Intervención farmacéutica en la adherencia al tratamiento de pacientes con enfermedad renal crónica / Pharmaceutical intervention on the therapeutic adherence in patients with chronic renal disease

Objetivos. Evaluar el cumplimiento terapéutico global en pacientes con enfermedad renal crónica (ERC) estadio 3-5, y determinar si la intervención farmacéutica mejora el cumplimiento terapéutico. Material y métodos. Estudio prospectivo no controlado de intervención tipo antes y después (julio 2008-marzo 2009), realizado en la Unidad de Atención Farmacéutica. Pacientes mayores de 65 años con ERC 3-5, polimedicados y en tratamiento con eritropoyetina. Se utilizó el programa Infowin® para ofrecer información escrita a los pacientes, quienes firmaron consentimiento informado. Para valorar el cumplimiento terapéutico se aplicaron los cuestionarios Haynes-Sackett y Morisky-Green. Resultados. De 103 pacientes candidatos, se propuso participar a 94; aceptaron 53 (56,4%); mujeres, 60,4%; media de edad, 76,8±6,9 años. Causas de exclusión: negación a participar (19,5%); el paciente o el cuidador habitual no asistieron (70,7%); paciente institucionalizado (9,8%). Número medio de fármacos/paciente: 10,8±2,97. El 88,7% no presentó dificultades en tomar la medicación (Haynes-Sackett) y el 73,6% se consideró cumplidor (Morisky-Green). Al relacionar estos dos métodos, se objetivó diferencia entre ambos (p=0,036). Los pacientes con dificultad en tomar la medicación fueron menos cumplidores en un 45,6%. Se realizó por segunda vez el cuestionario Morisky-Green al 78,6% de los incumplidores, quienes presentaron un 45,5% más de cumplimiento, aumentándose el cumplimiento global a un 87,8% (p=0,00003). Se detectaron 52 problemas relacionados con la medicación (PRM). Conclusiones. El cumplimiento inicial de los pacientes con ERC 3-5 se considera notable. No obstante, tras la intervención farmacéutica, se observa una mejora en la adherencia a los tratamientos, con resultados estadísticamente significativos(AU)

Objectives. To assess the therapeutic adherence in patients with stage 3-5 chronic renal disease (CRD), and evaluate whether pharmaceutical intervention improves medication adherence. Material and methods. A prospective uncontrolled before-after study (July 2008-March 2009) was carried out in the Pharmaceutical Care Unit of a tertiary hospital. Polymedicated patients >65years with stage 3-5 CRD, and on treatment with erythropoietin. Infowin® program was used to provide written information during the interviews with patients, who signed the informed consent. The Haynes-Sackett and Morisky-Green questionnaires were used to assess the therapeutic adherence. Results. Of a total of 103 candidates, we asked 94 patients to participate, of whom 53 agreed; women 60.4%, mean age: 76.8±6.9years. Exclusion criteria: refusal to participate (19.5%), non-appearance of patient or usual caregiver (70.7%), andinstitutionalised patients (9.8%). Average number of drugs per patient: 10.8±2.97. A total of 88.7% had no difficulty in taking medication (Haynes-Sackett) and 73.6% were considered compliant (Morisky-Green). Differences were observed when comparing both methods (P=.036). Patients with difficulty in taking medication were less compliant (45.6%). The Morisky-Green questionnaire was used for a second time on 78.6% of unreliable patients, and obtained a 45.5% increase in compliance, increasing the overall compliance to 87.8% (P=.00003). Fifty-two drug-related problems (DRP) were detected. Conclusions. The initial compliance of patients with stage 3-5 CRD was was noteworthy. However, after pharmaceutical intervention there was a statistically significant improvement in adherence to therapy(AU)

[Pharmaceutical intervention on the therapeutic adherence in patients with chronic renal disease]. / Intervención farmacéutica en la adherencia al tratamiento de pacientes con enfermedad renal crónica.

OBJECTIVES: To assess the therapeutic adherence in patients with stage 3-5 chronic renal disease (CRD), and evaluate whether pharmaceutical intervention improves medication adherence. MATERIAL AND METHODS: A prospective uncontrolled before-after study (July 2008-March 2009) was carried out in the Pharmaceutical Care Unit of a tertiary hospital. Polymedicated patients >65 years with stage 3-5 CRD, and on treatment with erythropoietin. Infowin(®) program was used to provide written information during the interviews with patients, who signed the informed consent. The Haynes-Sackett and Morisky-Green questionnaires were used to assess the therapeutic adherence. RESULTS: Of a total of 103 candidates, we asked 94 patients to participate, of whom 53 agreed; women 60.4%, mean age: 76.8 ± 6.9 years. EXCLUSION CRITERIA: refusal to participate (19.5%), non-appearance of patient or usual caregiver (70.7%), and institutionalised patients (9.8%). Average number of drugs per patient: 10.8 ± 2.97. A total of 88.7% had no difficulty in taking medication (Haynes-Sackett) and 73.6% were considered compliant (Morisky-Green). Differences were observed when comparing both methods (P=.036). Patients with difficulty in taking medication were less compliant (45.6%). The Morisky-Green questionnaire was used for a second time on 78.6% of unreliable patients, and obtained a 45.5% increase in compliance, increasing the overall compliance to 87.8% (P=.00003). Fifty-two drug-related problems (DRP) were detected. CONCLUSIONS: The initial compliance of patients with stage 3-5 CRD was was noteworthy. However, after pharmaceutical intervention there was a statistically significant improvement in adherence to therapy.

[Palliative treatment of carcinomatous ascites with peritoneovenous shunt]. / Tratamiento paliativo de la ascitis carcinomatosa con shunt peritoneovenoso.

Carcinomatous ascites (CA) is not an uncommon manifestation of a metastatic neoplasia. The aim of this study was to evaluate the utility of peritoneovenous shunt (PVS) in patients with CA refractory to conventional management. Twelve patients in whom a PVS was placed with palliative intention were studied. One patient died in the postoperative period. Permanent control of the ascites was achieved in 7 (63.6%) of the remaining patients. PVS obstruction occurred in 4 patients (36.4%) and no other complications related to the shunt were seen. Results were better in CA of gynecological origin but without reaching significant statistical differences. We conclude that PVS can be useful for palliation of CA with a low complication rate.