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      Evaluación del servicio de entrega de medicación a domicilio desde la Farmacia Hospitalaria durante la pandemia COVID-19 Translated title: Medication home delivery service set up in a Hospital Pharmacy Department during the COVID-19 pandemic

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          Abstract

          RESUMEN Objetivo: Analizar el procedimiento de entrega a domicilio de medicación de dispensación hospitalaria instaurado en el Servicio de Farmacia Hospitalaria (SFH) durante la pandemia COVID-19. Conocer el perfil de pacientes que aceptan la dispensación domiciliaria, analizar por patología las dispensaciones a domicilio y evaluar el grado de satisfacción de los pacientes mediante una encuesta telefónica. Métodos: Estudio observacional, retrospectivo y descriptivo. Se analizaron las entregas de medicación a domicilio desde el SFH en el periodo del 7 de abril al 7 de mayo. Las características clínicas y demográficas de los pacientes se obtuvieron a partir del programa informático de pacientes externos del SFH e historia clínica electrónica. El grado de satisfacción de los pacientes se evaluó mediante la realización de una encuesta telefónica posterior a la entrega a domicilio. Resultados: Se realizaron 2.028 entregas de medicación a domicilio abarcando toda la Comunidad Autónoma de Madrid (CAM), con un grado de aceptación del 76,82%. La patología con mayor número de entregas fue VIH. Los pacientes con enfermedades inmunomediadas fueron los que mayor aceptación reportaron. El 99% de los pacientes se mostraron satisfechos con el servicio. Conclusiones: El servicio de entrega de medicación a domicilio ha sido ampliamente aceptado por los pacientes, mostrando un alto grado de satisfacción con el mismo. Se han evitado desplazamientos al hospital, disminuyendo el riesgo de contagio. Los pacientes demandan la prolongación de este servicio fuera del periodo de pandemia y sugieren que se complemente con una consulta de atención farmacéutica por telefarmacia.

          Translated abstract

          SUMMARY Objective: To analyze the home delivery process of hospital medication set up in a Hospital Pharmacy Department (HPD) during the COVID-19 pandemic. To asses the profile of patients who accept home delivering, to analyze home dispensations by pathology and to evaluate the patient satisfaction through a telephone survey. Methods: Observational, retrospective and descriptive study. Medication home delivery from the HPD in the period from April 7 to May 7 was analyzed. Patients demographic and clinical characteristics were obtained from the outpatient software used at the HPD and the electronic medical record. The degree of patient satisfaction was assessed by conducting a telephone survey after home delivery. Results: A total of 2,028 home deliveries were made to the entire Community of Madrid, with an acceptance rate of 76,82%, being HIV the pathology with the highest number of deliveries. Patients with immune-mediated diseases were the ones with the greater acceptance rate. Overall patient satisfaction with the service was 99%. Conclusions: Medication home delivery service has been widely accepted by patients, showing a high degree of satisfaction. Avoiding trips to the hospital has reduced the risk of contagion. Patients demand the continuation of this service after the pandemic and support Pharmaceutical Care by telepharmacy.

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          Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?

          The most distinctive comorbidities of 32 non-survivors from a group of 52 intensive care unit patients with novel coronavirus disease 2019 (COVID-19) in the study by Xiaobo Yang and colleagues 1 were cerebrovascular diseases (22%) and diabetes (22%). Another study 2 included 1099 patients with confirmed COVID-19, of whom 173 had severe disease with comorbidities of hypertension (23·7%), diabetes mellitus (16·2%), coronary heart diseases (5·8%), and cerebrovascular disease (2·3%). In a third study, 3 of 140 patients who were admitted to hospital with COVID-19, 30% had hypertension and 12% had diabetes. Notably, the most frequent comorbidities reported in these three studies of patients with COVID-19 are often treated with angiotensin-converting enzyme (ACE) inhibitors; however, treatment was not assessed in either study. Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV] and SARS-CoV-2) bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels. 4 The expression of ACE2 is substantially increased in patients with type 1 or type 2 diabetes, who are treated with ACE inhibitors and angiotensin II type-I receptor blockers (ARBs). 4 Hypertension is also treated with ACE inhibitors and ARBs, which results in an upregulation of ACE2. 5 ACE2 can also be increased by thiazolidinediones and ibuprofen. These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19. If this hypothesis were to be confirmed, it could lead to a conflict regarding treatment because ACE2 reduces inflammation and has been suggested as a potential new therapy for inflammatory lung diseases, cancer, diabetes, and hypertension. A further aspect that should be investigated is the genetic predisposition for an increased risk of SARS-CoV-2 infection, which might be due to ACE2 polymorphisms that have been linked to diabetes mellitus, cerebral stroke, and hypertension, specifically in Asian populations. Summarising this information, the sensitivity of an individual might result from a combination of both therapy and ACE2 polymorphism. We suggest that patients with cardiac diseases, hypertension, or diabetes, who are treated with ACE2-increasing drugs, are at higher risk for severe COVID-19 infection and, therefore, should be monitored for ACE2-modulating medications, such as ACE inhibitors or ARBs. Based on a PubMed search on Feb 28, 2020, we did not find any evidence to suggest that antihypertensive calcium channel blockers increased ACE2 expression or activity, therefore these could be a suitable alternative treatment in these patients. © 2020 Juan Gaertner/Science Photo Library 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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            Global Preparedness Against COVID-19: We Must Leverage the Power of Digital Health

            The coronavirus disease (COVID-19) pandemic has revealed many areas of public health preparedness that are lacking, especially in lower- and middle-income countries. Digital interventions provide many opportunities for strengthening health systems and could be vital resources in the current public health emergency. We provide several use cases for infection control, home-based diagnosis and screening, empowerment through information, public health surveillance and epidemiology, and leveraging crowd-sourced data. A thoughtful, concerted effort—leveraging existing experience and robust enterprise-grade technologies—can have a substantive impact on the immediate and distal consequences of COVID-19.
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              Telepharmacy Services: Present Status and Future Perspectives: A Review

              Background and Objectives: The term “telepharmacy” indicates a form of pharmaceutical care in which pharmacists and patients are not in the same place and can interact using information and communication technology (ICT) facilities. Telepharmacy has been adopted to provide pharmaceutical services to underserved areas and to address the problem of pharmacist shortage. This paper has reviewed the multi-faceted phenomenon of telepharmacy, summarizing different experiences in the area. Advantages and limitations of telepharmacy are discussed as well. Materials and Methods: A literature analysis was carried out on PubMed, using as entry term “telepharmacy” and including articles on the topic published between 2012 and 2018. Results: The studies reviewed were divided into three categories of pharmacy practice, namely (1) support to clinical services, (2) remote education and handling of “special pharmacies”, and (3) prescription and reconciliation of drug therapies. In general, different telepharmacy services were effective and accompanied by a satisfaction of their targets. Conclusions: Nowadays, the shortage of health personnel, and in particular pharmacists, is a challenging issue that the health systems have to face. The use of a new technology such as telepharmacy can represent a possible option to solve these problems. However, there are unsolved limitations (e.g., legal implications) that make greater diffusion of telepharmacy difficult. Stronger data on the effectiveness of this area of pharmacy care, together with a critical evaluation of its limits, can make actors involved aware about the potentialities of it and could contribute to a larger diffusion of telepharmacy services in the interest of communities and citizens.
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                Author and article information

                Journal
                ofil
                Revista de la OFIL
                Rev. OFIL·ILAPHAR
                Organización de Farmacéuticos Ibero-Latinoamericanos (Madrid, Madrid, Spain )
                1131-9429
                1699-714X
                2020
                : 30
                : 3
                : 193-199
                Affiliations
                [1] Madrid orgnameHospital Universitario La Paz orgdiv1Servicio de Farmacia España
                Article
                S1699-714X2020000300193 S1699-714X(20)03000300193
                10.4321/s1699-714x2020000300008
                35f3ce9f-9e1e-4176-ba70-986661687ba3

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 08 June 2020
                : 05 June 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 7
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                SciELO Spain

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                Medication home delivery,hospital pharmacy,pharmaceutical care,atención farmacéutica,COVID-19,telefarmacia,telepharmacy,Entrega de medicación,farmacia hospitalaria

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