[Characterization of the problem of the therapeutic use of Cannabis Oil in Córdoba, Argentina]. / Caracterización de la problemática del uso terapéutico del Aceite de Cannabis en Córdoba, Argentina.

Introduction: The therapeutic use of the "cannabis" oil is a social problem that puts legal, health, scientific and cultural aspects under stress. Difficulty in access generates an emptiness exploited by the illegal market, to which patients and relatives resort to improve their health and quality of life. These oils, with unknown chemical composition, are used without therapeutic follow-up. An interdisciplinary team from the Universidad Nacional de Córdoba (UNC) started the study of this problem with the aim of characterizing the socio-therapeutic use of "cannabis" oil in Córdoba and establishing a relationship with the real content of cannabinoids. Methodology: Observational-descriptive and cross-sectional study approved by the Comité Institucional de Ética de las Investigaciones en Salud, Hospital Nacional de Clínicas from UNC (CIEIS-HNC-UNC): interviews with patients/caregivers of legal age who used the "cannabis" oil (year 2019). Experimental study: analysis of oil samples obtained from interviewees to determine their cannabinoid content, specifically delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), by High Performance Liquid Chromatography analysis (HPLC). Results: thirty-seven interviews were conducted, and 48 samples were analysed. The 73% were adults and older adults. The 92% started using the oil without prescription or medical suggestion, mainly due to the lack of effectiveness of other therapies (54%) and in the search for therapeutic alternatives (33%). The 84% perceived it to be effective (moderate to highly effective), and 78% reported no adverse events. Main uses: refractory epilepsy 27% and arthritis/arthrosis 24%. Fifteen percent of the samples showed no quantifiable content of CBD and THC, and 67% had only THC. The quantifiable content of cannabinoids was very low. Conclusions: This work allowed carrying out a preliminary information-gathering on several aspects (social and therapeutic) about the use of "cannabis" oil in Córdoba, and to analyze the chemical quality of the oils consumed. An important finding was the discrepancy between the effectiveness perceived by users and the low cannabinoid content detected.

Introducción: El uso terapéutico del aceite de "cannabis" es una problemática social que pone en tensión aspectos legales, sanitarios, científicos y culturales. La dificultad en el acceso genera un vacío aprovechado por el mercado ilegal, al que recurren pacientes y familiares para mejorar su salud y calidad de vida. Estos aceites, de composición química desconocida, se emplean sin un seguimiento terapéutico. Un equipo interdisciplinario de la UNC se involucró en esta problemática con el objetivo de aportar elementos para su caracterización en nuestro medio. Metodología: Estudio observacional-descriptivo y transversal (aprobado por el CIEIS-HNC-UNC): entrevistas a pacientes/cuidadores mayores de edad que usaban el aceite (2019). Estudio experimental: análisis de muestras de aceites de los entrevistados para determinar su contenido de cannabinoides (THC y CBD), mediante HPLC. Resultados: Se realizaron 37 entrevistas y analizaron 48 muestras. El 73% fueron adultos y adultos-mayores. El 79% empiezan a usar el aceite por recomendación de parientes/amigos o por iniciativa propia, principalmente por falta de efectividad de otras terapias (54%) y por búsqueda de alternativas (33%). El 84% lo percibe efectivo (moderado-muy efectivo) y el 78% no manifestó eventos adversos. Usos principales: epilepsia refractaria 27% y artritis/artrosis 24%. El 15% de las muestras no presentaron contenidos cuantificables de CBD y THC, y el 67% presentó THC sin CBD. El contenido de cannabinoides cuantificables fue muy bajo. Conclusiones: Se obtuvo una aproximación sobre el uso terapéutico del aceite de "cannabis" en Córdoba y su calidad. Se observó discrepancia entre la efectividad percibida y el bajo contenido de cannabinoides detectados.

Descripción de la disponibilidad y normas para el uso de las benzodiacepinas en algunos países de América Latina, 2022 / Description of benzodiazepines availability and regulation in several countries of Latin America, 2022 / Descrição da disponibilidade e regulamentação para o uso de benzodiazepínicos em alguns países da América Latina, 2022

Resumen: Introducción: las benzodiacepinas constituyen un grupo farmacológico de amplia prescripción a nivel mundial desde su aparición en la década de 1960. El objetivo del presente estudio fue identificar la disponibilidad, las modalidades de prescripción y dispensación de benzodiacepinas en diferentes países de América Latina, según reglamentación vigente en cada país participante del estudio. Materiales y métodos: estudio observacional, descriptivo y transversal, realizado con los datos disponibles al año 2022 de todos los países miembros de la Red de Centros de Información de Medicamentos de LatinoAmérica y el Caribe (Red CIMLAC) que fueron parte del estudio. Se utilizaron las bases de datos de las agencias regulatorias, la reglamentación vigente y otros documentos necesarios para obtener la información sobre la dispensación y prescripción en cada país. Resultados: doce de los 20 países de la Red CIMLAC completaron el estudio. El total de benzodiacepinas disponible en cada país varió entre 6 y 12 (media: 9). De ellas, en promedio 5 estaban incluidas en listados de medicamentos esenciales nacionales. La mayoría de los países cuentan con combinaciones a dosis fijas con benzodiacepinas. En todos los países se realiza la prescripción por receta especial. Más de la mitad de los países cuentan con recomendaciones nacionales. Conclusiones: la amplia disponibilidad de benzodiacepinas comercializadas, la existencia de combinaciones a dosis fijas y la falta de recomendaciones nacionales pueden ser factores que contribuyan al uso irracional de este grupo terapéutico.

Summary: Introduction: benzodiazepines constitute a widely prescribed group of drugs around the world, since they appeared in the sixties. This study aims to identify the availability, prescription modalities and dispensing of benzodiazepines in different countries around Latin America, as per the legal provisions in force in each of the countries participating in the study. Method: observational, descriptive, transversal study based on the information available in 2022 about all the member countries of the Network Medicines Information Centers of Latin America and the Caribbean (CIMLAC Network) that were part of the study. The databases of regulatory authorities were used and the legal provisions in force and relevant documents were consulted in order to obtain information on benzodiazepines dispensing and prescription in each country. Results: twelve out of the 20 CIMLAC Network member countries completed the study. The total number of benzodiazepines available in the study ranged from 6 to 12 (mean was 9), and 5 of them on average were included in the national essential medications lists. Most countries have benzodiazepines fixed dose combinations and in all countries a special medical prescription is needed. More than half of the countries have national recommendations. Conclusions: the wide availability of benzodiazepines in the market, the existence of fixed-dose combinations and the lack of national recommendations may constitute factors that contribute to the irrational use of this group of drugs.

Resumo: Introdução: os benzodiazepínicos constituem um grupo farmacológico amplamente prescrito em todo o mundo desde seu surgimento na década de 1960. O objetivo deste estudo foi identificar a disponibilidade, prescrição e modalidades de dispensação de benzodiazepínicos em diferentes países da América Latina, de acordo com as regulamentações vigentes em cada país participante do estudo. Materiais e métodos: estudo observacional, descritivo e transversal, realizado com os dados disponíveis até o ano de 2022 dos países membros da Rede de Centros de Informação sobre Medicamentos da América Latina e do Caribe (Red CIMLAC) que faziam parte do estudo. As bases de dados das agências reguladoras, normas vigentes e outros documentos necessários foram utilizados para obter informações sobre dispensação e prescrição em cada país. Resultados: doze dos 20 países da Rede CIMLAC completaram o estudo. O número total de benzodiazepínicos disponíveis em cada país variou entre 6 e 12 (média: 9). Destes, uma média de 5 foram incluídos nas listas nacionais de medicamentos essenciais. A maioria dos países tem combinações de dose fixa com benzodiazepínicos. Em todos os países é necessário prescrição especial. Mais da metade dos países têm recomendações nacionais. Conclusões: a ampla disponibilidade de benzodiazepínicos comercializados, a existência de combinações em doses fixas e a falta de recomendações nacionais podem ser fatores que contribuem para o uso irracional desse grupo terapêutico.

Integration of Community pharmacy and pharmacists in primary health care policies in Argentina

Argentina is a federal republic with approximately 44 million people, divided into 23 provinces and an autonomous city, Buenos Aires. The health system is segmented into public, social security and private subsystems. The social security and private sectors cover more than 60% of the population. Total health expenditure in 2017 was 9.4% of gross domestic product. Primary health care (PHC) was considered as the principal strategy for universal coverage policy for health system reform in Latin America at the end of 20th century. The most remarkable characteristics of the Argentinian health system are its fragmentation and disorganization. An increase of public sector demands, due to a socioeconomic crisis, led to the subsequent collapse of the system, caused primarily by a sustained lack of investment. First care level decentralization to the Integral Health Service Delivery Networks (IHSDN) becomes the cornerstone of a PHC-based system. Pharmacists and community pharmacies are not formally mentioned in PHC policies or IHSDN. However, pharmacies are recognized as healthcare establishments as part of the first care level. Community pharmacists are the only health care professional whose profit comes from the margin on product sales. Contracts with social security and private insurances provide small margins which reduce the viability of community pharmacies. There is a preference by community pharmacies to diversify product sales instead of providing professional services. This is driven by marketing and economic pressures rather than patient care and health policies. Dispensing is the main professional activity followed by management of minor illness and associated product recommendations. Currently, there are no national practice guidelines or standard operating procedures for the provision of pharmaceutical services and there is no nationally agreed portfolio of services. National pharmacy organizations appear to have no official strategic statements or plans which would guide community pharmacies. There are some isolated experiences in community pharmacies and in public first care level pharmacies that demonstrate the possibilities and opportunities for implementing pharmaceutical services under the PHC approach. There is a real lack of integration of community pharmacies and pharmacists in the healthcare system

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Integration of Community pharmacy and pharmacists in primary health care policies in Argentina.

Argentina is a federal republic with approximately 44 million people, divided into 23 provinces and an autonomous city, Buenos Aires. The health system is segmented into public, social security and private subsystems. The social security and private sectors cover more than 60% of the population. Total health expenditure in 2017 was 9.4% of gross domestic product. Primary health care (PHC) was considered as the principal strategy for universal coverage policy for health system reform in Latin America at the end of 20th century. The most remarkable characteristics of the Argentinian health system are its fragmentation and disorganization. An increase of public sector demands, due to a socioeconomic crisis, led to the subsequent collapse of the system, caused primarily by a sustained lack of investment. First care level decentralization to the Integral Health Service Delivery Networks (IHSDN) becomes the cornerstone of a PHC-based system. Pharmacists and community pharmacies are not formally mentioned in PHC policies or IHSDN. However, pharmacies are recognized as healthcare establishments as part of the first care level. Community pharmacists are the only health care professional whose profit comes from the margin on product sales. Contracts with social security and private insurances provide small margins which reduce the viability of community pharmacies. There is a preference by community pharmacies to diversify product sales instead of providing professional services. This is driven by marketing and economic pressures rather than patient care and health policies. Dispensing is the main professional activity followed by management of minor illness and associated product recommendations. Currently, there are no national practice guidelines or standard operating procedures for the provision of pharmaceutical services and there is no nationally agreed portfolio of services. National pharmacy organizations appear to have no official strategic statements or plans which would guide community pharmacies. There are some isolated experiences in community pharmacies and in public first care level pharmacies that demonstrate the possibilities and opportunities for implementing pharmaceutical services under the PHC approach. There is a real lack of integration of community pharmacies and pharmacists in the healthcare system.

[Strategies to foster an adequate compromise of the pharmacist with respect to over the counter medicines' advertisement.] / Estrategias para fomentar un adecuado compromiso del farmacéutico con respecto a la publicidad de medicamentos de venta libre.

The advertisement has a great influence on the public and, in over the counter medicines (OTC), it can generate health risks on the population if it is misregulated. The aim of this work is to analyze and disclose strategic viable actions emerged from a forum debate during an online course for fostering the pharmacist's compromise related to OTC advertisement. Methods: A content analysis was carried on, grouping by themes and categories the opinions of community pharmacists participating in a forum debate about OTC advertisement. Two audiovisual advertisement pieces were analyzed as triggers of discussion. Results: Sixty-five professionals participated in 3 groups of debate, and 103 opinions were collected. Among individual strategies, to guarantee the attention by a pharmacist was highlighted when health conditions or the use of medicines are consulted about. Other strategies include denouncing to the ANMAT the advertisements that do not comply with the norms, procuring a better regulation and assuming a critical posture. Within the collective strategies, including pharmacists in the evaluation committee of advertisement of ANMAT and furthering norms to reassess the role of the pharmacist and the community pharmacy in minor illnesses were stressed. Conclusion: The contribution of the community pharmacists allows disposing a set of professional strategies, both individuals and collectives, to promote a rational use of OTC for the patients and the community.

INTRODUCCIÓN: la publicidad ejerce una influencia muy importante sobre el público y, en el caso de los medicamentos de venta libre (MVL), puede generar riesgos en la salud de la población si no es adecuadamente fiscalizada. OBJETIVO: El objetivo de este trabajo es analizar y divulgar acciones estratégicas viables surgidas de la discusión en un foro de debate de un curso online, para fomentar el compromiso del farmacéutico ante la publicidad de MVL. MÉTODO: se realizó un análisis de contenido, agrupando por temas y categorías los aportes de los farmacéuticos comunitarios participantes en un foro de debate sobre publicidad de MVL. Como elemento disparador del debate, se analizaron 2 piezas publicitarias audiovisuales. RESULTADOS: participaron 65 profesionales en 3 grupos de debate y se efectuaron 103 aportes. Dentro de las estrategias individuales se destacan la de garantizar la atención por un farmacéutico ante consultas sobre problemas de salud o sobre el uso de estos medicamentos. Otras estrategias incluyen denunciar ante la ANMAT las publicidades que no cumplan con las normativas vigentes, solicitar mejor fiscalización y asumir una postura crítica. Dentro de las estrategias colectivas se destacan: incluir a farmacéuticos en la comisión evaluadora de publicidad de la ANMAT e impulsar normativas para revalorizar el rol del farmacéutico y la farmacia comunitaria frente a los trastornos menores.C CONCLUSIONES: la contribución de los farmacéuticos comunitarios permite disponer de un set de estrategias profesionales individuales y colectivas para promover un uso más racional de los MVL por parte de los pacientes y la comunidad.

[Analysis of over-the-counter medicines' information and strategies oriented to the community for improving its access and quality.] / Análisis de la información de medicamentos de venta libre y estrategias dirigidas a la población para mejorar su acceso y calidad.

Introduction: The Disposición ANMAT 753/2012 states definitions and guidelines about the information that inserts and labels must include in nonprescription drugs (also known as over-the-counter or OTC drugs). aim: Aims: to analyze the adequacy to the norm in a sample of OTC drugs; promote and disseminate strategic viable actions for being developed by pharmacists to improve the patient's information. formulated. Methods: During a course destined to community pharmacists, a practical activity and an on-line forum about the adequacy to the Disposición ANMAT 753/2012 were developed. The compliance of 17 requirements of the norm, in a sample of 66 OTC drugs, was registered. Forum duration: 2 weeks. A content analysis related to the strategies proposed by the participants was conducted. Results: From the sample, 87.9% of the medicines do not accomplish to at least 1 of the requirements. The major noncompliances were: inappropriately described composition, lack of telephone number for consultations, uncomprehensible therapeutic action, and package requirements. Strategies to develop by pharmacies individually, grouped, or through professional associations were Conclusions: A high level of noncompliance in the analyzed aspects of the norm was observed. The strategies proposed are oriented to patient empowerment by health education about OTC drugs and access to reliable information resources, comprehensible for consumers. It is necessary to reinforce the control procedures for the information the OTC drugs must include, and to encourage both the participation and commitment of the pharmacist.

Introducción: La Disposición ANMAT 753/2012: establece definiciones y lineamientos generales sobre la información que deben contener prospectos, etiquetas y rótulos de medicamentos de venta libre (MVL). Objetivos: analizar la adecuación a la normativa de una muestra de MVL; promover y divulgar acciones estratégicas viables a desarrollar por los farmacéuticos a fin de mejorar la información para los pacientes. Métodos: En un curso, dirigido a farmacéuticos comunitarios, se desarrollaron una actividad práctica y un foro de debate sobre la adecuación a la Disposición ANMAT 753/2012. Se registró el cumplimiento de 17 pautas de la normativa en una muestra de 66 MVL. Duración del foro: 2 semanas. Se realizó un análisis de contenido sobre las estrategias aportadas por los participantes. Resultados: El 87,9% de los medicamentos de la muestra incumple con al menos 1 de las pautas analizadas. Los mayores incumplimientos se relacionaron a composición inadecuadamente descripta, ausencia de número telefónico para consultas, acción terapéutica incomprensible y requerimientos del envase. Se plantearon estrategias a desarrollar en farmacias individualmente, agrupadas o a través de los colegios profesionales. Conclusión: Se observó un alto incumplimiento en las pautas analizadas de la normativa. Las estrategias planteadas se encaminan a conseguir el empoderamiento del paciente a través de educación sanitaria sobre el uso de MVL y el acceso a fuentes de información confiables que sean comprensibles para el usuario. Es necesario fortalecer los circuitos de control de la información que deben contener los MVL y promover la participación y el compromiso del farmacéutico.

Controversias en torno a la utilización de la vacuna contra el virus del papiloma humano / Controversy regarding the use of the vaccine against human papillomavirus / Controvérsias sobre o uso da vacina contra o vírus do papiloma humano

La vacuna contra el virus del papiloma humano (HPV) se presenta como una medida de prevención primaria del cáncer de cuello de útero (CCU), segunda causa de muerte de las mujeres a nivel mundial. Esta vacuna genera una dicotomía a nivel social que obliga a pensar si verdaderamente es necesario administrarla. En este artículo se desarrollan las posibles causas de esta contrariedad con la finalidad de colaborar en la toma de decisión informada sobre la administración de la misma. Se revisan las vacunas disponibles, las recomendaciones para su uso y las controversias en cuanto a eficacia, seguridad, número de dosis requeridas, eficiencia en la prevención y participación ciudadana. Las vacunas contra el HPV ofrecen un enfoque prometedor para la prevención del CCU y las afecciones asociadas a estos virus, pero no reemplazan a otras estrategias de prevención debido a que no protegen contra todos los tipos de virus de HPV.

The Human Papillomavirus (HPV) vaccine is presented as a primary preventive measure of cervical cancer (CC), the second cause of women deaths in the world. This vaccine generates such social dichotomy that makes us consider whether its administration is really necessary. The possible causes of this controversy are developed in this article, with the aim of helping to make an informed decision about its administration. Available vaccines are reviewed, as well as use recommendations and controversy regarding effectiveness, security, required doses, prevention efficiency and people’s participation. HPV vaccines offer a promising approach to prevent cervical cancer and conditions associated with these viruses, but they do not replace other prevention strategies since they do not protect against all HPV types.

A vacina contra o vírus do papiloma humano (HPV) é apresentada como uma medida de prevenção primária do câncer do colo do útero (CCU), a segunda principal causa de morte entre as mulheres em todo o mundo. Esta vacina gera tal dicotomia ao nível social que obriga a pensar se é realmente necessário administrá-la. Neste artigo discutem-se as possíveis causas desta controvérsia, a fim de ajudar na tomada de decisões informadas sobre a sua administração. Consideram-se as vacinas disponíveis, as recomendações para seu uso e a polêmica sobre a sua eficácia, segurança, número de doses necessárias, a eficiência na prevenção e a participação cidadã. As vacinas contra o HPV oferecem uma abordagem promissória para a prevenção do CCU e das doenças associadas a estes vírus, mas não substituem outras estratégias de prevenção, por não protegerem contra todos os tipos de vírus do HPV.

Importancia de los sistemas de información en programas de salud pública: bases de datos de pacientes diabéticos / Importance of the information systems in public health programs: diabetic patients databases

Objetivos: Describir las características de la población de pacientes diabéticos atendida en el subsector público de salud de la ciudad de Alta Gracia. Analizar el uso de la cantidad de dispensaciones mensuales como indicador de adherencia al tratamiento, comparando resultados entre establecimientos sanitarios. Valorar la coordinación de efectores públicos en la atención de pacientes. Materiales y métodos: Diseño: estudio observacional, descriptivo-analítico. Lugar: Hospital Arturo Umberto Illia (HAUI) y Dirección de Salud Pública (DSP). Alta Gracia (Provincia de Córdoba, Argentina). Población: Pacientes diabéticos pertenecientes a programas de salud de efectores públicos. Mediciones principales: Variables demográficas y epidemiológicas, cantidad de dispensaciones mensuales, adherencia global porcentual y coordinación de efectores. Resultados: Del total de pacientes diabéticos (n=540): 52% se atendían en el HAUI, 39% en la DSP y 9% en ambos centros; 55% eran mujeres y la edad promedio fue de 56 años; 81% correspondían a Diabetes Mellitus (DM) tipo 2, 1% a DM tipo 2 insulino-requirentes y 17% a DM tipo 1; la media general de cantidad de dispensaciones mensuales por paciente fue de 4,9 en 12 meses. Se observó falta de personal capacitado para gestión de información en ambos centros. Conclusiones: Las bases de datos permitieron conocer algunas características demográficas de la población diabética de Alta Gracia atendidas en el sector público. La frecuencia de dispensaciones durante los 12 meses pudo emplearse como indicador de adherencia al tratamiento. Se confirmó la exigua coordinación entre niveles de atención y jurisdicciones (provincial y municipal). Generar y mantener sistemas de información resulta necesario para tomar decisiones (AU)

Aims: To describe the characteristics of diabetic patients’ population attended in the public health sector of Alta Gracia city. To analyze the use of amount of monthly dispensations as indicator of adherence to treatment, by comparing the results between settings. To assess the coordination of public facilities for patients attention. Materials and methods: Design: observational descriptive-analytical study. Settings: Hospital Arturo Umberto Illia (HAUI) and Dirección de Salud Pública (DSP). Alta Gracia (province of Córdoba, Argentina). Subjects: diabetic patients belonging to health programs at public facilities. Main measures: demographic and epidemiological variables, amount of monthly dispensations, percentage of global adherence and coordination of settings. Results: From diabetic patients’ total (n=540): 52% were attended at HAUI, 39% at DSP, and 9% at both settings; 55% were female, and the average age was about 56 years old; 81% were type 2 Diabetes Mellitus (DM), 1% type 2 insulin-requiring DM, and 17% type 1 DM; the general mean of amount of monthly dispensations by patient was 4.9 in 12 months. Lack of trained personnel for information managing in both facilities was observed. Conclusions: The databases allowed knowing some demographic characteristics of diabetic population attended in the public sector of Alta Gracia. The dispensing frequency during 12 months was able to be used as an adherence to treatment indicator. The scarce coordination between care levels and jurisdictions (provincial and municipal) were confirmed. For decision making it is necessary to generate and maintain information systems (AU)

Cambios en el sistema de distribución de medicamentos en un hogar de ancianos: análisis sobre el consumo de medicamentos y errores de medicación / Changes in the drug distribution system in a nursing home: analysis of the consumption of drugs and medication errors

Objetivo: Implementar un sistema de distribución de medicamentos (SDM) adecuado para el Hogar de Ancianos (HA). Material y Métodos: Estudio cuasi-experimental, antes-después sin grupo control (enero 2011-enero 2012). Etapa 1: Análisis del SDM vigente, se lo esquematizó, se propuso el cambio a las autoridades. Etapa 2: Estudio prospectivo, concurrente respecto a la toma de datos y a las intervenciones. Se procedió a la implementación del nuevo SDM. Para la recogida de información se diseñó un Perfil Farmacoterapéutico donde se registraron datos personales de cada paciente, indicaciones médicas e incidentes referidos a la medicación. Resultados: Se implementó el cambio en el SDM, individualizando la medicación por períodos preestablecidos. Población incluida: 32 personas (15 mujeres-17 hombres). El 50% recibieron hasta 4 fármacos diarios y el 9,36% más de 9. Los grupos terapéuticos (clasificación ATC) más utilizados correspondieron a N y C. Categorías de errores de medicación evaluados que llegaron hasta el paciente: “omisión en la administración” y “medicamentos mal administrados”. Ambas sumadas resultaron en 7,12% en noviembre; 3,29% en diciembre y 0,94% en enero. Los errores atribuibles al SF también disminuyeron en el tiempo estudiado. Conclusiones: El sistema implementado centralizó la distribución individualizada de medicamentos en el SF. El diagnóstico del SDM realizado en la primera etapa fue útil para elaborar la propuesta de cambio. Luego de la implantación del nuevo SDM, se registró el consumo de medicamentos por paciente y el perfil de uso de los mismos en el HA. Se identificaron errores en los procesos de dispensación y administración de medicamentos (AU)

Aim: To implement a drug distribution system (DDS) suitable for the Nursing Home. Material and methods: A quasi-experimental study, without control group, was carried out (January 2011 - January 2012). Stage 1: An analysis of the current DDS and a proposal to improve it was presented to the authorities. Stage 2: Prospective field work with data collection and interventions. The new DDS was implemented and a pharmacotherapeutic profile was designed to record data from patient, prescriptions and adverse incidents related to medication. Results: The change in the DDS was implemented, medicines were distributed by standard periods of time, and patients were individualized. Thirty two people were included, 15 women and 17 men. The 50% of them received 4 medicines by day and the 9.36% received more than 9. Therapeutic groups N and C (according to ATC code) were the most utilized in the nursing home. Medication errors affecting patients were “Non-administered doses” and “Wrong-administered doses”. Adding both categories, the errors were 7.12% in November, 3.29% in December, and 0.94% in January. Also medication errors attributable to Pharmacy Service decreased over the time studied. Conclusion: The new DDS centralized the drug supply in the Pharmacy Service and individualized the pharmacotherapy. The diagnosis made in the first stage was useful to develop the proposed change. After the implementation, the drug consumption by patient and the drug use profile in the nursing home were registered. Also, errors were identified in the medication processes of dispensing and administering (AU)

Pacientes diabéticos sin cobertura de salud: Utilización de medicamentos, adherencia y complicaciones derivadas de su patología de base / Diabetic patients without health coverage: drug use, adherence and complications arising from their underlying disease

Objetivo: realizar un Estudio de Utilización de Medicamentos de los pacientes diabéticos atendidos en el Hospital Josefina Prieur (HJP) de la ciudad de Villa Allende (Córdoba, Argentina), determinar consumo de medicamentos antidiabéticos, grado de adherencia al tratamiento y pacientes afectados por complicaciones derivadas de la diabetes.Método: Estudio observacional, descriptivo y transversal, sobre pacientes diabéticos atendidos en el HJP que pertenecen al Programa Córdoba Diabetes (ProCorDia) durante los meses de Mayo a Diciembre de 2011.Conclusiones: Del total de medicamentos antidiabéticos dispensados, el 40,50% correspondió al subgrupo A10B (hipoglucemiantes orales) y el 59,50% al subgrupo A10A (Insulinas). Se observó una buena adherencia al tratamiento Pacientes diabéticos sin cobeRtuRa de salud: utilización de medicamentos, adheRencia y comPlicaciones deRivadas de su Patología de base Recibido: 23 de enero de 2013. Aprobado: 23 de mayo de 2013.(AU)

Objective: To carry out a drug usage study with diabetic patients treated at Josefina Prieur Hospital (HJP) Villa Allende city (Córdoba, Argentina) to determine anti-diabetic drug consumption, degree of treatment adherence, and amount of patients with complications arising from diabetes.Method: Observational, descriptive, cross-sectional study carried out on diabetic patients treated at the HJP belonging to the program ôPrograma Córdoba Diabetesö (ProCorDia), from May to December 2011. Drug consumption was determined in DDDs per 1000 inhabitants per day. Adherence was defined by the number of drug provisions for each patient during eight months. The presence of complications was obtained from records of drug delivery to patients receiving other medication besides anti-diabetic ones. Results: From 98 patients, 73 had some type of complication. The consumption of antidiabetic drugs in DDD per 1000 inhabitants per day was: Regular Insulin 1.990, NPH Insulin 6.244, Glibenclamide 2.826, Gliclazide 0.281, Metformin 2.497.Conclusions: From all anti-diabetic drugs dispensed, 40.50% belonged to subgroup A10B (oral hypoglycemic agents) and 59.50% to subgroup A10A (insulin). Good adherence to drug therapy was observed (mean = 81.63%, mode = 100%). A 74.49% of patients presented complications.(AU)

Programas de salud para pacientes diabéticos: calidad en la gestión del suministro esenciales / Health programs for diabetic patients: quality management supply essential

El objetivo general de esta tesis fue evaluar la calidad de productos y procesos asociados al suministro de medicamentos en programas de salud para pacientes diabéticos, desde 2 perspectivas: del acceso a medicamentos esenciales de la población (área 1) y de la calidad biofarmacéutica de los medicamentos y su intercambiabilidad (área 2). Los programas de salud y los efectores analizados fueron los del subsector público de la ciudad de Alta Gracia (Córdoba):  Programa Córdoba Diabetes (PROCORDIA, provincial), en el Hospital Arturo Umberto Illia.  Programa de Detección de Diabetes Tipo 2 de la Dirección de Salud Pública y Remediar (PROAPS, nacional), en la red de 12 Dispensarios, dependientes de la Municipalidad de Alta Gracia. Se trabajó en coordinación con los servicios de farmacia de ambos establecimientos asistenciales. Se consolidaron las bases de datos de pacientes con Diabetes Mellitus (DM) en cada efector y se generó una unificada del subsector público. La prevalencia calculada de DM fue de 3,1%, con más del 80% correspondiente al tipo 2 y uno de cada cuatro pacientes era mayor de 65 años. Se realizaron estudios de utilización de medicamentos de consumo basados en el sistema de clasificación ATC y la DDD como unidad técnica de medida (expresada como número de DDD por 1000 habitantes/día ó DHD). Los consumos globales fueron de 3,37 DHD de insulina y 11,99 DHD de antidiabéticos orales (ADO). Entre los ADO, se utilizaron en mayor proporción Metformina en combinación con Sulfonilureas, seguida por Sulfonilureas y Metformina, sin asociar. Se calculó la adherencia global porcentual a partir del registro de dispensaciones mensuales por paciente, observándo se una baja adherencia promedio entre los pacientes con DM tipo 2 (< 50%) en comparación con los tipo 1 y tipo 2 insulino-requirentes (> 70%).(AU)

SUMMARY: The general objective of this thesis was to evaluate the quality of products and processes associated to drug supply in health programs for diabetic patients from 2 perspectives: one of essential medicinesÆ access for population (area 1), and the other of biopharmaceutical quality of drugs and their interchangeability (area 2) The health programs and the facilities analyzed were form the public subsector in Alta Gracia city (Córdoba):  Programa Córdoba Diabetes (PROCORDIA, provincial), at the Arturo Umberto Illia Hospital.  Programa de Detección de Diabetes Tipo 2 of the Dirección de Salud Pública and Remediar (PROAPS, national), into the net of 12 health centers depending to the Municipality of Alta Gracia. This work was coordinated with the pharmacy services of both health care facilities. Databases of patients with Diabetes Mellitus (DM) were consolidated on each center, and a unified one of the public health subsector was generated. The calculated prevalence of DM was about 3.1%, with more than 80% corresponding to type 2, and one of four patients was older than 65 years. Drug utilization studies of consumption, based on the ATC classification system and the DDD as technical unit of measurement (expressed as number of DDD per 1000 inhabitants/day or DHD), were carried out. The global consumptions were 3.37 DHD for insulin and 11.99 DHD for oral antidiabetic drugs. Between the last ones, Metformin in combination with Sulfonylureas were utilized in the mayor proportion, followed by Sulfonylureas and Metformin, alone each one. The global adherence percentage was calculated from monthly dispensing records by patients. A low average adherence was observed among type 2 DM patients (< 50%) in comparison with type 1 and type 2 insulin-requirer ones (>70%).(AU)

Programas de salud para pacientes diabéticos: calidad en la gestión del suministro esenciales / Health programs for diabetic patients: quality management supply essential

El objetivo general de esta tesis fue evaluar la calidad de productos y procesos asociados al suministro de medicamentos en programas de salud para pacientes diabéticos, desde 2 perspectivas: del acceso a medicamentos esenciales de la población (área 1) y de la calidad biofarmacéutica de los medicamentos y su intercambiabilidad (área 2). Los programas de salud y los efectores analizados fueron los del subsector público de la ciudad de Alta Gracia (Córdoba):  Programa Córdoba Diabetes (PROCORDIA, provincial), en el Hospital Arturo Umberto Illia.  Programa de Detección de Diabetes Tipo 2 de la Dirección de Salud Pública y Remediar (PROAPS, nacional), en la red de 12 Dispensarios, dependientes de la Municipalidad de Alta Gracia. Se trabajó en coordinación con los servicios de farmacia de ambos establecimientos asistenciales. Se consolidaron las bases de datos de pacientes con Diabetes Mellitus (DM) en cada efector y se generó una unificada del subsector público. La prevalencia calculada de DM fue de 3,1%, con más del 80% correspondiente al tipo 2 y uno de cada cuatro pacientes era mayor de 65 años. Se realizaron estudios de utilización de medicamentos de consumo basados en el sistema de clasificación ATC y la DDD como unidad técnica de medida (expresada como número de DDD por 1000 habitantes/día ó DHD). Los consumos globales fueron de 3,37 DHD de insulina y 11,99 DHD de antidiabéticos orales (ADO). Entre los ADO, se utilizaron en mayor proporción Metformina en combinación con Sulfonilureas, seguida por Sulfonilureas y Metformina, sin asociar. Se calculó la adherencia global porcentual a partir del registro de dispensaciones mensuales por paciente, observándo se una baja adherencia promedio entre los pacientes con DM tipo 2 (< 50%) en comparación con los tipo 1 y tipo 2 insulino-requirentes (> 70%).

SUMMARY: The general objective of this thesis was to evaluate the quality of products and processes associated to drug supply in health programs for diabetic patients from 2 perspectives: one of essential medicines’ access for population (area 1), and the other of biopharmaceutical quality of drugs and their interchangeability (area 2) The health programs and the facilities analyzed were form the public subsector in Alta Gracia city (Córdoba):  Programa Córdoba Diabetes (PROCORDIA, provincial), at the Arturo Umberto Illia Hospital.  Programa de Detección de Diabetes Tipo 2 of the Dirección de Salud Pública and Remediar (PROAPS, national), into the net of 12 health centers depending to the Municipality of Alta Gracia. This work was coordinated with the pharmacy services of both health care facilities. Databases of patients with Diabetes Mellitus (DM) were consolidated on each center, and a unified one of the public health subsector was generated. The calculated prevalence of DM was about 3.1%, with more than 80% corresponding to type 2, and one of four patients was older than 65 years. Drug utilization studies of consumption, based on the ATC classification system and the DDD as technical unit of measurement (expressed as number of DDD per 1000 inhabitants/day or DHD), were carried out. The global consumptions were 3.37 DHD for insulin and 11.99 DHD for oral antidiabetic drugs. Between the last ones, Metformin in combination with Sulfonylureas were utilized in the mayor proportion, followed by Sulfonylureas and Metformin, alone each one. The global adherence percentage was calculated from monthly dispensing records by patients. A low average adherence was observed among type 2 DM patients (< 50%) in comparison with type 1 and type 2 insulin-requirer ones (>70%).

Pacientes diabéticos sin cobertura de salud: Utilización de medicamentos, adherencia y complicaciones derivadas de su patología de base / Diabetic patients without health coverage: drug use, adherence and complications arising from their underlying disease

Objetivo: realizar un Estudio de Utilización de Medicamentos de los pacientes diabéticos atendidos en el Hospital Josefina Prieur (HJP) de la ciudad de Villa Allende (Córdoba, Argentina), determinar consumo de medicamentos antidiabéticos, grado de adherencia al tratamiento y pacientes afectados por complicaciones derivadas de la diabetes.Método: Estudio observacional, descriptivo y transversal, sobre pacientes diabéticos atendidos en el HJP que pertenecen al Programa Córdoba Diabetes (ProCorDia) durante los meses de Mayo a Diciembre de 2011.Conclusiones: Del total de medicamentos antidiabéticos dispensados, el 40,50% correspondió al subgrupo A10B (hipoglucemiantes orales) y el 59,50% al subgrupo A10A (Insulinas). Se observó una buena adherencia al tratamiento Pacientes diabéticos sin cobeRtuRa de salud: utilización de medicamentos, adheRencia y comPlicaciones deRivadas de su Patología de base Recibido: 23 de enero de 2013. Aprobado: 23 de mayo de 2013.

Objective: To carry out a drug usage study with diabetic patients treated at Josefina Prieur Hospital (HJP) Villa Allende city (Córdoba, Argentina) to determine anti-diabetic drug consumption, degree of treatment adherence, and amount of patients with complications arising from diabetes.Method: Observational, descriptive, cross-sectional study carried out on diabetic patients treated at the HJP belonging to the program “Programa Córdoba Diabetes” (ProCorDia), from May to December 2011. Drug consumption was determined in DDDs per 1000 inhabitants per day. Adherence was defined by the number of drug provisions for each patient during eight months. The presence of complications was obtained from records of drug delivery to patients receiving other medication besides anti-diabetic ones. Results: From 98 patients, 73 had some type of complication. The consumption of antidiabetic drugs in DDD per 1000 inhabitants per day was: Regular Insulin 1.990, NPH Insulin 6.244, Glibenclamide 2.826, Gliclazide 0.281, Metformin 2.497.Conclusions: From all anti-diabetic drugs dispensed, 40.50% belonged to subgroup A10B (oral hypoglycemic agents) and 59.50% to subgroup A10A (insulin). Good adherence to drug therapy was observed (mean = 81.63%, mode = 100%). A 74.49% of patients presented complications.

[Importance of the information systems in public health programs: diabetic patients databases]. / Importancia de los sistemas de información en programas de salud publica: bases de datos de pacientes diabéticos.

AIMS: To describe the characteristics of diabetic patients' population attended in the public health sector of Alta Gracia city. To analyze the use of amount of monthly dispensations as indicator of adherence to treatment, by comparing the results between settings. To assess the coordination of public facilities for patients attention. DESIGN: observational descriptive-analytical study. SETTINGS: Hospital Arturo Umberto Illia (HAUI) and Dirección de Salud Pública (DSP). Alta Gracia (province of Córdoba, Argentina). SUBJECTS: diabetic patients belonging to health programs at public facilities. MAIN MEASURES: demographic and epidemiological variables, amount of monthly dispensations, percentage of global adherence and coordination of settings. RESULTS: From diabetic patients' total (n=540): 52% were attended at HAUI, 39% at DSP, and 9% at both settings; 55% were female, and the average age was about 56 years old; 81% were type 2 Diabetes Mellitus (DM), 1% type 2 insulin-requiring DM, and 17% type 1 DM; the general mean of amount of monthly dispensations by patient was 4,9 in 12 months. Lack of trained personnel for information managing in both facilities was observed. CONCLUSIONS: The databases allowed knowing some demographic characteristics of diabetic population attended in the public sector of Alta Gracia. The dispensing frequency during 12 months was able to be used as an adherence to treatment indicator. The scarce coordination between care levels and jurisdictions (provincial and municipal) were confirmed. For decision making it is necessary to generate and maintain information systems.

[Community pharmacies' professional image: causes and improvement strategies by applying qualitative research techniques]. / Imagen profesional de farmacias comunitarias: causas y estrategias de mejora aplicando técnicas de investigación cualitativa.

OBJECTIVE: Ascertaining pharmacists' views related to factors explaining the lack of visibility of community pharmacies as being health facilities and proposing strategies for improving community pharmacy professional service accessibility using qualitative research techniques. METHODS: The nominal group technique (NGT) was used in two successive rounds using separate guidelines for factors and strategies. Framework analysis was then carried out. RESULTS: Thirty-four ideas related to "factors" and 32 related to "strategies" were obtained. Strategies were grouped into 14 topics, emphasising those prioritising patient-orientated professional services, ethical aspects and pharmacists' ongoing education. DISCUSSION: The techniques used led to identifying situations perceived by pharmacists which are not formally described in the literature. Raising awareness of professional services in community pharmacies implies agreeing on and developing strategies which should be based on joint participation by the pharmacists themselves, professional associations and universities.

Imagen profesional de farmacias comunitarias: causas y estrategias de mejora aplicando técnicas de investigación cualitativa / Community pharmacies' professional image: causes and improvement strategies by applying qualitative research techniques

Objetivo Conocer las opiniones de los farmacéuticos con relación a los factores que explican la falta de visibilidad de la farmacia comunitaria como establecimiento sanitario y proponer estrategias de desarrollo profesional a fin de lograr mejorar la accesibilidad a los servicios profesionales mediante técnicas de investigación cualitativa. Material y métodos Se utilizó una Técnica de Grupo Nominal (TGN) en 2 rondas sucesivas, respondiendo a 2 consignas guía sobre factores y estrategias. Posteriormente se realizó un Framework analysis. Resultados Se aportaron 34 ideas referidas a factores y 32 a estrategias. Las estrategias fueron agrupadas en 14 temas, destacándose las vinculadas a la priorización de los servicios profesionales orientados a los pacientes, al cumplimiento de la ética y a la formación continua del farmacéutico. Discusión Las técnicas utilizadas permitieron evidenciar situaciones percibidas por los farmacéuticos que no están formalmente descriptas en la literatura. Aumentar la visibilidad de los servicios profesionales en las farmacias comunitarias implica acordar y abordar estrategias que deben sustentarse en la participación conjunta de los propios farmacéuticos, las asociaciones profesionales y las universidades.

Objective Ascertaining pharmacists' views related to factors explaining the lack of visibility of community pharmacies as being health facilities and proposing strategies for improving community pharmacy professional service accessibility using qualitative research techniques. Methods The nominal group technique (NGT) was used in two successive rounds using separate guidelines for factors and strategies. Framework analysis was then carried out. Results Thirty-four ideas related to "factors" and 32 related to "strategies" were obtained. Strategies were grouped into 14 topics, emphasising those prioritising patient-orientated professional services, ethical aspects and pharmacists' ongoing education. Discussion The techniques used led to identifying situations perceived by pharmacists which are not formally described in the literature. Raising awareness of professional services in community pharmacies implies agreeing on and developing strategies which should be based on joint participation by the pharmacists themselves, professional associations and universities.

Barriers to pharmaceutical care in Argentina.

OBJECTIVE: To identify the perceived barriers to implementing pharmaceutical care in Argentina. METHOD: A semi-structured questionnaire was designed to carry out a cross-sectional descriptive study. The questionnaires were distributed in different continuing professional development events for pharmacists during November-December 2005. RESULTS: Ninety completed questionnaires were collected with the following distribution: 16.7% at the national congress of hospital pharmacy, 18.9% after a conference, 64.4% during two courses related to pharmaceutical care. The surveyed pharmacists work for community pharmacies (76.7%), hospital/institutional pharmacies (20.0%) and primary care centers (2.2%). The most important barriers mentioned were lack of time, lack of specific training and lack of communication skills. CONCLUSION: The opinions of Argentinian pharmacists from different places and professional practice settings were obtained. In all work settings, "lack of time" is the main barrier to overcome for implementing pharmaceutical care.

[Validation of a questionnaire on patient satisfaction with the dispensing service in community pharmacies]. / Validación de un cuestionario de satisfacción de pacientes con el servicio de dispensación en farmacias comunitarias.

OBJECTIVE: To analyze the validity and reliability of a patient satisfaction questionnaire about drug dispensing in Argentine community pharmacies. DESIGN: Descriptive, cross-sectional study. SETTING: Community pharmacies of Argentina that voluntarily agreed to take part in the study. PARTICIPANTS: All patients or their careers who attended the pharmacies during the period of the study (March and April, 2006) and knew how to read and write. MAIN MEASUREMENTS: Scores on the satisfaction scale of the questionnaire. RESULTS: Twenty-seven pharmacies from 6 provinces of Argentina took part; 473 questionnaires were obtained with a 72.4% response rate. Factorial analysis revealed one single component that explained 54.8% of total variance. A 0.90 Cronbach's alpha coefficient was obtained and Pearson's correlation between each of the items and the total score on the scale showed that all items correlated with each other (P<.01). Patients expressed additional comments in 124 questionnaires (26.2%). These concerned the quality of care received and other aspects, such as gratitude, cost of medicines, insufficient stock, and friendliness. CONCLUSIONS: The questionnaire, in showing evidence of content validity, validity as internal structure, validity related to other variables, and reliability, could assess patient satisfaction with the drug dispensing service in the community pharmacies of Argentina.

Validación de un cuestionario de satisfacción de pacientes con el servicio de dispensación en farmacias comunitarias / Validation of a questionnaire on patient satisfaction with the dispensing service in community pharmacies

Objetivo. Analizar la validez y fiabilidad de un cuestionario de satisfacción de pacientes con el servicio de dispensación en las farmacias comunitarias argentinas. Diseño. Descriptivo, de corte transversal. Emplazamiento. Farmacias comunitarias de Argentina que voluntariamente aceptaron participar en el estudio. Participantes. Todos los pacientes o sus cuidadores que concurrieron a las farmacias durante el período de estudio (marzo y abril de 2006) y que supieran leer y escribir. Mediciones principales. Puntuaciones de la escala de satisfacción del cuestionario. Resultados. Participaron 27 farmacias, pertenecientes a 6 provincias de Argentina. Se consiguieron 473 cuestionarios, con un porcentaje de respuesta del 72,4%. El análisis factorial reveló un único componente que explicaba el 54,8% de la varianza total. Se obtuvo un coeficiente alfa de Cronbach de 0,90 y la correlación de Pearson entre cada uno de los ítems y la puntuación total de la escala mostró que todos los ítems están correlacionados entre sí (p < 0,01). Los pacientes expresaron comentarios adicionales en 124 cuestionarios (26,2%) que se relacionaron con la calidad de la atención recibida y con otros aspectos, tales como agradecimiento, coste de los medicamentos, insuficiente stock y amabilidad. Conclusiones. El cuestionario mostró evidencias de la validez de contenido, validez como estructura interna, validez relacionada con otras variables y fiabilidad para valorar la satisfacción de los pacientes con el servicio de dispensación en las farmacias comunitarias argentinas

Objective. To analyze the validity and reliability of a patient satisfaction questionnaire about drug dispensing in Argentine community pharmacies. Design. Descriptive, cross-sectional study. Setting. Community pharmacies of Argentina that voluntarily agreed to take part in the study. Participants. All patients or their careers who attended the pharmacies during the period of the study (March and April, 2006) and knew how to read and write. Main measurements. Scores on the satisfaction scale of the questionnaire. Results. Twenty-seven pharmacies from 6 provinces of Argentina took part; 473 questionnaires were obtained with a 72.4% response rate. Factorial analysis revealed one single component that explained 54.8% of total variance. A 0.90 Cronbach's alpha coefficient was obtained and Pearson's correlation between each of the items and the total score on the scale showed that all items correlated with each other (P<.01). Patients expressed additional comments in 124 questionnaires (26.2%). These concerned the quality of care received and other aspects, such as gratitude, cost of medicines, insufficient stock, and friendliness. Conclusions. The questionnaire, in showing evidence of content validity, validity as internal structure, validity related to other variables, and reliability, could assess patient satisfaction with the drug dispensing service in the community pharmacies of Argentina

La prevención de los PRM y el Segundo Consenso de Granada / No disponible

Con el objeto de evitar que se presenten los Problemas Relacionados con Medicamentos (PRM) se hace necesario implementar medidas de tipo preventivas en el ámbito dela salud pública. Es importante el papel que el farmacéutico puede desarrollar en esta área, para actuar antes de que los PRM se manifiesten y provoquen la morbimortalidad relacionada con medicamentos. Por ello, los PRM potenciales, no manifestados o riesgo de PRM deben ser considerados en las actividades cotidianas del farmacéutico. Se analiza el artículo sobre el Segundo Consenso de Granada, considerando los alcances teóricos del concepto de PRM, la utilidad práctica de los mismos y su clasificación. Se aconseja que, conjuntamente con la definición de PRM, se contemple el concepto de los PRM potenciales, no manifestados o riesgo de PRM como aquellos que «pueden conducir a la no consecución del objetivo terapéutico o a la aparición de efectos no deseados». Además, y dada su importancia, se debería presentar a cada uno de los PRM en forma potencial (AU)

Avoiding the appearance of Drug Related Problems (DRP) to implement preventive measures in the field of public health is necessary. The role of pharmacist acting beforethe DRP arise provoking drug related morbidity is important. Therefore the risk of DRP, also known as potential or not manifested DRP, should be considered between the daily activities of the pharmacist. The article about the Second Consensus of Granada is analyzed taking into account the theoretical scope of the concept of DRP as well as their practical usefulness and classification. The potential or not manifested DRP or the risk of DRP should be contemplated as those that «can conduct not to reach the therapeutic aim or to the appearance of undesirable effects». In addition and because of their importance, each one of the DRP should be introduced in the potential way too (AU)