Validation of a Scorecard of Quality and Activity Indicators for Telepharmacy Pharmaceutical Care Services in Spanish Hospitals

Luis Margusino-Framiñán,1 Olatz Ibarra-Barrueta,2 Irene Mangues-Bafalluy,3 Emilio Monte-Boquet,4 Patricia Sanmartín-Fenollera,5 Amparo Talens-Bolós,6 Ramón Morillo-Verdugo7 1Pharmacy Department, Research Group of Hospital Pharmacy, a Coruña Biomedical Research Institute, INIBIC, a Coruña University Hospital (CHUAC), SERGAS, a Coruña University (UDC), A Coruña, Spain; 2Pharmacy Department, Hospital Universitario de Galdakao Usansolo, Pharmacotherapy and Drug Safety Research Group, ISS Biobizkaia, Barakaldo, Spain; 3Pharmacy Service, Hospital Universitari Arnau de Vilanova de Lleida, Pharmacoepidemiology and Pharmacodynamics Research Group, Institut de Recerca Biomèdica, IRBLleida, Lleida, Spain; 4Pharmacy Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain; 5Pharmacy Service, Hospital Universitario Fundación Alcorcón, Madrid, Spain; 6Pharmacy Service, Hospital General Universitario Dr. Balmis, Alicante, Spain; 7Pharmacy Service, Hospital de Valme, Seville, SpainCorrespondence: Luis Margusino-Framiñán, Pharmacy Department, Research Group of Hospital Pharmacy, a Coruña Biomedical Research Institute, INIBIC, a Coruña University Hospital (CHUAC), SERGAS, a Coruña University (UDC), 84 as Xubias St, A Coruña, 15006, Spain, Tel +34981176480, Email [email protected]: Telepharmacy must be monitored within a quality management system in order to guarantee the efficiency, safety and quality of the activities it encompasses. The Spanish Society of Hospital Pharmacy has proposed the first scorecard of quality and activity indicators for Telepharmacy (TIS). The objective of this project is to validate this TIS for its implementation in hospital pharmacy services.Material and Methods: The project was developed in 4 phases: elaboration of the validation questionnaire/validation criteria; selection of hospitals where the study will be carried out; completion of the validation questionnaire by the selected hospitals; analysis of the results, a proposal of conclusions, and preparation of the final document. The validation criteria were performed using the RAND/UCLA methodology for each of the 5 TIS characteristics: holistic, practical, quantitative, usability, and continuous improvement. Characteristics were considered validated when the median was found to be within the score range 5– 9 and at least 2/3 (66.66%) of the respondents scored in the range containing the median.Results: Forty-four hospitals were included and the responses related to TIS characteristics were: holistic=8.2 and 98.5% of responses > 5; practical=7.9 and 98.9% of responses > 5; quantitative=7.9 and 98.6% of responses > 5; usability=6.9 and 87.37% of responses > 5; continuous improvement= 7.9 and 100% of responses > 5.Discussion: TIS has been validated for use in hospital pharmacy services and its tools and supporting documents are very useful and comprehensive. Hospital informatics systems are needed to allow efficient extraction of the data necessary to obtain the TIS indices.Keywords: validation studies, telepharmacy, quality indicators, pharmaceutical care, hospital pharmacy services, telemedicin

Evaluation of Patient Experience With A Model of Coordinated Telematic Pharmaceutical Care Between Hospital and Rural Pharmacies in Spain: A Proof of Concept

Ramón Morillo-Verdugo,1 Rosa Morillo-Lisa,2 Jaime Espolita-Suarez,3 Olga Delgado-Sanchez4 1Pharmacy Hospital Service, Hospital Valme, Área de Gestión Sanitaria Sur de Sevilla, Sociedad Española de Farmacia Hospitalaria, Sevilla, Spain; 2Rural Community Pharmacy, Sociedad Española de Farmacia Rural, Zaragoza, Spain; 3Rural Community Pharmacy, Sociedad Española de Farmacia Rural, León, Spain; 4Pharmacy Hospital Service, Hospital Son Spases, Sociedad Española de Farmacia Hospitalaria, Palma de Mallorca, SpainCorrespondence: Ramón Morillo-Verdugo, Pharmacy Hospital Service, Hospital Valme, Área de Gestión Sanitaria Sur de Sevilla, Sociedad Española de Farmacia Hospitalaria, Avda/Bellavista s/n, Sevilla, CP 41014, Spain, Tel +34 955015467, Email [email protected]: To determine the usefulness of a coordinated pharmaceutical care model between the specialized hospital setting and the rural community care setting, based on the incorporation of telepharmacy based on Capacity-Motivation-Opportunity (CMO) methodology to improve patient experience with hospital medication prescriptions.Patients and Methods: Prospective cohort study in outpatients receiving telepharmacy based on CMO-based pharmaceutical care in rural areas in Spain between January and November 2021, conducted by the pharmacy department of four hospitals and 29 rural communities’ pharmacy. Each patient was followed for 48 weeks on both face-to-face and telematic visits, scheduled and unscheduled at the patients’ request. Patient experience (IEXPAC questionnaire), and satisfaction (EVASAF) were determined. Secondary variables included pharmaceutical care interventions, care coordination and clinical variables (compliance with pharmacotherapeutic objectives according to the clinical conditions of each patient), additionally measurement of individual holistic results (EQ5D-5L score) was evaluated.Results: A new telepharmacy tool (called Telemaco) was developed for a multidisciplinary healthcare team (available at: https://inteligeniapps.com/telemaco/) that includes seven different functionalities. We evaluated the first 20 patients (50% women) were included. Their median age was 66.0 years (IQR=14). A total of 215 visits were made (adding 150 video calls). A total of 64 visits were unscheduled (29.7%). The patient´s experience showed improvement (7.4 vs 9.5, p< 0.005). The results of the EVASAF questionnaire were also higher (44 vs 48, p 0.05).Conclusion: Telepharmacy based on the CMO-PC model, using the “Telemaco” tool, has improved the patient experience, satisfaction, and offered other advantages over the traditional model, including more pharmaceutical interventions adapted to the needs of each patient.Keywords: telepharmacy, pharmaceutical care, patient satisfaction, outcome assessmen

Evaluation of Patient Experience with a Model of Coordinated Telematic Pharmaceutical Care Between Hospital and Rural Pharmacies in Spain [Response To Letter]

Ram&oacute;n Morillo-Verdugo,1 Rosa Morillo-Lisa,2 Jaime Espolita-Suarez,3 Olga Delgado-Sanchez4 1Pharmacy Hospital Service, Hospital Valme, &Aacute;rea de Gesti&oacute;n Sanitaria Sur de Sevilla, Sociedad Espa&ntilde;ola de Farmacia Hospitalaria, Sevilla, Spain; 2Rural Community Pharmacy, Sociedad Espa&ntilde;ola de Farmacia Rural, Alcal&aacute; de Ebro, Zaragoza, Spain; 3Rural Community Pharmacy, Sociedad Espa&ntilde;ola de Farmacia Rural, Le&oacute;n, Spain; 4Pharmacy Hospital Service, Hospital Son Spases, Sociedad Espa&ntilde;ola de Farmacia Hospitalaria, Palma de Mallorca, SpainCorrespondence: Ram&oacute;n Morillo-Verdugo, Hospital de Valme, Avda/Bellavista s/n, Seville, CP: 41014, Spain, Tel +34 955015467, Email [email protected]

Prevalence of prescription of the Top-10 drug classes to avoid in elderly people living with HIV in a real practice cohort.

We assessed the prevalence of potentially inappropriate prescriptions (PIP) among older (≥ 65 years) people living with HIV (PLWHIV). Additionally, the secondary objective was to analyse the relationship between pharmacotherapeutic complexity and compliance with STOPP-Beers criteria associated with Top-10 drugs classes to avoid (TOP-10-A) of European AIDS Clinical Society (EACS) guidelines. This was a cross-sectional observational single-centre study. PLWHIV aged 65 years-old or over on ART attending at hospital pharmacy outpatient service from December-2019 to March-2020 were included. Patients were classified by age group: 65-69, 70-75 and more than 75 years. Moreover, was analysed the relationship between pharmacotherapeutic complexity and compliance with STOPP-Beers Criteria associated with Top-10-A drugs. A total of 19 individuals were included. Overall polypharmacy was observed in 16 PLWHIV (84.2%). A PIP included Top-10-A was identified in 9 (47.4%) PLWHIV. Benzodiazepines were the most prevalent group of prescribed drugs in 6 patients (30.0%). Complex patients were observed in 57.9% (MRCI index value greater than 11.25). Similarly, the sum of criteria STOPP-Beers was higher in older patients. Student's t test showed the existence of a statistically significant relationship between pharmacotherapeutic complexity and sum of STOPP-Beers Criteria (p Prescription of PIPs is highly prevalent in older PLWHIV. Consistent with data, presence of PIPs were associated a presence of higher pharmacotherapeutic complexity and sum of STOPP-Beers Criteria. The basis for a new revised care plan for PLWHIV focussed on optimising overall patient care pharmacotherapeutic complexity and its possible consequences

Prescripción de medicamentos en receta y en informe de alta del servicio de medicina interna de un hospital general

ObjetivoAnalizar la prescripción de medicamentos realizada por el Servicio de Medicina Interna de un hospital general (Hospital Universitario de Valme) en los 2 documentos donde se origina la prescripción (informes de alta y recetas oficiales), evaluar los indicadores de uso racional del medicamento (URM) definidos en el Contrato Programa (CP) del Servicio Andaluz de Salud (SAS)1 y el cumplimiento de los objetivos establecidos en él, además de analizar las posibles desviaciones entre la prescripción en el informe y en la receta oficial.DiseñoEstudio observacional retrospectivo sobre las prescripciones de medicamentos al alta hospitalaria realizadas por el Servicio de Medicina Interna, tanto en los informes como en las recetas oficiales, durante el primer trimestre del año 2003.EmplazamientoHospital Universitario de Valme. Nivel de atención especializada.Mediciones principalesCumplimiento de los objetivos de URM establecidos en el CP del SAS1. Evaluación del porcentaje de adecuación de la prescripción al alta a la Guía Farmacoterapéutica del hospital (GFT).ResultadosSe revisaron 400 informes de alta y 5.798 recetas. En la tabla 1 se exponen los resultados de los indicadores del CP evaluados en los informes de alta y en las recetas realizadas. En todos ellos, las diferencias entre los resultados en ambos documentos fueron estadísticamente significativas. De los 6 indicadores de URM establecidos en el CP, tan sólo cumplieron con los objetivos 3 indicadores en los informes y uno en las recetas. La adecuación de la prescripción a la GFT del hospital ha sido del 66,8% en los informes de alta y del 46,3% en las recetas.Discusión y conclusionsCon respecto al porcentaje de adecuación a la GFT, destacamos que el resultado obtenido en las recetas (46,3%) es bastante desfavorable en comparación con los comunicados en la bibliografía (50,0-79,7%)2-5.El porcentaje de prescripción en principios activos en los informes ha sido mucho más favorable que en las recetas (un 15 frente al 7,6%, respectivamente; p<0,001), lo que hace pensar en la existencia de factores externos en los criterios de prescripción del especialista. Esto nos motiva para la próxima realización de estudios que permitan identificar cuáles son estos factores y cómo se puede actuar sobre ellos.Se observan diferencias aún mayores al comparar el resultado de prescripción en principio activo en receta con el obtenido en atención primaria de nuestra área sanitaria, dato facilitado por los servicios centrales del SAS (un 7,6 frente al 22,9%; p<0,001). Estos resultados resaltan la importancia de poner en marcha en los hospitales intervenciones encaminadas a unificar criterios de prescripción en ambos niveles para así reducir la prescripción inducida

High level of medication regimen complexity index correlate with worse quality of life in people living with HIV.

People living with HIV (PLWHIV) have now a near-normal life expectancy and thus, a higher risk of polypharmacy. The main objective was to assess the correlation between medication regimen complexity index (MRCI) and quality of life (EQ-5D) and health utilities among PLWHIV patients on ART. Observational prospective single-center study including adult PLWHIV on ART from January to March-2020 attended at hospital pharmacy outpatient service according to a Capacity-Motivation-Opportunity (CMO) pharmaceutical care model. A total of 428 patients were included, mean age of 50 ± 10.9 years, 82.2% males. Negative correlation (r2=-0.147; p= 0.0002) between MRCI and EQ-5D was found. Relationship between the comorbidity pattern and quality of life, was also observed. Regarding MRCI, Anxiety/Depression, Pain/discomfort and Self-Care were the dimensions with the worst assessment. A new multidimensional revised care plan for PLWHIV focussed on optimising overall patient care, not limited to viral load goal achievement alone but also in their pharmacotherapeutic complexity and quality of life is needed