Evaluación e impacto de la implantación de nuevos servicios profesionales especializados en salud visual en la atención farmacéutica al paciente crónico polimedicado

Abstract

Introduction: Health problems related to the eye and vision in the elderly are an important Public Health problem with a high social and economic impact. There is a need to offer a greater number of services for the early detection and control of Ocular Health Problems (OHP) directed to the polymedicated patient, in which different factors associated as: age, comorbidity, lack of adherence and knowledge about medication, can be cause of alterations of their visual health. The Community Pharmacy (CF) is the ideal health facility for the implementation of these services due to its capillarity and availability. Objectives: To assess the impact of pharmacist intervention with new Professional Services Specialized in Visual Health (PSSVH) integrated in the Pharmacotherapeutic Follow-up (PTF), and focused in the detection, control and resolution of OHP in chronic polymedicated patients. Assess and improve adherence, knowledge of pharmacotherapy, Health-Related Quality of Life (HRQoL) and final satisfaction of patients. Methodology: Prospective, quasi-experimental, pre-post interventionist study, performed in a CF with Optical and Optometric services. Patients with a diagnosed or were suspected of some OHP who used ?4 chronic medications were included. All patients underwent a Protocolized Visual Health Examination integrated in the PTF by the Dáder method, for the detection of OHP not controlled (OHPNC). 3 interviews were established per patient during a monitoring period of 6 months, in which the results of the interventions made on the OHPNC and the Negative Results associated to the Medication (NRM) detected were collected. Validated questionnaires were used for the measurement of HRQoL, adherence and knowledge about medication: SF-36, SMAQ and Patient Knowledge Questionnaire on their Medication (PKM), respectively. Results: 92 patients participated in the study, the majority were women (70.7%), housewives, retired or unemployed (64.1%), without studies or with primary studies (90.2%), with an average age of 66.4 years and with an average of 9.1 medications used. The PSSVH provided a significant improvement in visual acuity, reducing from 16.3% to 6.5% the percentage of patients with visual impairment, as well as a decrease in intraocular pressure in patients with high values and a decrease in the frequency of dry eye symptoms. A total of 303 OHP were detected, of which 64% were not controlled and 32.3% were unknown by patients, being the refractive defects, the main OHPNC detected (49.5%). The intervention through the PSSVH reduced the total number of OHPNC by 78%, either by direct action on the patient (70.6%), the referral to another health professional (25.8%) or both (3.6%). The main factors associated with the OHP and their lack of control were: advanced age, low sociocultural level and low HRQoL. After the pharmaceutical intervention, there was a significant improvement in HRQoL and in the number of adherent patients and with an adequate knowledge about their ophthalmologic and general medication. The majority of actions aimed at resolving the NRM were focused at modifying the pharmacological strategy (42.9%), and to improve health education (38.9%), receiving a high degree of acceptance (73.6%). After the pharmaceutical intervention, the number of NRM was reduced by 57.3%. At the end of the study, patients showed a high degree of satisfaction with the service. Conclusions: The PSSVH integrated in the PTF, provide comprehensive health care for chronic polymedicated patients; both at eye level, by detecting and improving the control of the OHP, as in optimizing the use and results of ophthalmic and general pharmacotherapy, bringing in an improvement of HRQoL. For this, the collaboration of the pharmacist with other health professionals is essential.