Objetivos: Describir cuáles son los principales métodos para medir la adherencia terapéutica de los pacientes y determinar los más idóneos para ser utilizados en la práctica clínica diaria de la Farmacia Comunitaria. Métodos: Se realizó una búsqueda no sistemática de los artículos de investigación más importantes publicados sobre el tema en la base de datos National Library of Medicine, Washington, DC (MEDLINE: PubMed). Resultados: Los métodos para medir la adherencia terapéutica pueden dividirse en métodos directos o indirectos. Dentro de los métodos directos están la determinación de la concentración del fármaco o su metabolito en una muestra biológica y la terapia directamente observada. Los métodos indirectos pueden ser basados en la entrevista clínica al paciente (incluye la utilización de cuestionarios), en el recuento de medicación sobrante, en el empleo de dispositivos electrónicos o en el análisis de los registros de dispensación. El empleo de cuestionarios para determinar la adherencia autocomunicada por el propio paciente es un método muy útil en la práctica clínica diaria, sencillo y barato. Entre la multitud de cuestionarios existentes, la elección de uno frente a otros se basará en la patología que sufre el paciente y en la información que se quiera analizar (comportamiento del paciente, barreras o creencias acerca de la adherencia terapéutica). Conclusiones: Existen múltiples y diferentes métodos para medir la adherencia terapéutica. No hay ningún método óptimo por lo que se recomienda la combinación de varias técnicas. Las opciones más factibles para su empleo durante la práctica clínica diaria de la Farmacia Comunitaria son la utilización de cuestionarios administrados por el propio paciente y el análisis del registro de dispensaciones.

Objetivos: Describir los factores que pueden influir en la adherencia a los tratamientos farmacológicos y las intervenciones que han sido desarrolladas para su mejora. Métodos: Se realizó una búsqueda de los artículos de investigación más importantes publicados sobre el tema en la base de datos National Library of Medicine, Washington, DC (MEDLINE: PubMed). Resultados: La adherencia al tratamiento es un comportamiento complejo influenciado por múltiples factores: socioeconómicos, relacionados con el sistema sanitario, con el tratamiento, con la patología o con el paciente. En cuanto a las intervenciones, principalmente pueden diferenciarse en intervenciones de tipo técnico, intervenciones conductuales o intervenciones educativas. Ninguna de las intervenciones estudiada hasta la fecha ha demostrado ser efectiva de forma universal y permanente. Conclusiones: La adherencia terapéutica es un comportamiento dinámico influenciado por una gran variedad de factores y, por ello, las estrategias para mejorarla deberán individualizarse para cada paciente.

Background It is necessary to determine the cost utility of adherence interventions in chronic diseases due to humanistic and economic burden of non-adherence. Purpose To evaluate, alongside a cluster-randomized controlled trial, the cost-utility of a pharmacist-led medication adherence management service (MAMS) compared with usual care in community pharmacies. Materials and Methods The trial was conducted over six months. Patients with treatments for hypertension, asthma or chronic obstructive pulmonary disease (COPD) were included. Patients in the intervention group (IG) received a MAMS based on a brief complex intervention, whilst patients in the control group (CG) received usual care. The cost–utility analysis adopted a health system perspective. Costs related to medications, healthcare resources and adherence intervention were included. The effectiveness was estimated as quality-adjusted life years (QALYs), using a multiple imputation missing data model. The incremental cost–utility ratio (ICUR) was calculated on the total sample of patients. Results A total of 1186 patients were enrolled (IG: 633; CG: 553). The total intervention cost was estimated to be €27.33 ± 0.43 per patient for six months. There was no statistically significant difference in total cost of medications and healthcare resources per patient between IG and CG. The values of EQ-5D-5L at 6 months were significantly higher in the IG [IG: 0.881 ± 0.005 vs CG: 0.833 ± 0.006; p = 0.000]. In the base case, the service was more expensive and more effective than usual care, resulting in an ICUR of €1,494.82/QALY. In the complete case, the service resulted in an ICUR of €2,086.30/QALY, positioned between the north-east and south-east quadrants of the cost–utility plane. Using a threshold value of €20,000/QALY gained, there is a 99% probability that the intervention is cost-effective. Conclusion The medication adherence management service resulted in an improvement in the quality of life of the population with chronic disease, with similar costs compared to usual care. The service is cost-effective.

The objective of this systematic review was to provide a compilation of all the literature available on the association between single-nucleotide polymorphisms (SNPs) in the genes involved in the metabolic pathway of vitamin D and overall survival (OS) and progression-free survival (PFS) in patients with non-small cell lung cancer (NSCLC). This systematic review was conducted in accordance with the PRISMA guidelines. It included all the literature published up to 1 November 2022 and was carried out in four databases (Medline [PubMed], Scopus, Web of Science, and Embase), using the PICO strategy, with relevant keywords related to the objective. The quality of the studies included was evaluated with an assessment tool derived from the Strengthening the Reporting of Genetic Association Studies (STREGA) statement. Six studies were included in this systematic review. Our findings showed that the BsmI (rs1544410), Cdx-2 (rs11568820), FokI (rs2228570), ApaI (rs7975232), TaqI (rs731236), rs4646536, rs6068816, rs7041, and rs10741657 SNPs in the genes that play a part in vitamin D synthesis (CYP2R1, CYP27B1), transport (GC), and metabolism (CYP24A1), as well as in the vitamin D receptor (VDR), are associated with OS and/or PFS in patients with NSCLC. The SNPs in VDR have been the most extensively analyzed. This systematic review summed up the available evidence concerning the association between 13 SNPs in the main genes involved in the vitamin D metabolic pathway and prognosis in NSCLC. It revealed that SNPs in the VDR, CYP27B1, CYP24A1, GC, and CYP2R1 genes could have an impact on survival in this disease. These findings suggest the identification of prognostic biomarkers in NSCLC patients. However, evidence remains sparse for each of the polymorphisms examined, so these findings should be treated with caution.

The aim of this systematic review was to provide a comprehensive overview of the literature published in the last decade on the association of single-nucleotide polymorphisms in genes involved in the pharmacodynamic and pharmacokinetic pathways of capecitabine with treatment outcomes among colorectal cancer patients. A systematic search of the literature published in the last 10 years was carried out in two databases (Medline and Scopus) using keywords related to the objective. Quality assessment of the studies included was performed using an assessment tool derived from the Strengthening the Reporting of Genetic Association (STREGA) statement. Thirteen studies were included in this systematic review. Genes involved in bioactivation, metabolism, transport, mechanism of action of capecitabine, DNA repair, and folate cycle were associated with toxicity. Meanwhile, genes related to DNA repair were associated with therapy effectiveness. This systematic review reveals that several SNPs other than the four DPYD variants that are screened in clinical practice could have an impact on treatment outcomes. These findings suggest the identification of future predictive biomarkers of effectiveness and toxicity in colorectal cancer patients treated with capecitabine. However, the evidence is sparse and requires further validation.