2. Universidad Cardenal Herrera-CEU

The increase in life expectancy has also been accompanied by an increase in the use of medication to treat chronic diseases. Polypharmacy is associated with medication-related problems such as the increase in the anticholinergic burden. Older people are more susceptible to anticholinergic effects on the central nervous system and this, in turn, may be related to cognitive impairment. In this paper, we develop an updated anticholinergic burden scale, the CRIDECO Anticholinergic Load Scale (CALS) via a systematic review of the literature and compare it with the currently most used Anticholinergic Burden Scale (ACB). Our new scale includes 217 different drugs with anticholinergic properties, 129 more than the ACB. Given the effect that anticholinergic medications have on cognitive performance, we then used both scales to investigate the relationship between anticholinergic burden and cognitive impairment in adult Spanish subjects with subjective memory complaint. In our population, we observed an association between cognitive impairment and the anticholinergic burden when measured by the new CALS, but not when the ACB was applied. The use of a more comprehensive and upgraded scale will allow better discrimination of the risk associated with the use of anticholinergic medications on cognitive impairment. CALS can help raise awareness among clinicians of the problems associated with the use of medications, or combinations of them, with large anticholinergic effect, and promote a better personalized pharmacological approach for each patient.

Cognitive impairment (CI), an intermediate phase between the decline in physiological cognition and dementia, is known to be mediated by a variety of risk and protective factors, with age being the most influential of these. The multifactorial nature of CI and the worldwide phenomenon of an aging population makes decoupling old age from disease through the concept of healthy aging (HA) a matter of major interest. Focusing on psychosocial variables and psychological constructs, here we designed and piloted a data collection booklet (DeCo-B) to assess CI and HA from a holistic perspective. The DeCo-B comprises six sections: sociodemographic factors, CI, meaning in life, psychosocial factors, health problems, and lifestyle. The estimated prevalence of CI and HA in our cohort were 24.4% and 6.6%, respectively. Spearman correlations mainly identified pairwise associations between the meaning in life domains and psychosocial variables. Moreover, age, marital status, purpose in life, resilience, chronic pain, cognitive reserve, and obstructive sleep apnea were significantly associated with an increased risk of CI. Our results showed that DeCo-B is a suitable tool for researching how modifiable risk and protective factors influence cognitive status. The complex interrelationships between variables should be further investigated and, for practical reasons, the questionnaire should be optimized in future work.

Introducción: Las benzodiacepinas (BZD) son medicamentos generalmente indicados para el insomnio y la ansiedad, que se utilizan mucho más tiempo del aconsejado por la Agencia Española del Medicamento y pueden producir, entre otras reacciones adversas, deterioro cognitivo, pérdida de memoria, sedación y, en uso continuado, tolerancia y dependencia. Objetivo: Mejorar desde la farmacia el uso de las BZD en mayores de 65 años y, con ello, el estado de salud del paciente. Material y métodos: Estudio controlado a simple ciego, realizado en 12 farmacias desde febrero de 2006 hasta febrero de 2008. Los pacientes forman parte del grupo control o de intervención según el orden de una lista aleatoria. Se utilizan hojas de registro del uso de BZD, fi chas de registro farmacoterapéutico y los cuestionarios de Siu-Reuben, Pfeiffer y de Reacciones Adversas. Se considera un resultado satisfactorio si al fi nal del estudio el paciente disminuye la dosis de BZD, pasa a uso esporádico, la elimina o cambia por lorazepam. Resultados: Se incluyen 164 pacientes en el grupo control y 173 en el de intervención. El 85% de los pacientes utiliza las BZD más tiempo del aconsejado. La intervención farmacéutico-médico-paciente consigue un mejor resultado (84%) que la del farmacéuticopaciente (41%). Obtienen resultados satisfactorios el 29% de los pacientes del grupo de intervención, frente al 10,8% del grupo control, y ello supone una mejora del test de Pfeiffer y de Reacciones Adversas. Conclusiones: Las BZD son fármacos mal utilizados. La intervención del farmacéutico mejora su uso y conlleva una mejora en el estado de salud del paciente. Se debe mejorar la relación farmacéutico-médico.

The increased pressure on primary care makes it important for other health care providers, such as community pharmacists, to collaborate with general practitioners in activities related to chronic disease care. Therefore, the objective of the present project was to develop a protocol of action that allows close pharmacist-physician collaboration to carry out a coordinated action for very early detection of cognitive impairment (CI). Methods: A comparative study to promote early detection of CI was conducted in 19 community pharmacies divided into two groups: one group with interprofessional collaboration (IPC) and one group without interprofessional collaboration (NonIPC). IPC was defined as an interactive procedure involving all pharmacists, general practitioners and neurologists. A total of 281 subjects with subjective memory complaints were recruited. Three tests were used in the community pharmacies to detect possible CI: Memory Impairment Screening, Short Portable Mental State Questionnaire, and Semantic Verbal Fluency. Individuals with at least one positive cognitive test compatible with CI, were referred to primary care, and when appropriate, to the neurology service. Finally, we evaluated the differences in clinical and diagnostic follow-up in both groups after six months. Results: The NonIPC study group included 38 subjects compatible with CI referred to primary care (27.54%). Ten were further referred to a neurology department (7.25%) and four of them (2.90%) obtained a confirmed clinical diagnosis of CI. In contrast, in the IPC group, 46 subjects (32.17%) showed results compatible with CI and were referred to primary care. Of these, 21 (14.68%) were subsequently referred to a neurology service, while the remaining 25 were followed up by primary care. Nineteen individuals out of those referred to a neurology service obtained a confirmed clinical diagnosis of CI (13.29%). The percentage of subjects in the NonIPC group referred to neurology and the percentage of subjects diagnosed with CI, was significantly lower in comparison to the IPC group (p-value 0.0233; p-value 0.0007, respectively). Conclusions: The creation of IPC teams involving community pharmacists, general practitioners, and neurologists allow for increased detection of patients with CI or undiagnosed dementia and facilitates their clinical follow-up. This opens the possibility of diagnosis in patients in the very early stages of dementia, which can have positive implications to improve the prognosis and delay the evolution of the disease.

Introducción: la vacuna antigripal está indicada entre el personal sanitario, aunque la cobertura antigripal en farmacéuticos comunitarios españoles actualmente se desconoce. Este trabajo pretende averiguar esta cobertura, las causas de los farmacéuticos para vacunarse o no de la gripe, el absentismo laboral que les ocasiona, si recomiendan la vacunación antigripal entre los grupos de riesgo y su disposición a administrarla en la farmacia. Métodos: estudio descriptivo transversal mediante un cuestionario online destinado a farmacéuticos comunitarios de toda España. Se realizó un análisis descriptivo de las variables estudiadas y de la asociación entre la vacunación y las variables cualitativas (test Chi-cuadrado y Fisher) y cuantitativas (ANOVA). Resultados: se obtuvo una tasa de respuesta del 9,4 % (n=1.436). Los farmacéuticos refirieron vacunarse en torno al 30 % en las tres temporadas estudiadas (2016- 2019), siendo del 31-35,8 % (IC95 %) en la temporada 2018-2019. Ser titular/cotitular de la farmacia, la experiencia profesional, la edad, vacunarse para evitar la gripe y/o por responsabilidad, y vacunarse en temporadas anteriores son factores asociados a vacunarse (p<0,05). Ser socio de SEFAC también lo es. El absentismo por gripe en la temporada 2018-2019 fue del 9,5 %. Los farmacéuticos que más dijeron vacunarse recomiendan más la vacuna que los que no, y tendrían mayor predisposición a administrarla (p<0,05). Conclusiones: la cobertura vacunal antigripal entre los farmacéuticos comunitarios es baja a pesar del absentismo que les causa. Facilitar la vacunación a los farmacéuticos podría incrementar su cobertura. Los farmacéuticos recomiendan la vacunación contra la gripe a los pacientes de riesgo y estarían dispuestos a vacunar en farmacias autorizadas. / Introduction: while the influenza vaccine is indicated for healthcare personnel, its coverage among Spanish community pharmacists is currently unknown. This study aims to quantify this coverage as well as evaluate the causes leading pharmacists to be inoculated or not, their flu-related absenteeism, whether they recommend the vaccine to risk groups, and their willingness to administer it in the pharmacy. Methods: descriptive cross-sectional study using an online questionnaire aimed at community pharmacists throughout Spain. A descriptive analysis of the variables studied and of the association between vaccination and qualitative (Chi-square and Fisher test) and quantitative (ANOVA) variables was performed. Results: a response rate of 9.4% (n=1,436). Pharmacists reported vaccinating around 30 % in the three seasons under study (2016-2019), being 31-35.8% (IC95%) in the 2018-2019 season. Being a pharmacy owner/co-owner, professional experience, age, being vaccinated to avoid influenza and/or for responsibility, and being vaccinated in previous seasons are factors associated with being vaccinated (p<0.05). Being a member of SEFAC is also a factor. Flu-related absenteeism in the 2018-2019 season was 9.5%. Pharmacists who reported being vaccinated themselves were more likely to recommended the vaccine and more likely to administer it (p<0.05). Conclusions: flu vaccination coverage among community pharmacists is low despite the absenteeism this causes. Making vaccination easier for pharmacists could increase coverage. Pharmacists recommend flu vaccination for at-risk patients and would be willing to vaccinate in licensed pharmacies.

Introducción: la labor del farmacéutico comunitario en el Servicio de Indicación Farmacéutica (SIF) es muy importante como primera línea de asistencia a la población, aunque no está suficientemente documentada. Objetivos: evaluar la intervención del farmacéutico comunitario en el SIF ante una consulta sobre enfermedad de ojo seco (EOS) con el uso de protocolos. Material y métodos: estudio descriptivo, observacional realizado dentro del programa I-VALOR (enero-junio 2015). Los participantes fueron farmacéuticos voluntarios y pacientes que solicitaron algún remedio para aliviar la EOS. Se utilizó el protocolo del SIF del Foro de Atención Farmacéutica en Farmacia Comunitaria, un consenso para EOS realizado entre sociedades científicas, una hoja de derivación, un informe para el paciente y una hoja de recomendaciones. Resultados: participaron 6.350 pacientes. 62,7 % consultas fueron realizadas por mujeres (24,3 % 46-65 años). El 60 % de los pacientes no presentaba ningún criterio de derivación. Se detectaron 3.887 criterios de derivación en 2.537 pacientes. Se decidió no derivar al 15,4 %, y del resto, 87,3 % aceptó la derivación. La dispensación de algún tratamiento tuvo lugar en el 80 % de los pacientes: 3.157 con tratamiento farmacológico (89,2 % un único medicamento) y 2.403 con tratamiento no farmacológico. El 35 % recibió consejos higiénico-dietéticos y consejo farmacéutico. Se detectaron 25 reacciones adversas a medicamentos (0,4 %). El 70,5 % de todas las consultas realizadas fueron resueltas sin necesidad de derivar al médico. Conclusiones: el programa I-VALOR para EOS ha permitido evaluar la intervención protocolizada del farmacéutico en EOS mediante el registro de las actuaciones farmacéuticas para demostrar la labor desarrollada desde la farmacia comunitaria. / Background: Minor ailment service offered in community pharmacist is a key element in patient care. Thought in Spain the service is not properly documented. Aims: The main objective was to evaluate community pharmacists’ interventions through an agreed minor ailment service for dry eye syndromes (DES). Method: Descriptive study undertaken alongside I-VALOR programme (January-June 2015). Participants were pharmacists from SEFAC who voluntarily decided to do, and patients were those who consulted about DES in community pharmacy. Pharmacists used the Pharmaceutical Care Forum guideline for the Minor Ailment Service and an agreed consensus between pharmaceutical and medical societies. A patient’s form and a referral’s form were designed. Results: There were 6,350 patients involved. 62.7% consultations were made by women (24.3% of 46-65 years old). No referral criteria were detected in 60% of patients. The pharmacist detected 3,887 referral criteria in 2,537 patients. Pharmacists decided not to refer 15.4% of those patients. 87.3% of the patients referred accepted the referral. Treatments were dispensed in 80% of patients: 3,157 pharmacological treatment (89.2% a single medication) and 2,403 non-pharmacological treatment (medical device, food supplement or eye cleaning product). 35% received hygienic-dietary advice and pharmaceutical advice. Twenty-five adverse drug reactions were detected (0.4%). 70.5% of all consultations made were managed with no referral to a general practitioner (GP). Conclusions: I-VALOR programme allowed to evaluate an agreed intervention for DES in community pharmacy through the record of MAS to demonstrate CP contribution to manage minor ailments.

Introducción: El deterioro cognitivo (DC) es una enfermedad que aumenta con la edad. Es importante conocer los factores protectores y de riesgo de esta enfermedad. Metodología: Estudio observacional realizado a 729 personas mayores de 65 años en 13 farmacias comunitarias durante dos años. Se recogieron datos demográficos (sexo, edad, nivel de estudios) y de estilos de vida (afición a la lectura, realización de pasatiempos, horas de televisión) y para el cribaje de los pacientes se realizaron los test SPMSQ (Short-Portable Mental State Questionaire) de Pfeiffer y Mini-Mental State Examination (MMSE) versión NORMADERM. También se realizó una revisión bibliográfica del tema. Resultados: Se detectó un 17,6% de DC. Se encontró una asociación estadísticamente significativa como protección frente al DC con la afición a la lectura y el nivel de estudios. No se encontró asociación con las horas de televisión (TV) ni con la realización de pasatiempos. La revisión bibliográfica aportó más factores protectores y de riesgo. Discusión: Con nuestros datos podemos afirmar que tanto la reserva cognitiva (años de estudio) como la estimulación cognitiva (horas de lectura) protegen del DC. Sobre los demás datos obtenidos no se han encontrado coincidencias, por lo que sería necesario aumentar el tamaño muestral para poder realizar una comparación más eficaz. Conclusiones: El nivel educativo bajo es un factor de riesgo de DC, mientras que estudios superiores serían un factor preventivo. La lectura es un factor protector de DC. / Introduction: Cognitive Dysfunction (CD) is a disease that increases with age. It is important to know the protective and risk factors for this disease. Methodology: Observational study carried out on 729 people over 65 years of age in community 13 pharmacies for two years. Demographic data were collected (sex, age, level of studies) and lifestyles (love of reading, hobbies such as crossword puzzles or sudokus etc, TV hours), and the SPMSQ (Short-Portable Mental State Questionaire) test of Pfeiffer and Mini- Mental State Examination (MMSE) were carried out to check the patient’s CD. A bibliographic review of the subject was also conducted. Results: 17.6% of CD was detected. A statistically significant association was found as a protection against CD with a love of reading and the level of studies. No association was found with TV hours or hobbies. The literature review provided more protective and risk factors. Discussion: With our data we can affirm that both cognitive reserve (years of study) and cognitive stimulation (hours of reading) protect from CD. No coincidences were found on the other data obtained, so it would be necessary to increase the sample size in order to make a more effective comparison. Conclusions: Low educational level is a risk factor for CD while higher education would be a preventive factor. Reading is a protective factor of CD.

Purpose: The early detection of Mild Cognitive Impairment (MCI) is essential in aging societies where dementia is becoming a common manifestation among the elderly. Thus our aim is to develop a decision tree to discriminate individuals at risk of MCI among non-institutionalized elderly users of community pharmacy. A more clinically and patient-oriented role of the community pharmacist in primary care makes the dispensation of medication an adequate situation for an effective, rapid, easy, and reproducible screening of MCI. Methods: A cross-sectional study was conducted with 728 non-institutionalized participants older than 65. A total of 167 variables were collected such as age, gender, educational attainment, daily sleep duration, reading frequency, subjective memory complaint, and medication. Two screening tests were used to detect possible MCI: Short Portable Mental State Questionnaire (SPMSQ) and the Mini-Mental State Examination (MMSE). Participants classified as positive were referred to clinical diagnosis. A decision tree and predictive models are presented as a result of applying techniques of machine learning for a more efficient enrollment. Results: One hundred and twenty-eight participants (17.4%) scored positive on MCI tests. A recursive partitioning algorithmwith themost significant variables determined that the most relevant for the decision tree are: female sex, sleeping more than 9 h daily, age higher than 79 years as risk factors, and reading frequency. Moreover, psychoanaleptics, nootropics, and antidepressants, and anti-inflammatory drugs achieve a high score of importance according to the predictive algorithms. Furthermore, results obtained from these algorithms agree with the current research on MCI. Conclusion: Lifestyle-related factors such as sleep duration and the lack of reading habits are associated with the presence of positive in MCI test. Moreover, we have depicted how machine learning provides a sound methodology to produce tools for early detection of MCI in community pharmacy. Impact of findings on practice: The community of pharmacists provided with adequate tools could develop a crucial task in the early detection of MCI to redirect them immediately to the specialists in neurology or psychiatry. Pharmacists are one of the most accessible and regularly visited health care professionals and they can play a vital role in early detection of MCI.