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      Receta electrónica: diferencias entre comunidades autónomas que afectan al acceso a los tratamientos y a la calidad de la atención farmacéutica Translated title: Electronic prescription: differences between autonomous communities affecting access to treatment and the quality of pharmaceutical care

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          Abstract

          Resumen Fundamento Los sistemas de receta electrónica implantados en las distintas comunidades autónomas españolas presentan diferencias. Este trabajo trata de describir cómo afectan estas diferencias al acceso a los tratamientos y a la atención farmacéutica, y las características específicas que los facilitan. Métodos Se diseñó una encuesta para valorar los sistemas de receta electrónica que fue cumplimentada por los Centros de Información del Medicamento de los Colegios Oficiales de Farmacéuticos de todas las comunidades autónomas de España durante febrero y marzo de 2020. Resultados En todas las comunidades autónomas se registró alguna limitación respecto a la disponibilidad temporal del tratamiento, y en cinco de ellas se registraron incidencias relativas al modo de acceso a la receta electrónica. En ninguna comunidad las farmacias pueden resolver problemas de disponibilidad en circunstancias especiales, ni existe sistema de comunicación efectivo con el médico ni de registro de datos del paciente. Solo algunas comunidades gestionan determinadas sustituciones para adaptar la prescripción a los requerimientos del paciente. Conclusiones El sistema actual de receta electrónica podría optimizarse para evitar desigualdades entre comunidades autónomas y mejorar la calidad de la atención que reciben los pacientes, facilitando el acceso a los tratamientos y evitando desplazamientos y demoras. El acceso presentando solo la tarjeta sanitaria, la adaptación de las limitaciones temporales para evitar bloqueos, la dispensación en circunstancias especiales justificada y registrada por el farmacéutico, así como habilitar una comunicación eficiente farmacéutico-médico, son medidas generales que evitarían desigualdades y facilitarían el acceso a los tratamientos y la atención farmacéutica.

          Translated abstract

          Abstract Background The electronic prescription systems implemented in the different autonomous communities in Spain show differences. This study aims to describe how these differences affect access to treatment and pharmaceutical care, and what specific characteristics facilitate them. Methods A survey was designed to evaluate the electronic prescription systems. This survey was carried out at the Drug Information Centers of the Official Pharmacists' Colleges of all the Spanish autonomous communities during February and March 2020. Results In all autonomous communities there were some limitations regarding the temporary availability of the treatment, and incidents regarding the way of accessing the electronic prescription were recorded only in only five communities. In no community are pharmacies able to solve availability problems in special circumstances, nor is there any effective system for communicating with the doctor or recording patient data. Only some communities organize certain replacements to adapt the prescription to the patient's requirements. Conclusions The current electronic prescription system could be optimized to avoid inequalities between autonomous communities and improve the quality of care received by patients, facilitating access to treatment, and avoiding the need to travel and delays. Access on presenting the health card, adaptation of time limitations to avoid blockages, dispensing medicines in special circumstances justified and registered by the pharmacist, as well as enabling efficient pharmacist-doctor communication, are general measures that avoid inequalities and facilitate access to treatments and pharmaceutical care.

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          Most cited references25

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          Medication adherence: WHO cares?

          The treatment of chronic illnesses commonly includes the long-term use of pharmacotherapy. Although these medications are effective in combating disease, their full benefits are often not realized because approximately 50% of patients do not take their medications as prescribed. Factors contributing to poor medication adherence are myriad and include those that are related to patients (eg, suboptimal health literacy and lack of involvement in the treatment decision-making process), those that are related to physicians (eg, prescription of complex drug regimens, communication barriers, ineffective communication of information about adverse effects, and provision of care by multiple physicians), and those that are related to health care systems (eg, office visit time limitations, limited access to care, and lack of health information technology). Because barriers to medication adherence are complex and varied, solutions to improve adherence must be multifactorial. To assess general aspects of medication adherence using cardiovascular disease as an example, a MEDLINE-based literature search (January 1, 1990, through March 31, 2010) was conducted using the following search terms: cardiovascular disease, health literacy, medication adherence, and pharmacotherapy. Manual sorting of the 405 retrieved articles to exclude those that did not address cardiovascular disease, medication adherence, or health literacy in the abstract yielded 127 articles for review. Additional references were obtained from citations within the retrieved articles. This review surveys the findings of the identified articles and presents various strategies and resources for improving medication adherence.
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            Interventions for enhancing medication adherence.

            People who are prescribed self administered medications typically take only about half their prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications.
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              Interventions for enhancing medication adherence.

              People who are prescribed self-administered medications typically take less than half the prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications, but also might increase their adverse effects. To update a review summarizing the results of randomized controlled trials (RCTs) of interventions to help patients follow prescriptions for medications for medical problems, including mental disorders but not addictions. We updated searches of The Cochrane Library, MEDLINE, CINAHL, EMBASE, International Pharmaceutical Abstracts (IPA), PsycINFO (all via OVID) and Sociological Abstracts (via CSA) in January 2007 with no language restriction. We also reviewed bibliographies in articles on patient adherence and articles in our personal collections, and contacted authors of relevant original and review articles. Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive initial findings. Study design features, interventions and controls, and results were extracted by one review author and confirmed by at least one other review author. We extracted adherence rates and their measures of variance for all methods of measuring adherence in each study, and all outcome rates and their measures of variance for each study group, as well as levels of statistical significance for differences between study groups, consulting authors and verifying or correcting analyses as needed. The studies differed widely according to medical condition, patient population, intervention, measures of adherence, and clinical outcomes. Therefore, we did not feel that quantitative analysis was scientifically justified; rather, we conducted a qualitative analysis. For short-term treatments, four of ten interventions reported in nine RCTs showed an effect on both adherence and at least one clinical outcome, while one intervention reported in one RCT significantly improved patient adherence, but did not enhance the clinical outcome. For long-term treatments, 36 of 81 interventions reported in 69 RCTs were associated with improvements in adherence, but only 25 interventions led to improvement in at least one treatment outcome. Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up, and supportive care. Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes. For short-term treatments several quite simple interventions increased adherence and improved patient outcomes, but the effects were inconsistent from study to study with less than half of studies showing benefits. Current methods of improving adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized. High priority should be given to fundamental and applied research concerning innovations to assist patients to follow medication prescriptions for long-term medical disorders.
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                Author and article information

                Journal
                asisna
                Anales del Sistema Sanitario de Navarra
                Anales Sis San Navarra
                Gobierno de Navarra. Departamento de Salud (Pamplona, Navarra, Spain )
                1137-6627
                December 2020
                : 43
                : 3
                : 297-306
                Affiliations
                [1] Granada Andalucía orgnameUniversidad de Granada orgdiv1Programa de Doctorado en Farmacia Spain
                [2] Santander orgnameFarmacia Dr. José Daniel Carballeira Rodríguez España
                Article
                S1137-66272020000300002 S1137-6627(20)04300300002
                10.23938/assn.0880
                e2b3ed8b-9185-44d3-a564-ae7422c89f76

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 08 June 2020
                : 29 June 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 10
                Product

                SciELO Spain

                Categories
                Artículos Originales

                Autonomous communities,Receta electrónica,Atención farmacéutica,Desigualdades,Comunidades autónomas,Electronic prescription,Pharmaceutical care,Inequalities

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