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Contreras Macías E, Espina Lozano JM, Cantudo-Cuenca MD, Robustillo-Cortés MDLA, Gabella-Bazarot E, Morillo-Verdugo R. Comparative analysis of the prevalence 3-HIT concept in people living with HIV and seronegative patients with chronic conditions. Cross-3HIT Project. Eur J Hosp Pharm 2024:ejhpharm-2023-004023. [PMID: 38697803 DOI: 10.1136/ejhpharm-2023-004023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/16/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES This study aimed to assess and compare the occurrence of 3-HIT in people living with HIV (PLWH) and seronegative patients. Additionally, the study investigated whether HIV infection could serve as a predictor of the presence of 3-HIT. METHODS A cross-sectional study was conducted between December 2022 and January 2023 to compare PLWH with a group of seronegative patients with chronic diseases attending an outpatient hospital pharmacy service. The 3-HIT concept encompasses the simultaneous presence of non-adherence to concomitant treatment (NAC), drug-drug interactions (DDIs), and high pharmacotherapeutic complexity in polymedicated patients. The assessment of 3-HIT compliance included NAC, evaluated using both the Morisky-Green questionnaire and electronic pharmacy dispensing records. DDIs were analysed using the Liverpool University and Micromedex databases. Pharmacotherapeutic complexity was measured using the Medication Regimen Complexity Index (MRCI) tool. Logistic regression analysis was performed to identify independent factors related to 3-HIT. Additionally, an explanatory logistic model was created to investigate whether HIV infection, along with other adjustment variables, could predict compliance with the 3-HIT concept. RESULTS The study included 145 patients: 75 PLWH and 70 seronegative patients. The median age was 40 versus 39 years, respectively (p=0.22). Seronegative patients exhibited a higher prevalence of NAC (p<0.01). HIV infection was identified as a protective factor in the context of DDIs (p<0.01). Male sex (p<0.01) and age (p=0.01) were identified as being associated with an MRCI ≥11.25 points. A higher prevalence of 3-HIT was observed in seronegative patients (18.7% vs 48.6%, p<0.01). However, the developed regression model identified HIV infection as a risk factor associated with an increased likelihood of 3-HIT (OR 4.00, 95% CI 1.88 to 8.52, p<0.01). CONCLUSIONS The 3-HIT concept exhibited a high prevalence among seronegative patients with chronic diseases, with HIV infection identified as a predicted risk factor for NAC and the development of 3-HIT.
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Contreras-Macías E, Gutiérrez-Pizarraya A, Pineda-Vergara JA, Morillo-Verdugo R. Analysis of antiretroviral therapy interruption in people living with HIV during the 2010-2021 Period. Farm Hosp 2024; 48:T101-T107. [PMID: 38582664 DOI: 10.1016/j.farma.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 04/08/2024] Open
Abstract
OBJECTIVE In the context of the advancement of antiretroviral therapy and, as the characteristics of people living with HIV progress toward an aging population, understanding the causes of treatment interruption becomes crucial. The aim of the study was to determine the change in reasons for antiretroviral treatment discontinuation for 12 years. Secondarily, compare annual antiretroviral regimen discontinuation rate and factors associated. METHODS We conducted an analysis using data from people living with HIV who were receiving antiretroviral therapy and discontinued it for any reason. The study included people with HIV infection who visited an outpatient hospital pharmacy clinic from January 2010 to December 2021. Two periods were differentiated for the analysis: 2010-2015 and 2016-2021. The reasons for antiretroviral treatment discontinuation followed classification described by Swiss cohort. In the context of this study, it is pertinent to note that the term 'interruption' will be consistently used in this article to refer to the act of switching or stopping antiretroviral treatment. To examine factors associated with antiretroviral therapy discontinuation, we utilized Kaplan-Meier methods and Cox proportional models. RESULTS We included 789 people living with HIV, predominantly male (81,5%). The main reason for discontinuation was clinical decision (50.2%) followed by adverse effects (37.9%). Focusing on clinical decision, we observed a trend change that went from antiretroviral treatment simplification regimen (56.1%) in the first part of the period analyzed to the therapeutic optimization (53.6%) in the second half. Furthermore, factors that were statistically significantly associated with antiretroviral treatment discontinuation were people with HIV ≥50 years (HR 1.60; 95%CI 1.25-2.04), post-discontinuation single-tablet regimen (HR 1.49; 95%CI 1.06-2.11) and antiretroviral drug classes. CONCLUSIONS Over the 12 years there has been a change in the main cause of antiretroviral treatment discontinuation, currently therapeutic optimization being the main reason. Integrase inhibitors-based regimens and singletablet regimen strategies were less likely to be discontinued than others antiretroviral drug classes, allowing for better clinical management due to the efficacy profile, especially in people living with HIV ≥50 years with comorbidities.
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Morillo-Verdugo R, Lizeaga-Cundin G. [Translated article] Precision pharmaceutical care in oncohematology. Farm Hosp 2024; 48:T91-T92. [PMID: 38705827 DOI: 10.1016/j.farma.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 05/07/2024] Open
Affiliation(s)
- Ramón Morillo-Verdugo
- Servicio de Farmacia, Hospital de Valme, Coordinador del proyecto Mapa Estratégico de Atención al paciente externo de la Sociedad Española de Farmacia Hospitalaria (MAPEX-SEFH), Madrid, Spain.
| | - Garbiñe Lizeaga-Cundin
- Servicio de Farmacia, Hospital Universitario Donostia, San Sebastián, Coordinadora Grupo GEDEFO-SEFH, Madrid, Spain
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Contreras-Macías E, Gutiérrez-Pizarraya A, Pineda-Vergara JA, Morillo-Verdugo R. Analysis of antiretroviral therapy interruption in people living with HIV during the 2010-2021 period. Farm Hosp 2024; 48:101-107. [PMID: 38336553 DOI: 10.1016/j.farma.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION In the context of the advancement of antiretroviral therapy and as the characteristics of people living with HIV progress toward an ageing population, understanding the causes of treatment interruption becomes crucial. The aim of the study was to determine the change in reasons for antiretroviral treatment discontinuation for 12 years. Secondarily, compare annual antiretroviral regimen discontinuation rate and factors associated. METHODS We conducted an analysis using data from people living with HIV who were receiving antiretroviral therapy and discontinued it for any reason. The study included people with HIV infection who visited an outpatient hospital pharmacy clinic from January 2010 to December 2021. Two periods were differentiated for the analysis: 2010-2015 and 2016-2021. The reasons for antiretroviral treatment discontinuation followed classification described by Swiss cohort. In the context of this study, it is pertinent to note that the term "discontinuation" is employed synonymously with "interruption". The term "discontinuation" will be consistently used in this article to refer to the act of switching or stopping antiretroviral treatment. To examine factors associated with antiretroviral therapy discontinuation, we utilised Kaplan-Meier methods and Cox proportional models. RESULTS We included 789 people living with HIV, predominantly male (81.5%). The main reason for discontinuation was clinical decision (50.2%) followed by adverse effects (37.9%). Focusing on clinical decision, we observed a trend change that went from antiretroviral treatment simplification regimen (56.1%) in the first part of the period analysed to the therapeutic optimisation (53.6%) in the second half. Furthermore, factors that were statistically significantly associated with antiretroviral treatment discontinuation were people with HIV≥50 years (HR 1.60; 95%CI 1.25-2.04), post-discontinuation single-tablet regimen (HR 1.49; 95%CI 1.06-2.11) and antiretroviral drug classes. CONCLUSION Over the 12 years, there has been a change in the main cause of antiretroviral treatment discontinuation, currently therapeutic optimisation being the main reason. Integrase inhibitors-based regimens and single-tablet regimen strategies were less likely to be discontinued than others antiretroviral drug classes, allowing for better clinical management due to the efficacy profile, especially in people living with HIV≥50 years with comorbidities.
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Morillo-Verdugo R, Lizeaga-Cundin G. Precision pharmaceutical care in oncohematology. Farm Hosp 2024; 48:91-92. [PMID: 38658254 DOI: 10.1016/j.farma.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Ramón Morillo-Verdugo
- Servicio de Farmacia, Hospital de Valme, Proyecto Mapa Estratégico de Atención al Paciente Externo de la Sociedad Española de Farmacia Hospitalaria (MAPEX-SEFH), Sevilla, España.
| | - Garbiñe Lizeaga-Cundin
- Servicio de Farmacia, Hospital Universitario Donostia, San Sebastián, Grupo Español para el Desarrollo de la Farmacia Oncológica, Sociedad Española de Farmacia Hospitalaria, (GEDEFO-SEFH), Sevilla, España
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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. Farm Hosp 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Vicente-Escrig E, Bonastre PT, Barrueta OI, Izquierdo MM, Fernández-Llamazares CM, Morillo-Verdugo R. [Translated article] Analysis 2016-2021 of the development of the MAPEX outpatient pharmaceutical care Project by Regions in Spain. Farm Hosp 2024; 48:T64-T69. [PMID: 38151407 DOI: 10.1016/j.farma.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVE To analyse the evolution of the MAPEX Project (Strategic Map of Pharmaceutical Care for Outpatients) by regions in Spain, through the results of the comparative situation survey between 2016 and 2021. METHODS A committee of national experts belonging to the Spanish Society of Hospital Pharmacy prepared the MAPEX Survey on the situation of Outpatient Units, which consisted of 43 specific questions on aspects related to structure, context, integration, processes, results and training, teaching, and investigation. It was carried out in 2 periods, one in 2016 and another in 2021 (with 3 additional questions in 2021, related to the progress of the MAPEX initiative and the priority lines to follow). A comparative analysis of results was carried out at the national level and by regions in Spain. RESULTS 141 hospitals participated in 2016 and 138 in 2021, with representation from the 17 autonomous communities. The analysis of the results shows significant improvements in all the dimensions of the survey, with variability between the different regions. Among the most important improvements, the development and consolidation of telepharmacy stood out, the greater specialisation of pharmacists by areas of knowledge and their integration into multidisciplinary teams. The improvement of the healthcare model was considered the greatest advance at a general level (65%), and remote pharmaceutical care at the hospital level (48.2%). Priority lines of work were considered the expansion and practical application of the pharmaceutical care methodology (66.4%), research (58.4%), and training in all MAPEX initiatives (53.3%). CONCLUSIONS The implementation and development of the MAPEX initiatives has had a positive impact on the evolution in all healthcare areas of pharmaceutical care for outpatients. The situation survey makes it possible to identify by regions the significant points for improvement, as well as those areas to be developed through strengthening and corrective actions. The expansion of the project in the coming years will mean progress toward excellence in care and in the improvement of health results.
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Affiliation(s)
| | | | - Olatz Ibarra Barrueta
- Servicio de Farmacia, Hospital Universitario Galdakao-Usansolo, Osi Barrualde Galdakao, Spain
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Vicente-Escrig E, Taberner Bonastre P, Ibarra Barrueta O, Murillo Izquierdo M, Fernández-Llamazares CM, Morillo-Verdugo R. Analysis 2016-2021 of the development of the MAPEX outpatient pharmaceutical care Project by regions in Spain. Farm Hosp 2024; 48:64-69. [PMID: 37749003 DOI: 10.1016/j.farma.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Analyse the evolution of the MAPEX Project (Strategic Map of Pharmaceutical Care for Outpatients) by regions in Spain, through the results of the comparative situation survey between the years 2016 and 2021. METHODS A committee of national experts belonging to the Spanish Society of Hospital Pharmacy prepared the MAPEX Survey on the situation of Outpatient Units, which consisted of 43 specific questions on aspects related to structure, context, integration, processes, results and training, teaching and investigation. It was carried out in two periods, one in 2016 and another in 2021 (with 3 additional questions in 2021, related to the progress of the MAPEX initiative and the priority lines to follow). A comparative analysis of results was carried out at the national level and by regions in Spain. RESULTS 141 hospitals participated in 2016 and 138 in 2021, with representation from the 17 autonomous communities. The analysis of the results shows significant improvements in all the dimensions of the survey, with variability between the different regions. Among the most important improvements, the development and consolidation of telepharmacy stood out, the greater specialization of pharmacists by areas of knowledge and their integration into multidisciplinary teams. The improvement of the healthcare model was considered the greatest advance at a general level (65%), and remote pharmaceutical care at the hospital level (48.2%). Priority lines of work were considered the expansion and practical application of the pharmaceutical care methodology (66.4%), research (58.4%), and training in all MAPEX initiatives (53.3%). CONCLUSIONS The implementation and development of the MAPEX initiatives has had a positive impact on the evolution in all healthcare areas of pharmaceutical care for outpatients. The situation survey makes it possible to identify by regions the significant points for improvement, as well as those areas to be developed through strengthening and corrective actions. The expansion of the project in the coming years will mean progress towards excellence in care and in the improvement of health results.
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Affiliation(s)
| | | | - Olatz Ibarra Barrueta
- Servicio de Farmacia, Hospital Universitario Galdakao-Usansolo, Osi Barrualde Galdakao, España
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Sánchez-Yáñez E, Huertas-Fernández MJ, Robustillo-Cortes MA, Ramos-Guerrero R, Fernández-Espínola S, Diaz-Acedo R, Montero-Martin V, Morillo-Verdugo R. Application of CMO (capacity, motivation, and opportunity) methodology in pharmaceutical care to optimize the pharmacotherapy in older people living with HIV. DISPIMDINAC project. Rev Esp Quimioter 2023; 36:584-591. [PMID: 37724451 DOI: 10.37201/req/021.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To determine the effectiveness of a pharmaceutical intervention, based on the CMO methodology (capacity, motivation and opportunity), to decrease the prevalence of the PIMDINAC concept (potentially inappropriate medication+drug interactions+non-adherence to concomitant medication) in people living with HIV infection. METHODS Longitudinal prospective multicenter study, conducted between October 2021 and October 2022. Patients living with HIV older than 65 years, on antiretroviral treatment and concomitant drug prescription were included. Demographic, clinical, and pharmacotherapeutic variables were collected. Pharmaceutical care was provided for6 months according to the CMO model in each patient. The main variable was the percentage of patients who simultaneously fulfilled the PIMDINAC concept, comparing the baseline value with the same value at the end of the study. In addition, the percentage of patient's adherent to concomitant and antiretroviral treatment and the percentage of patients meeting the pharmacotherapeutic targets established for the prescribed medicationat 24 weeks of follow-up were compared. RESULTS Sixty-eight patients were included. Seventy-two percent were men, with a median age of 68 years. The median number of concomitant drugs was 7. A 60.6% of the patients had polypharmacy. The prevalence of the presence of the PIMDINAC concept decreased significantly (10.3 vs. 0%). In isolation, each of the aspects also decreased significantly (p<0.031). The percentage of patients who met the objectives improved significantly from 48,5 at baseline to 88.2 (p<0.001). CONCLUSIONS The pharmaceutical intervention based onarmaceutical intervention based on the CMO methodology significantly decreased the prevalence of the PIMDINAC concept and increased the number of patients who achieved the objectives, optimising their pharmacotherapy.
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Affiliation(s)
| | | | - M A Robustillo-Cortes
- María de las Aguas Robustillo Cortes. Valme University Hospital (Pharmacy Department). Av/ Bellavista s/n, Seville, 41014, Spain.
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De la Torre-Lima J, Oteo JA, Pinilla J, Mansilla R, Zamora C, Ayala Vargas V, Morillo-Verdugo R, Moreno S, Fuster-Ruiz de Apodaca MJ, Pérez-Molina JA, Colom J. Study on the approach to HIV: health management and the healthcare process in Spain. Enferm Infecc Microbiol Clin (Engl Ed) 2023; 41:604-611. [PMID: 36624033 DOI: 10.1016/j.eimce.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION HIV continues to represent a problem of great relevance for public health in Spain. This study aims to carry out an analysis that will provide in-depth knowledge of the resources, clinical care, and management during the diagnosis, follow-up, and treatment phases of HIV infection in Spain. METHODS In the first phase, a multidisciplinary Scientific Committee designed an information collection tool in the form of a survey. In the second phase, carried out in the autonomous communities of Andalusia, Catalonia, and La Rioja, a multidisciplinary group of 42 experts, representatives of the public administration, clinical profiles, and representatives of NGOs in the field of HIV answered the survey. RESULTS The assessment of HIV resources is generally positive. As regards diagnosis, the experts considered that there was good coordination between Primary and Hospital care. Regarding treatment, the evaluations reflected good opinions on therapeutic conciliation and adherence, with a negative opinion in the evaluation of drug interactions with antiretroviral treatment. Regarding follow-up, the perception expressed was disparate concerning the coordination between Hospital and Primary Care as well as the adaptation of care to chronicity, aging, fragility, mental health, and oncological processes. CONCLUSION There are certain processes that can be improved in the management of HIV infection in people with HIV in Spain, including protocols for follow-up and coordination between primary and hospital care in the treatment and follow-up of the disease.
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Affiliation(s)
- Javier De la Torre-Lima
- Plan Andaluz frente al VIH/sida y otras ITS, Consejería de Salud y Consumo de la Junta de Andalucía, Spain; Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Málaga, Spain.
| | - José Antonio Oteo
- Centro de Rickettsiosis y Enfermedades Transmitidas por Artrópodos Vectores, Departamento de Enfermedades Infecciosas, Hospital Universitario San Pedro-Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Javier Pinilla
- Servicio de Medicina Interna, Complejo Hospitalario San Millán-San Pedro, Logroño, Spain; Comisión Ciudadana Anti-Sida de La Rioja (CCASLR), Logroño, La Rioja, Spain
| | - Rosa Mansilla
- Vigilancia, Prevención y Control de las Infecciones de Transmisión Sexual y el VIH, Subdirección General de Vigilancia y Respuesta a Emergencias de Salud Pública, Agencia de Salud Pública de Cataluña, Departamento de Salud, Generalidad de Cataluña, Barcelona, Spain
| | - Carmen Zamora
- Plan Andaluz frente al VIH y otras ITS, Consejería de Salud y Consumo de la Junta de Andalucía, Spain
| | | | - Ramón Morillo-Verdugo
- Servicio de Farmacia, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - María José Fuster-Ruiz de Apodaca
- Departamento de Psicología Social y de las Organizaciones, UNED, Madrid, Spain; Sociedad Española Interdisciplinaria del Sida (SEISIDA), Madrid, Spain
| | - José A Pérez-Molina
- CSUR de Enfermedades Tropicales, Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Joan Colom
- Programa de Prevención, Control y Atención al VIH, las ETS y las Hepatitis Víricas de la Agencia de Salud Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
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Morillo-Verdugo R, Margusino Framiñan L. [Translated article] Pharmaceutical care without borders. Farm Hosp 2023; 47:T181-T182. [PMID: 37689585 DOI: 10.1016/j.farma.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 09/11/2023] Open
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Morillo-Verdugo R, Margusino Framiñan L. Pharmaceutical care without borders. Farm Hosp 2023; 47:181-182. [PMID: 37689584 DOI: 10.1016/j.farma.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 09/18/2023] Open
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Lao-Domínguez FÁ, Robustillo-Cortés MDLA, Morillo-Verdugo R. Drug burden index in people living with HIV over 50 years of age in a real clinical practice cohort. Enferm Infecc Microbiol Clin (Engl Ed) 2023:S2529-993X(23)00189-2. [PMID: 37394403 DOI: 10.1016/j.eimce.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/30/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES To determine DBI and its relationship with polypharmacy and pharmacotherapeutic complexity (PC) in a cohort of PLWH over 50 years of age at follow-up of pharmacotherapy in a tertiary hospital. METHODS Observational and retrospective study that included PLWH in active antiretroviral treatment over 50 years of age who have been followed up in outpatient pharmacy services. Pharmacotherapeutic complexity was estimated through Medication Regimen Complexity Index (MRCI). Collected variables included comorbidities, current prescriptions and its classification according to anticholinergic and sedative activity and associated risk of falls. RESULTS Studied population included 251 patients (85.7% men; median age: 58 years, interquartile range: 54-61). There was a high prevalence of high DBI scores (49.2%). High DBI was significantly correlated with a high PC, polypharmacy, psychiatric comorbidity and substances abuse (p<0.05). Among sedative drugs, the most prescribed were anxiolytic drugs (N05B) (n=85), antidepressant drugs (N06A) (n=41) and antiepileptic drugs (N03A) (n=29). For anticholinergic drugs, alpha-adrenergic antagonist drugs (G04C) were the most prescribed (n=18). Most frequent drugs associated with risk of falls were anxiolytics (N05B) (n=85), angiotensin-converting enzyme inhibitors (C09A) (n=61) and antidepressants (N06A) (n=41). CONCLUSION The DBI score in older PLWH is high and it is related to PC, polypharmacy, mental diseases and substance abuse as is the prevalence of fall-related drugs. Control of these parameters as well as the reduction of the sedative and anticholinergic load should be included in the lines of work in the pharmaceutical care of people living with HIV+.
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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. Enferm Infecc Microbiol Clin (Engl Ed) 2023:S2529-993X(23)00186-7. [PMID: 37394400 DOI: 10.1016/j.eimce.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Contreras-Macías E, Gutiérrez-Pizarraya A, Morillo-Verdugo R. Influence of polypharmacy in the simultaneous presence of high pharmacotherapeutic complexity, drug interactions and non-adherence to medication in patients with HIV infection. Project 3-HIT. Enferm Infecc Microbiol Clin (Engl Ed) 2023; 41:342-347. [PMID: 36175284 DOI: 10.1016/j.eimce.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The high pharmacotherapeutic complexity, drug interactions and lack of adherence to concomitant medication are circumstances with negative consequences in the clinical evolution of patients with HIV infection. The 3-HIT phenomenon refers to the simultaneous occurrence of these situations. The objective of the study is to determine the prevalence of the phenomenon 3-HIT in the polymedicated HIV population as well as to determine factors related to its occurrence. METHODS Observational, retrospective and single-center study that included all elderly patients on active antiretroviral treatment in pharmacotherapeutic follow-up between January and March 2020. A logistic regression model was carried out to evaluate the factors associated with the occurrence of the 3-HIT concept with the variables significantly associated with this phenomenon and those considered clinically relevant. RESULTS 428 patients were included, registering a prevalence of polypharmacy in 25.9% of the study sample. The 3-HIT phenomenon was detected in 6.3% of the patients. For each concomitant drug prescribed the risk of developing the phenomenon 3-HIT increases 1.5 times. CONCLUSION Prevalence of the phenomenon 3-HIT is high in HIV patients with polymedication. A change in the pharmaceutical care model to a multidimensional setting is essential, together with pharmacotherapeutic optimization strategies to improve patient health outcomes.
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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 [Response To Letter]. J Multidiscip Healthc 2023; 16:1473-1474. [PMID: 37261275 PMCID: PMC10228583 DOI: 10.2147/jmdh.s418682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Ramón Morillo-Verdugo
- Pharmacy Hospital Service, Hospital Valme, Área de Gestión Sanitaria Sur de Sevilla, Sociedad Española de Farmacia Hospitalaria, Sevilla, Spain
| | - Rosa Morillo-Lisa
- Rural Community Pharmacy, Sociedad Española de Farmacia Rural, Alcalá de Ebro, Zaragoza, Spain
| | | | - Olga Delgado-Sanchez
- Pharmacy Hospital Service, Hospital Son Spases, Sociedad Española de Farmacia Hospitalaria, Palma de Mallorca, 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. Farm Hosp 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] [What about the content of this article? (0)] [Affiliation(s)] [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. Farm Hosp 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] [What about the content of this article? (0)] [Affiliation(s)] [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, Aguilar Pérez T, Gimeno-Gracia M, Rodríguez-González C, Robustillo-Cortes MDLA. Simplification and Multidimensional Adaptation of the Stratification Tool for Pharmaceutical Care in People Living With HIV. Ann Pharmacother 2023; 57:163-174. [PMID: 35707861 DOI: 10.1177/10600280221096759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND People living with human immunodeficiency virus (HIV) require specific pharmaceutical care (PC). Although the 2017 Capacity-Motivation-Opportunity (CMO) PC model allows a multidisciplinary approach that focuses on patient needs, it is too complex and presents room for improvement. OBJECTIVE The aim of this study is to simplify and adapt the previous 2017 PC tool through a multidimensional approach to improve HIV patient care, to prove the validity of the model in real-life patients. METHODS The new PC tool was generated by keeping some of the variables of the 2017 document and conducting a literature search. Content validity was determined by a 2-round Delphi methodology with an expert panel of 42 pharmacists. Consensus for the first and second rounds was defined as ≥70% agreement. The tool generated was validated in 407 real-life patients. RESULTS Thirty-seven experts completed the first round of the Delphi survey and 36 the second. No consensus was reached for 3 variables, any of the frequency options and 4 interventions, while the experts agreed not to include 1 intervention in round 1. Consensus to include them was found for all but 1 variable and 1 intervention in round 2. The final tool obtained to select and stratify HIV-positive patients was composed of 9 dimensions divided into 17 variables. The new tool was validated with real-life patients and 3 priority levels were defined. CONCLUSIONS AND RELEVANCE We created a new pyramid of score thresholds to classify patients into priority levels. The new tool simplifies the 2017 model and improves its utility to help HIV-positive patients, owing to its multidimensional approach.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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García-Lloret P, Borrego-Izquierdo Y, Manzano-García M, Cantillana-Suárez MG, Gutiérrez-Pizarraya A, Morillo-Verdugo R. Potentially inappropriate medications according to Marc, STOPP and PRISCUS criteria in a cohort of elderly HIV+ patients. The COMMPI project. Rev Esp Quimioter 2023; 36:52-58. [PMID: 36415149 PMCID: PMC9910679 DOI: 10.37201/req/070.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective is to determine the prevalence of potentially inappropriate drugs according to the Marc, STOPP, and PRISCUS lists in elderly HIV patients. METHODS It was an observational, retrospective, and multicenter study. People living with HIV 65 years or older who underwent chronic concomitant treatment were included. Descriptive and multivariate analyzes were performed to study the association between polypharmacy and potentially inappropriate medication compliance. RESULTS A total of 55 patients were included, 81.8% men and a median age of 69 years (IQR: 67-73). The median number of comorbidities was 3 (IQR: 2-5) and the most frequent pattern of multimorbidity was cardiometabolic (62.9%). The predominant antiretroviral treatment was triple therapy (65.5%). Polypharmacy was present in 70.9% of the patients and 25.5% had major polypharmacy. The most frequent polypharmacy pattern was cardiovascular (69.2%). The percentage of potentially inappropriate medications according to the Marc, STOPP and PRISCUS lists was 65.5%, 30.9% and 14.5%, respectively (p<0.001). Adjusted for age and sex, polypharmacy was not independently associated with potentially inappropriate medication compliance in any of the lists. CONCLUSIONS Polypharmacy and potentially inappropriate medications have a high prevalence. There is great variability in the percentage according to the list applied. Age, sex, and presence of polypharmacy are not predisposing factors to the presence of potentially inappropriate medications.
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Affiliation(s)
| | - Yolanda Borrego-Izquierdo
- Pharmacy Department, Gerencia de Atención Primaria. Cantabria (Spain),Correspondence: Yolanda Borrego Izquierdo Pharmacy Department, Gerencia de Atención Primaria. Cantabria (Spain). E-mail:
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Cantudo-Cuenca MD, Gutiérrez-Pizarraya A, García-Lloret P, Gabella-Bazarot E, Morillo-Verdugo R. Prevalence of compliance with PIMDINAC criteria among elderly people living with HIV and in non-infected outpatients with other chronic diseases. Eur J Hosp Pharm 2022:ejhpharm-2022-003454. [PMID: 36585218 DOI: 10.1136/ejhpharm-2022-003454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND There is a high prevalence of multimorbidity and polypharmacy among older people, especially in people living with HIV (PLWH) with an increased life expectancy due to effective antiretroviral therapy (ART). Consequently, there is a higher risk of potentially inappropriate medications (PIM), potential drug-drug interactions (DI), and problems of non-adherence to treatment (NAC) in older PLWH. PIMDINAC criteria (potentially inappropriate medications (PIM), drug-drug interactions (DI), and non-adherence to treatment (NAC)) purport to jointly analyse these problems. The purpose of the study was to compare the prevalence of PIMDINAC criteria among elderly PLWH and non-infected patients with chronic diseases, and to determine whether HIV infection constitutes a predictor of the presence of PIMDINAC criteria, totally or partially. METHODS A cross sectional study was conducted between February and June 2020. HIV positive patients aged ≥65 years were compared with a group of patients with chronic conditions attending the outpatient hospital pharmacy service. RESULTS The study involved 140 patients: 47 HIV positive and 93 HIV negative, and mean age was 69 versus 73 years, respectively (p=0.062). The prevalence of total PIMDINAC criteria was similar between the groups (12.5 vs 10.8%, p=0.505). In relation to inappropriate medication, no differences were observed between groups (48.9 vs 55.9%, p=0434). Drug-drug interactions were higher in patients with chronic conditions (52.7 vs 25.5%, p=0.002) compared with non-adherence, which was higher in people with HIV (22.6 vs 65.6%, p<0.001). No differences in polypharmacy (≥6 and 11 drugs) rates were observed. CONCLUSIONS PIMDINAC criteria were highly prevalent in older PLWH, similar to non-infected patients. HIV infection in older people was associated with a lower risk of drug-drug interactions. However, non-adherence was a risk factor compared with age matched controls. Deprescribing strategies, including a capability-motivation-opportunity pharmaceutical care model based intervention should be implemented in clinical routines.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sanmartín-Fenollera P, Mangues-Bafalluy I, Talens-Bolos A, Ibarra-Barrueta O, Villamañán-Bueno E, Monte-Boquet E, Morillo-Verdugo R, Margusino-Framiñán L. Telepharmacy scorecard: Activity and quality indicators for the pharmaceutical care in a hospital pharmacy service. Farm Hosp 2022; 46:92-105. [PMID: 36520564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Telepharmacy, as a complementary activity to face-to-face pharmaceutical care in a Hospital pharmacy service, must have specific activity, effectiveness and quality indicators. The objectives of the project were to design a scorecard of activity, effectiveness and quality indicators that will make it possible to assess the situation and progress of Telepharmacy and enable continuous improvement. A tool is also provided to measure the indicators, and some recommendations are given for its implementation. METHOD The project, led by a panel of expert pharmacists, was developed in 2021 in four phases: a literature review, preliminary identification of quality criteria and indicators, evaluation of indicators, adjustment of the proposal and definition of priority indicators, and drafting of descriptive files, as well as the development and validation of a scorecard. The indicators were prioritized based on their appropriateness, usefulness, relevance and feasibility. Finally, the scorecard was submitted for evaluation by the members and Patient Committee of the Spanish Hospital Pharmacy Society. RESULTS The resulting scorecard consists of 50 indicators grouped into five areas: General aspects (18); pharmacotherapeutic follow-up (12); home drug delivery (15); patient information and education (2); and coordination with the care team (3). A total of 31 were considered priority or essential indicators, which are initially recommended for the implementation of a Telepharmacy program. In contrast, 15 are general indicators, including measurement of patient and professional satisfaction; 6 indicators refer to pharmacotherapeutic follow-up; 1 is related to patient information and education, and 2 correspond to care team coordination. CONCLUSIONS The scorecard developed is a management tool for the implementation and evaluation of Telepharmacy in the Hospital pharmacy service. This tool enables assessing the initial situation, monitoring implementation progress, measuring quality and performance, facilitating decision-making and establishing an improvement plan.
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Morillo-Verdugo R, Morillo-Lisa R, Espolita-Suárez J, Delgado-Sánchez O. Assessing patient experience with a Telepharmacy model coordinated in the hospital and rural pharmacy setting: The TELEMACO project. Farm Hosp 2022; 46:128-133. [PMID: 36520567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine variation in patient experience with a model of Telepharmacy coordinated in the specialist hospital and rural pharmacy setting. METHOD A pre-post experimental analytical study. A set of common essential pharmacy tasks based on the capacity-motivation-opportunity method will be performed in each participating site. A a Telepharmacy software will be designed to include the following functionalities: history of patient pharmaceutical profiling and prioritization; scheduled appointment book; unscheduled visit record; generic participant communication wall; patient- professional instantaneous messaging chat; video calls; monitoring of treatment adherence; and evaluation of patient-reported outcomes. Inclusion criteria: age older than 18 years; being on regular hospital pharmacy follow-up for the last 6 months; using a stable drug therapy (without treatment changes in the last 6 months); using a chronic hospital outpatient prescription (any prescription valid for at least 6 months); living in any of the municipalities served by the participating pharmacies or using the services of a participating pharmacy located near the usual place of residence; granting informed consent prior to inclusion in the study. A 48-week follow-up will be performed of each patient. The primary endpoint will be variation in patient experience, as assessed using the "Instrumento de Evaluación de la eXperiencia del PAciente Crónico" scale at baseline and at the end of the follow-up period. CONCLUSIONS The incorporation, development and implementation of a coordinated Telepharmacy care model will help us determine whether this model is useful in improving patient follow-up and communication with pharmacy professionals at different levels of healthcare.
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Morillo-Verdugo R, Collado-Borell R, Arrondo-Velasco A, Domínguez-Cantero M, Fernández-Polo A, González-Corominas E, Gutiérrez E, Linares-Alarcón A, Parro-Martín MDLÁ, Rodríguez-Cabezas MÁ, Gomis-Pastor M. Implementation of pharmaceutical care through Telepharmacy: A guide for professionals and patients. Farm Hosp 2022; 46:115-122. [PMID: 36520566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To provide a practical guide for the implementation and use of Pharmaceutical Care through Telepharmacy by healthcare professionals and patients in its different scopes of application. To establish a definition of Telepharmacy and describe the technological tools necessary, advantages, and keys to facilitating its implementation. METHOD Between December 2020 and January 2021, the Board of Directors of the Spanish Society of Hospital Pharmacy, along with the coordinators of the project "Outpatient Care Strategies" ("Mapa Estratégico para la Atención al Paciente Externo") designed a strategy to foster the development and expansion of Telepharmacy in Spain. This strategy involved four courses of action. To develop the first course of action, a call was made in March 2021 among the Spanish Society of Hospital Pharmacy members to develop seven methodological guidelines. The purpose of these documents was to meet the needs for the implementation of Telepharmacy, the most relevant being the development of specific guides for professionals and patients. The guides were developed in four stages between May and October 2021, including a literature review; consensus-based interviews, online workshops, and, finally, the drafting and validation of the final documents. Once the final draft was prepared, a public evaluation of suggestions and observations was performed for a month. The documents were also presented to the Patient Committee of the Spanish Society of Hospital Pharmacy. RESULTS The Guide for Professionals provides guidelines for the development and implementation of Telepharmacy in its different scopes of application. These guides provide a description of specific goals, healthcare benefits, tools required, and keys to the implementation of Telepharmacy. The Guide for Patients is complementary to face-to-face pharmaceutical care from the point of view of the patient, with special emphasis being placed on the most frequently used tools, the potential benefits, and the keys to facilitating patients' understanding of the purpose and use of Telepharmacy. CONCLUSIONS A Practical Guide for Professionals and Patients was developed to ensure the standard development, implementation, and spread of Telepharmacy in all its scopes. This guide is intended to help Hospital Pharmacy professionals benefit from Telepharmacy as a complementary tool to face-to-face pharmaceutical care.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Mar Gomis-Pastor
- Servicio de Farmacia, Hospital de la Sant Creu y Sant Pau, Barcelona.
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Mercadal-Orfila G, Lizeaga G, Fernández-Llamazares CM, Tortajada-Goitia B, García Cabrera E, Morillo-Verdugo R, Negro-Vega E. Outpatient pharmaceutical care satisfaction survey through Telepharmacy during COVID-19 pandemic in Spain. Farm Hosp 2022; 46:69-85. [PMID: 36520562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To present the results of a survey about the Telemedicine outpatients experience and satisfaction of a pharmaceutical care program through Telepharmacy, carried out from hospital pharmacy departments in Spain during COVID-19 Pandemic (ENOPEX survey), and identify differences across regions in Spain. METHOD An analysis of results of the national survey ENOPEX on outpatient Telepharmacy services during the lockdown due to the COVID‑19 pandemic, analyzed by autonomous community in Spain. Data was collected in relation to point of delivery; pharmacotherapeutic follow-up; patient's opinion and satisfaction with Telemedicine; confidentiality; future development of pharmaceutical care, through Telepharmacy services; and coordination with the patient care team. Four multilevel regressions were performed to evaluate the differences between Spanish regions on the most relevant variables of the study, using the R version 4.0.3 software. RESULTS A total of 8,079 interviews were valid, 52.8% of respondents were female, age was 41-65 years in 54.3% of participants; 42.7% had been receiving treatment for more than 5 years; 42.8% lived 10-50 km from the hospital; the journey to hospital took more than one hour for 60.2% of participants. Globally, 85.7% received medicines at home. However, medicines were delivered at a community pharmacy in some communities, such as Cantabria (95.8%), or at primary care centers as in Castile La Mancha (16.5%). In total, 96.7% of participants were satisfied or very satisfied with Telemedicine pharmaceutical care, through Telepharmacy services, with differences across communities, with users in Andalusia reporting the highest satisfaction (OR = 1.58), and users in Castile-León being less satisfied with Telepharmacy services (OR = 0.66). Users in Catalonia are the ones more clearly in favor of Telemedicine pharmaceutical care, through Telepharmacy services as a complementary service, with an OR = 5.85 with respect to other users. The Telemedicine most frequently mentioned advantage was that Telepharmacy services avoided visits, especially in Cantabria (92.5%) and Extremadura (88.4%). Most patients prefer informed delivery of medicines at home when they do not have an appointment at the hospital: total of 75.6 %, from 50.1% of users in Cantabria to 96.3% in Catalonia (p < 0.001). The users less willing to pay for Telepharmacy services were the ones from Castile- León and Galicia, with users in Catalonia and Navarra showing higher willingness. CONCLUSIONS In general terms, patients were satisfied with Telemedicine pharmaceutical care, through Telepharmacy services during the COVID‑19 pandemic, being mostly in favor of maintaining these services to avoid travels.
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Affiliation(s)
| | - Garbiñe Lizeaga
- Departamento de Farmacia, Hospital Universitario de Donostia, San Sebastián.
| | | | | | - Emilio García Cabrera
- Profesor Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla.
| | | | - Eva Negro-Vega
- Departamento de Farmacia, Hospital Universitario de Getafe, Getafe (Madrid).
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Díaz-Acedo R, Soriano-Martinez M, Gutiérrez-Pizarraya A, Fernandez-Gonzalez-Caballos JA, Raya-Siles M, Morillo-Verdugo R. Prevalence of PIMDINAC criteria and associated factors in elderly HIV patients. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:258-261. [PMID: 35248518 DOI: 10.1016/j.eimce.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Aging of people living with HIV could be related to potentially inappropiate medication prescriptions, drugs interactions and lack of drugs adherence. PIMDINAC criteria seek to jointly analyze these problems. The objective of this study is to determine the prevalence of PIMDINAC criteria in an elderly HIV population. METHODS Observational, cross-sectional, multicenter study that included patients older than 65 years in pharmacotherapeutic follow-up between February-April 2020. The main endpoint was the percentage of PIMDINAC criteria identified in the study population. RESULTS Forty-seven patientes were included, identifying total PIMDINAC in 12.5%. Non-adherence to concomitant treatment was detected in 65.6% of patients, potentially inappropiate medication in 48.9% and drugs interactions in 25.2%. The number of concomitant drugs and polypharmacy were associated with a higher appearance of PIMDINAC criteria. CONCLUSION The prevalence of PIMDINAC criteria in elderly HIV patients is high.
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Affiliation(s)
- Rocío Díaz-Acedo
- Servicio de Farmacia, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain.
| | | | | | | | | | - Ramón Morillo-Verdugo
- Servicio de Farmacia, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
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Morillo-Verdugo R, Robustillo-Cortes MDLA, Navarro-Ruiz A, Sánchez-Rubio Ferrandez J, Fernández Espínola S, Fernández-Pacheco García-Valdecasas M, Vélez-Diaz-Pallares M. Clinical Impact of the Capacity-Motivation-Opportunity Pharmacist-Led Intervention in People Living with HIV in Spain, 2019–2020. J Multidiscip Healthc 2022; 15:1203-1211. [PMID: 35637720 PMCID: PMC9147399 DOI: 10.2147/jmdh.s361305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background People living with HIV (PLWH) have significantly enhanced their life expectancy. Consequently, age-associated comorbidities and related health conditions are increasingly found in PLWH complicating their clinical management. Objective To determine the effect of the capacity-motivation-opportunity (CMO) structured pharmaceutical care intervention for improving clinical health-care results frequently associated to PLWH. Methods Multicenter, prospective, pre-post intervention study evaluating the CMO pharmacist-led program in adult PLWH was conducted between September 2019 and September 2020 with six months of follow-up. The primary objective of this study was to determine differences in clinical outcomes (total cholesterol, triglycerides, HDL, blood pressure and glycosylated hemoglobin) and variation in the patient’s activation measure before and after the intervention. Results A total of 61 patients were included, 72% were men with a median age of 53 years. After the implementation of the pharmacist-driven program, the percentage of patients with high levels of total cholesterol decreased significantly (18% to 4.9%; p < 0.001). Similarly, the prevalence of patients with high levels of triglycerides, HDL or with hypertension was significantly lower post intervention (13.1% to 6.6%, p < 0.001; 47.5% to 6.6%, p = 0.019 and 24% to 4%, p = 0.009, respectively). The number of patients who achieved the highest activation level increased from 69% to 77.6% (p < 0.001). Conclusion The CMO program resulted in significantly better health outcomes during the six months following the pharmacist-led intervention as well as improved activation in PLWH.
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Affiliation(s)
- Ramón Morillo-Verdugo
- Pharmacy Hospital Service, Hospital Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
- Correspondence: Ramón Morillo-Verdugo, Pharmacy Hospital Service, Hospital Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain, Email
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Margusino-Framiñán L, Fernández-Llamazares CM, Negro-Vega E, Tortajada-Goitia B, Lizeaga G, Mercadal-Orfila G, Almeida-González C, Morillo-Verdugo R. Outpatients' Opinion And Experience Regarding Telepharmacy During The COVID-19 Pandemic: The Enopex Project. J Multidiscip Healthc 2022; 14:3621-3632. [PMID: 35002251 PMCID: PMC8725846 DOI: 10.2147/jmdh.s343528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background Telepharmacy, as a remote pharmaceutical care procedure, is being used worldwide during the COVID-19 pandemic, with the aim of preserving the health of patients and professionals. Its future development should incorporate the assessment of patient perception, but no research study has investigated it. Objective The objective was to poll the opinions and experiences of outpatients with telepharmacy through a purpose-developed questionnaire and to assess it’s quality through an internal validity and reliability analysis. Methods Cross-sectional observational study of adult patients who used telepharmacy services during the COVID-19 lockdown period in Spain. The subjects answered a 24-item questionnaire, after giving their informed consent. Place of delivery, informed pharmacotherapeutic follow-up, opinion about telepharmacy, future development, ethics/satisfaction, and coordination constituted the six questionnaire categories. After assessing the adequate sample size with the Kaiser–Meyer–Olkin test, the Bartlett sphericity test analyzed the validity of the questionnaire. The intraclass correlation coefficient and Cronbach’s α coefficient calculations verified the reliability and internal consistency. Results A total of 9442 interviews were administered to patients from 81 hospitals, of which 8079 were valid (52.8% female). A 54.1% were aged between 41–65 years; 42.7% had been in treatment for more than 5 years; 42.8% lived between 6–31 miles from the hospital. As many as 96.7% of patients were “satisfied” or “very satisfied” with telepharmacy, 97.5% considering it complementary to their usual follow-up; 55.9% expressed a preference for being followed up face to face when visiting the hospital. 75.6% said they had rather receive their medication at home. The sample size obtained was deemed appropriate [the Kaiser–Meyer–Olkin test (0.789) and Bartlett’s sphericity test (p<0.005)]. The reliability analysis resulted in a Cronbach α = 0.7. Conclusion Patients have shown high satisfaction with telepharmacy and the ENOPEX questionnaire is a tool with sufficient validity and reliability to be used in the evaluation of the care that patients receive through telepharmacy.
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Affiliation(s)
| | | | - Eva Negro-Vega
- Pharmacy Department, Getafe Universitary Hospital, Madrid, Spain
| | | | - Garbiñe Lizeaga
- Pharmacy Department, Donostia Universitary Hospital, San Sebastian, Spain
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Morillo-Verdugo R, Sánchez-Rubio-Ferrández J, Gimeno-Gracia M, Robustillo-Cortés MDLA, Almeida-González CV. Prevalence of polypharmacy and associated factors among patients living with HIV infection in Spain: The POINT study. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:7-13. [PMID: 34991854 DOI: 10.1016/j.eimce.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/26/2020] [Indexed: 06/14/2023]
Abstract
PURPOSE Survival in people living with HIV (PLWH) has increased and thus people are aging with HIV, increasing the frequency of multimorbidity and polypharmacy. This cross-sectional study was conducted to evaluate the prevalence of polypharmacy among PLWH who were on antiretroviral treatment and were followed in an outpatient setting by the pharmacy department of several hospitals across Spain. In addition, we aimed to evaluate factors associated with polypharmacy and treatment complexity among this population. MATERIAL AND METHODS We recorded information on demographic data, data on disease control including viral load and CD4 count at the time of inclusion, comorbidities, pharmacologic treatment and drugs interactions. Polypharmacy was defined as the use of 6 or more different drugs, including antiretroviral medication; major polypharmacy was defined as the use of ≥11 different drugs. RESULTS Overall, 1225 PLWH were eligible in the study. The median (IQR) age was 49 (40-54). Comorbidities were present in 819 (67%) PLWH and 571 (47%) had two or more comorbidities. Overall, 397 (32.4%, 95% CI 29.8-34.9) PLWH met the criteria for polypharmacy, and 67 (5.5%, 95% CI, 4.2-6.7) had major polypharmacy. Several factors were associated with polypharmacy such as type of antiretroviral treatment, presence of potential interactions, the use of several types of medications and the number of comorbidities. Treatment complexity was also a factor strongly associated with polypharmacy; for each point increase in the medication regimen complexity index (MRCI), the likelihood of polypharmacy increased 2.3-fold. CONCLUSIONS Polypharmacy is frequent among PLWH in Spain and contributes to a relevant extent to treatment complexity.
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Affiliation(s)
| | | | | | | | - Carmen V Almeida-González
- Statistics and Research Methodology Unit, Valme University Hospital, Sevilla, Spain; Preventive Medicine and Public Health, Seville University, School of Medicine, Seville, Spain
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Morillo-Verdugo R, Álvarez-Díaz A, Gorgas-Torner MQ, Poveda-Andrés JL, Mugarza-Borque F, Díaz-Olmo J. Patient and health practitioner perceptions about the role of hospital pharmacists along the care continuum: the Fharmaconectados Project. Farm Hosp 2021; 45:268-276. [PMID: 34806588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE To determine the perception of patients and practitioners regarding the role of the hospital pharmacist along the care continuum. METHOD This was a multicenter cross-sectional observational analytical study, carried out in two phases between 15 October and 31 December 2020. In the first phase, a literature search was carried out to identify specific questionnaires that measured the overall satisfaction of patients in relation to the work of hospital pharmacists. Subsequently, a specific consensus-based questionnaire was developed, structured into three areas: care, relationships, and capacity-building and training. The study included patients treated in the participating centers and served by patient associations. They had to be older than 18 years, present with a chronic condition, and be treated with medication for hospital use. In the second phase, a qualitative study was carried out using focus group discussions to analyze how hospital pharmacists are perceived and how they would like to be recognized by patients. Four meetings were held in different territories of Spain. Previously, the research team agreed on the questions to be asked, which were grouped into four sections: healthcare, relational, training and information. RESULTS A total of 482 surveys were obtained. The percentage of patients who expressed a positive view of the role of the hospital pharmacist was 88.0% (n = 424). In the multivariate analysis, the most positive opinions about these professionals were expressed by women and by patients who had received previous care in the hospital, those who had a high opinion of the coordination of these professionals with the rest of the care team, and those who had received the greatest amount of emotional support. Integration of the pharmacist with the healthcare team was found to vary across different hospitals and the hospitals' public image we seen to be related to the way they were pharmacoeconomically managed. In the sections related to capacity-building and training and challenges for the future, respondents emphasized the need to promote the introduction of new patient monitoring technologies. CONCLUSIONS Patients have a good opinion of the service provided by hospital pharmacists, although many are unaware of the significance of their role.
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Affiliation(s)
- Ramón Morillo-Verdugo
- Hospital Pharmacy Department, Hospital Universitario de Valme, AGS Sur de Sevilla, Sevilla. Spain.
| | - Ana Álvarez-Díaz
- Pharmacy Department, Hospital Universitario Ramón y Cajal, Madrid. Spain.
| | | | - José Luis Poveda-Andrés
- Hospital Pharmacy Department, Área Clínica del Medicamento, Hospital Universitari i Politècnic La Fe, Departament de Salut Valencia La Fe, Valencia. Spain.
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Guzmán Ramos MI, Manzano Garcia M, Robustillo-Cortés MA, Gutiérrez Pizarraya A, Morillo-Verdugo R. Influence of CMO pharmaceutical care model-based intervention on readmission rate in high risk HIV patients: the INFARDAR study. Rev Esp Quimioter 2021; 34:459-467. [PMID: 34231351 PMCID: PMC8638845 DOI: 10.37201/req/025.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Many studies have indicated that hospitalization and readmissions occur frequently, especially among people living with HIV. The aim of the study was to determine the effectiveness of a programmed and structured pharmaceutical intervention, based on "CMO PC model" to reduce the readmission rate in high-risk HIV patients. METHODS This was a single-center, prospective study based on a structured health intervention conducted between March-2017 and March-2018 with 12 months of follow-up at outpatient pharmacy services. At discharge, HIV patients included were classified according to the risk of readmission as low or high risk patients, being the latter proposed to participate. The selected patients were randomly assigned to a control group (usual care) or intervention group (including stratification-motivational interview and new technologies: CMO pharmaceutical care). The primary endpoint was readmission rate at one year of follow-up in each group. RESULTS A total of 39 patients were included. As regards the main variable, in the intervention group, 21,4% (n=3) of patients were readmitted in the first year after discharge vs. 66,7% (n=6) in the control group (p=0,042). CONCLUSIONS Tailored pharmaceutical care based on risk stratification, motivational interviewing, and new technologies has a positive influence to reduce the percentage of readmission in high risk HIV patients.
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Affiliation(s)
- M I Guzmán Ramos
- Maria Isabel Guzman Ramos, Pharmacy Department. Juan Ramón Jiménez Hospital, Huelva, Spain.
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Morillo-Verdugo R, Vélez-Díaz-Pallarés M, Fernández-Pacheco García-Valdecasas M, Fernández-Espínola S, Sánchez-Rubio Ferrández J, Navarro-Ruiz A. Application of the CMO methodology to the improvement of primary adherence to concomitant medication in people living with-HIV. The PRICMO Project. Farm Hosp 2021; 45:247-252. [PMID: 34806584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE To determine the effectiveness of a pharmaceutical care intervention based on the CMO methodology (Capacity, Motivation and Opportunity) in improving primary adherence to concomitant treatment in HIV+ patients on antiretroviral treatment. METHOD This was a longitudinal prospective multicenter study carried out between September 2019 and September 2020, which included HIV+ patients older than 18 years who were on antiretroviral treatment and were taking concomitant medications. Demographic, clinical, and pharmacotherapeutic variables were collected. As required by the CMO methodology, all patients were followed for 6 months and stratified into three levels of care. Individualized pharmaceutical care was provided according to the interventions established for each level. At every consultation, a motivational interview was conducted based on each patient's alignment with and achievement of their pharmacotherapeutic objectives. A website was developed to deal with the opportunity pillar. The main variable was the percentage of patients considered primary adherents to the prescribed concomitant medication. Adherence over the six months prior to the study was compared to adherence at the end of the study. Additionally, the percentage of patients considered secondary adherents to concomitant treatment and antiretroviral treatment during the 6 months prior to the start of the study was compared to the percentage of such patients at the end of the study. Adherence was measured based on dispensation records and specific validated questionnaires. Patients were only considered adherent if they were deemed adherent by both methods. RESULTS A total of 61 patients were included in the study, 72% male. Median age was 53 years and the median number of concomitant drugs prescribed was 7. A total of 60.6% of patients were polymedicated. The percentage of patients considered primary non-adherent was 52.5% at baseline (n = 32) and 4.9% (n = 3, p < 0.001) at the end of the study. Secondary adherence to both concomitant medication (41.6% vs 88.3%) and antiretroviral treatment (85.2% vs 95.1%) improved at the end of the study (p < 0.0001). CONCLUSIONS Pharmaceutical care based on the CMO methodology significantly improved both primary and secondary dherence to concomitant drugs and to antiretroviral treatment.
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Affiliation(s)
- Ramón Morillo-Verdugo
- Pharmacy Department, Hospital Universitario de Valme, AGS Sur de Sevilla, Sevilla. Spain..
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Cantudo-Cuenca MD, Gutiérrez-Pizarraya A, Pinilla-Fernández A, Contreras-Macías E, Fernández-Fuertes M, Lao-Domínguez FA, Rincón P, Pineda JA, Macías J, Morillo-Verdugo R. Drug-drug interactions between treatment specific pharmacotherapy and concomitant medication in patients with COVID-19 in the first wave in Spain. Sci Rep 2021; 11:12414. [PMID: 34127740 PMCID: PMC8203634 DOI: 10.1038/s41598-021-91953-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022] Open
Abstract
Primary aim was to assess prevalence and severity of potential and real drug-drug interactions (DDIs) among therapies for COVID-19 and concomitant medications in hospitalized patients with confirmed SARS-CoV-2 infection. The secondary aim was to analyze factors associated with rDDIs. An observational single center cohort study conducted at a tertiary hospital in Spain from March 1st to April 30th. rDDIs refer to interaction with concomitant drugs prescribed during hospital stay whereas potential DDIs (pDDIs) refer to those with domiciliary medication. DDIs checked with The University of Liverpool resource. Concomitant medications were categorized according to the Anatomical Therapeutic Chemical classification system. Binomial logistic regression was carried out to identify factors associated with rDDIs. A total of 174 patients were analyzed. DDIs were detected in 152 patients (87.4%) with a total of 417 rDDIs between COVID19-related drugs and involved hospital concomitant medication (60 different drugs) while pDDIs were detected in 105 patients (72.9%) with a total of 553 pDDIs. From all 417 rDDIs, 43.2% (n = 180) were associated with lopinavir/ritonavir and 52.9% (n = 221) with hydroxychloroquine, both of them the most prescribed (106 and 165 patients, respectively). The main mechanism of interaction observed was QTc prolongation. Clinically relevant rDDIs were identified among 81.1% (n = 338) ('potential interactions') and 14.6% (n = 61) (contraindicated) of the patients. Charlson index (OR 1.34, 95% IC 1.02-1.76) and number of drugs prescribed during admission (OR 1.42, 95% IC 1.12-1.81) were independently associated with rDDIs. Prevalence of patients with real and pDDIs was high, especially those clinically relevant. Both comorbidities and polypharmacy were found as risk factors independently associated with DDIs development.
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Affiliation(s)
- M D Cantudo-Cuenca
- Pharmacy Unit, Hospital Universitario Virgen de Valme, Ctra. de Cádiz Km. 548,9, Seville, Spain
| | | | - Ana Pinilla-Fernández
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Avda. Bellavista s/n, 41014, Seville, Spain
| | | | - M Fernández-Fuertes
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Avda. Bellavista s/n, 41014, Seville, Spain
| | - F A Lao-Domínguez
- Pharmacy Unit, Hospital Universitario Virgen de Valme, Ctra. de Cádiz Km. 548,9, Seville, Spain
| | - Pilar Rincón
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Avda. Bellavista s/n, 41014, Seville, Spain
| | - Juan Antonio Pineda
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Avda. Bellavista s/n, 41014, Seville, Spain
| | - Juan Macías
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Avda. Bellavista s/n, 41014, Seville, Spain
| | - Ramón Morillo-Verdugo
- Pharmacy Unit, Hospital Universitario Virgen de Valme, Ctra. de Cádiz Km. 548,9, Seville, Spain
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Sicras-Mainar A, Morillo-Verdugo R. Potential interactions between pangenotypic direct-acting antivirals and concomitant cardiovascular therapies in patients with chronic hepatitis C virus infection. J Int Med Res 2021; 48:300060520964659. [PMID: 33111612 PMCID: PMC7645390 DOI: 10.1177/0300060520964659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To identify potential drug interactions (DIs) between pangenotypic direct-acting antivirals (pDAAs) and concomitant cardiovascular (CV) therapies in patients with chronic hepatitis C (CHC). METHODS A retrospective observational study was carried out. Patients ≥18 years of age diagnosed with CHC and treated with pDAAs during 2017 were included. Information was collected on concomitant CV therapies and potential DIs [www.hep-druginteractions.org]. The pDAAs analyzed were sofosbuvir/velpatasvir (SOF/VEL), glecaprevir/pibrentasvir (GLE/PIB) and sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX). An analysis including lipid-lowering drugs was also performed. RESULTS In total, 1286 patients (mean age 64.9 years, 56.6% men) were recruited. The percentages of potential DIs with CV drugs were 1.9% contraindications, 38.1% clinically significant and 2.4% weak. When lipid-lowering drugs were included, the percentages of potential DIs with CV drugs were 10.3% contraindications, 46.3% clinically significant and 3.2% weak. Potential DIs associated with each pDAA were as follows (contraindications; clinically significant; weak): SOF/VEL (1.4%; 23.0%; 0.9%), GLE/PIB (12.8%; 60.8%; 4.7%) and SOF/VEL/VOX (16.6%; 55.1%; 4.9%). CONCLUSIONS Approximately on third of patients with CHC are concomitantly treated with CV drugs. SOF/VEL may have fewer DIs with CV drugs than other pDAAs.
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Affiliation(s)
- Antoni Sicras-Mainar
- Scientific Management, Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | - Ramón Morillo-Verdugo
- Pharmacist, Specialist in Hospital Pharmacy, Hospital de Valme, AGS Sur de Sevilla, Spain
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Macías J, González-Moreno P, Sánchez-García E, Morillo-Verdugo R, Pérez-Venegas JJ, Pinilla A, Macho M, Martínez M, González-Serna A, Corma A, Real LM, Pineda JA. Similar incidence of coronavirus disease 2019 (COVID-19) in patients with rheumatic diseases with and without hydroxychloroquine therapy. PLoS One 2021; 16:e0249036. [PMID: 33831011 PMCID: PMC8031374 DOI: 10.1371/journal.pone.0249036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 03/09/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hydroxychloroquine is not efficacious as post-exposure prophylaxis against coronavirus disease 2019 (COVID-19). It is not known whether as pre-exposure prophylaxis it may prevent COVID-19. OBJECTIVE To compare the incidence of COVID-19 in Spanish patients with autoimmune rheumatic diseases treated with and without hydroxychloroquine. PATIENTS AND METHODS Retrospective electronic record review, from February 27th to June 21st, 2020, of patients with autoimmune inflammatory diseases followed at two academic tertiary care hospitals in Seville, Spain. The cumulative incidence of confirmed COVID-19, by PCR or serology, was compared between patients with and without hydroxychloroquine as part of their treatment of autoimmune inflammatory diseases. RESULTS Among 722 included patients, 290 (40%) were receiving hydroxychloroquine. During the seventeen-week study period, 10 (3.4% [95% CI: 1.7%-6.7%] cases of COVID-19 were registered among patients with hydroxychloroquine and 13 (3.0% [1.6%-5.1%]) (p = 0.565) in those without hydroxychloroquine. COVID-19 was diagnosed by PCR in four (1.4%, 95% CI 0.38%-3.5%) subject with hydroxychloroquine and six (1.4%, 95% CI 0.5%-3.0%) without hydroxychloroquine (p = 0.697). Three patients on hydroxychloroquine and four patients without hydroxychloroquine were admitted to the hospital, none of them required to be transferred to the intensive care unit and no patient died during the episode. CONCLUSIONS The incidence and severity of COVID-19 among patients with autoimmune rheumatic diseases with and without hydroxychloroquine was not significantly different.
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Affiliation(s)
- Juan Macías
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Seville, Spain
| | | | | | | | | | - Ana Pinilla
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Seville, Spain
| | - MªMar Macho
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Seville, Spain
| | - MªVictoria Martínez
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Seville, Spain
| | - Alejandro González-Serna
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Seville, Spain
| | - Anaïs Corma
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Seville, Spain
| | - Luis M. Real
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Seville, Spain
| | - Juan A. Pineda
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Seville, Spain
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Contreras-Macías E, Gutiérrez-Pizarraya A, RobustilloCortés MA, Morillo-Verdugo R. High level of medication regimen complexity index correlate with worse quality of life in people living with HIV. Rev Esp Quimioter 2021; 34:93-99. [PMID: 33499583 PMCID: PMC8019467 DOI: 10.37201/req/097.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives People living with HIV (PLWHIV) have now a near-normal life expectancy and thus, a higher risk of polypharmacy. The main objective was to assess the correlation between medication regimen complexity index (MRCI) and quality of life (EQ-5D) and health utilities among PLWHIV patients on ART. Patients and methods Observational prospective single-center study including adult PLWHIV on ART from January to March-2020 attended at hospital pharmacy outpatient service according to a Capacity-Motivation-Opportunity (CMO) pharmaceutical care model. Results A total of 428 patients were included, mean age of 50 ± 10.9 years, 82.2% males. Negative correlation (r2= −0.147; p= 0.0002) between MRCI and EQ-5D was found. Relationship between the comorbidity pattern and quality of life, was also observed. Regarding MRCI, Anxiety/Depression, Pain/ discomfort and Self-Care were the dimensions with the worst assessment. Conclusions A new multidimensional revised care plan for PLWHIV focussed on optimising overall patient care, not limited to viral load goal achievement alone but also in their pharmacotherapeutic complexity and quality of life is needed
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Affiliation(s)
| | - A Gutiérrez-Pizarraya
- Antonio Gutiérrez-Pizarraya, Pharmacy Unit. Hospital Universitario Virgen Valme. Ctra. de Cádiz Km. 548,9. Seville, Spain.
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Cantillana-Suárez MG, Robustillo-Cortés MDLA, Gutiérrez-Pizarraya A, Morillo-Verdugo R. Impact and acceptance of pharmacist-led interventions during HIV care in a third-level hospital in Spain using the Capacity-Motivation-Opportunity pharmaceutical care model: the IRAFE study. Eur J Hosp Pharm 2021; 28:e157-e163. [PMID: 33627478 DOI: 10.1136/ejhpharm-2020-002330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/17/2020] [Accepted: 01/26/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In recent decades, HIV has become a chronic disease with which the HIV specialist pharmacist plays a fundamental role. The traditional pharmaceutical care model followed to date relied excessively on the medication, obviating the uniqueness of each patient. The purpose of this study was to determine the influence and acceptance of a Capacity-Motivation-Opportunity (CMO)-based structured pharmaceutical care (PC) intervention in a multidisciplinary team for improving healthcare results. METHODS Prospective single-centre study of a structured health intervention with patients living with HIV who attended hospital between January 2017 and June 2018 for any cause. Pharmacotherapeutic follow-up was applied according to the CMO PC model based on three key elements, namely stratification, motivational interview and new technologies. To assess differences in the variables collected before and after the intervention, Student's t-test or Wilcoxon test, and McNemar's test were used for quantitative and dichotomous variables, respectively. RESULTS A total of 349 patients were included, 76.1% of which were men. The acceptance of pharmacist intervention by both doctors and patients was high [336 (97.7%) and 321 (93.3%)] and the adherence rate to antiretroviral therapy before intervention was lower than that observed afterwards (85.6%±33.7% vs 96.4%±17.7%; p<0.001). No differences were found between median viral load pre- versus post-intervention [1175 (62.75-26 050) copies/mL vs 274 (76.75-5542) copies/mL], although the undetectability rate was recorded as higher after intervention compared with the previous period [294 (85.5%) vs 274 (79.7%); p<0.001]. CONCLUSIONS Our results could help HIV pharmacy clinic specialists to recognise high-risk patients and to develop personalised follow-up care, thereby ensuring good adherence and response to treatments.
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Díaz-Acedo R, Soriano-Martinez M, Gutiérrez-Pizarraya A, Fernandez-Gonzalez-Caballos JA, Raya-Siles M, Morillo-Verdugo R. Prevalence of PIMDINAC criteria and associated factors in elderly HIV patients. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(20)30417-1. [PMID: 33451809 DOI: 10.1016/j.eimc.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Aging of people living with HIV could be related to potentially inappropriate medication prescriptions, drugs interactions and lack of drugs adherence. PIMDINAC criteria seek to jointly analyze these problems. The objective of this study is to determine the prevalence of PIMDINAC criteria in an elderly HIV population. METHODS Observational, cross-sectional, multicenter study that included patients older than 65 years in pharmacotherapeutic follow-up between February-April 2020. The main endpoint was the percentage of PIMDINAC criteria identified in the study population. RESULTS Forty-seven patientes were included, identifying total PIMDINAC in 12.5%. Non-adherence to concomitant treatment was detected in 65.6% of patients, potentially inappropriate medication in 48.9% and drugs interactions in 25.2%. The number of concomitant drugs and polypharmacy were associated with a higher appearance of PIMDINAC criteria. CONCLUSION The prevalence of PIMDINAC criteria in elderly HIV patients is high.
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Affiliation(s)
- Rocío Díaz-Acedo
- Servicio de Farmacia, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España.
| | | | | | | | | | - Ramón Morillo-Verdugo
- Servicio de Farmacia, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España
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Sicras-Mainar A, Morillo-Verdugo R. Concomitant use of direct-acting antivirals (DAA) and central nervous system drugs in patients with hepatitis C virus infection. Adicciones 2020; 34:279-284. [PMID: 33338248 DOI: 10.20882/adicciones.1551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Our objective was to determine potential drug interactions (DI) between pangenotypic direct-acting antivirals (pDAA) and concomitant central nervous system (CNS) medication in patients with chronic hepatitis C virus (HCV). Transversal design. Patients aged ≥ 18 years on treatment with pDAA during 2017 were included. The variables collected were comorbidity, concomitant CNS medication and potential DI. The pDAA analyzed were a) Sofosbuvir/Velpatasvir (SOF/VEL), b) Glecaprevir/Pibrentasvir (GLE/PIB) and c) Sofosbuvir/Velpatasvir/Voxilaprevir (SOF/VEL/VOX). Descriptive statistical analysis. We recruited 1,170 patients (mean age 60.1 years, 56.4% male). Mean concomitant drug use was 3.2 per patient/year. The percentages of potential / possible DI between the DAAs and the concomitant drugs on the CNS were: 2.7% contraindications, 11.3% significant and 4.2% weak. By pDAA, the percentages were: SOF/VEL (2.7%; 0.0%; 4.4%), GLE/GDP (2.7%; 26.5%; 1.6%) SOF/VEL/VOX (2.7%; 6.8%; 4.4%), respectively. Concomitant CNS medication was used in one third of HCV patients. It is important to select a pDAA with a low rate of potential DI to simplify treatment. SOF/VEL is a good alternative compared with the other pDAA studied, mainly due to the concomitant use of antipsychotics and analgesics.
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Macías J, Pinilla A, Lao-Dominguez FA, Corma A, Contreras-Macias E, González-Serna A, Gutierrez-Pizarraya A, Fernández-Fuertes M, Morillo-Verdugo R, Trigo M, Real LM, Pineda JA. High rate of major drug-drug interactions of lopinavir-ritonavir for COVID-19 treatment. Sci Rep 2020; 10:20958. [PMID: 33262433 PMCID: PMC7708981 DOI: 10.1038/s41598-020-78029-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
The impact of drug-drug interactions (DDI) between ritonavir-boosted lopinavir (LPV-r) to treat patients with coronavirus disease 2019 (COVID-19) and commonly used drugs in clinical practice is not well-known. Thus, we evaluated the rate and severity of DDI between LPV-r for COVID-19 treatment and concomitant medications. This was a cross-sectional study including all individuals diagnosed of SARS-CoV-2 infection treated with LPV-r and attended at a single center in Southern Spain (March 1st to April 30th, 2020). The frequency [95% confidence interval (95% CI)] of potential and major DDI were calculated. Overall, 469 patients were diagnosed of COVID-19, 125 (27%) of them were prescribed LPV-r. LPV-r had potential DDI with concomitant medications in 97 (78%, 95% CI 69-85%) patients, and in 33 (26%, 95% CI 19-35%) individuals showed major DDI. Twelve (36%) patients with major DDI and 14 (15%) individuals without major DDI died (p = 0.010). After adjustment, only the Charlson index was independently associated with death [adjusted OR (95% CI) for Charlson index ≥ 5: 85 (10-731), p < 0.001]. LPV-r was discontinued due to side effects in 31 (25%) patients. Management by the Infectious Diseases Unit was associated with a lower likelihood of major DDI [adjusted odds ratio (95% CI): 0.14 (0.04-0.53), p = 0.003). In conclusion, a high frequency of DDI between LPV-r for treating COVID-19 and concomitant medications was found, including major DDI. Patients with major DDI showed worse outcomes, but this association was explained by the older age and comorbidities. Patients managed by the Infectious Diseases Unit had lower risk of major DDI.
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Affiliation(s)
- Juan Macías
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Avda Bellavista s/n, 41014, Seville, Spain.
| | - Ana Pinilla
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Avda Bellavista s/n, 41014, Seville, Spain
| | | | - Anaïs Corma
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Avda Bellavista s/n, 41014, Seville, Spain
| | | | - Alejandro González-Serna
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Avda Bellavista s/n, 41014, Seville, Spain
| | | | - Marta Fernández-Fuertes
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Avda Bellavista s/n, 41014, Seville, Spain
| | | | - Marta Trigo
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Avda Bellavista s/n, 41014, Seville, Spain
| | - Luis M Real
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Avda Bellavista s/n, 41014, Seville, Spain
| | - Juan A Pineda
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen de Valme, Avda Bellavista s/n, 41014, Seville, Spain
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Morillo-Verdugo R, Sánchez-Rubio-Ferrández J, Gimeno-Gracia M, Robustillo-Cortés MDLA, Almeida-González CV. Prevalence of polypharmacy and associated factors among patients living with HIV infection in Spain: The POINT study. Enferm Infecc Microbiol Clin 2020; 40:S0213-005X(20)30317-7. [PMID: 33229100 DOI: 10.1016/j.eimc.2020.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/15/2020] [Accepted: 09/26/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Survival in people living with HIV (PLWH) has increased and thus people are aging with HIV, increasing the frequency of multimorbidity and polypharmacy. This cross-sectional study was conducted to evaluate the prevalence of polypharmacy among PLWH who were on antiretroviral treatment and were followed in an outpatient setting by the pharmacy department of several hospitals across Spain. In addition, we aimed to evaluate factors associated with polypharmacy and treatment complexity among this population. MATERIAL AND METHODS We recorded information on demographic data, data on disease control including viral load and CD4 count at the time of inclusion, comorbidities, pharmacologic treatment and drugs interactions. Polypharmacy was defined as the use of 6 or more different drugs, including antiretroviral medication; major polypharmacy was defined as the use of ≥11 different drugs. RESULTS Overall, 1225 PLWH were eligible in the study. The median (IQR) age was 49 (40-54). Comorbidities were present in 819 (67%) PLWH and 571 (47%) had two or more comorbidities. Overall, 397 (32.4%, 95% CI 29.8-34.9) PLWH met the criteria for polypharmacy, and 67 (5.5%, 95% CI, 4.2-6.7) had major polypharmacy. Several factors were associated with polypharmacy such as type of antiretroviral treatment, presence of potential interactions, the use of several types of medications and the number of comorbidities. Treatment complexity was also a factor strongly associated with polypharmacy; for each point increase in the medication regimen complexity index (MRCI), the likelihood of polypharmacy increased 2.3-fold. CONCLUSIONS Polypharmacy is frequent among PLWH in Spain and contributes to a relevant extent to treatment complexity.
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Affiliation(s)
| | | | | | | | - Carmen V Almeida-González
- Statistics and Research Methodology Unit, Valme University Hospital, Sevilla, Spain; Preventive Medicine and Public Health, Seville University, School of Medicine, Seville, Spain
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Tortajada-Goitia B, Morillo-Verdugo R, Margusino-Framiñán L, Marcos JA, Fernández-Llamazares CM. Survey on the situation of telepharmacy as applied to the outpatient care in hospital pharmacy departments in Spain during the COVID-19 pandemic. Farm Hosp 2020; 44:135-140. [PMID: 32646343 DOI: 10.7399/fh.11527] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVE To analyze the status of the implementation and development of telepharmacy as applied to the pharmaceutical care of outpatients treated at hospital pharmacy services in Spain during the COVID-19 pandemic. METHOD Six weeks after the beginning of the confinement period, an online 10- question survey was sent to all members of the Spanish Society of Hospital Pharmacists. A single response per hospital was requested. The survey included questions on the provision of remote pharmaceutical care prior to the onset of the health crisis, patient selection criteria, procedures for home delivery of medications and the means used to deliver them, the number of patients who benefited from telepharmacy, and the number of referrals made. Finally, respondents were asked whether a teleconsultation was carried out before sending patients their medication and whether these deliveries were recorded. RESULTS A total of 39.3% (n = 185) of all the hospitals in the National Health System (covering all of Spain's autonomous regions) responded to the survey. Before the beginning of the crisis, 83.2% (n = 154) of hospital pharmacy services did not carry out remote pharmaceutical care activities that included telepharmacy with remote delivery of medication. During the study period, 119,972 patients were treated, with 134,142 deliveries of medication being completed. Most hospitals did not use patient selection criteria. A total of 30.2% of hospitals selected patients based on their personal circumstances. Home delivery and informed delivery (87%; 116,129 deliveries) was the option used in most cases. The means used to deliver the medication mainly included the use of external courier services (47.0%; 87 hospitals) or the hospital's own transport services (38.4%; 71 hospitals). As many as 87.6% of hospitals carried out teleconsultations prior to sending out medications and 59.6% recorded their telepharmacy activities in the hospital pharmacy appointments record. CONCLUSIONS The rate of implementation of telepharmacy in outpatient care in Spain during the study period in the pandemic was high. This made it possible to guarantee the continuity of care for a large number of patients.
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Affiliation(s)
| | - Ramón Morillo-Verdugo
- Hospital Universitario Virgen de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla. Spain..
| | | | - José Antonio Marcos
- Pharmacy Department, Hospital Universitario Virgen Macarena, Sevilla. Spain..
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Morillo-Verdugo R, Calleja-Hernández MÁ, Robustillo-Cortés MDLA, Poveda-Andrés JL. A new definition and refocus of pharmaceutical care: the Barbate Document. Farm Hosp 2020; 44:158-162. [PMID: 32646347 DOI: 10.7399/fh.11389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVE To propose an updated definition of Pharmaceutical Care based on the Capacity-Motivation-Opportunity (CMO) model and on the key elements and optimal activities for its development that guarantee the highest levels of quality and excellence in this professional activity. METHOD The consensus was developed by a working group composed of members of the Spanish Society of Hospital Pharmacy and other pharmacists from different healthcare fields. A literature review of PubMed was conducted of the available scientific evidence on pharmaceutical healthcare models and activities with the greatest impact and ease of implementation. A working definition was developed and the initiatives chosen as key elements were collected and included in each pillar of the proposed model. After creating an initial list of activities and terms, the working group reviewed it and made corrections or proposed new activities. In addition, the definitions of the three key elements of the CMO model were agreed upon: Capacity-Motivation- Opportunity. In order to incorporate all appropriate suggestions and contributions before finalizing the consensus, the final draft was sent to the different scientific, pharmaceutical, and medical societies as well as patient associations with which the Spanish Society of Hospital Pharmacy has a collaboration agreement. RESULTS The definition of consensual Pharmaceutical Care was "Any professional activity by which the pharmacist is linked to the patient (and/or caregiver) and other healthcare professionals, to attend to the patient according to their needs, setting out strategies to align and achieve the shortand medium-/long-term objectives of pharmacotherapy and incorporating new technologies and the means available to continuously interact with ment was reached on the definitions of the three key elements of the CMO model. Finally, 27 key elements for the development of pharmaceutical activity were identified and included in the three pillars of the model. CONCLUSIONS A new definition of Pharmaceutical Care has been agreed upon that refocuses this professional activity, allowing us to advance within the multidisciplinary working approach toward a longitudinal and multidimensional approach to the patient.
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Affiliation(s)
- Ramón Morillo-Verdugo
- Servicio de Farmacia Hospitalaria, Hospital Universitario Virgen de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla. Spain.
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Gimeno-Gracia M, Sánchez-Rubio-Ferrández J, Robustillo-Cortés MDLA, Morillo-Verdugo R. Prevalence of polypharmacy and pharmacotherapy complexity in elderly people living with HIV in Spain. POINT study. Farm Hosp 2020; 44:127-134. [PMID: 32646344 DOI: 10.7399/fh.11367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the prevalence of polypharmacy in persons living with HIV of at least 65 years of age receiving antiretroviral treatment. A characterization of antiretroviral treatment, as well as a determination of the prevalence of comorbidities; of the most common types of concomitant medication; of adherence rates; of the pharmacotherapeutic complexity; and of drug-drug interactions were also among the goals of the study. METHOD This was a multi-center, cross-sectional observational study that included persons living with HIV aged 65 years or more who were on active antiretroviral treatment. Demographic, clinical (viral load, CD4 count and comorbidities) and pharmacotherapeutic (type of antiretroviral treatment: single tablet regimen, polypharmacy [six active ingredients or more] and major polypharmacy [11 active ingredients or more] variables were considered). Adherence to antiretroviral treatment was measured by dispensation records and the Simplified Medication Adherence Questionnaire, while adherence to concomitant medication was measured using dispensation records and the Morisky-Green questionnaire. The Medication Regimen Complexity Index was calculated. Drug-drug interactions were analyzed using the Liverpool and Lexicomp databases. RESULTS Seventy-four patients (86.5% male) were included, with a median age of 69 years (66.7-72.0). The sexual route was the most common route of transmission of the disease (67.6%). The virus was undetectable in 89.2% of patients; the CD4 count was over 200/mL in 94.6% of the sample. The median number of comorbidities was 3.5 (2.0-5.0), 52.7% of them being cardiovascular; 50.0% related to the central nervous system; 17.6% hepatic; and 8.1% consisting in chronic pulmonary disease. A total of 81.1% of patients received triple therapy and 48.6% single tablet regimen. The median number of concomitant drugs administered was 5.0 (2.0-7.0), polypharmacy was observed in 71.6% of cases and major polypharmacy in 25.7%. Antihypertensive and cardiovascular drugs were prescribed to 56.8% of patients, lipid-lowering drugs to 50.0%, antiulcer agents to 33.8% and psychoactive drugs to 32.4%. According to dispensation records, adherence to antiretroviral treatment was 85.1% and to concomitant medication 62.8%. The median Medication Regimen Complexity Index for the whole treatment was 13.0 (8.0-17.6). Potential drug- drug interactions were observed in 55.4% of patients and contraindicated interactions in 12.2%. CONCLUSIONS Elderly persons living with HIV exhibit a high prevalence of polypharmacy, pharmacotherapeutic complexity, poor adherence and drug-drug interactions. For that reason, pharmacotherapeutic optimization must be a priority in these patients.
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Affiliation(s)
- Mercedes Gimeno-Gracia
- Department of Pharmacy, Hospital Clínico Universitario Lozano Blesa, Zaragoza. Spain. IIS Institute for Health Research Aragon, Zaragoza. Spain..
| | | | | | - Ramón Morillo-Verdugo
- Department of Pharmacy, Hospital Universitario Nuestra Señora de Valme, Sevilla. Spain..
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Morillo-Verdugo R, Polo R, Knobel H. Consensus document on enhancing medication adherence in patients with the human immunodeficiency virus receiving antiretroviral therapy. Farm Hosp 2020; 44:163-173. [PMID: 32646348 DOI: 10.7399/fh.11441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Adherence to treatment in patients living with HIV remains the focus of attention of health professionals and researchers. However, patient profiles and the available therapeutic arsenal have changed greatly over the last decade. Inadequate adherence not only to antiretroviral therapy but also to other prescribed drugs remains the main cause of therapeutic failure. There are several factors associated with poor adherence and others that facilitate it, hence the importance of identifying, managing and correcting situations that may hinder adherence. Likewise, adherence should be periodically reassessed during the follow-up of ART and other prescribed drugs. It has so far proved impossible to find a single method capable of providing a reliable measurement of adherence. That is why it is necessary to use a combination of multiple easy- to-implement methods. Additionally, a good relationship with the patient facilitates the conveyance of adequate information on adherence. It is currently considered that interventions to improve adherence should be multidisciplinary, individualized and adjusted to the new patterns of infection transmission, and that controlling adherence to other drugs prescribed to patients with HIV should be part of such interventions. This document provides an update on the recommendations published in 2008 based on a review of the scientific literature. The main goal is to help healthcare professionals dedicated to the clinical and therapeutic management of HIV patients (doctors, pharmacists, nurses, psychologists and social workers) improve adherence of such patients to all the drugs prescribed to them as treatment for their HIV infection.
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Affiliation(s)
- Ramón Morillo-Verdugo
- Specialist Pharmacist. Hospital Universitario de Valme. Southern Healthcare Area, Sevilla. Spain..
| | - Rosa Polo
- Clinical and Research Division. Secretariat of the Spanish AIDS Plan, Ministerio de Sanidad, Madrid. Spain..
| | - Hernando Knobel
- Department of Infectious Diseases, Hospital del Mar, Barcelona. Spain..
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Morillo-Verdugo R, Margusino-Framiñán L, Monte-Boquet E, Morell-Baladrón A, Barreda-Hernández D, Rey-Piñeiro XM, Negro-Vega E, Delgado-Sánchez O. Spanish Society of Hospital Pharmacy Position Statement on Telepharmacy: Recommendations for its implementation and development. Farm Hosp 2020; 44:174-181. [PMID: 32646349 DOI: 10.7399/fh.11515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The use of information and communication technologies have nowadays become part and parcel of hospital pharmacy practice. Against this background, it is hardly surprising that Telepharmacy has sparked the interest of a large number of stakeholders. In this respect, the Spanish Society of Hospital Pharmacy has developed a definition of the concept and outlined the conditions under which Telepharmacy should operate. It has also shared its institutional stance on the subject through a position statement that states that Telepharmacy is the provision of pharmaceutical care at a distance through information and communication technologies. Telepharmacy practice includes activities such as therapeutic validation, drafting of clinical documents, provision of pharmaceutical care, therapeutic follow-up, adherence monitoring, drug education and information, coordination between healthcare providers and evaluation of health outcomes. The clinical tasks performed as part of Telepharmacy practice must adhere to a standardized procedure and revolve around the patient's clinical record. Access to Telepharmacy must be provided without discrimination. The service comprises four main activities: pharmacotherapeutic follow-up; patient and caregiver-directed education and information-dissemination; coordination with healthcare providers from the same or different hospitals; and remote informed home drug delivery. Implementation of Telepharmacy requires an adjustment of human (training and capacity-building) and technological resources (validation, interoperability, confidentiality). It must also comply with the laws and regulations in force both at a regional and a national level. Telepharmacy procedures must also be adapted to the relevant ethical standards and codes of good practice. Appropriate indicators must be used to evaluate the performance of Telepharmacy and its impact on health outcomes. According to Spanish Society of Hospital Pharmacy Telepharmacy is a necessary complementary tool to provide specialized pharmaceutical care and thereby improve health outcomes and maximize patient safety and satisfaction.
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Affiliation(s)
- Ramón Morillo-Verdugo
- Department of Pharmacy, Virgen de Valme University Hospital, Seville. Spain. MAPEX Project Working Group: Strategic Telepharmacy Framework, Spanish Society of Hospital Pharmacy. Spain.
| | - Luis Margusino-Framiñán
- MAPEX Project Working Group: Strategic Telepharmacy Framework, Spanish Society of Hospital Pharmacy. Spain Department of Pharmacy, A Coruña University Hospital Complex, A Coruña. Spain..
| | - Emilio Monte-Boquet
- MAPEX Project Working Group: Strategic Telepharmacy Framework, Spanish Society of Hospital Pharmacy. Spain Department of Pharmacy, La Fe University and Polytechnic Hospital, Valencia. Spain..
| | - Alberto Morell-Baladrón
- MAPEX Project Working Group: Strategic Telepharmacy Framework, Spanish Society of Hospital Pharmacy. Spain Department of Pharmacy, La Princesa University Hospital, Madrid. Spain..
| | - Dolores Barreda-Hernández
- Department of Pharmacy, Virgen de la Luz Hospital, Cuenca. Spain. Ethos Working Group of the Spanish Society of Hospital Pharmacy. Spain.
| | - Xosé Manuel Rey-Piñeiro
- MAPEX Project Working Group: Strategic Telepharmacy Framework, Spanish Society of Hospital Pharmacy. Spain Legal Department of the Spanish Society of Hospital Pharmacy. Spain.
| | - Eva Negro-Vega
- Department of Pharmacy, Getafe University Hospital, Getafe (Madrid). Spain. Madrid Regional Director of the Spanish Society of Hospital Pharmacy. Spain.
| | - Olga Delgado-Sánchez
- Department of Pharmacy, Son Espases University Hospital, Palma de Majorca. Spain. Chair of the Spanish Society of Hospital Pharmacy. Spain.
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Margusino-Framiñán L, Illarro-Uranga A, Lorenzo-Lorenzo K, Monte-Boquet E, Márquez-Saavedra E, Fernández-Bargiela N, Gómez-Gómez D, Lago-Rivero N, Poveda-Andrés JL, Díaz-Acedo R, Hurtado-Bouza JL, Sánchez-Gundín J, Casanova-Martínez C, Morillo-Verdugo R. Pharmaceutical care to hospital outpatients during the COVID-19 pandemic. Telepharmacy. Farm Hosp 2020; 44:61-65. [PMID: 32533674 DOI: 10.7399/fh.11498] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hospital Pharmacy Service (HPS) in Spain have been impacted by the health crisis caused by the COVID-19 pandemic. Thus, the outbreak has forced HPSs to adapt their outpatient consultation services to Telepharmacy to optimize clinical outcomes and reduce the risk of contagion. The purpose of this article is to describe and analyze the experience of HPSs with outpatient Telepharmacy during the COVID-19 pandemic and expose the lessons learned. Measures have been adopted in on-site outpatient pharmacy clinics to prevent exposure of patients and professionals to the virus. These measures are based on national and international recommendations on social distancing and hygiene. With regard to remote outpatient pharmacy services, teleconsultation with drug dispensing has been promoted based on five basic procedures, each with its advantages and limitations: home drug delivery from HPSs, with the advantage of universal access and the limitation of entailing a substantial investment in resources; HPS coordination with primary care pharmacists, which requires no investments but with limited access to some geographic areas; HPS coordination with community pharmacists based on a large network of pharmacies, which requires the patient to go to the pharmacy, without confidentiality being guaranteed for any patient; geolocation and hospital-based medication dispensing, which provides universal access and direct traceability, but entails investment in human resources; and HPS coordination with associations of patients, which does not entail any additional cost but limits the information available on the diseases of society members. Three main lessons have been learned during the pandemic: the satisfactory capacity of HPS to provide outpatient pharmacy consultation services in the setting of a public health crisis; the usefulness of Telepharmacy for the clinical follow-up, healthcare coordination, outpatient counseling, and informed dispensing and delivery of medication (with a high level of satisfaction among patients); and the need to foster Telepharmacy as a complementary tool through a mixed model of outpatient pharmacy consultation service that incorporates the advantages of each procedure and adapts to the individual needs of each patient in a context of humanized healthcare.
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Affiliation(s)
| | | | | | - Emilio Monte-Boquet
- Servicio de Farmacia, Hospital Universitari i Politécnic La Fe, Valencia. España.
| | | | | | - David Gómez-Gómez
- Servicio de Farmacia, Hospital Universitario Marqués de Valdecilla, Santander. España.
| | | | | | - Rocío Díaz-Acedo
- Servicio de Farmacia, Hospital Universitario Virgen de Valme, Sevilla. España.
| | | | - Julia Sánchez-Gundín
- Servicio de Farmacia, Hospital Universitario Marqués de Valdecilla, Santander. España.
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Guzman Ramos MI, Manzano-García M, Robustillo-Cortés MDLA, Pineda JA, Morillo-Verdugo R. Effect on the adherence to concomitant medications after initiation of treatment with direct-acting antiviral agents against hepatitis C virus. Gastroenterol Hepatol 2020; 43:418-425. [PMID: 32279937 DOI: 10.1016/j.gastrohep.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 02/03/2020] [Accepted: 02/11/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Many patients with hepatitis C virus (HCV) have associated comorbidities that require complex treatments. We sought to determine the impact of treatment with direct-acting antiviral agents (DAAs) for HCV on adherence to prescribed concomitant medications for associated comorbidities and to identify predictors of non-adherence to comedications. PATIENTS AND METHODS HCV-infected patients treated with DAAs in a Spanish hospital between January 2015 and December 2016 and followed-up by the pharmacy unit were included in the study. Adherence to concomitant comedication prescribed before and during HCV therapy with DAAs was compared to adherence during the same number of weeks before DAA initiation. Demographic, clinical and pharmacotherapy variables were analyzed to determine factors associated with non-adherence. A multivariate regression model was created for prediction of non-adherence to concomitant medication. RESULTS Data from 214 patients using prescribed concomitant therapies were analyzed. Significant reduction on adherence to comedications was observed after initiation of DAA treatment compared with a similar period before therapy initiation (29.9% vs. 36.9%, p=0.032). The univariate analysis showed that polypharmacy and presence of vascular disease were associated negatively with adherence to concomitant medications (87.8%, p=0.006 and 84.7%, p<0.001, respectively). Multivariate analysis indicated that HIV/HBV coinfection was associated with adherence (OR 0.19; 95% CI 0.09-0.39), while polypharmacy was a predictor for non-adherence (OR 4.54; 95% CI 1.48-13.92). DISCUSSION Adherence to concomitant medications decreases in HCV-infected patients when DAA therapy is initiated. Polypharmacy is a predictor for non-adherence, while HIV/HBV coinfection reduce non-adherence rates. Polymedicated patients on DAAs might benefit from close follow-up and educational programmes to improve their adherence.
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