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Jerez de la Frontera, Spain

Horna O.,Servicio de Farmacia | Toyas C.,Servicio de Medicina Interna
Medicina Clinica | Year: 2013

Background and objective Roflumilast is a recently marketed drug, indicated for maintenance treatment of severe chronic obstructive pulmonary disease associated with chronic bronchitis in adult patients with a history of frequent exacerbations as add on to bronchodilator treatment. Material and methods The safety data of this drug have always been subjected to controversy and concerns. The Food and Drug Administration rejected the drug after the first evaluation, asking the company to clarify the adverse reactions during the investigation process, the European Medicines Agency approved the drug including a Risk Management Plan, designed to promote a safe use of the drug. Results During the first months after the marketing process, the Spanish Pharmacovigilance System has already been acquainted of several adverse events notifications; therefore, these patients may be closely monitored, mainly because of digestive and psychiatric disorders. Conclusions Here we report the case of a female patient who showed a serious digestive clinical profile and a severe weight loss, more than 25% of her initial weight, when a treatment with roflumilast was started. The suspicion of a side effect as the cause of the reported clinical profile and its resolution required 3 hospital admissions. © 2012 Elsevier España, S.L. All rights reserved.

Objective: To analyze the incidence of medication problems in an emergency department after incorporation of a pharmacist into the multidisciplinary team. Methods: Prospective observational study lasting 1 year. All patients in observation and preadmission beds were included. The pharmacist verified the patients' medication use and when problems came to light the team discussed them and came to an agreement on the recommended course of action. The reasons for problems and their seriousness were analyzed, along with patient characteristics (demographic and clinical) and the medical specialty involved. Results: A total of 1725 medication interventions in 950 patients (59.5% under the care of emergency physicians, 29.3% under another specialist physician's care, and 11.2% under a surgeon's care); 668 were therapeutic replacements and 1057 were medication errors. Problems affected the safety we seen in patients under an emergency physician's care (68%) (P<.05), while prescription problems were mainly in patients under a surgeon's care (48%) (P<.05). Agents affecting the cardiovascular system (27.3%) or the digestive tract (22.3%) were most often involved in problems. Most required a change in therapy or increased monitoring (71.1%). Seventy-eight percent of the problems were solved, and 11% could not be assessed (half in patients under an emergency physician's care) (P<.05). The incorporation of an emergency department pharmacist led to an estimated savings of 20% in medication costs. Conclusions: The emergency department has a high incidence of problems related to medication. Incorporating a staff pharmacist and training multidisciplinary teams are measures that help correct medication problems early and improve the cost-effectiveness of drug therapy.

Martinez Lopez I.,Hospital Universitari Son Espases | Do Pazo-Oubina F.,Servicio de Farmacia | Lozano Vilardell P.,Hospital Universitari Son Espases
Farmacia Hospitalaria | Year: 2011

Objective: The pharmacist must work with the clinical team across the continuum of care to develop and therefore improve the patient's quality of life. In this study, we present the results from a continuous pharmaceutical care programme for patients admitted to an angiology and vascular surgery department. Material and methods: A 5-month prospective study to evaluate the results of a pharmaceutical care programme in an angiology and vascular surgery department. The pharmacist went on the rounds with the clinical team from Monday to Friday and helped make decisions on treatment, and detect and resolve conciliation discrepancies upon admission and discharge, and drug-related problems during the hospital stay. Results: We detected and resolved 273 conciliation discrepancies in 99 patients and 76 drug-related problems in 46 patients. Global acceptance of pharmacist interventions was 96%. Conclusions: Seventy-four percent of patients presented conciliation discrepancies. Efficiency of pharmaceutical activity across the continuum of care is demonstrated by the high acceptance of the interventions. © 2011 SEFH. Published by Elsevier España, S.L. All rights reserved.

Background: Calcium supplements and vitamin D are involved in current debates of health, as cardiovascular safety of calcium, and correction of vitamin levels. The aim is to review the possibilities of making better use of supplements marketed in Spain, depending on their availability, information and related epidemiology. Methods: Analysis of comercial offer and available information about pharmacological aspects of Spanish medicinal supplements in data-sheets (39), guides and reports current institutional and professional, with additional search of this information and epidemiological data related Spanish in Cochrane Database of Systematic Reviews ®, Pub-Med ® (tool "Clinical Queries"), Dialnet database and hand search of Spanish journals directly related. Results: There is no uniformity in terms of indication, expression of content, dosages, precautions and safety in data sheets or technical reports. The literature search found more recent publications volume for vitamin D than calcium, No evidence was found to establish appropriate dosing regimens indisputable or universal, or cholecalciferol bioavailability tests with aqueous vehiculización. In Spain nutritional situation is found generally suitable for the calcium but a status mostly unsuitable for vitamin D with several references for insufficiency and vitamin deficiency in adults. Corrective treatments primarily affect calcium supplements. Conclusions: There is an ample supply of calcium and vitamin D in Spain, whose drug design should rethink because don't respond to the needs identified or correction possibilities currently recommended. It should also improve and update their information, with particular interest in health status related to hypovitaminosis D.

Objectives: To describe the monthly costs of drugs per standardized patient in the Doctor Peset health department in Valencia, Spain and to correlate them with the computerization of prescription in primary care clinics using time series analysis. Other objectives were to identify internal causes that could explain the variations observed, and to evaluate the drug costs associated with these variations. Material and methods: Observational and retrospective study to analyse the variables: a) monthly costs of drugs by standardized patient and b) number of defined daily doses (DDD) per 1000 inhabitants and per day of drugs used to prevent cardiovascular risk prescribed by the Primary Care doctors of the Doctor Peset health department in Valencia, between January 2001 and August 2009. Time series were adjusted using ARIMA models. The impact of computerization was assessed using an intervention analysis on time series. Results: ARIMA models for the monthly costs of drugs by standardized patient shows that this indicator was increased by 4.9% in August 2007. The modelling of daily DDD per 1000 inhabitants showed an increase of 8.5% on the same date. Both increases occurred together with the introduction of the computerized prescription in Primary Care clinics. The pharmacoeconomic study estimated that drug costs associated with the trend changes increased by 11,365,409 euros within the period September 2007 to August 2009. Conclusions: The computerization of prescription in Primary Care clinics can be correlated with an increase in the monthly costs of drugs per standardized patient and with the number of daily DDD per 1000 inhabitants of drugs to reduce the cardiovascular risk by 4.5% and 8.5%, respectively. © 2009 SECA. Published by Elsevier España, S.L. All rights reserved.

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