Calvin-Lamas Marta, Calleja Hernández Miguel Ángel, Monte-Boquet Emilio, Rodriguez Sagrado Miguel Ángel, Ventayol Bosch Pere
Servicio de Farmacia, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
Servicio de Farmacia, Hospital Universitario Virgen Macarena, Sevilla, Spain.
Farm Hosp. 2023 Nov-Dec;47(6):T277-T284. doi: 10.1016/j.farma.2023.09.004. Epub 2023 Oct 19.
To develop a checklist to facilitate pharmaceutical care for patients with interstitial lung disease who require or are undergoing treatment with antifibrotic drugs.
Five hospital pharmacists developed an initial list of 37 items divided into 4 blocks: (1) First visit, which included general patient data and data from the first treatment; (2) follow-up visits, assessing aspects of the follow-up of the treatment with nintedanib or pirfenidone; (3) telepharmacy, consisting of the evaluation of the inclusion of patients in a program of this type, course of the disease, and identification of the contact with the pharmacy service; (4) non-pharmacological treatment and patient information. To decide its potential inclusion in the checklist, 2 rounds of the Delphi were carried out in which the panelists had to assess the degree of agreement of each proposed item according to its "utility", which was the determining criterion for its inclusion, and its "applicability".
Forty-eight hospital pharmacists were contacted, 30 (63%) agreed in writing to participate, 28 (58%) completed the first round of the Delphi, and 27 (56%) completed the second round. After the first round of the Delphi, the questionnaire was amended and comprised 40 items. Of the 40 items evaluated after the 2 rounds of the Delphi, there were 2 that, based on utility, the participants did not reach consensus for inclusion in the checklist: the one referring to "History of surgical intervention, specifically abdominal surgery in the last 4 weeks" (finally kept on the checklist due to its involvement in the indication of nintedanib) and to make recommendations on "Relaxation". No consensus was reached on their applicability for 2 of the items: "Patient stratification according to the Spanish Society of Hospital Pharmacy (SEFH) chronic patient model" and "Collection of Results Reported by the Patient".
The management of patients with ILD and/or pulmonary fibrosis is complex and requires a multidisciplinary approach where the hospital pharmacist plays a key role, especially, although not only, in monitoring drug treatment. We believe that this checklist can contribute from pharmaceutical care to improving the integrated care of patients with ILD who require or are undergoing treatment with antifibrotic drugs.
制定一份清单,以促进对需要或正在接受抗纤维化药物治疗的间质性肺疾病患者的药学服务。
五名医院药剂师制定了一份初始清单,包含37项内容,分为4个板块:(1)首次就诊,包括患者一般资料和首次治疗数据;(2)随访就诊,评估使用尼达尼布或吡非尼酮治疗的随访方面;(3)远程药学,包括评估患者纳入此类项目的情况、疾病进程以及确定与药学服务的联系;(4)非药物治疗和患者信息。为决定其是否可能纳入清单,进行了两轮德尔菲法,小组成员必须根据每个提议项目的“实用性”(这是其纳入的决定性标准)及其“适用性”来评估一致程度。
联系了48名医院药剂师,30名(63%)书面同意参与,28名(58%)完成了第一轮德尔菲法,27名(56%)完成了第二轮。第一轮德尔菲法后,问卷进行了修订,包含40项内容。在两轮德尔菲法后评估的40项内容中,有2项基于实用性,参与者未就纳入清单达成共识:一项是关于“外科手术史,特别是过去4周内的腹部手术”(由于其与尼达尼布的适应证有关,最终保留在清单上)以及关于“放松”的建议。有2项内容在适用性方面未达成共识:“根据西班牙医院药学协会(SEFH)慢性病患者模型对患者进行分层”和“收集患者报告的结果”。
ILD和/或肺纤维化患者的管理很复杂,需要多学科方法,医院药剂师在其中发挥关键作用,尤其是在监测药物治疗方面(但不仅限于此)。我们认为,这份清单可从药学服务方面为改善需要或正在接受抗纤维化药物治疗的ILD患者的综合护理做出贡献。