que la mortalidad a largo plazo esté relacionada sobre todo con la recidiva de la enfermedad actuaciones en una guía de seguimiento del paciente trasplantado. . documento recoge recomendaciones farmacoterapéuticas, de autocuidado, de . de las guías. • Algunos pacientes pueden comenzar con una diabetes de. Efectividad del seguimiento farmacoterapéutico en diabéticos tipo 2 clínica, se obtuvo información sobre medicamentos antidiabéticos utilizados, dosis, .. Guías ALAD de diagnóstico, control y tratamiento de la diabetes mellitus tipo 2. Objetivos: Realizar un seguimiento farmacoterapéutico y educar a pacientes conocimiento sobre la menopausia y la THR en pacientes menopaúsicas. Keywords: Hormone . ministerial que generará Guías Clínicas y tratará . stock de éste por el laboratorio que los produce. Diabetes. 38%. Depresión.
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To determine the effectiveness of pharmaceutical care to improve control of type-2 diabetes mellitus. Through an interview and evaluation of medical records, we obtained information about antidiabetic medications used, doses, other medications, along with Hemoglobin A1c level, arterial pressure, serum low-density lipoprotein cholesterol level, nephropathy screening, retinal screening, foot exams in the last year and problems associated with medication use by means of the DADER method Negative Outcomes Associated with Medication NOM.
The study had a sample of patients 64 intervened and 79 controls with female predominance The patients in both groups were taking an average of 6. Initial HbA1c mean was 7. The mean cost per patient in controls was 1. Increased effectiveness of the antidiabetic therapy was not demonstrated in patients intervened with pharmacotherapeutical monitoring, but we did obtain a reduction in healthcare costs. Diabetes mellitus; Glucosylated hemoglobin A; Hypoglycemic agents; Pharmaceutical services; Colombia.
Participaron pacientes, 64 intervenidos y 79 controles, con predominio de mujeres Los pacientes de ambos grupos tomaban en promedio 6. La HbA1c inicial tuvo un promedio de 7.
El cociente medio del costo por paciente en el grupo control fue 1. Diabetes mellitus DM is an increasingly occurring disease, which generates important complications that affect the quality of life of patients; hence, its care generates high costs, given that it is a disease of utmost interest for public health. DM affects million individuals around the world, million are in America, and nearly million are in Latin America and the Caribbean. It is calculated that by there will be million diabetics in the world and million of these will live in our continent 1 – 3.
Universidad de Granada Grupo de Investigación en Atención Farmacéutica [WorldCat Identities]
Diabetic patients do not adequately adhere to pharmacological or nutritional treatment, or to the recommended physical activity, which are required to reach a suitable metabolic control, leading to the emergence of micro and macrovascular complications 4. To reduce health complications and costs in healthcare systems, strategies have been sought to contribute to such aims and which directly involve the pharmacist through a pharmaceutical care program, developed by Hepler and Strand in 8 ; its objective is the optimization of the clinical results of the drug therapy, improvement of patient quality of life, contribution to the rational use of medications, and detection, prevention, and solution to Negative Outcomes Associated with Medication NOM 9 Pharmacotherapeutic Monitoring PTM is defined as the professional practice in which the pharmacist assumes responsibility for the needs of the patient related to medications.
It is a useful tool for contributing to the adequate use of medications and guaranteeing their safe, effective, and economic use.
All this based on good communication and cooperation between the patient and health personnel 9. NOM are classified into farmacoterapeutkco of necessity, effectiveness, and safety; necessity Farmaocterapeutico include untreated health gula and guis effects of unnecessary medications, segkimiento NOM include the quantified and non-quantified ineffectiveness, and safety NOM include quantified and non-quantified lack of safety 9 There is evidence in different countries around the world that the lack of NOM detection and solution may lead to additional costs in the healthcare system.
A study conducted in Spain in found that three out of every four patients admitted to emergengy services were because of an NOM 11 There is also evidence in that the results of pharmaceutical care may lead to reduced utilization of healthcare services and to a lower number of medications prescribed In Colombia sufficient evaluations have not been conducted on the results of pharmaceutical care.
Given that different studies have not been able to show the efficacy of pharmacotherapeutic monitoring to better control the disease and even reduce healthcare costs, we suggest the need for said intervention to aid in optimizing the benefits in healthcare services for patients with chronic treatments. A study was developed to permit determining the efficacy of pharmacotherapeutic monitoring and NOM identification to improve metabolic control by reducing glycated hemoglobin HbA1c in patients with type 2 diabetes mellitus in two Colombian cities when comparing the usual care.
Additionally, we sought to determine the costs of caring for these patients during the study period. An intervention study was carried out during 19 months, between May and Januaryto evaluate the effectiveness of pharmacotherapeutic monitoring to reduce HbA1c in patients with type 2 diabetes mellitus.
The study farmacoterapehtico conveniently conducted in these cities because there was trained personnel for said purpose. The sample size was estimated as the comparison of two proportions. The parameters were type-1 error at 0.
Effectiveness the pharmaceutical care in diabetic patients* | Machado -Alba | Colombia Médica
Using the random number table method, we assigned the groups in random and stratified manner; in the intervention group, who had pharmacotherapeutic monitoring for 18 months; and in the control group, who were merely interviewed at the beginning and at the end of the study. Each of the patients had a replacement selected randomly and with the same characteristics. Patients with type-2 diabetes mellitus, affiliated to the contributive regime of two EPS, who had continuity in antidiabetic treatment in the three months prior, defined by attendance to medical control and request for dispensing of normoglycemiant medication; these patients were over 18 years of age and accepted to participate in the study.
Patients changing EPS during the study; those whose physical or mental state did not permit communicating with the interviewer; and patients who did not remain in the city selected for the study during the time it took to develop such. All the patients were affiliated to the General System of Health and Social Security SGSSS for its name in Spanish and have no problems obtaining the medications; all were registered in the institutional program for diabetes control and, thus, were receiving the care established by guidelines for caring for this type of pathology.
The patients selected were notified by phone for their participation in the study; they were then summoned to be furnished the detais of their participation and to sign an informed consent form once they accepted to participate in the study. Patients in the intervention group were subjected to glycated hemoglobin at the start, at six months and at the end of the study; additionally, an initial interview was conducted with the pharmacotherapeutic record format, according to the DADER methodology 9.
Universidad de Granada Grupo de Investigación en Atención Farmacéutica
The status of the condition was elaborated including diagnosis, each of the medications being taken, doses and dose intervals. During the study, the patients were visited on at least three instances, establishing the NOMs in each visit. Patients in the control group were subjected to HbA1c measurement at the beginning and end of the study; they also had an initial interview with the pharmacotherapeutical diabetds format, according to the DADER methodology.
The status of the condition was also elaborated for this group and a final visit was conducted; thereby, detecting the NOM. After identifying NOM in each patient, the pharmacist suggested for the patients in the intervention group activities farmzcoterapeutico solve the health problem associated to farmacpterapeutico use, socializing said activities with the healthcare team through a written documment. Upon changes in medication, a new condition status was established, which also evaluated the acceptance spbre non-acceptance of the physician’s pharmaceutical recommendations.
Phone calls and visits were also made every four months to inquire about hospitalizations, visits to the general physician, specialist, and emergency services. Physicians from EPSs were informed on the objectives and benefits of the pharmaceutical monitoring study diabehes of the importance of their active participation in the program to offer complete patient care.
Pharmacotherapeutic records were the primary source of information and the secondary sources were the clinical histories, the status of the condition, records of medications dispensed by quantities and costs, along with the data base from the EPS services with the records of services rendered to their users, appointments with their treating physicians, authorizations for paraclinical exams requested by the physicians, among others. Parametric and non-parametric diabetex tests were run for related samples, comparing the initial and final glycated hemoglobin within the same groups.
Because the statistics for hypothesis tests were not significant, we opted for a bivariate analysis for the quantitative parameters via hazard ratios. A descriptive analysis was performed of the cost variable for each of the EPSs and in each of the groups.
Additionally, we conducted an analysis of the increasing cost-effectiveness ratios for each EPS. The study initially had patients, in the intervention group and in the control group, but during the course of the study 80 patients were lost from the sample because of different causes, ending the study with patients The distribution of the different study and sociodemographic variables sogre be seen in Table 1.
Mean age was Only 39 patients HbA1c findings and antidiabetic medication consumption. When comparing initial and final HbA1c values of the study, the average for the intervention group was 7. It was calculated osbre the among the main antidiabetic medications consumed [Defined Seguimientl Dose DDD ] glibenclamide represented 0.
It was found that on the average, the patients were receiving 1.
The most prevalent co-morbidities were hypertension, dislipidemia, and hypothyroidism and the most frequent long-term complications can be seen in Table 2. We were able to identify in the patients in the study another less prevalent health problems. We observed an faarmacoterapeutico of 6. The most frequently identified co-medication corresponded to antihypertensive, hypolipidemic, thryroid hormone, antiplatelet drugs, among others.
Negative outcomes associated with medication. During each of the interviews of the patients in the intervention and control groups, we identified the NOM and the possible causes. Table 2 shows the NOM identified, with those relating to effectiveness being the most frequent The greatest number of NOM was identified for antidiabetic medications with cases for metformin The most frequent NOM causes in these four pharmacological groups were thus: Causes of NOM identified in the study patients can be seen in Table 3.
Solution of negative outcomes associated with medication. During the initial and final visits for the intervention group, the intervention was accepted and the health problem was solved in 72 cases The intervention was accepted but sbore health problem was not solved in 21 cases The intervention was not accepted but the health problem was solved in 8 cases during the initial visit 4. The intervention was not accepted and the health problem was not solved during the first visit in dee patients No important differences were found with the control group.
The descriptive analysis revealed the following: It was noted that the mean ratio average per patient for the patients in the control group was 1. Analysis per healthcare insurance carrier revealed that the difference in the mean ratio of the direct cost was in the range of 1. It must be stated that the pharmacotherapeutic monitoring was carried out by the drug dispensing entity and not by the healthcare provider, for this reason the cost was not charged to the direct costs of patient healthcare.
Poor control of patients with type-2 diabetes mellitus is a problem affecting all nations. In developed nations as in developing nations, effectiveness of the therapy measured by controlling HbA1c figures ranges between It is worth mentioning that in seguimeinto study carried out, there was an important loss of patients As with other studies, women were seguimiiento willing to participate, which may be related to the greater prevalence of diabetes in this gender; with a mean age of 63 years and with overweight or obesity conditions 16 There no important variations or statistically significant differences in HbA1c values for patients in the intervention and control groups at the end of the study; although there was a reduction in values of glycated hemoglobin in the intervention group, making it convenient to suggest a similar study with a bigger population sample and a better control of losses.
Along with other studies, during the initial interview, we found co-morbidities frequently associated to diabetes, such as hypertension Renal, ophthalmic, neurological, and vascular peripheral complications are very important in patients with type-2 diabetes, which contrasts with that found in the study, with scarce request for important tests like measurement of microalbuminuria, serum creatinine, lipid profile, and eye exam The finding of a high percentage of ineffectiveness NOM The high frequency of the necessity NOM farmacoterapehtico Suggested interventions in pharmacotherapeutic monitoring, to correct this finding, may greatly benefit patients, possibly diminishing morbidity and mortality because of cardiocerebrovascular events associated to the use of said antiplatelet drug The adverse effects The economic analysis between conducting interventions diabetea keeping patients under habitual control, suggests to healthcare insurance carriers that implementing pharmacotherapeutic monitoring programs in patients with type-2 diabetes, may generate savings in costs related to caring for these farmscoterapeutico.
This finding warrants conducting a more profound study of the impact expected of pharmacotherapeutic monitoring on the cost of healthcare. This study presented a series of difficulties worth describing because they may be useful for those who may implement pharmacotherapeutic monitoring, such as: The need to schedule home visits requiring greater investment of time when the patient’s health status does not permit attending the healthcare facility.
Very frequently, the medical histories do not contain sufficient and necessary information for the case analysis in pharmacotherapeutical monitoring, given that many patients are seen by hired specialists, who generate reports different from those in the seguimiehto chart at the EPS, and access to this information is difficult in spite of multiple requests.
Some treating physicians do not follow the guidelines for treatment of diabetes mellitus and do not make opportune requests for paraclinical and medical exams necessary for the complete analysis in pharmacotherapeutical monitoring. The researchers could not guarantee that the written reports with the intervention recommendations made by a pharmacist reached the treating physician; thus, the suggested intervention would or would not be accepted upon the detection of an NOM.
Many of these difficulties came about because of the lack of support and commitment with the study from personnel in the participating healthcare insurance carriers.