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      Implantación y desarrollo de un programa de conciliación farmacoterapéutica en paciente prequirúrgico del Servicio de Otorrinolaringología: proyecto QonciliaX Translated title: Implantation and development of a pharmacotherapy reconciliation program in the presurgery otorhinolariyngology patient: QonciliaX program

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          Abstract

          Resumen Introducción: El objetivo del estudio es diseñar un procedimiento normalizado de trabajo (PNT) de conciliación prequirúrgica en paciente de otorrinolaringología (ORL) con hospitalización convencional. Material y métodos: El diseño del PNT se realizó en varias fases. Fase 1: revisión bibliográfica; Fase 2: selección de pacientes candidatos, definición de responsabilidades, establecimiento del circuito de trabajo y elaboración del PNT, planificación de la consulta de farmacia; Fase 3: aprobación del PNT; Fase 4: sesiones informativas/formativas a los servicios implicados. Resultados: 1. la selección de pacientes candidatos será realizada por ORL; 2. Citación de pacientes candidatos en la consulta de farmacia previa a la consulta de preanestesía; 3. Consulta de farmacia, se obtendrá el listado farmacoterapéutico y se valorará la adherencia junto con recomendaciones dirigidas al anestesista, otorrino y médico de primaria (MAP); 4. Elaboración de un informe de conciliación; 5. En la consulta de preanestesía, el anestesista podrá consultar el informe de farmacia; 6. Durante el ingreso del paciente en el hospital, el otorrino podrá consultar el informe de farmacia; 7. Alta del paciente, en la que se le entregará un informe con recomendaciones para el MAP y un plan horario con indicaciones sobre administración de medicación. Discusión: La elección de pacientes de otorrino se basa en el hecho de tratarse de pacientes con patologías crónicas y comorbilidades y podrían beneficiarse por tanto de una atención farmacéutica. La integración de diversos profesionales en un equipo multidisciplinar permite mejorar y protocolizar el procedimiento de trabajo. Integra el ámbito de primaria y especializada mejorando de este modo la continuidad asistencial.

          Translated abstract

          Abstract Introduction: The main target of the proyect is to design a Standard Operational Process (SOP) of presurgery medication reconciliation on otorhinolaryngology patients with coventional hospitalization. Material and methods: The SOP design was performed in several stages. Stage 1: bibliography review; Stage 2: candidate patient selection, responsability assignments, establishment of a working circuit, SOP elaboration, pharmacy consultory planification; Stage 3: SOP approval; Stage 4: informative/formative sessions directed to the involved departments. Results: 1. Otorhinolaringoloty department will carry candidate patient selection; 2. Candidate patients pharmacy consultory appointment previous to preanesthetic consultory; 3. Pharmacy consultory, in which it will be acquired the pharmacotherapy patient list and adherence evaluation along with pharmacology recommendations directed to the anesthesiologist, otolaryngologist and primary care physician; 4. Medication reconciliation report preparation; 5. In the preanesthesic consultory, the anesthesiologist will be able to consult the pharmacy report; 6. Patient admission, during this period, the otolaryngologist may use of the pharmacy report; 7. During patient hospital discharge, the patient will be delivered a report with recommendations for the primary care physician and a mediation schedule with medication administration indactions. Discussion: Otolaryngologist patients selection is based on the fact that it is a group of patients with chronic pathologies and comorbilities and therefore, they could benefit from a pharmaceutical care. Divers professionals integration in a multidisciplinary work team, allows to improve and protocolize a Standard Operational Process. It integrates primary and specialist care, improving care continuity.

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          Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study.

          To assess the effectiveness of the simplified medication adherence questionnaire (SMAQ) in identifying non-adherent patients. Prospective observational study of adherence. The six-item SMAQ was developed. The following aspects were evaluated: (i) criterion validity, comparison with electronic adherence monitoring; (ii) construct validity, association between adherence, as defined by the SMAQ, and virological outcomes; and (iii) reliability, internal consistency and reproducibility. A group of 3004 unselected HIV patients who had initiated nelfinavir therapy combined with other antiretroviral drugs [21% naive, 15% protease inhibitor (PI)-naive, 64% PI-experienced] between January 1998 and December 1999 were enrolled in 69 hospitals in Spain. The SMAQ was administered at months 3, 6 and 12. The SMAQ showed 72% sensitivity, 91% specificity and a likelihood ratio of 7.94 to identified non-adherent patients, compared with the medication-event monitoring system (40 patients evaluated). At month 12, 1797 patients were evaluated, of whom 32.3% were defined as non-adherent; viral load 5 log10/ml, CD4 cell count < 200 x 10(6)/l, and non-adherence as independent variables. Non-adherence was the only significant risk factor in failing to achieve virological suppression. Cronbach's alpha internal consistency coefficient was 0.75, and overall inter-observer agreement was 88.2%. The SMAQ appears to be an adequate instrument with which to assess adherence in HIV-infected patients, and may be applied in most clinical settings.
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            Polypharmacy in a general surgical unit and consequences of drug withdrawal.

            To identify drug usage/withdrawal in surgical patients and the relative risk this imposes on postoperative surgical complications. A prospective survey of patients' medicines, oral intake (food/fluids/ medicines) and postoperative complications was carried out in the General Surgical Unit, Dunedin Hospital, Dunedin, New Zealand. One thousand and twenty-five general surgical patients aged >/= 16 years, were entered into the study. Half of the patients were taking medicines unrelated to surgery. On average these patients received 9 different drugs (range 1-47) from a selection of 251, of which 21% were released in the last 10 years. The mean number of these drugs taken increased with age, vascular surgery and other major procedures. The majority of patients (53%) were taking drugs for cardiovascular problems. Only 8% of admissions were on the drugs more traditionally recognized to be of importance to the surgery, i.e. steroids and diabetic therapy. With respect to risk, taking a drug unrelated to surgery was associated with an increased relative risk of a postoperative complication by 2.7 (95% C.I. 1.76-4.04) compared with those who were not taking any drug. Cardiovascular drugs contributed significantly to this risk; when they were excluded from analysis, the risk dropped to 1.8 (95% C.I. 1.14-2.93). Death may be more common in those taking ACE inhibitors. Drug withdrawal and complications were analysed and as the time without medicines increased (range 1-42 days) so did the complication rate (chi2 = 14.7, DF = 2, P = 0.007). Of those patients who were taking a cardiovascular medicine and were without their normal medicines for a period of time postoperatively, 12% suffered a cardiac complication. Many patients admitted to a general surgical ward, are taking medicines unrelated to surgery. Drug therapy unrelated to surgery is a useful predictor for increased postoperative complications and one for which preventive action can be taken. This study provides evidence that withdrawal of regular medicines may add significant risk to the surgery and further complicate outcome. The longer patients were without their regular medicines the more nonsurgical complications they suffered. Reintroduction of patients' regular medicines early in their postoperative course may decrease morbidity and mortality in-patients.
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              Guidelines for the management of chronic medication in the perioperative period: systematic review and formal consensus.

              The worldwide volume of surgery is huge and the number of interventions performed is increasing as a result of advances in technological resources and refinement of medical teams' expertise, in a progressively elderly and sick population. Consequently, half of the general surgical patients take medications unrelated to surgery. Evidence-based guidelines for perioperative medication management are therefore critically needed to improve safety in surgery. The purpose of this work was to develop practice recommendations for the management of chronic medication in the perioperative period. A systematic review and a formal consensus were performed. A search in Medline, Embase, ISI Web of Knowledge and Medscape were conducted in September 2008. Two independent investigators assessed the quality of selected studies. Evidence-based guidelines with strength classification were found for some therapeutic groups. Those guidelines were adopted and no further analysis was performed. For the other therapeutic groups, a formal consensus was used, based on a modified nominal group technique: 32 statements were formulated considering the literature retrieved. A selected panel of experts was asked by electronic mail to rate their level of agreement with each statement. Then, a meeting was convened and a second round survey was used to determine the final level of agreement. The statements which met the established criteria of consensus were developed into practice recommendations, supported by the results of the formal consensus and the evidence-based findings from systematic review. A total of 23 studies were included in the systematic review; three randomized controlled trials (RCTs), 13 cohorts, two case-controls and three clinic-cases. Twenty-two practice recommendations for the management of chronic medication in the perioperative period resulted from formal consensus. Epidemiological studies concerning the perioperative management of chronic medications are clinically heterogeneous and there are few RCTs available. However, the formal consensus method proved to be a helpful tool to integrate different strands of evidence for the development of practice guidelines. © 2010 Blackwell Publishing Ltd.
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                Author and article information

                Journal
                ofil
                Revista de la OFIL
                Rev. OFIL·ILAPHAR
                Organización de Farmacéuticos Ibero-Latinoamericanos (Madrid, Madrid, Spain )
                1131-9429
                1699-714X
                December 2021
                : 31
                : 4
                : 371-375
                Affiliations
                [2] Coslada orgnameHospital del Henares España
                [3] Coslada orgnameHospital del Henares España
                [4] Coslada orgnameHospital del Henares España
                [1] Coslada Madrid orgnameHospital Universitario del Henares España mgallego.hulp@ 123456salud.madrid.org
                Article
                S1699-714X2021000400008 S1699-714X(21)03100400008
                10.4321/s1699-714x2021000400008
                f30632cc-7fcc-4003-a587-54424411c451

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

                History
                : 03 July 2020
                : 28 May 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 12, Pages: 5
                Product

                SciELO Spain

                Categories
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                Conciliación medicación,Medication reconcilation,consulta farmacia,paciente preanestesia,pharmacy consultory,preanesthesic patient

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