Measurement complexity of adherence to medication

Dayani Galato, Fabiana Schuelter-Trevisol, Anna Paula PiovezanMaster Program in Health Sciences, University of Southern Santa Catarina (Unisul) Tubarão, Santa Catarina, BrazilAdherence to pharmacologic therapy is a major challenge for the rational use of medicines, particularly when it comes to antiretroviral drugs that require adherence to at least 95% of prescribed doses.1 Studies in this area are always important and contribute to medication adherence understanding, even though there is no reference test for measuring this. Recently, an article was published in this journal that proposes the determination of lamivudine plasma concentration to validate patient self-reported adherence to antiretroviral treatment.2 In that study, serum levels obtained after 3 hours of ingestion of the last dose of the drug were compared with patient reports that were classified into different levels of adherence, based on their recall of missed doses in the previous 7 days.It was hypothesized by the authors that the use of a biological marker for drug adherence was extremely important, given the relevance of the topic. However, we would like to draw attention to some points that may determine the success of the use of similar methods for this purpose. The formation of groups with similar anthropometric characteristics is relevant since the dose of lamivudine may have to be changed, depending, for example, on sex, weight, and age.3 Even information considered important by the authors of that study was not provided. There is a need for greater clarity on the eligibility criteria, especially with regard to the clinical stage of the disease, CD4 counts and viral load, associated diseases, and comorbidity, as well as the evaluation of kidney function and other medications used that can affect lamivudine pharmacokinetics.3View original paper by Minzi and colleague

Pharmacy practice simulations: performance of senior pharmacy students at a University in southern Brazil

Objective: A simulation process known as objective structured clinical examination (OSCE) was applied to assess pharmacy practice performed by senior pharmacy students. Methods: A cross-sectional study was conducted based on documentary analysis of performance evaluation records of pharmacy practice simulations that occurred between 2005 and 2009. These simulations were related to the process of selfmedication and dispensing, and were performed with the use of patients simulated. The simulations were filmed to facilitate the evaluation process. It presents the OSCE educational experience performed by pharmacy trainees of the University of Southern Santa Catarina and experienced by two evaluators. The student general performance was analyzed, and the criteria for pharmacy practice assessment often identified trainees in difficulty. Results: The results of 291 simulations showed that students have an average yield performance of 70.0%. Several difficulties were encountered, such as the lack of information about the selected/prescribed treatment regimen (65.1%); inadequate communication style (21.9%); lack of identification of patients´ needs (7.7%) and inappropriate drug selection for self-medication (5.3%). Conclusions: These data show that there is a need for reorientation of clinical pharmacy students because they need to improve their communication skills, and have a deeper knowledge of medicines and health problems in order to properly orient their patients.Objetivo: Se aplicó un proceso conocido como examen clínico estructurado objetivo (OSCE) para evaluar la actuación en práctica farmacéutica de estudiantes sénior de farmacia. Métodos: Se realizó un estudio transversal basado en un análisis documental de los registros de simulaciones de farmacia práctica que ocurrieron entre 2005 y 2009. Estas simulaciones estaban relacionadas con el proceso de auto-medicación y dispensación con el uso de pacientes simulados. Las simulaciones fueron filmadas para facilitar el proceso de evaluación. Se presentan la experiencia educativa OSCE realizada por alumnos de la Universidad del Sur de Santa Catarina y gestionada por dos evaluadores. Se analizó la evaluación global de los estudiantes y los criterios de la evaluación en práctica farmacéutica identificados por los alumnos por su dificultad. Resultados: Los resultados de las 291 evaluaciones mostraron que los estudiantes tienen una actuación promedio del 70%. Se encontraron varias dificultades, tales como la falta de información sobre el tratamiento seleccionado/prescrito (65,1%); estilo de comunicación inadecuado (21,9%); falta de identificación de las necesidades del paciente (7,7%) y selección inadecuada de medicamento para auto-medicación (5,3%). Conclusiones: Estos datos demuestran que hay una necesidad de re-orientación de los estudiantes de farmacia clínica porque necesitan mejorar sus habilidades de comunicación y tengan un conocimiento más profundo de medicamentos y problemas de salud para orientar adecuadamente a sus pacientes

Factors associated with hepatitis C seropositivity in people living with HIV

OBJECTIVE: To identify risk factors associated with hepatitis C virus (HCV) seropositivity in human immunodeficiency virus (HIV)-infected patients. METHODS: A paired case-control study adjusted by age and gender was conducted. It included adults coinfected with HIV and HCV (cases) and HIV mono-infected subjects (controls) using non-probability sampling. Data were collected through interviews and review of medical records. The chi-square test was used for comparing categorical variables and the Student’s t-test or Wilcoxon (Mann-Whitney U) test for continuous variables. Confidence intervals (95%) were estimated along with crude and adjusted odds ratios using conditional logistic regression. RESULTS: A total of 165 patients were surveyed, including 55 cases and 110 controls. The mean age was 43.6 ± 8.4 years, ranging from 19 to 64 years; 70.9% were male. Independent risk factors for HIV/HCV coinfection were education (up to eight years of schooling); age at first intercourse < 15 years; having undergone tattooing; blood transfusion; and use of injecting drugs. CONCLUSIONS: Low level of education, early age at first sexual intercourse, tattooing, blood transfusions, and sharing needles and other drug injection equipment were factors that increased the risk of HIV/HCV coinfection. The results from this research can be compared with similar data from other regions to help direct preventive and educational efforts targeting people living with HIV