ABSTRACT
Background and importance Patients with immune-mediated diseases (IMIDs) frequently need therapies from the hospital pharmacy. Due to the COVID-19 pandemic, a home delivery service (HDS) with telepharmacy follow-up was started to avoid unnecessary visits to hospital. Aim and objectives To describe the population that accepted the HDS and evaluate their satisfaction about it. Material and methods Descriptive retrospective observational study in a cohort of patients with IMIDs who had received HDS from February to August 2021. Data collected were age, sex, pathology, distance to hospital, number of shipments and satisfaction survey score. Surveys were made by telephone and scored the Pharmacy Service, the transport company and global satisfaction by means of seven questions (each with scores ranging from 1 to 5). Results 130 patients received HDS (7.23% of IMIDs outpatients), 116 of them were contacted for the survey. 81.9% were female. Median age was 74 (IQR 65.50-80.00) years. Pathologies distribution: 63 (54.31%) rheumatoid arthritis;18 (15.52%) spondyloarthropathies;14 (12.07%) multiple sclerosis;7 (6.03%) inflammatory bowel disease;5 (4.31%) psoriasis;5 (4.31%) connective tissue diseases and 4 (3.45%) other IMIDs (hydradenitis or vasculitis). 22.41% patients lived outside of the city centre where the hospital is located. Patients received an average of 2.17 (SD 1.12) shipments during these months. 84.48% patients were offered HDS from the hospital pharmacy;15.52% asked for the service themselves. Main reason chosen by patients to accepted HDS was the COVID-19 pandemic situation or self-insolation due to contact or infection (75.86%), followed by mobility difficulties (31.90%), distance to hospital (6.90%) and work schedule (0.86%). Average survey score for Pharmacy Service: 4.93 (SD 0.29) about pharmacist follow-up, 5.00 (SD 0) about correct medication and 4.98 (SD 0.13) about shipping material. In relation to the transport company, the scores were 5.00 (SD 0) about carrier treatment, 4.86 (SD 0.58) about schedule compliance and 5.00 (SD 0) about proper packaging conditions. Average score for global satisfaction was 4.99 (SD 0.10). Conclusion and relevance The pandemic situation increased HDS necessity (75.86% of patients requested it) but its continuity is justified specially due to mobility difficulties (31.90%) in older or incapacitated people, a frequent situation in IMIDs outpatients. Home delivery is a service that is highly valued by patients. Even so, telepharmacy follow-up and trying to adapt the shipping schedule could be areas to improve the service.
ABSTRACT
INTRODUCTION: A small percentage of patients will develop a severe form of COVID-19 caused by SARS-CoV-2 infection. Thus, it is important to predict the potential outcomes identifying early markers of poor prognosis. In this context, we evaluated the association of SARS-CoV-2 infection with lipid abnormalities and their role in prognosis. METHODS: Single-center, retrospective, observational study of COVID-19 patients admitted from March to October 2020. Clinical and laboratory data, comorbidities, and treatments for COVID-19 were evaluated. Main outcomes including intensive care unit (ICU) admission and mortality were analyzed with a multivariable Cox proportional hazards regression model. RESULTS: We selected 1489 from a total of 2038 consecutive patients with confirmed COVID-19, who had a complete lipid profile before ICU admission. During the follow-up performed in 1109 patients, we observed a decrease in T-c, HDL-c, and LDL-c in 28.6%, 42.9%, and 30.4% of patients, respectively, and an increase in TG in 76.8%. The decrease of both T-c and HDL- c was correlated with a decrease in albumin levels (r = 0.39 and r = 0.37, respectively). Kaplan-Meier survival curves found an increased ICU admission in patients with lower T-c (HR 0.55, CI 0.36-0.86), HDL-c (HR 0.61, CI 0.45-0.84), and LDL-c (HR 0.85, CI 0.74-0.97). Higher values of T-c (HR 0.45, CI 0.36-0.57), HDL-c (HR 0.66, CI 0.54-0.81), and LDL-c (HR 0.86, CI 0.78-0.94) showed a protective effect on mortality. CONCLUSIONS: Abnormalities in lipid profile are a frequent complication of SARS-CoV-2 infection and might be related to morbidity and mortality. FUNDING: Proyectos de Investigación en Salud (FIS) and cofinanced by FEDER.