Outpatient pharmaceutical care satisfaction survey through Telepharmacy during COVID-19 pandemic in Spain.

OBJECTIVE: To present the results of a survey about the Telemedicine outpatients experience and satisfaction of a pharmaceutical care  program through Telepharmacy, carried out from hospital pharmacy  departments in Spain during COVID-19 Pandemic (ENOPEX survey), and  identify differences across regions in Spain. METHOD: An analysis of results of the national survey ENOPEX on outpatient Telepharmacy services during the lockdown due to the COVID­19 pandemic, analyzed by autonomous community in Spain. Data was collected in relation to point of delivery; pharmacotherapeutic follow-up; patient's opinion and satisfaction with Telemedicine; confidentiality; future development of pharmaceutical care, through Telepharmacy services;  and coordination with the patient care team. Four multilevel regressions were performed to evaluate the differences between Spanish regions on the most relevant variables of the study, using the R version 4.0.3 software. RESULTS: A total of 8,079 interviews were valid, 52.8% of respondents were  female, age was 41-65 years in 54.3% of participants; 42.7% had been  receiving treatment for more than 5 years; 42.8% lived 10-50 km  from the  hospital; the journey to hospital took more than one hour for 60.2% of  participants. Globally, 85.7% received medicines at home. However, medicines  were delivered at a community pharmacy in some communities, such as  Cantabria (95.8%), or at primary care centers as in Castile La Mancha  (16.5%). In total, 96.7% of participants were satisfied or very satisfied with  Telemedicine pharmaceutical care, through Telepharmacy services, with  differences across communities, with users in Andalusia reporting the highest  satisfaction (OR = 1.58), and users in Castile-León being less satisfied with  Telepharmacy services (OR = 0.66). Users in Catalonia are the ones more  clearly in favor of Telemedicine pharmaceutical care, through Telepharmacy  services as a complementary service, with an OR = 5.85 with respect to other  users. The Telemedicine most frequently mentioned advantage was that  Telepharmacy services avoided visits, especially in Cantabria (92.5%) and  Extremadura (88.4%). Most patients prefer informed delivery of medicines at  home when they do not have an appointment at the hospital: total of 75.6 %,  from 50.1% of users in Cantabria to 96.3% in Catalonia (p < 0.001). The users  less willing to pay for Telepharmacy services were the ones from Castile- León and Galicia, with users in Catalonia and Navarra showing higher  willingness. CONCLUSIONS: In general terms, patients were satisfied with Telemedicine pharmaceutical care, through Telepharmacy services during the COVID­19 pandemic, being mostly in favor of maintaining these services to avoid travels.

OBJETIVO: Describir los resultados de la encuesta sobre experiencia y  atisfacción de la Telemedicina en pacientes externos relativo a un programa de  atención farmacéutica a través de la Telefarmacia, realizado desde los servicios de farmacia durante la pandemia COVID-19 (encuesta ENOPEX) e identificar  las diferencias entre las comunidades autónomas de España.Método: Se analizaron los resultados de la encuesta nacional ENOPEX sobre  Telefarmacia en pacientes externos durante el confinamiento debido a la  pandemia COVID-19, realizado en las diferentes comunidades autónomas de  España. Se recogieron datos relativos a lugar de entrega, seguimiento farmacoterapéutico, opinión y satisfacción del paciente con la  Telefarmacia, confidencialidad, desarrollo futuro de la atención farmacéutica a  través de los servicios de Telefarmacia, y coordinación con el equipo de atención al paciente. Se realizaron cuatro regresiones multinivel para  evaluar las diferencias entre comunidades autónomas sobre las variables más relevantes del estudio por medio del software R versión 4.0.3. RESULTADOS: Un total de 8.079 entrevistas fueron válidas: el 52,8% eran mujeres, el 54,3% tenía entre 41-65 años, el 42,9% estaban en  tratamiento  prodesde hacía más de 5 años, el 42,8% vivía a 10-50 km del  hospital y el 60,2%  tardaba más de una hora en acudir al hospital.  globalmente, el 85,7% recibieron medicación a domicilio, aunque hubo  comunidades autónomas en las que se optó también por las oficinas de  farmacia, como en Cantabria (95,8%), o los centros de atención primaria,  como en Castilla­La Mancha (16,5%). El 96,7% de los pacientes refirieron estar satisfechos o muy satisfechos con la Telemedicina en la atención farmacéutica  mediante el uso de la Telefarmacia, detectándose variabilidad en cuanto a la  opinión entre comunidades, desde la mejor opinión en Andalucía (odds ratio  =1,58) y la menos favorable en Castilla y León (odds ratio = 0,66). Por su  parte, Cataluña es la comunidad que estaría más claramente a favor de la  Telemedicina en la atención farmacéutica de usar la Telefarmacia como  actividad complementaria, con una odds ratio de 5,85 respecto al resto. Las  ventajas más mencionadas de la Telemedicina fue que los servicios de  Telefarmacia evitaban desplazamientos, especialmente en Cantabria (92,5%) y Extremadura (88,4%). Los pacientes mayoritariamente prefieren el  acercamiento y entrega informada de la medicación a domicilio cuando no  tienen que acudir al hospital, el 75,6% globalmente, desde el 50,1% de  pacientes de Cantabria al 96,3% en Cataluña (p < 0,001). Las comunidades  autónomas menos dispuestas a pagar por el servicio de Telefarmacia fueron  Castilla y León y Galicia, y las que más, Cataluña y Navarra. CONCLUSIONES: En líneas generales, los pacientes están satisfechos con la  Telemedicina aplicada a la atención farmacéutica a través de los servicios de  Telefarmacia durante la pandemia COVID-19, estando mayoritariamente a  favor de mantenerla para evitar desplazamientos.

Health care costs of breast, prostate, colorectal and lung cancer care by clinical stage and cost component.

OBJECTIVE: To measure 3-year care costs of breast, prostate, colorectal and lung cancers disaggregated by site and clinical stage. METHOD: A retrospective observational design was employed to investigate care costs of cases recorded in the Registry of the Basque Country between 2010 and 2015. Data gathered included TNM stage and demographic, clinical and resource use variables. Total costs per patient with stage IV disease were calculated by combining generalized linear models with parametric survival analysis. Unit costs were obtained from the analytical accounting system of the Basque Health Service. RESULTS: The sample comprised 23,782 cancer cases (7801 colorectal, 5530 breast, 4802 prostate and 5649 lung cancer). The mean 3-year costs per patient with stage I to III disease were €11,323, €13,727, €8,651 and €12,023 for colorectal, breast, prostate and lung cancer, respectively. The most important cost components were surgery and chemotherapy. Total survival-adjusted costs until death for patients with stage IV disease (€27,568, €26,296, €16,151 and €15,931 for breast, colorectal, lung and prostate cancer, respectively) were higher than the 3-year costs for those with earlier-stage disease. CONCLUSIONS: This study quantitatively shows the pattern of changes in the economic burden of cancer throughout its natural history and the great magnitude of this burden for the health system. The use of indicators based on real-world data from each regional health service would allow cancer care in each region to be tailored to local population needs.

Outpatients' Opinion And Experience Regarding Telepharmacy During The COVID-19 Pandemic: The Enopex Project.

BACKGROUND: Telepharmacy, as a remote pharmaceutical care procedure, is being used worldwide during the COVID-19 pandemic, with the aim of preserving the health of patients and professionals. Its future development should incorporate the assessment of patient perception, but no research study has investigated it. OBJECTIVE: The objective was to poll the opinions and experiences of outpatients with telepharmacy through a purpose-developed questionnaire and to assess it's quality through an internal validity and reliability analysis. METHODS: Cross-sectional observational study of adult patients who used telepharmacy services during the COVID-19 lockdown period in Spain. The subjects answered a 24-item questionnaire, after giving their informed consent. Place of delivery, informed pharmacotherapeutic follow-up, opinion about telepharmacy, future development, ethics/satisfaction, and coordination constituted the six questionnaire categories. After assessing the adequate sample size with the Kaiser-Meyer-Olkin test, the Bartlett sphericity test analyzed the validity of the questionnaire. The intraclass correlation coefficient and Cronbach's α coefficient calculations verified the reliability and internal consistency. RESULTS: A total of 9442 interviews were administered to patients from 81 hospitals, of which 8079 were valid (52.8% female). A 54.1% were aged between 41-65 years; 42.7% had been in treatment for more than 5 years; 42.8% lived between 6-31 miles from the hospital. As many as 96.7% of patients were "satisfied" or "very satisfied" with telepharmacy, 97.5% considering it complementary to their usual follow-up; 55.9% expressed a preference for being followed up face to face when visiting the hospital. 75.6% said they had rather receive their medication at home. The sample size obtained was deemed appropriate [the Kaiser-Meyer-Olkin test (0.789) and Bartlett's sphericity test (p<0.005)]. The reliability analysis resulted in a Cronbach α = 0.7. CONCLUSION: Patients have shown high satisfaction with telepharmacy and the ENOPEX questionnaire is a tool with sufficient validity and reliability to be used in the evaluation of the care that patients receive through telepharmacy.

[Immunotherapy with CAR-T cells in paediatric haematology-oncology]. / Inmunoterapia con células CAR-T en hematooncología pediátrica.

Despite being a rare disease, cancer is the first cause of mortality due to disease during the paediatric age in the developed countries. The current, great increase in new treatments, such as immunotherapy, constitutes a new clinical and regulatory paradigm. Cellular immunotherapy is one of these types of immunotherapy. In particular, the advanced therapy drugs with chimeric antigen receptors in the T-lymphocytes (CAR-T), and particularly the CAR-T19 cells, has opened up a new scenario in the approach to haematology tumours like acute lymphoblastic leukaemia and the B-Cell lymphomas. The approval of tisagenlecleucel and axicabtagene ciloleucel by the regulatory authorities has led to the setting up of the National Plan for Advanced Therapies-CAR-T drugs in Spain. There is evidence of, not only the advantage of identifying the centres most suitable for their administration, but also the need for these to undergo a profound change in order that their healthcare activity is extended, in some cases, to the ability for the in-house manufacture of these types of therapies. The hospitals specialised in paediatric haematology-oncology thus have the challenge of progressing towards a healthcare model that integrates cellular immunotherapy, having the appropriate capacity to manage all aspects relative to their use, manufacture, and administration of these new treatments.