesterol serum levels is high, but effectiveness is limited and costs are elevated. OBJECTIVE: The efficiency and effectiveness of prescriptions were analyzed in a pilot study in a community pharmacy. DESIGN: A cross-sectional study. LOCATION: Community pharmacy. Prescriptions from two Murcian Health Service Centers in Lorca, Murcia (Spain). PARTICIPANTS: A total of 141 patients and 32 general practitioners were included. The efficiency was analyzed in 141 and effectiveness in 110 PATIENTS: MAIN MEASUREMENTS: Socio-demographic characteristics and clinical history of patients and information about statin type and dosage were collected. Each patient was analyzed to determine the effectiveness of treatment according to cardiovascular risk and previous LDL-cholesterol level, and efficiency comparing the statin prescribed against other statins with equal pharmacological power. RESULTS: The most prescribed statin was atorvastatin (57.4%). Almost two-thirds (63.9%) of prescriptions were inefficient, and 17.3% were ineffective. In a bivariate analysis, patients with previous cardiovascular events (8/38; 21% vs 41/103; 39.8%. P=.040) and smokers (42/114; 36.8% vs 4/23; 17.4%, P=.047) were more likely to receive an inefficient prescription than patients with no cardiovascular events and non-smokers. In a multivariate analysis, smokers were more likely to receive an inefficient prescription than non-smokers (OR ajusted 3.76; 95% CI;1.03-0.77, P=.012). CONCLUSIONS: Most of the participants reached therapeutic objectives for LDL-Cholesterol levels, but more than half of the prescriptions were considered inefficient
Assuntos
Feminino , Humanos , Masculino , Serviços Comunitários de Farmácia/classificação , Serviços Comunitários de Farmácia/ética , Prescrições/classificação , Atenção Primária à Saúde , Eficiência/classificação , Estudos Transversais/métodos , Serviços Comunitários de Farmácia/economia , Serviços Comunitários de Farmácia , Prescrições/enfermagem , Atenção Primária à Saúde/métodos , Eficiência/fisiologia , Estudos Transversais/instrumentaçãoRESUMO
BACKGROUND: The efficacy of statins to reduce LDL-cholesterol serum levels is high, but effectiveness is limited and costs are elevated. OBJECTIVE: The efficiency and effectiveness of prescriptions were analyzed in a pilot study in a community pharmacy. DESIGN: A cross-sectional study. LOCATION: Community pharmacy. Prescriptions from two Murcian Health Service Centers in Lorca, Murcia (Spain). PARTICIPANTS: A total of 141 patients and 32 general practitioners were included. The efficiency was analyzed in 141 and effectiveness in 110 patients. MAIN MEASUREMENTS: Socio-demographic characteristics and clinical history of patients and information about statin type and dosage were collected. Each patient was analyzed to determine the effectiveness of treatment according to cardiovascular risk and previous LDL-cholesterol level, and efficiency comparing the statin prescribed against other statins with equal pharmacological power. RESULTS: The most prescribed statin was atorvastatin (57.4%). Almost two-thirds (63.9%) of prescriptions were inefficient, and 17.3% were ineffective. In a bivariate analysis, patients with previous cardiovascular events (8/38; 21% vs 41/103; 39.8%. P=.040) and smokers (42/114; 36.8% vs 4/23; 17.4%, P=.047) were more likely to receive an inefficient prescription than patients with no cardiovascular events and non-smokers. In a multivariate analysis, smokers were more likely to receive an inefficient prescription than non-smokers (OR ajusted 3.76; 95% CI;1.03-0.77, P=.012). CONCLUSIONS: Most of the participants reached therapeutic objectives for LDL-Cholesterol levels, but more than half of the prescriptions were considered inefficient.
