Background Patients with chronic heart failure (CHF) take several medicines and frequently manage their medicines inappropriately. In our hospital, a postdischarge pharmacist educational interventions program (PEIP) has been introduced as a part of a multidisciplinary CHF disease management program. Purpose To describe CHF patient profiles, adherence, treatment knowledge and detection of drug-related problems (DRP) through the PEIP. To analyse the relation between DRPs detected and CHF patient characteristics. Materials and methods Prospective observational study including all CHF patients attending the PEIP from May 2010 to August 2011. Data: demographics; New York Heart Association (NYHA) class; mean ejection fraction (EF); cardiovascular risk factors (CRF); self-administration of medicine (SA); self-reported adherence to diet (AD) and medicine (AM) and motivation (M) (Modified Morisky Scale); knowledge of CHF medicines: %dose (D), frequency (F) and indication (I); contraindicated drugs (CID) and DRP (DRP1: did not use a needed medicine; DRP2: used a medicine not needed; DRP3: ineffective treatment; DRP4: infradose; DRP5: overdose; DRP6: adverse reaction) and cases of acute decompensation. Statistical test: χ2 and Fischer exact test for dichotomous variables and t-test for continuous variables. Results Patients: 75. Patient profile: 54 (72%) male; age: 71.8±1.3; patients/NYHA class: I: 2 (2.7%); II: 58 (77.3%); III: 14 (18.7%); IV: 1 (1.3%), EF< 45%: 42(56%); smokers: 20(26.7%); alcohol consumption: 17(22.7%). Adherence and knowledge: SA: 41(54.7%); AD: 56(74.7%); AM: 75(100%); M: 61(81.3%); Mean knowledge of CHF medicine: DFI: 29.7%± 32.0; DF: 47.8%± 41.5; patients who were aware of CID: 12(16%). DRP: 17 patients (22.7%); DRP1: 9 (12%); DRP2: 2(2.7%); DRP3: 6 (8%); DRP4: 3 (4%); DRP5: 2 (2.7%); DRP6: 4(5.3%). Patients with decompensation: 11(14.7%). Comparison between patients with and without DRP: decompensated: 5/17(29.4%) versus 6/58(10.3%)(p=0.05); SA: 12/17(70.6%) versus 29/58(50%)(p=0.134). No other significant differences were observed between the two groups. Conclusions The PEIP evaluated the adherence and knowledge of the treatment in CHF patients and allowed us to detect DRPs in about 23% of the patients. The presence of any DRP was only correlated with acute decompensation and self-administration of drugs, suggesting the importance of an appropriate CHF treatment self-management.

Background There has been a remarkable growth in approved oral anticancer agents (OAA) in recent years. This situation involves the pharmacist as a key part of the interdisciplinary team ensuring the safety and an adequate knowledge of the treatment with OAA. This may enhance compliance and reduce adverse events. A patient educational surgery was established by a team of a pharmacist and a nurse (PESPN). Purpose To describe the first PESPN patients. To compare the number of calls received by the continuing oncology care unit (COCU) before and after the establishment of PESPN. Materials and methods Prospective observational study from 2010 to present in a tertiary hospital. The authors included all patients initiating OAA. The information tools employed were validated leaflets about each drug, others leaflets related to symptoms management and personalised treatment calendars. Furthermore, The authors checked potential interactions between OAA and other concomitant treatment. Data collected: demographics, family support, KI (Karnofsky index), comorbidities, disease, staging, treatment type, information support, concomitant medicines, interactions prevented, number of phone calls received by the COCU. Results 34 patients. No. (%): women: 20 (60.6%); age (mean 66.5+/-15.2); family support 28 (84.8%); KI 90-100%: 28 (84.8%); comorbidities: 20 (60.6%); disease: breast 14 (42.4%), lung 9 (27.2%), CNS: 8 (24.2%), colon: 2 (6.1%); stageIV: 32(97.0%); metastatic: 23(69.7%), adjuvant: 10 (30.3%); indication for OAA: progression by imaging: 15 (45.5%), first-line treatment: 13 (39.4%), biochemical progression: 3 (9.1%), patient preference: 2 (6.1%), pathological progression: 1(3.0%); OAA: vinorelbine: 11(33.3%), capecitabine: 8 (24.2%), temozolomide: 8 (24.2%), topotecan: 3 (9.1%), erlotinib: 2(6.1%), gefitinib 1(3.0%); information tools: OAA leaflets: 31(93.9%), personalised calendar: 4(12.1%), others 3(9.1%); concomitant medicines: 32 (97.0%)(mean 3.8+/-2.2); complementary medicine: 2 (6.1%); total interactions: 6(18.2%); erlotinib-omeprazole:3(9.1%), erlotinib-acenocoumarol: 1(3.0%), capecitabine- acenocoumarol (3.0%), valproic-temozolomide: 1(3.0%). Phone-calls received by COCU: year 2009:1320 versus year 2010:1087 (17.7% reduction). Conclusions The typical patient profile was a woman with metastatic breast cancer initiating OAA after imaging progression. The treatment most dispensed was vinorelbine and the patients were given information leaflets specifically about the OAA. Almost all patients were on concomitant medicines and potential interactions were prevented. There was a significant reduction in the number of telephone inquiries received by COCU.

BackgroundSeveral factors, such as toxicity, virological failure or low adherence can justify the need for switching antiretroviral therapy (ART) in HIV patients.PurposeTo study the reasons for switching ART in an HIV unit in a tertiary hospital. Secondary objectives were to study the number of switches over time and their estimated annual cost (EAC).Material and methodsWe recorded ART switches performed every 6 months from January 2012–June 2014 in our cohort of 1,550 HIV-infected patients. Date collected: previous and new ART, reason for switching and EAC (difference in the daily acquisition cost between the new and the previous ART calculated for 365 days of treatment). The Spearman test was used for bivariate correlations.Results685 switches were performed: 117 (7.5%), 98 (6.3%), 130 (8.4%), 157 (10.1%) and 183 (11.8%) in each 6-month period. An increase in the number of changes/6 months over time was observed (Spearman rho: 0.9; p < 0.05). The total number of switches/6 months correlated only with toxicity (Spearman rho: 0.95; p < 0.05).Abstract CP-065 Table 1Reasons for switching and EAC (euros)Year20122013First six months of 2014Switches/EAC215/-10,8512871/-59,7251831/20,616Annual acquisition cost of ART10,318,40310,325,6385,063,660Reasons for switching/EAC: Toxicity125/-12,189180/-73,508107/1,175Virological failure37/102,71233/53,08424/34,997Simplification45/-103,27149/-68,65035/-35,371Drug interaction8/1,89822/25,55114/24,7541Three for pregnancy.ConclusionAn increase in the number of switches per 6-month period was observed over time. Total number of switches/6 months was correlated to those associated with toxicity. The availability of new and less toxic ARTs may explain these results.Toxicity remained the most frequent reason for switching, representing between 58% and 63% depending on the year.Switches due to virological failure entailed an increase in the EAC, while those due to simplification brought cost savings. Overall, the economic impact of this strategy on the annual acquisition cost of ARTs in our hospital seems to be minimal.References and/or AcknowledgementsNo conflict of interest.

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