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Morillo-Verdugo R, Parra Zuñiga S, Álvarez de Sotomayor Paz M, Contreras Macías E, Almeida González CV, Robustillo-Cortes MDLA. Concordance between two models of stratification for patients living with HIV infection to providing pharmaceutical care. FARMACIA HOSPITALARIA 2024:S1130-6343(24)00087-4. [PMID: 38902115 DOI: 10.1016/j.farma.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVE To determine the degree of agreement of two differents stratification models for pharmaceutical care to people living with HIV. METHODS This was a single-centre observational prospective cohort study of patients with regular follow-up in pharmaceutical care consultations according to the Capacity-Motivation-Opportunity methodology, conducted between January 1st and March 31th, 2023. Patients received the pharmacotherapeutic interventions applied routinely to ambulatory care patients according to this model. As part of the usual clinical practice, the presence or absence of the variables that apply to both stratification models were collected. The scores obtained and the corresponding stratification level were collected for each patient according to both stratification models published (ST-2017 and ST-2022). To analyze the reliability between the measurements of two numerical score models of the stratification level with both tools, their degree of concordance was calculated using the intraclass correlation coefficient. Likewise, reliability was also evaluated from a qualitative perspective by means of Cohen's Kappa coefficient. Additionally, the existence of correlation between the scores of the two models was assessed by calculating Pearson's correlation coefficient. RESULTS Of the total of 758 patients being followed in the cohort, finally, 233 patients were enrolled. The distribution of patients for each stratification model was: ST-2017: 59.7% level-3, 25.3% level-2 and 15.0% level-1, while for ST-2022: 60.9% level-3, 26.6% level-2 and 12.4% level-1. It was observed that the reclassification was symmetrical (p=0.317). The qualitative analysis of the agreement between the models showed a good Cohen's kappa value, (K=0.66). A value of 0.563 was found as the intraclass correlation coefficient. Finally, the correlation analysis between the quantitative scores of the two models yielded a Pearson correlation coefficient of 0.86. CONCLUSIONS The concordance between the two models was good, which confirms that the multidimensional adaptation and simplification of the model were correct and that its use can be extended in routine clinical practice.
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Affiliation(s)
| | - Sebastián Parra Zuñiga
- Departamento de Farmacología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, España
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Contreras-Macías E, Robustillo-Cortés MDLA, Morillo-Verdugo R. Correlates of one-year mortality among patients living with HIV according to the stratification level of the pharmaceutical care model. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:302-307. [PMID: 37394400 DOI: 10.1016/j.eimce.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/05/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES The patient living with HIV (PLWH) profile has changed and with it, the importance of patient-oriented pharmaceutical care (PC) has been highlighted, for which the stratification tool of the Capacity-Motivation-Opportunity (CMO) PC model helps us which adapts to the needs of each patient. To assess the true relevance, our main objective is to evaluate the differences of one-year mortality among PLWH stratified according to this model. METHODS A single-center observational analytical survival research study including adult PLWH on antiretroviral therapy (ART) from January-2021 to January-2022 treated at hospital pharmacy outpatient service according to CMO pharmaceutical care model. RESULTS A total of 428 patients were included, a median age of 51 years (interquartile range 42-57 year). Overall, the number of patients stratified according to the CMO PC model was 86.2% at level 3, 9.8% at level 2, and 4.0% at level 1. Cox proportional hazard model that included the stratification level was associated with a higher mortality, whose level 1 patients had a 99.7% higher mortality (Hazard ratio=0.0003; 95%CI: 0.001-0.027). CONCLUSIONS To sum up, mortality of-one year differs when comparing the PC strata of level 1 and non-level 1, although being similar in age and other clinical conditions. This result suggests that the multidimensional stratification tool, included in the CMO PC model, could be used to modulate the patients intensity follow-up and design interventions more tailored to their needs.
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Martínez Sesmero JM, Margusino Framiñan L, Gimeno Gracia M, Áreas Del Águila V, Navarro Aznares H, Huertas Fernández MJ, Molina Cuadrado E, Díaz Ruiz P, Martin Conde MT, Alonso Grandes E, Lázaro López A, Morillo Verdugo R. [Comparison of quality of life in patients living with HIV infection through pharmaceutical care according to CMO methodology vs. conventional follow-up. MAS-VIH project]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2024; 37:149-157. [PMID: 38240196 PMCID: PMC10945106 DOI: 10.37201/req/105.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/29/2023] [Accepted: 12/19/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To compare quality of life, in patients living with HIV infection with pharmaceutical care according to the CMO methodology: capacity, motivation and opportunity versus conventional follow-up. METHODS Longitudinal, prospective, multicenter, health intervention study, conducted between October 2019 and November 2021 in 14 centers throughout Spain. Patients over 18 years of age, receiving antiretroviral treatment and attending the consultations of the participating Pharmacy Services for 1 year were included. Patients who did not have the autonomy to complete the planned questionnaires were excluded. At baseline, participating centers were randomized to continue using the same systematics of work (traditional follow-up) or to implement the CMO model using patient stratification models, goal setting in relation to pharmacotherapy, use of motivational interviewing, as well as longitudinal follow-up enabled by new technologies. The main variable was the difference in the number of dimensions positively affected in each follow-up arm at 24 weeks of follow-up according to the MOS-HIV questionnaire. In the CMO group, the interventions performed the most frequently were recorded. RESULTS 151 patients were included. The median age was 51.35 years. A significant improvement in quality of life was found at the end of follow-up in the CMO group, reducing the number of patients with negatively affected dimensions (2/11 vs 8/11). The most frequent interventions carried out in the CMO group, according to the taxonomy, were Motivation (51,7%) and review and validation (49,4%). CONCLUSIONS The quality of life of patients is higher in those centers that develop Pharmaceutical Care based on the CMO methodology compared to traditional follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - A Lázaro López
- Alicia Lázaro López. FEA Farmacia Hospitalaria. Hospital Universitario de Guadalajara. C/ Donante de Sangre s/n CP: 19002.Spain.
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Morillo-Verdugo R, Parra-Zuñiga S, Alvarez de Sotomayor-Paz M, Contreras-Macias E, Almeida-González CV, Robustillo-Cortes MDLA. Concordance between two models of stratification for patients living with HIV infection to providing pharmaceutical care. FARMACIA HOSPITALARIA 2024:S1130-6343(24)00020-5. [PMID: 38448361 DOI: 10.1016/j.farma.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE To determine the degree of agreement of 2 differents stratification models for pharmaceutical care to people living with HIV. METHODS This was a single-center observational prospective cohort study of patients with regular follow-up in pharmaceutical care consultations according to the Capacity-Motivation-Opportunity methodology, conducted between January 1 and March 31, 2023. Patients received the pharmacotherapeutic interventions applied routinely to ambulatory care patients according to this model. As part of the usual clinical practice, the presence or absence of the variables that apply to both stratification models were collected. The scores obtained and the corresponding stratification level were collected for each patient according to both stratification models published (ST-2017 and ST-2022). To analyze the reliability between the measurements of 2 numerical score models of the stratification level with both tools, their degree of concordance was calculated using the intraclass correlation coefficient. Likewise, reliability was also evaluated from a qualitative perspective by means of Cohen's Kappa coefficient. Additionally, the existence of correlation between the scores of the 2 models was assessed by calculating Pearson's correlation coefficient. RESULTS Of the total of 758 patients being followed in the cohort, finally, 233 patients were enrolled. The distribution of patients for each stratification model was: ST-2017: 59.7% level-3, 25.3% level-2, and 15.0% level-1, while for ST-2022: 60.9% level-3, 26.6% level-2, and 12.4% level-1. It was observed that the reclassification was symmetrical (P=.317). The qualitative analysis of the agreement between the models showed a good Cohen's kappa value, (K=0.66). A value of 0.563 was found as the intraclass correlation coefficient. Finally, the correlation analysis between the quantitative scores of the 2 models yielded a Pearson correlation coefficient of 0.86. CONCLUSIONS The concordance between the 2 models was good, which confirms that the multidimensional adaptation and simplification of the model were correct and that its use can be extended in routine clinical practice.
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Affiliation(s)
| | - Sebastián Parra-Zuñiga
- Departamento de Farmacología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
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Martin Conde MT, Monte Boquet E, Navarro Aznares H, Robustillo Cortes MDLA, Rodríguez González C, Serrano López de Las Hazas JI, Morillo-Verdugo R. 2022 update of the indicators for quality of care and pharmaceutical care for people living with human immunodeficiency virus. FARMACIA HOSPITALARIA 2023; 47:113-120. [PMID: 37029055 DOI: 10.1016/j.farma.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 04/09/2023] Open
Abstract
OBJECTIVE To update and define indicators for improving the quality of care and pharmaceutical care for people living with HIV infection in Spain. METHOD The present project, which updates the previous version of the 2013 document, was developed in four work phases carried out between January and June 2022. In phase 1, the organization phase, a working group was created, made up of seven hospital pharmacy specialists with extensive experience in pharmaceutical care and from different SFHs in Spain. In addition, another 34 specialists participated in the evaluation of the indicators through two rounds of online evaluation to generate consensus. For phase 2, initially, a review of the identified reference literature was carried out with the aim of establishing a basis from which to define a proposal for quality criteria and indicators. Then, a preliminary proposal of criteria was made and revisions were established for their adjustment in several telematic work meetings. In phase 3, consensus was established based on the Delphi-Rand/UCLA consensus methodology. In addition, all the indicators classified as appropriate and necessary were grouped according to two levels of monitoring recommendation, so as to guide the hospital pharmacy services in the priority of their measurement: key and advanced. Finally, in phase 4, the final project document was prepared, along with the corresponding descriptive sheets for each indicator in order to facilitate the measurement and evaluation of the indicators by the hospital pharmacy services. RESULTS Following the consensus methodology used, a list of items made up of 79 appropriate and necessary indicators was drawn up to establish a follow-up and monitoring of the quality and activity of pharmaceutical care for people living with HIV. Of these, 60 were established as key and 19 advanced. CONCLUSIONS The indicators defined and updated, since the previous version of 2013, are intended to be a tool for professionals to guide decision-making and facilitate the measurement and assessment of the most relevant aspects of the quality and pharmaceutical care of people living with HIV.
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Affiliation(s)
| | | | | | | | | | | | - Ramón Morillo-Verdugo
- Hospital Universitario de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España
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Martin Conde MT, Monte Boquet E, Navarro Aznares H, Robustillo Cortes MDLA, Rodríguez González C, Serrano López de Las Hazas JI, Morillo-Verdugo R. [Translated article] 2022 update of the indicators for quality of care and pharmaceutical care for people living with human immunodeficiency virus. FARMACIA HOSPITALARIA 2023; 47:T113-T120. [PMID: 37236838 DOI: 10.1016/j.farma.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To update and define indicators for improving the quality of care and Pharmaceutical Care for people living with HIV infection in Spain. METHOD The present project, which updates the previous version of the 2013 document, was developed in four work phases carried out between January and June 2022. In phase 1, the organization phase, a working group was created, made up of seven hospital pharmacy specialists with extensive experience in pharmaceutical care and from different SFHs in Spain. In addition, another 34 specialists participated in the evaluation of the indicators through two rounds of online evaluation to generate consensus. For phase 2, initially, a review of the identified reference literature was carried out with the aim of establishing a basis from which to define a proposal for quality criteria and indicators. Then, a preliminary proposal of criteria was made and revisions were established for their adjustment in several telematic work meetings. In phase 3, consensus was established based on the Delphi-Rand/UCLA consensus methodology. In addition, all the indicators classified as appropriate and necessary were grouped according to two levels of monitoring recommendation, so as to guide the hospital pharmacy services in the priority of their measurement: key and advanced. Finally, in phase 4, the final project document was prepared, along with the corresponding descriptive sheets for each indicator in order to facilitate the measurement and evaluation of the indicators by the hospital pharmacy services. RESULTS Following the consensus methodology used, a list of items made up of 79 appropriate and necessary indicators was drawn up to establish a follow-up and monitoring of the quality and activity of Pharmaceutical Care for people living with HIV. Of these, 60 were established as key and 19 advanced. CONCLUSIONS The indicators defined and updated, since the previous version of 2013, are intended to be a tool for professionals to guide decision-making and facilitate the measurement and assessment of the most relevant aspects of the quality and pharmaceutical care of people living with HIV.
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Affiliation(s)
| | - Emilio Monte Boquet
- Jefe de Sección Farmacia Hospitalaria, Servicio Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - Herminia Navarro Aznares
- Jefe de Sección Farmacia Hospitalaria, Servicio Farmacia, Hospital Miguel Servet, Zaragoza, Spain
| | | | | | | | - Ramón Morillo-Verdugo
- FEA Farmacia Hospitalaria, Hospital Universitario de Valme, AGS Sur de Sevilla, Spain.
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Morillo-Verdugo R, Morillo-Lisa R, Espolita-Suarez J, Delgado-Sanchez O. Evaluation of Patient Experience With A Model of Coordinated Telematic Pharmaceutical Care Between Hospital and Rural Pharmacies in Spain: A Proof of Concept. J Multidiscip Healthc 2023; 16:1037-1046. [PMID: 37082105 PMCID: PMC10112476 DOI: 10.2147/jmdh.s406636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
Purpose To determine the usefulness of a coordinated pharmaceutical care model between the specialized hospital setting and the rural community care setting, based on the incorporation of telepharmacy based on Capacity-Motivation-Opportunity (CMO) methodology to improve patient experience with hospital medication prescriptions. Patients and Methods Prospective cohort study in outpatients receiving telepharmacy based on CMO-based pharmaceutical care in rural areas in Spain between January and November 2021, conducted by the pharmacy department of four hospitals and 29 rural communities' pharmacy. Each patient was followed for 48 weeks on both face-to-face and telematic visits, scheduled and unscheduled at the patients' request. Patient experience (IEXPAC questionnaire), and satisfaction (EVASAF) were determined. Secondary variables included pharmaceutical care interventions, care coordination and clinical variables (compliance with pharmacotherapeutic objectives according to the clinical conditions of each patient), additionally measurement of individual holistic results (EQ5D-5L score) was evaluated. Results A new telepharmacy tool (called Telemaco) was developed for a multidisciplinary healthcare team (available at: https://inteligeniapps.com/telemaco/) that includes seven different functionalities. We evaluated the first 20 patients (50% women) were included. Their median age was 66.0 years (IQR=14). A total of 215 visits were made (adding 150 video calls). A total of 64 visits were unscheduled (29.7%). The patient´s experience showed improvement (7.4 vs 9.5, p<0.005). The results of the EVASAF questionnaire were also higher (44 vs 48, p<0.001). Overall, 573 pharmaceutical interventions were performed. A difference was observed in patients who achieved the intended pharmacotherapeutic objectives: 48.5 vs 88.2 (p< 0.001). The mean EQ-5D-5L score was 74.7 ± 3.3 at baseline and 80.6 ± 3.6 points at the end (p>0.05). Conclusion Telepharmacy based on the CMO-PC model, using the "Telemaco" tool, has improved the patient experience, satisfaction, and offered other advantages over the traditional model, including more pharmaceutical interventions adapted to the needs of each patient.
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Affiliation(s)
- Ramón Morillo-Verdugo
- Pharmacy Hospital Service, Hospital Valme, Área de Gestión Sanitaria Sur de Sevilla, Sociedad Española de Farmacia Hospitalaria, Sevilla, Spain
- Correspondence: Ramón Morillo-Verdugo, Pharmacy Hospital Service, Hospital Valme, Área de Gestión Sanitaria Sur de Sevilla, Sociedad Española de Farmacia Hospitalaria, Avda/Bellavista s/n, Sevilla, CP 41014, Spain, Tel +34 955015467, Email
| | - Rosa Morillo-Lisa
- Rural Community Pharmacy, Sociedad Española de Farmacia Rural, Zaragoza, Spain
| | | | - Olga Delgado-Sanchez
- Pharmacy Hospital Service, Hospital Son Spases, Sociedad Española de Farmacia Hospitalaria, Palma de Mallorca, Spain
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Morillo-Verdugo R, Lazaro-Lopez A, Alonso-Grandes E, Martin-Conde MT, Diaz-Ruiz P, Molina-Cuadrado E, Huertas-Fernandez MJ, Navarro-Aznares H, Areas Del Aguila V, Gimeno-Gracia M, Margusino-Framiñán L, Martínez-Sesmero JM. Patient Experience Evaluation of the CMO-Based Pharmaceutical Care Model vs Usual Care in People Living with HIV. J Multidiscip Healthc 2022; 15:2991-3003. [PMID: 36601427 PMCID: PMC9807066 DOI: 10.2147/jmdh.s392398] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/05/2022] [Indexed: 12/29/2022] Open
Abstract
Objective To compare patient experience in a real-life population of people living with HIV (PLWH) who received pharmaceutical care (PC) based on the Capacity-Motivation-Opportunity (CMO) model versus the traditional model. Methods Prospective cohort study in PLWH receiving either CMO-based PC or traditional PC in Spain between October 2019 and June 2021 (24 weeks), performed by the pharmacy department of 14 Spanish hospitals. Participants were adult patients with a clinical diagnosis of HIV treated with antiretrovirals who had been monitored in the participating hospital pharmacies for >1 year. Patient experience (IEXPAC questionnaire), clinical outcomes (cholesterol, triglycerides, HDL, glycated haemoglobin, and blood pressure), adherence to treatment, virologic control and patient satisfaction were determined. Results Patient experience in the CMO group at week 24 was significantly better (7.6 vs 6.9) than in the traditional group, with a higher mean improvement. Adherence was better in the CMO group, particularly with regard to concomitant medications (53.2% to 91.7%, p<0.001); no changes were observed in the traditional group. Patient satisfaction improved in the CMO group vs the traditional group (48 vs 44, p<0.001). Conclusion To our knowledge, this is the first study to compare CMO vs traditional methodology. The CMO model showed an overall improvement in real-life patient experience, satisfaction, and adherence to treatment compared to the traditional methodology.
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Affiliation(s)
- Ramón Morillo-Verdugo
- Pharmacy Hospital Service, Hospital Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
| | - Alicia Lazaro-Lopez
- Pharmacy Hospital Service, Hospital Universitario de Guadalajara, Guadalajara, Spain,Correspondence: Alicia Lazaro-Lopez, Hospital Universitario de Guadalajara, C/Donante de Sangre s/n CP: 19002 (Castilla-La Mancha, Spain), Guadalajara, Spain, Tel +34 626915820, Email
| | | | | | - Pilar Diaz-Ruiz
- Pharmacy Hospital Service, Hospital Virgen de la Candelaria, Tenerife, Spain
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