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      Intervención farmacéutica en el manejo de inhaladores con pacientes EPOC citados para una espirometría en un centro de salud Translated title: Pharmaceutical intervention in the usage of inhalers with COPD patients that have an appointment in a health center to do an spirometry

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          Abstract

          Resumen Antecedentes: el uso de los inhaladores es algo complejo, con este trabajo en pacientes con EPOC debido a su complejidad, lo que se pretende es que tras la intervención de un farmacéutico se garantice el uso adecuado de dichos medicamentos con el fin de mejorar la calidad de vida. Métodos: se citaba a los pacientes para la realización de una espirometría por parte de la enfermera y por otro lado la farmacéutica en una consulta valoraba el uso de los inhaladores y realizaba los test de adherencia y calidad de vida. A los tres meses los pacientes acudían a la segunda visita y la farmacéutica repetía el mismo el proceso para detectar los posibles cambios tras la intervención. Resultados: en aquellos pacientes que acudieron a las dos visitas se observó que había cambios estadísticamente significativos entre las puntuaciones de adherencia en la primera visita respecto a la segunda. La media de puntuaciones es mayor en la segunda visita (49,09) respecto a la primera (46,45), diferencia significativa con una p<0,05. La calidad de vida era igual en ambas visitas y la media de errores en el uso de inhaladores en la segunda visita (1,773) se reduce de forma significativa respecto a la media de errores en la primera visita (4,727). Conclusiones: la intervención de un farmacéutico en un equipo multidisciplinar para el seguimiento de pacientes EPOC ha resultado beneficiosa para dichos pacientes, sobre todo en cuanto al manejo de los inhaladores y la adherencia al tratamiento.

          Translated abstract

          Abstract Background: the usage of inhalers is something complex. This work with COPD patients pretends that, after the pharmacist intervention, the correct usage of these drugs is guaranteed so as to improve the quality of life. Methods: the nurse set a date to do an spirometry to the patients. On the other hand, the pharmacist assessed the usage of the inhalers and carried out the adherence and quality of life tests. Three months after, the patients came back to the consultation and the pharmacist repeated the same procedure to detect any possible change after the intervention. Results: on those patients that attended both appointments, it was seen that there were statistically significant changes between the adherence punctuation regarding both appointments. The average of punctuation is higher in the second appointment (49.09) in respect to the first one (46.45), this is a significant difference with a p<0.05. The quality of life was the same in both appointments and the errors average in the usage of inhalators in the second appointment decreased (1773) significantly in respect to the errors average in the first appointment (4727). Conclusion: the intervention of a pharmacist in a multidisciplinary team to the following of COPD patients is advantageous to these patients, mainly in relation to the usage of inhalers and the adherence to treatment.

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          Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities.

          This study aimed to determine the prevalence of chronic obstructive pulmonary disease (COPD) in Spain and identify the level of undiagnosed disease and its impact on health-related quality of life (HRQL) and activities of daily living (ADL). A population-based sample of 4274 adults aged 40-80 years was surveyed. They were invited to answer a questionnaire and undergo prebrochodilator and postbronchodilator spirometry. COPD was defined as a postbronchodilator FEV(1)/FVC (forced expiratory volume in 1 s/forced vital capacity) ratio of <0.70. For 3802 participants with good-quality postbronchodilator spirometry, the overall prevalence of COPD was 10.2% (95% CI 9.2% to 11.1%) and was higher in men (15.1%) than in women (5.6%). The prevalence of COPD stage II or higher was 4.4% (95%CI; 3.8%-5.1%). The prevalence of COPD increased with age and with cigarette smoking and was higher in those with a low educational level. A previous diagnosis of COPD was reported by only 27% of those with COPD. Diagnosed patients had more severe disease, higher cumulative tobacco consumption and more severely impaired HRQL compared with undiagnosed subjects. However, even patients with undiagnosed COPD stage I+ already showed impairment in HRQL and in some aspects of ADL compared with participants without COPD. The prevalence of COPD in individuals between 40 and 80 years of age in Spain is 10.2% and increases with age, tobacco consumption and lower educational levels. The rate of diagnosised COPD is very high and undiagnosed individuals with COPD already have a significant impairment in HRQL and ADL.
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            Effectiveness of pharmaceutical care for patients with chronic obstructive pulmonary disease (PHARMACOP): a randomized controlled trial.

            Few well-designed randomized controlled trials have been conducted regarding the impact of community pharmacist interventions on pharmacotherapeutic monitoring of patients with chronic obstructive pulmonary disease (COPD). We assessed the effectiveness of a pharmaceutical care programme for patients with COPD. The pharmaceutical care for patients with COPD (PHARMACOP) trial is a single-blind 3 month randomized controlled trial, conducted in 170 community pharmacies in Belgium, enrolling patients prescribed daily COPD medication, aged ≥ 50 years and with a smoking history of ≥ 10 pack-years. A computer-generated randomization sequence allocated patients to an intervention group (n = 371), receiving protocol-defined pharmacist care, or a control group (n = 363), receiving usual pharmacist care (1:1 ratio, stratified by centre). Interventions focusing on inhalation technique and adherence to maintenance therapy were carried out at start of the trial and at 1 month follow-up. Primary outcomes were inhalation technique and medication adherence. Secondary outcomes were exacerbation rate, dyspnoea, COPD-specific and generic health status and smoking behaviour. From December 2010 to April 2011, 734 patients were enrolled. Forty-two patients (5.7%) were lost to follow-up. At the end of the trial, inhalation score [mean estimated difference (Δ),13.5%; 95% confidence interval (CI), 10.8-16.1; P < 0.0001] and medication adherence (Δ, 8.51%; 95% CI, 4.63-12.4; P < 0.0001) were significantly higher in the intervention group compared with the control group. In the intervention group, a significantly lower hospitalization rate was observed (9 vs. 35; rate ratio, 0.28; 95% CI, 0.12-0.64; P = 0.003). No other significant between-group differences were observed. Pragmatic pharmacist care programmes improve the pharmacotherapeutic regimen in patients with COPD and could reduce hospitalization rates. © 2013 The British Pharmacological Society.
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              Adherence to asthma therapy in elderly patients.

              To assess the adherence to antiasthmatic therapy by the use of questionnaire and objective methods in elderly people, as well as to evaluate the association between cognition, depressive symptoms, functional status, and compliance. Patients aged 65 to 102 with chronic asthma under therapy were analyzed retrospectively to evaluate adherence using the Modified Morisky (MM) scale and a visual analog scale (VAS). In the second part of the study, a 1-year monitoring of asthma based on electronic diary and assessment of drug usage was performed. The MM scale and VAS as well as the estimation of cognition, depression symptoms, and functional status were carried out at the beginning and at the end of the observations. Among 117 participants at the beginning of the study, only 9% and 21% had high adherence to therapy according to the MM scale and VAS, respectively. After 1 year of monitoring, the compliance assessed by the MM scale increased from 3.08 +/- 0.97 to 3.85 +/- 1.01 and by the VAS from 44% +/- 7.8% to 90% +/- 5.9%. Adherence by electronic diary and drug packages was lower than in both MM scale and VAS. Cognition status correlated with the results of MM and VAS tests but did not influence other methods of assessment. There was a statistical correlation between depression symptoms, cognition, and adherence (p >.01) in contrast to functional status. Compliance correlated with asthma control tests and PEFR. Low adherence to antiasthmatic treatment is common in elderly people. Proper monitoring of asthma by the use of diary or assessment of drugs packages with estimation of depression symptoms and cognition status could increase the compliance and asthma control in this group of patients.
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                Author and article information

                Journal
                pharmcare
                Pharmaceutical Care España
                Pharm Care Esp.
                Fundación Pharmaceutical Care España (Barcelona, Barcelona, Spain )
                1139-6202
                2794-1140
                April 2023
                : 25
                : 2
                : 34-49
                Affiliations
                [3] Malaga orgnameCosta del Sol Health Care Area orgdiv1Health care Arroyo de la Miel Spain
                [5] Andalucía orgnameUniversidad de Granada orgdiv1Faculty of Pharmacy, Cathedratic Department of Pharmaceutical Care Spain
                [1] Madrid orgnameHealth care Federica Montseny Spain
                [2] Malaga orgnameCosta del Sol Health Care Area Spain
                [4] Malaga orgnameCosta del Sol Health Care Area orgdiv1Health care Arroyo de la Miel Spain
                [6] Andalucía orgnameUniversidad de Málaga orgdiv1Faculty of Health Sciencies Spain
                Article
                S2794-11402023000200004 S2794-1140(23)02500200004
                10.60103/phc.v25i2.804
                e97cd258-f3cb-48e0-b951-9e69f4df72bc

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 07 February 2023
                : 27 January 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 16
                Product

                SciELO Spain

                Categories
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                EPOC,Pharmaceutical Care,pharmacist,inhalers,adherence,COPD,adherencia inhaladores,Atención Farmacéutica,farmacéutico

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