Gestión integral de la farmacoterapia en un paciente hospitalizado con VIH y tuberculosis / Comprehensive medication management in a patient hospitalized with HIV and tuberculosis

Paciente varón de 27 años derivado desde infectología al Servicio de Gestión Integral de la Farmacoterapia para optimizar la administración del tratamiento antifímico. Se encontraba internado en hospital por un absceso submaxilar y axilar, candidiasis esofágica, desnutrición proteico-calórica, infección por VIH, tuberculosis pulmonar y ganglionar. Se analizó la experiencia farmacoterapéutica para lograr una mejor comprensión del uso de la medicación en el paciente y posteriormente lograr establecer un plan de cuidados individualizado para identificar y resolver 7 problemas farmacoterapéuticos mediante el sistema Pharmacotherapy Workup, obteniendo mejoría y estabilidad de su estado de salud. En las 11 condiciones clínicas que padecía el paciente, se realizaron un total de 7 intervenciones, para resolver los 6 problemas farmacoterapéuticos y prevenir la nueva aparición de uno de ellos. Uno de los problemas que consistía en que el paciente no deseaba tomar la medicación debido a los efectos adversos, fue resuelto con el propio paciente mediante la comprensión de su experiencia farmacoterapéutica, de esta forma se llegó a un acuerdo para lograr la tolerancia del fármaco. El resto se resolvieron mediante el trabajo colaborativo con la médica infectóloga y la nutricionista. (AU)

A 27-year-old male patient referred from infectious diseases to the Comprehensive medication Man-agement Service to optimize the administration of antifungal management. He was hospitalized for a submaxillary and axillary abscess, esophageal candida infection, protein-calorie malnutrition, HIV infection, pulmonary and ganglial tuberculosis.The pharmacotherapeutic experience was analyzed to achieve a better understanding of the patient's medication use and subsequently establish an indi-vidualized care plan to identify and solve 7 pharma-cotherapeutic problems through the Pharmacother-apy Workup system, obtaining improvement and stability in the patient's state of health.In the 11 clinical conditions suffered by the patient, a total of 7 interventions were performed to solve the 6 pharmacotherapeutic problems and prevent the new appearance of one of them. 1 of the prob-lems was solved by the patient himself because it was necessary to understand his medication expe-rience. The rest were solved through collaborative work with the infectious disease physician and the nutritionist. (AU)

[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.

Revisión bibliográfica sobre la Gestión Integral de la Farmacoterapia en pacientes hospitalizados en Cirugía Ortopédica y Traumatología / Literature review on Medication Therapy Management in patients admitted to Orthopedic Surgery and Trauma Departments

Objetivo: Explorar la literatura científica sobre las intervenciones farmacéuticas (IF) y la Gestión Integral de la Farmacoterapia (GIF) brindada por farmacéuticos en pacientes hospitalizados en Cirugía Ortopédica y Traumatología (COT). Métodos: Se realizó una búsqueda de artículos originales y revisiones, publicados en inglés o castellano, hasta el 17 de junio de 2021, cuyo tema principal fueran las IF en pacientes hospitalizados en COT. Bases de datos consultadas: Medline, Cochrane Library y Scielo. Términos empleados: “Orthopedics”, “Traumatology”, “orhopedic surgery”, “orhopedic trauma”, “Medication Therapy Management”, “Pharmacy Service, Hospital”, “Pharmacists”, “Medication Reconciliation”, “Pharmaceutical Care”, “Clinical Pharmacy”. La IF fue considerada GIF cuando implicaba una revisión profunda de la medicación del paciente (Valoración inicial/“Assessment”), evaluando indicación, efectividad, seguridad y cumplimiento/adherencia de cada uno de los medicamentos, y comprobando que todas sus necesidades farmacoterapéuticas estuvieran cubiertas. La implantación de la GIF fue considerada completa cuando además se realizaba un plan de cuidados farmacoterapéutico (“Care Plan”) y evaluación/seguimiento (“Follow up-evaluation”). Resultados: Se seleccionaron 29 artículos, principalmente estudios observacionales descriptivos (51,7%). La mayoría fueron publicados en Estados Unidos (27,6%) y España (20,7%). IF mayoritarias: conciliación de medicación (55,2%), revisión de medicación (44,8%), seguimiento farmacoterapéutico (SFT) (34,5%), manejo del dolor físico postquirúrgico (27,6%) y evaluación/reducción de riesgos (27,6%). La GIF fue analizada en cinco referencias bibliográficas (17,2%); siendo su implantación completa solamente en tres (10,3%). Conclusiones: La presente revisión bibliográfica sintetiza las principales IF en pacientes hospitalizados en COT, destacando: conciliación de medicación, revisión de medicación y SFT... (AU)

Objective: To review the scientific literature on Pharmaceutical Interventions (PIs) and Medication Therapy Management (MTM) by pharmacists in patients admitted to Orthopedic Surgery and Trauma (OST) Departments. Methods: A search was conducted of Medline, Cochrane Library, and Scielo databases for original articles and reviews on PIs in adults (≥18 yrs) hospitalized in OST published in English or Spanish up to June 17 2021. Search terms were: “orthopedics”, “traumatology”, “orthopedic surgery”, “orthopedic trauma”, “medication therapy management”, “pharmacy service, hospital”, “pharmacists”, “medication reconciliation”, “pharmaceutical care”, “clinical pharmacy”. Titles and abstracts of retrieved items were examined. A PI was considered MTM when part of a more in-depth review of the patient’s medication, evaluating the indication, effectiveness, safety, and treatment adherence for each medication and ensuring that all pharmacotherapeutic needs were covered (Assessment). MTM implementation was considered complete when plans for pharmacotherapy care (Care Plan) and follow-up (Follow-up evaluation) were developed. Results: The review included 29 articles, mainly descriptive observational studies (51.7%). The majority were published in the USA (27.6%) or Spain (20.7%). The most frequent PIs were: medication reconciliation (55.2%); medication review (44.8%); pharmacotherapeutic follow-up (34.5%); post-surgical physical pain management (27.6%); health education (27.6%); and risk assessment/reduction (27.6%). MTM was analyzed in five retrieved articles (17.2%) and its complete implementation in only three (10.3%). Conclusions: This literature review compiles the main PIs implemented in patients hospitalized in OST, highlighting medication conciliation, medication review, and pharmacotherapeutic follow-up. MTM implementation remains scarce in these patients. (AU)

Entrevistas en profundidad: técnica complementaria a las entrevistas clínicas en las intervenciones basadas en necesidades del paciente / In-depth interviews: complementary technique to the clinical interviews in the interventions based on the patient’s needs

Se brindó Comprehensive Medication Management a una mujer de 78 años, con antecedentes de trombosis venosa profunda y fractura de cadera. Diagnosticada de hidrocefalia, artrosis, hipertensión arterial y dislipemia, que tomaba 12 medicamentos. Se evaluaron las necesidades farmacoterapéuticas integrando aspectos biomédicos y psicosociales, a través de un análisis clínico, que permitió detectar 7 necesidades y un análisis complementario de narrativas extraídas de entrevistas en profundidad, que permitió la detección de 5 necesidades adicionales. Utilizar entrevistas en profundidad para interrelacionar aspectos cualitativos de la experiencia personal al evaluar la farmacoterapia, permitió plantear intervenciones biopsicosociales adaptadas a la resolución integral de necesidades farmacoterapéuticas, que fueron recogidas en un plan de cuidados, donde se incluyó un informe al médico de atención primaria con 4 recomendaciones de las cuales 2 fueron aceptadas y otras 4 fueron propuestas y aceptadas por la paciente y su cuidador, consiguiéndose la resolución de 8 necesidades farmacoterapéuticas.(AU)

Comprehensive Medication Management was provided to a 78-year-old woman. Medical history: deep vein thrombosis, hip fracture, hydrocephalus, arthrosis, arterial hypertension and dyslipidemia. She was taking 12 medications. Patient’s medication-related needs were evaluated integrating biomedical and psychosocial aspects, through a clinical analysis, which allowed the de-tection of 7 medication-related needs. Complemen-tary analysis of narratives extracted from in-depth interviews allowed detection of 5 additional medi-cation-related needs. Using in-depth interviews to interrelate qualitative aspects of personal experience when evaluating pharmacotherapy, allowed to propose biopsycho-social interventions adapted to the comprehensive resolution of medication-related needs, collected in a care plan. Included a medical report with 4 recommendations whereby 2 were accepted by the primary care physician. Another 4 medication-re-lated needs were proposed and accepted by the patient and her caregiver, achieving the resolution of 8 medication-related needs.(AU)