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Background: Clopidogrel is a CYP2C19-activated pro-drug, used to prevent cardiovascular events. Up to 27% of Caucasians has at least one CYP2C19*2 allele (impaired enzymatic activity), whereas 38% have at least one CYP2C19*17 allele (higher enzymatic activity). However, CYP2C19 pharmacogenetic analysis before prescribing clopidogrel is not widely implemented in clinical practice. Purpose(s): To evaluate feasibility and operability of a collaborative pilot circuit to determine pharmacogenetic markers to optimise clopidogrel prescription. Method(s): The authors expect 150 patients with a clopidogrel prescription by a cardiologist of Hospital de Sant Pau to enrol. They can enrol when filling their prescriptions in one of the 24 collaborating community pharmacies in the Hospital's area. Community pharmacists collect from each participant's pharmacotherapeutic profile and a saliva sample to be sent to the hospital for CYP2C19 genotyping. Hospital pharmacists collate all obtained data with their clinical records. Data are analysed jointly with a cardiologist to assess clopidogrel prescription adequacy. Barcelona Pharmacists' Association (COFB) coordinates the whole project and provides IT and logistic support. Result(s): This project started in January 2020 and it was temporarily suspended due to the COVID19 pandemic. On 13th March 2020, 114 patients with clopidogrel prescriptions were registered, 21 met the inclusion criteria and 15 were enrolled. Five out of the eight already genotyped patients were intermediate or poor metabolisers. Conclusion(s): This circuit seems to be feasible, but further research is needed once the study is resumed. Pharmacogenetics increasing clinical relevance needs more clinical implication of pharmacists.
RESUMEN
Introduction: Community pharmacists were amongst the few healthcare professionals readily available for face-to-face consultation after the first COVID19 outbreak in Catalonia, Spain. A collaborative practice programme was created in September 2020 to ease the referral to and communication with Primary Care (PC) of those Community Pharmacy (CP) users who had COVID19-like symptoms. This programme, known as JoDIC, was created by the Epidemiological Surveillance Services (ESS) of Valles and Barcelones-Nord-Maresme Areas, the Catalan Healthcare Service (CatSalut) and Barcelona Pharmacists Association (COFB). After using a paper-based system at the beginning, a safe cloud-based software hosted in Farmaserveis, the Catalan pharmacy services platform, started running in February 2021, to facilitate patients' follow-up. In June 2021, referral for COVID19 vaccination was included to the platform. COVID19 antigenic tests were not available in Spanish CPs until July 2021. Objective(s): To enable an effective and safe referral and communication system from CPs to PC centers of patients needing COVID19-related healthcare interventions, within the JoDIC programme;and to describe the pharmaceutical interventions performed in the JoDIC programme framework. Method(s): COFB, ESS and CatSalut jointly designed JoDIC circuit, which was activated at the CP to detect users with COVID19-like symptoms, users who were a close contact to a COVID19 case or users who were not fully vaccinated. The initial paper-based circuit started in September 2020, involving Valles area only. Complete referral data was gathered from the 5th February 2021 to the 31st December 2020 period of study, when Farmaserveis specific module was launched. On the 23rd June 2021, JoDIC was expanded to the whole Northern Barcelona Metropolitan Area, comprising more than two million inhabitants who are serviced by 649 CP. By filling up a form on Farmaserveis, the patient's data was referred by a community pharmacist to the PC centre to evaluate each case and to provide further care needed. Result(s): 528 community pharmacists working in 372 CP were trained in the protocol. Community pharmacists performed interventions in 1303 CP users (496, paper-based;and 807, registered on Farmaserveis). 111 CP registered pharmaceutical interventions on Farmaserveis (7.4 patients per CP). 63.1% (n = 509) of CP users, received health education by the pharmacist, while 36.9% (n = 298) were referred to their PC centre. 71.6% of the referred patients were due to having COVID19-like symptoms;25.3%, were close contacts to COVID19-positive cases;and 3.1%, to be vaccinated. 68.8% of the referred patients eventually attended their appointments with their family physician. 63.4% of the visited patients needed some kind of diagnostic test. 30.8% tests were COVID19-positive. Conclusion(s): The current pandemic favoured the establishment of new COVID19 detection circuits and communication ways between ESS, CP and PC centers. Our data shows high efficacy to detect COVID19-positive cases (30.8% positivity) and good acceptability amongst referred citizens (68.8% successful referrals). JoDIC programme is a seminal project that will facilitate communication amongst PC and CP professionals in other contexts.
RESUMEN
OBJECTIVE: The health crisis due to the COVID-19 pandemic is a challenge in the dispensing of outpatient hospital medication (OHM). Models of Antiretroviral Therapy (ART) based on community pharmacy support (ARTCP) have proven to be successful. The aim was to evaluate the degree of satisfaction, acceptability and limitations of the implementation of ARTCP, in the context of a pandemic, in our environment. METHODS: Descriptive cross-sectional study carried out in a Barcelona hospital, during the months of July-November 2020. A telephone survey was carried out via a questionnaire on the quality dimensions of the model (degree of satisfaction, acceptability) and associated inconveniences. Data collected: demographics, antiretroviral treatment (ART), concomitant medication, drug interactions (DDIs), CD4 lymphocyte count and plasma viraemia. Data analysis included descriptive statistics. RESULTS: A total of 533 (78.0%) HIV patients receiving ART were included. 71.9% (383/533) of these patients were very satisfied and 76.2% preferred attending the community pharmacy rather than the hospital. The mean satisfaction rating was 9.3 (DS: 1.4). The benefits reported were: 1) proximity to home (406: 76.1%); 2) lower risk of contagion of COVID-19 (318: 59.7%); 3) shorter waiting time (201: 37.1%); 4) time flexibility (104: 19.5%); 5) reduction of financial expenses (35: 6.57%). A total of 11 (2%) patients reported no benefit. Only 22.9% reported disadvantages associated with ARTCP: 1) lack of privacy (65: 12.2%); 2) lack of coordinationorganization (57: 10.7%). CONCLUSIONS: The COVID-19 pandemic has had an impact on the provision of pharmaceutical care for HIV patients. The ARTPC model has proved efficient, with patients reporting a high degree of satisfaction.