Showing papers by "Fernando Martínez-Martínez published in 2011"

Comparison of the white-coat effect in community pharmacy versus the physician's office: the Palmera study.

Abstract: The aim of this study was to measure the community pharmacy white-coat effect (CPWCE) in treated hypertensive patients and to compare its magnitude with the WCE in the physician's office (POWCE). This cross-sectional study attempted to cover the treated hypertensive population, of more than 18 years of age and users of a rural CP located in Palmera (Valencia, Spain). Blood pressure (BP) was measured at three different settings, according to clinical guidelines: CP (three visits), PO (three visits), and home (4 consecutive days). The WCE was defined as the difference between the average CPBP or the average PO BP and the average home BP: CPWCE and POWCE, respectively. Differences between BP measurements were assessed by paired t-tests. The study sample consisted of 70 patients. The CPWCE was not significant, both for systolic BP (SBP) and for diastolic BP (DBP): 1.4 mmHg [standard deviation (SD): 11.3; 95% confidence interval (CI): -1.3 to 4.1] and -1.1 mmHg (SD: 7.5; 95% CI: -2.9 to 0.7), respectively. The POWCE was positive and statistically greater than 0 for SBP [13.3 mmHg (SD: 11.5); 95% CI: 10.5-16.0] and for DBP [2.4 mmHg (SD: 9.3); 95% CI: 0.2-4.6]. Finally, the POWCE was greater than the CPWCE both for SBP and for DBP (P<0.001). In this sample of treated hypertensive patients, the CPWCE was not statistically significant and was statistically lower than the POWCE.

Categorización de las farmacias españolas según la teoría de difusión de las innovaciones de Rogers en relacion a la práctica del seguimiento farmacoterapéutico.

Abstract: Introduccion: El presente estudio pretende categorizar las farmacias espanolas en funcion de su situacion en el proceso de decision-innovacion de Rogers en relacion a la provision del Seguimiento Farmacoterapeutico (SFT).Metodo: Se empleo un cuestionario, no validado, previamente utilizado con el mismo objetivo, mediante la tecnica de CATI. Las variables dependientes fueron las cinco fases del proceso de implantacion/adopcion de Rogers [Conocimiento (F-C); Persuasion (F-P); Decision (F-D); Implantacion (F-I); Mantenimiento (F-M)], a las que se sumo la fase previa al conocimiento (No conocen). Las farmacias en F-M se sub-categorizaron en funcion del numero de pacientes en Seguimiento, siempre que este fuera superior a 1: (F-M1) de 2 a 5 pacientes; (F-M2) 6 a 10 pacientes; (F-M3) 11 a 25 pacientes; (F-M4) 26 a 50; (F-M5) 51 a 100 y (F-M6) 101 o mas pacientes. Las farmacias con un unico paciente se incluyeron en F-I.Resultados: Se obtuvieron 1.135 respuestas (tasa de respuesta = 54%). Su distribucion segun el proceso de decision/innovacion de Rogers es la siguiente: No conocen (353; 31,1%); F-C (351; 30,9%); F-P (145; 12,8%); F-D (129; 11,4%); F-I (100; 8,8%); F-M (57; 5,0%). Las subcategorias en la F-M son: F-M1(15; 26,3%); F-M2 (12; 21,1%); F-M3 (10; 17,5%) F-M4 (10; 17,5%); F-M5 (4; 7,0%). Hay grandes diferencias entre las distintas CCAA siendo Aragon la que tiene mayor porcentaje de farmacias en F-I y F-M mientras que Cantabria es la que mayor desconocimiento refleja (50,0%) con un 0% en las F-I y F-M. Tambien se observa un 0% en F-M en La Rioja, Canarias y Asturias. La existencia de una ZAP se muestra como un facilitador para la realizacion del servicio y la presencia de un responsable del SFT parece que es importante para conseguir su mantenimiento una vez implantado el mismo.Conclusiones: A pesar de los esfuerzos realizados por diferentes organizaciones e instituciones para impulsar la implantacion y sostenibilidad del SFT, de acuerdo con los datos obtenidos es posible afirmar que este servicio se encuentra muy poco implantado en Espana. El hecho de que en la farmacia exista una zona de atencion personalizada (ZAP) se muestra como un elemento que facilita la implantacion del SFT. Por otra parte, la existencia de un farmaceutico responsable del servicio aparece como un elemento que permite la sostenibilidad del mismo una vez implantado. Es necesario modificar los objetivos de la formacion postgrado de los farmaceuticos. Esta debe estar menos orientada a aumentar el conocimiento y mas orientada a mejorar las habilidades y competencias, es decir, debe estar encaminada al cambio de comportamiento.

Percepción del paciente mayor polimedicado sobre el rol del farmacéutico comunitario

Abstract: Introduccion: Actualmente casi un 80% del gasto sanitario espanol corresponde a las personas mayores de 65 anos que, debidoa su pluripatologia, se convierten en pacientes polimedicados. El farmaceutico comunitario es uno de los agentes de salud que puede ayudar a controlar este gasto y mejorar la calidad deluso de los medicamentos debido a su cercania y accesibilidad, aunque actualmente solo se le reconozca un rol dispensador demedicamentos. Objetivos: Explorar la percepcion que tiene el paciente mayor polimedicado sobre el rol del farmaceutico. Material y metodos: Se utilizo un metodo exploratorio basado en la investigacion cualitativa, usando como medio de obtencion deinformacion la entrevista semiestructurada y como marcos teoricos la Teoria del Rol complementada con la Teoria de las Creenciasen Salud. Resultados: Los pacientes mayores polimedicados identifi cancon el rol de profesional sanitario principalmente a su medicode cabecera y al personal de enfermeria, relegando al farmaceuticoa funciones de indole menor y, sobre todo, con un rol dispensador de medicamentos y productos sanitarios, aunque resaltan la gran accesibilidad y la confi anza que tienen con este profesional. Conclusion: Los pacientes mayores polimedicados en Espana esperan del farmaceutico un buen trato y un rol dispensador. Esto puede deberse a la baja expectativa que se tiene del farmaceutico para realizar servicios profesionales distintos de los clasicos (dispensacion). Los farmaceuticos deberian empezar a cambiar su rol actual implantando servicios para que la percepciondel paciente cambie.

Role of the hospital pharmacy and therapeutics committee in detecting and regulating off-label drug use.

Abstract: Dear Sir, We have read the article published by Duran-Garcia et al. [1] and would like to congratulate the authors on their work. Moreover, based on our own experience, we would also like to highlight the importance of the role of the Pharmacy and Therapeutics Committee in detecting and regulating the ‘‘off-label’’ drug use in hospitals. Prescription-indication studies can be used to detect if medication is being used in ways other than those authorised by the drug regulatory agencies. This non-approved use is called ‘‘off-label’’ drug use [2]. Our work area focuses on cytostatic drugs, and we know that the ‘‘offlabel’’ use of these drugs become a common practice in some hospitals [3–5]. For example, Conde-Garcia M et al. [3] found that Rituximab was used to treat unauthorised diagnoses (18 diagnoses) in 37.1% of patients between 2003 and 2007. Additionally, Rituximab was used in unauthorised chemotherapy plans (use with other cytostatic drugs) and lines of treatment (order of preference for the treatment alternatives available) in a considerable number of cases. On the other hand, Vargas-Rivas et al. [4] found that Trastuzumab was used in patients (36.4% of cases) who did not have HER2-Overexpressing (HER2-Overexpressing is one of the requirements established by regulatory agencies for using this drug). When situations like these are detected, it is important to assess whether use of the medication is pertinent or suitable. To assess it, first it is necessary to search for scientific evidence supporting the use of drugs in these unauthorised conditions (‘‘off-label’’ use). If evidence is not found or may be of moderate/lowquality, new studies should be designed to evaluate the effectiveness of the ‘‘off-label’’ drug use, and, ideally, to evaluate the cost-effectiveness ratio of treatment. In the study by Conde-Garcia et al. [3], the off-label use of the CHOP-Rituximab plan to treat follicular lymphoma (48.1% of plans used in this diagnosis) was supported by the results of high-quality randomised clinical trials [6, 7]. As a result, the ‘‘off-label’’ use of CHOP-Rituximab during the study period was deemed reasonable. Moreover, this chemotherapy plan was later approved and authorised by the national drug regulatory agency. In other words, ‘‘offlabel’’ drug use could be sometimes the correct treatment approach and can have positive effects on patient health, even before this use is approved by regulatory boards. On these occasions, the work carried out by the hospital Pharmacy and Therapeutics Committee becomes particularly important, as one of its main objectives is to assess the suitability of the ‘‘off-label’’ drug use [1]. If high-quality scientific evidence supporting the ‘‘off-label’’ drug use is found, the committee can decide to authorise this use in the corresponding hospitals, accepting the entailed advantages and drawbacks. Furthermore, as we mentioned above, the evidence supporting the ‘‘off-label’’ drug use could be not found or may be of moderate/low-quality [3] (i.e. poor-quality randomised controlled trials and/or several phase II studies). This situation should be the starting point for well-designed studies, which could generate evidence for the benefit/risk ratio of treatments, and help us to decide whether the ‘‘offlabel’’ use of a certain drug could be suitable. In these studies, it is important to include a specialist physician in the research team. With this fact, we want to ensure that clinical outcomes are correctly assessed and interpreted, J. E. Vargas-Rivas (&) D. Sabater-Hernandez M. A. Calleja-Hernandez M. J. Faus F. Martinez-Martinez Pharm. D. Pharmaceutical Care Research Group, Grupo de Investigacion en Atencion Farmaceutica, University of Granada, Campus Universitario de Cartuja S/N, 18071 Granada, Spain e-mail: jevargasrivas@gmail.com

Exploración de las percepciones de los farmacéuticos comunitarios en la práctica del seguimiento farmacoterapéutico dentro del contexto del programa conSIGUE

Abstract: Introduccion: Para la realizacion del estudio principal del programa conSIGUE se han desarrollado dos fases prepiloto (Murcia y Granada) y una fase piloto (Cadiz), en las que han participado sesenta farmacias. Objetivos: Explorar la percepcion de los farmaceuticos participantes en estas fases sobre su experiencia como proveedores de seguimiento farmacoterapeutico, sobre las dificultades encontradas y las areas de mejora identificadas, en el contexto del programa conSIGUE. Metodo: Para la obtencion de informacion se eligio el grupo focal.Todos los grupos focales tuvieron lugar en las sedes de lostres colegios de farmaceuticos, y en todos los casos participaronel mismo coordinador y la misma observadora. Las reuniones segrabaron y se transcribieron integramente. Se realizo un analisisde contenido utilizando el software NVivo®. Resultados: Se realizaron un total de ocho grupos focales. Las mayores dificultades para la realizacion del servicio son la falta de tiempo, de personal y la falta de formacion y experiencia clinica para realizar las diferentes intervenciones. El seguimiento permite mejorar la organizacion interna de la farmacia, la relacion entre los miembros del equipo, conocer mejor Bot Plus, superar el miedo a relacionarse con los medicos y modificar el tipo de relacion con los pacientes. Ademas, produceuna importante satisfaccion personal. Los formadores colegialesson valorados muy positivamente. Conclusiones: La figura del formador colegial es de gran interes tanto en los momentos iniciales de implantacion del servicio como en su sostenibilidad en el tiempo, ya que permite solucionar los problemas que surgen en la practica del seguimiento.

Percepción del paciente mayor polimedicado sobre el rol del farmacéutico comunitario Perception of the polymedicated elderly patient about the community pharmacist's role

Abstract: Introduction: Nowadays, almost 80 percent of the health expenditure in Spain corresponds to people over 65 years of age as a result of their multiple pathology, have become polymedicated patients. Community pharmacists are community health workers who can help to control this expense and improve the quality of use of the medications due to the proximity and approachability although nowadays they are only known in their role as the medication dispenser.

Pharmacist experience of delivering medication reviews with follow up within the project conSIGUE

Abstract: Introduction: Prior to undertaking a main study, “conSIGUE” 60 pharmacies participated in two pre-pilot phases (Murcia y Granada) and one pilot (Cadiz). Correspondencia: M.A. Gastelurrutia. Paseo de Larratxo, 98. 20017 Donostia. Correo electronico: magastelu@medynet.com Exploracion de las percepciones de los farmaceuticos comunitarios en la practica del seguimiento farmacoterapeutico dentro del contexto del programa conSIGUE Pharmacist experience of delivering medication reviews with follow up within the project conSIGUE M.A. Gastelurrutia1, E. Feletto1, M.aA. Noain1, F. Martinez-Martinez1, R. Varas2, S.I. Benrimoj3 1Grupo de Investigacion en Atencion Farmaceutica de la Universidad de Granada. 2Consejo General de Colegios Ofi ciales de Farmaceuticos de Espana. 3University of Technology. Sydney (Australia)

adherence and blood pressure control in treated hypertensive patients: Rationale, design and methods of the AFenPA pilot study.

Abstract: Objective: To assess the effect of a protocol-based pharmacist intervention on blood pressure control and medication adherence among treated hypertensive patients who are users of community pharmacies. Methods: A quasi experimental study design with control group has been designed to compare the effect of pharmaceutical intervention (intervention group) versus the standard healthcare procedure (control group) on blood pressure and medication adherence among hypertensive patients receiving drug therapy in community pharmacies. The patients will be allocated evenly between the two groups (ncontrol = nintervention), with a 6-month follow-up. The pharmaceutical intervention program will comprise three main parts: 1) patient education / information on issues relating to hypertension and medication adherence; 2) self-monitoring of blood pressure; and 3) interaction with the physician through personalized reports when the mean blood pressure values recorded at home exceed the treatment goal according to the clinical condition of the patient. In order to evaluate the effect of the pharmaceutical intervention upon medication adherence and blood pressure, blood pressure recordings will be made in the pharmacy, while percent medication adherence will be established based on pill count in both groups at the start and end of the study. Discussion: To our knowledge, this is the first study in the community pharmacy setting in Spain to evaluate the effectiveness of pharmaceutical intervention in combination with home blood pressure monitoring on blood pressure control. In addition, the pharmaceutical intervention has been designed for inclusion as standard practice in the context of Pharmaceutical Care.