Pilar García-Delgado

Diseño y pilotaje de un proceso estructurado para el servicio de dispensación de medicamentos

Resumen Objetivo Diseñar y pilotar un protocolo para el servicio de dispensación de medicamentos. Diseño Se partió de los requisitos propuestos en el Consenso de Atención Farmacéutica del Ministerio de Sanidad, se realizó una búsqueda bibliográfica y se aplicaron técnicas cualitativas de consenso. Para el pilotaje se realizó un estudio observacional transversal de marzo a junio de 2009. Emplazamiento 53 farmacias comunitarias de 24 provincias españolas. Participantes Pacientes que solicitaron uno o varios medicamentos concretos con o sin receta médica para uso propio o para alguien a su cuidado. Mediciones principales La información personalizada sobre el medicamento (IPM), los problemas relacionados con los medicamentos (PRM) y los resultados negativos asociados a la medicación (RNM) detectados por el farmacéutico en cada dispensación, así como la percepción de operatividad del farmacéutico sobre el protocolo. Resultados Se realizaron 870 dispensaciones, se detectaron 423 (48,6%) casos de falta de información en los que se ofreció IPM. En un 10,11% de las dispensaciones realizadas se detectaron PRM y 68 sospechas de RNM (7,81%): de seguridad (n = 35; 51,5%), efectividad (n = 29; 42,6%) y necesidad (n = 4; 5,8%). El 65,21% de los farmacéuticos afirmaron que el proceso estructurado es operativo. Conclusiones El protocolo diseñado permite detectar las carencias de información del paciente sobre sus medicamentos, así como los PRM y RNM siendo una herramienta fácil de utilizar y aplicable.OBJECTIVE The aim of this article is to design and pilot a protocol for the dispensing of medications service. DESIGN Using the requirements proposed in the Ministry of Health Pharmaceutical Care Consensus, a literature search was made applying qualitative consensus techniques. An observational, cross-sectional study was conducted from March to June 2009. SETTING A total of 53 community pharmacies from 24 Spanish counties. PARTICIPANT Patients who requested one or more particular medications with or without medical prescription for their own use or for someone in their care. MAIN MEASUREMENTS The personalised medication information (IPM), the problems associated with the medications (PRM), and the negative results associated with the medication (RNM), detected by the pharmacist each time medication was dispensed, as well as the perception of the pharmacist on the operability of the protocol were recorded. RESULTS A total of 870 medications were dispensed, with 423 (48.6%) cases of lack of personalised medication information (IPM) being detected. PRM were detected in 10.11% of the dispensed medications, as well as 68 (7.81%) suspected RNM: safety (n = 35; 51.5%), effectiveness (n = 29; 42.6%) and necessity (n = 4; 5.8%). Almost two-thirds (65.21%) of the pharmacists said that the protocol is in operation. CONCLUSIONS The designed protocol helped to detect deficiencies in the information to the patients about their medications, as well as the PRM and RNM, and is shown to be tool that is easy to use and apply.

Prevalence and predictors of inadequate patient medication knowledge.

Objectives To assess medication knowledge in adult patients and to explore its determinants. Method Cross-sectional study. Medication knowledge was the primary outcome and was assessed using a previously validated questionnaire. A multivariate logistic regression analysis was performed to explore the association between medication knowledge and the factors included in the model. Results Seven thousand two hundred seventy-eight patients participated in the study. 71.9% (n = 5234) (95% CI: 70.9%–73.0%) of the surveyed patients had an inadequate knowledge of the medication they were taking. The dimensions obtaining the highest level of knowledge were the ‘medication use process’ and ‘therapeutic objective of medication’. The items ‘frequency’ (75.4%), ‘dosage’ (74.5%) and ‘indication’ (70.5%) had the highest percentage of knowledge. Conversely, ‘medication safety’ represented the dimension with the lowest scores, ranging from 12.6% in the item “contraindications” to 15.3% in the item ‘side effects’. The odds ratio (OR) of having an inadequate medication knowledge increased for unskilled workers (OR: 1.33; 85% CI:1.00–1.78; P = 0.050), caregivers (OR:1.46; 95% CI:1.18–1.81; P < 0.001), patients using more than one medication (OR: 1.14; 95% CI: 1.00–1.31; P = 0.050) and patients who did not know the name of the medication they were taking (OR: 2.14, 95% CI: 1.71–2.68 P < 0.001). Conclusion Nearly three quarters of the analysed patients had inadequate knowledge regarding the medicines they were taking. Unskilled workers and caregivers were at a higher risk of lacking of medication knowledge. Other factors that correlated with inadequate medication knowledge were the use of more than one drug and not knowing the name of the medication dispensed.

Validación del cuestionario de medida del conocimiento del paciente sobre su medicamento adaptado al portugués

The scope of this study was the validation of a cross-culturally adapted questionnaire into Portuguese in five community pharmacies in Portugal. The discriminatory power of items, content and construct validity and factor analysis of the main components and their reliability and stability were determined. A high degree of semantic equivalence between the original questionnaire and the cross-culturally adapted questionnaire into Portuguese was observed. A Kaiser-Meyer-Olkin index of 0.550 was obtained and the Bartlett sphericity test confirmed the adequacy of the data for the application of factor analysis (p <0.0001). Three factors which accounted for 52.6% of the total variability were considered. With respect to reliability the following results were obtained: 0.519 for Cronbachs alpha test; 0.89 for Cohens kappa coefficient; and 0.756 (IC=0.598-0.963) for the CCI exam. In this work, the first adaptation for the Portuguese culture of a specific questionnaire was produced to measure the degree of knowledge patients have about their medication.

Validation of a simple screening tool for early diagnosis of advanced Parkinson’s disease in daily practice: the CDEPA questionnaire

Early clinical diagnosis of advanced Parkinson’s disease (APD) may be difficult. This study aimed to validate a simple screening tool, the CDEPA questionnaire (“Cuestionario De Enfermedad de Parkinson Avanzada” [Questionnaire for Advanced Parkinson’s Disease]), for the identification of APD in daily practice. The study included 173 consecutively selected patients with PD (40% were women, mean age was 68.4 ± 10.5 years), stratified according to the Hoehn and Yahr (HY) scale. The CDEPA questionnaire defined APD as the presence of severe disability requiring help for activities of daily living (ADL), motor fluctuations with limitation or inability to perform ADL, severe dysphagia, recurrent falls, or dementia. The diagnostic performance of the questionnaire was assessed against the gold standard criterion based on clinical judgment. PD was categorized as advanced in 65 (38%) patients when using the gold standard and in 109 (63%) patients when the CDEPA questionnaire was used. The CDEPA questionnaire and the gold standard agreed moderately (kappa statistic of 0.48, P < 0.001). The CDEPA classified APD with a sensitivity of 97%; specificity of 57%; total accuracy of 72.3%; and area under the curve (for a binary classifier) of 77.2%. Significant differences were found between the groups created by the CDEPA in several usual PD evaluations (HY Scale, SCOPA Motor Scale, Non-motor Symptoms Scale for PD, Clinical Impression of Severity Index for PD, Clinical Global Impression–Severity Scale, and Patient Global Impression–Severity Scale). CDEPA showed satisfactory inter-rater agreement (kappa = 0.88) and test–retest concordance (kappa 0.83). In conclusion, the CDEPA questionnaire is a valid, reliable, and useful instrument for easily screening APD.Questionnaire aids diagnosis of advanced diseaseA Spanish questionnaire for advanced Parkinson’s disease, CDEPA, is a reliable tool for identifying patients with late-stage PD. Patients with advanced PD have severe motor and non-motor symptoms, and show poor response to conventional therapies. Early diagnosis is the key to determine which patients will benefit from the alternative treatment options such as deep brain stimulation. A study led by Pablo Martinez-Martin at the Carlos III Institute of Health in Madrid compared the accuracy of advanced PD diagnosis using the CDEPA questionnaire and a neurologist’s clinical judgment. The diagnostic accuracy of the questionnaire was >70% and the questionnaire results agreed with the diagnosis of advanced PD based on clinical judgment in 97% of cases. This quick and easy-to-administer questionnaire could be highly valuable for detecting advanced PD in outpatient clinics.