Early health system responses to the COVID-19 pandemic in Mediterranean countries: A tale of successes and challenges.

This paper conducts a comparative review of the (curative) health systems' response taken by Cyprus, Greece, Israel, Italy, Malta, Portugal, and Spain during the first six months of the COVID-19 pandemic. Prior to the COVID-19 pandemic, these Mediterranean countries shared similarities in terms of health system resources, which were low compared to the EU/OECD average. We distill key policy insights regarding the governance tools adopted to manage the pandemic, the means to secure sufficient physical infrastructure and workforce capacity and some financing and coverage aspects. We performed a qualitative analysis of the evidence reported to the 'Health System Response Monitor' platform of the European Observatory by country experts. We found that governance in the early stages of the pandemic was undertaken centrally in all the Mediterranean countries, even in Italy and Spain where regional authorities usually have autonomy over health matters. Stretched public resources prompted countries to deploy "flexible" intensive care unit capacity and health workforce resources as agile solutions. The private sector was also utilized to expand resources and health workforce capacity, through special public-private partnerships. Countries ensured universal coverage for COVID-19-related services, even for groups not usually entitled to free publicly financed health care, such as undocumented migrants. We conclude that flexibility, speed and adaptive management in health policy responses were key to responding to immediate needs during the COVID-19 pandemic. Financial barriers to accessing care as well as potentially higher mortality rates were avoided in most of the countries during the first wave. Yet it is still early to assess to what extent countries were able to maintain essential services without undermining equitable access to high quality care.

Short-Term Pilot Study to Evaluate the Impact of Salbi Educa Nutrition App in Macronutrients Intake and Adherence to the Mediterranean Diet: Randomized Controlled Trial.

Promoting a healthy diet is a relevant strategy for preventing non-communicable diseases. This study aims to evaluate the impact of an innovative tool, the SAlBi educa nutrition app, in primary healthcare dietary counseling to improve dietary profiles as well as adherence to the Mediterranean diet. A multi-center randomized control trial comprising 104 participants was performed. Both control (n = 49) and intervention (n = 55) groups attended four once-weekly sessions focusing on healthy eating habits and physical activity, over one month. As well as attending the meetings, the intervention group used the app, which provides self-monitoring and tailored dietary advice based on the Mediterranean diet model. In a second intervention (one arm trial), the potential of SAlBi educa was evaluated for three months during the COVID-19 pandemic. At 4 weeks, the intervention group had significantly increased their carbohydrate intake (7.7% (95% CI: 0.16 to 15.2)) and decreased their total fat intake (-5.7% (95% CI: -10.4 to -1.15)) compared to the control group. Significant differences were also found for carbohydrates (3.5% (95% CI: -1.0 to 5.8)), total fats (-5.9% (95% CI: -8.9 to -3.0)), fruits and vegetables (266.3 g/day (95% CI: 130.0 to 402.6)), legumes (7.7g/day (95% CI: 0.2 to 15.1)), starchy foods (36.4 g/day (95% CI: 1.1 to 71.7)), red meat (-17.5 g/day (95% CI: -34.0 to -1.1)), and processed meat (-6.6 g/day (95% CI: -13.1 to -0.1)) intakes during the COVID-19 pandemic. SAlBi educa is a useful tool to support nutrition counseling in primary healthcare, including in special situations such as the COVID-19 pandemic. Trial registration: ISRCTN57186362.

SAlBi educa (Tailored Nutrition App for Improving Dietary Habits): Initial Evaluation of Usability.

In recent years, the use of applications to improve dietary habits has increased. Although numerous nutrition apps are available on the market, only few have been developed by health and nutrition professionals based on scientific evidence and subsequently tested to prove their usability. The main objective of this study was to design, develop, and evaluate the usability of a tailored nutrition application to be used to promote healthy eating habits. In order to decide app design and content, three focus groups took place with fifteen professionals from primary healthcare, nutrition, and food science and computer science, as well as expert users. For the general and feedback message design, a reference model based on the scientific literature was developed. To address the multi-perspective approach of users' and external healthcare professionals' feedback, a one-day pilot testing with potential users and healthcare professionals was conducted with four focus groups. To evaluate the relevance and potential usability of the app a 1-month pilot test was conducted in a real-life environment. A total of 42 volunteers participated in the one-day pilot testing, and 39 potential users participated in the 1-month pilot test. The SAlBi educa app developed includes an online dietary record, a self-monitoring tool to evaluate dietary patterns, general and feedback messages, and examples of traditional Mediterranean recipes. The usability study showed that volunteers think that SAlBi educa is pleasant (59%) and easy to learn to use (94%). Over 84% of the volunteers declared that the nutritional messages were clear and useful. Volunteers stated that general and tailored recommendations, as well as self-monitoring, were SAlBi educa's most motivating and useful features. SAlBi educa is an innovative, user-friendly nutritional education tool with the potential to engage and help individuals to follow dietary habits based on the Mediterranean model.

Improving the loading and release of NSAIDs from pHEMA hydrogels by copolymerization with functionalized monomers.

Poly(hydroxyethyl methacrylate), pHEMA, hydrogels are widely used for preparing implants, contact lenses, and other biomedical devices, which in many circumstances should load drugs to deliver them in the adjacent tissues. To enhance the potential of pHEMA hydrogels as nonsteroidal anti-inflammatory drugs (NSAIDs) delivery systems, 4-vinyl-pyridine (VP) and N-(3-aminopropyl) methacrylamide (APMA) were incorporated to the network (25-150 mM). The incorporated monomers did not change the viscoelastic properties neither the state of water, but remarkably increased the amount of ibuprofen (up to 10-fold) and diclofenac (up to 20-fold) loaded. Dried loaded pHEMA-APMA and pHEMA-VP hydrogels quickly swelled in water but ionic/hydrophobic interactions prevented the amount of drug released to be above 10%. By contrast, once the water-swollen hydrogels were transferred to pH 5.8 or 8.0 phosphate buffers or NaCl solutions, the release was prompted by competition with ions of the medium. The remaining of hydrophobic interactions and the high polymeric density of the pHEMA hydrogels contributed to sustain the release process for at least 24 h for ibuprofen and almost 1 week for diclofenac. The release rate was independent of the salt content and pH in the physiological range of values, which enables the design of hydrogel-based delivery systems with predictable release rate.

Implementation of Specialized Pharmaceutical Care Hospital Outpatient Clinics in a Hospital Pharmacy Department.

OBJECTIVE: To describe the organization of patient care into Specialized Pharmaceutical Care Hospital Outpatient Clinics in a Hospital Pharmacy Department, to evaluate their healthcare quality, and the quality  perceived by outpatients. METHOD: A retrospective observational study in a High-Level Hospital Pharmacy Department during three periods (years 2010, 2013 and 2016); description of  the organization at the levels of structure, human resources, material resources  and working procedures; evaluation of healthcare quality through the analysis of  three variables in terms of procedure: prior appointment compliance, waiting  time and documentation of pharmaceutical care; evaluation of quality perceived  by outpatients through a satisfaction survey; comparative statistical analysis of  means (Student's t) and proportions (Pearson's chi square). RESULTS: Fifteen (15) specialized outpatient clinics were opened and managed by 18 pharmacists; between the initial and final periods of the study (2010 vs. 2016), the compliance with previous appointments was of 61.3% vs. 88.8% (p <0001), waiting time was 27.6±12.1 vs. 12.1±5.4 minutes (p  <0.0001), documentation of pharmaceutical care in the clinical record was of  2.3% vs. 9.81% (p <0.0001), and the overall satisfaction perceived by the  patients was 6.63±2.36 vs. 9.16±1.27 (p <0.01). CONCLUSIONS: The model of Specialized Pharmaceutical Care Hospital Outpatient  Clinics exposed, focused on the patient and with continuity of care, has improved the quality of care and the quality perceived by the patients and it´s in optimal conditions to investigate its contribution on health outcomes and on the health system through a better quality, safety and efficiency of pharmacotherapy.

Objetivo: Describir la organización asistencial de Consultas Externas Monográficas de Atención Farmacéutica de un Servicio de Farmacia Hospitalaria, evaluar su calidad asistencial y la calidad percibida por los pacientes externos.Método: Estudio observacional retrospectivo en un servicio de farmacia de un hospital de nivel terciario durante tres períodos (años 2010, 2013 y 2016); descripción de la organización asistencial a nivel de estructura, recursos humanos, recursos materiales y procedimientos de trabajo; evaluación de la calidad asistencial mediante el análisis de tres variables de procedimiento: cumplimiento cita previa, tiempo de espera y documentación de la atención farmacéutica; evaluación de la calidad percibida por los pacientes externos mediante encuestas de satisfacción; análisis estadístico comparativo de  medias (t Student) y proporciones (chi cuadrado Pearson).Resultados: 15 consultas monográficas abiertas atendidas por 18 farmacéuticos; entre el período inicial y el período final del estudio (2010 vs. 2016) el cumplimiento de cita previa fue del 61,3% vs. 88,8% (p<0001), el tiempo de espera fue 27,6±12,1 vs. 12,1±5,4 minutos (p<0,0001), la documentación de la atención farmacéutica en la historia clínica del 2,3% vs. 9,81% (p<0,0001) y la satisfacción global percibida por los pacientes del 6,63±2,36 vs. 9,16±1,27 (p<0,01).Conclusiones: El modelo de Consulta Externa Monográfica de Atención Farmacéutica expuesto, centrado en el paciente y con continuidad asistencial, ha mejorado la calidad asistencial y la calidad percibida por los pacientes y se encuentra en condiciones óptimas para investigar su aportación a los resultados en salud del paciente y al sistema sanitario a través de una mejor calidad, seguridad y eficiencia de la farmacoterapia.

Study on adherence to treatment with imatinib in chronic myeloid leukaemia and its association with therapeutic response.

OBJECTIVE: To assess the level of adherence to treatment with imatinib in patients with chronic myeloid leukaemia and its association with therapeutic response. MATERIALS AND METHODS: Study conducted on October, 2013 - March, 2014, including patients diagnosed with Chronic Myeloid Leukaemia on treatment with imatinib in the hospital. Therapeutic adherence was assessed through the standard Morisky-Green Questionnaire and the medication dispensing record. Those patients who did not complete 6 months of treatment and/or did not complete the questionnaire were excluded. Therapeutic response was assessed following clinical guidelines. The descriptive analysis of variables and correlation was conducted through Pearsons's Chi-Square Test. RESULTS: The study included 31 patients. When assessing the level of association between response variables and therapeutic adherence: 1. The highest molecular response was reached by 68.4% of those patients with high adherence, and by 75% of those patients with intermediate adherence. 2. Complete molecular response was achieved by 57.9% of patients with high adherence, and by 58.3% of patients with intermediate adherence. No statistically significant differences were found in response variables between patients with high and intermediate therapeutic adherence. No association was observed between level of adherence and therapeutic response. CONCLUSIONS: We cannot confirm that a different level of therapeutic adherence might have an impact on response to imatinib, though this should be taken into account in cases of therapeutic failure or sub-optimal response.

Objetivo: El objetivo es evaluar el grado de adhesión terapéutica a imatinib en pacientes con leucemia mieloide crónica y su relación con la respuesta terapéutica. Material y métodos: Estudio realizado en octubre 2013-marzo 2014 que incluye a pacientes diagnosticados de leucemia mieloide crónica en tratamiento con imatinib en el hospital. Se evaluó la adhesión terapéutica mediante el cuestionario estandarizado Morisky-Green y el registro de dispensaciones de medicación. Se excluyeron aquellos que no completaron 6 meses de tratamiento y/o no realizaron el cuestionario. La respuesta terapéutica se evaluó siguiendo guías clínicas. Se realizó el análisis descriptivo de variables y correlación mediante test Chi-cuadrado de Pearson. Resultados: Se incluyeron 31 pacientes. Al evaluar el grado de asociación entre variables de respuesta y adhesión terapéutica: 1. La respuesta molecular mayor fue alcanzada por el 68,4% de los pacientes con alta adhesión y por el 75% de los pacientes con adhesión media. 2. La respuesta molecular completa fue alcanzada por el 57,9% de los pacientes con alta adhesión y por el 58,3% de los pacientes con adhesión media. No se observaron diferencias estadísticamente significativas en las variables de respuesta entre pacientes con adhesión terapéutica alta y media. No se observó asociación entre el grado de adhesión y la respuesta terapéutica. Conclusiones: No podemos afirmar que el distinto grado de adhesión terapéutica influya en la respuesta al imatinib, aunque debería considerarse en casos de fallo terapéutico o respuesta subóptima.

Implantación de consultas externas monográficas de atención farmacéutica en un servicio de farmacia hospitalaria / Implementation of specialized pharmaceutical care hospital outpatient clinics in a hospital pharmacy department

Objetivo: Describir la organización asistencial de Consultas Externas Monográficas de Atención Farmacéutica de un Servicio de Farmacia Hospitalaria, evaluar su calidad asistencial y la calidad percibida por los pacientes externos. Método: Estudio observacional retrospectivo en un servicio de farmacia de un hospital de nivel terciario durante tres períodos (años 2010, 2013 y 2016); descripción de la organización asistencial a nivel de estructura, recursos humanos, recursos materiales y procedimientos de trabajo; evaluación de la calidad asistencial mediante el análisis de tres variables de procedimiento: cumplimiento cita previa, tiempo de espera y documentación de la atención farmacéutica; evaluación de la calidad percibida por los pacientes externos mediante encuestas de satisfacción; análisis estadístico comparativo de medias (t Student) y proporciones (chi cuadrado Pearson). Resultados: 15 consultas monográficas abiertas atendidas por 18 farmacéuticos; entre el período inicial y el período final del estudio (2010 vs. 2016) el cumplimiento de cita previa fue del 61,3% vs. 88,8% (p< 0001), el tiempo de espera fue 27,6±12,1 vs. 12,1±5,4 minutos (p< 0,0001), la documentación de la atención farmacéutica en la historia clínica del 2,3% vs. 9,81% (p< 0,0001) y la satisfacción global percibida por los pacientes del 6,63±2,36 vs. 9,16±1,27 (p< 0,01). Conclusiones: El modelo de Consulta Externa Monográfica de Atención Farmacéutica expuesto, centrado en el paciente y con continuidad asistencial, ha mejorado la calidad asistencial y la calidad percibida por los pacientes y se encuentra en condiciones óptimas para investigar su aportación a los resultados en salud del paciente y al sistema sanitario a través de una mejor calidad, seguridad y eficiencia de la farmacoterapia (AU)

Objective: To describe the organization of patient care into Specialized Pharmaceutical Care Hospital Outpatient Clinics in a Hospital Pharmacy Department, to evaluate their healthcare quality, and the quality perceived by outpatients. Method: A retrospective observational study in a High-Level Hospital Pharmacy Department during three periods (years 2010, 2013 and 2016); description of the organization at the levels of structure, human resources, material resources and working procedures; evaluation of healthcare quality through the analysis of three variables in terms of procedure: prior appointment compliance, waiting time and documentation of pharmaceutical care; evaluation of quality perceived by outpatients through a satisfaction survey; comparative statistical analysis of means (Student's t) and proportions (Pearson's chi square). Results: Fifteen (15) specialized outpatient clinics were opened and managed by 18 pharmacists; between the initial and final periods of the study (2010 vs. 2016), the compliance with previous appointments was of 61.3% vs. 88.8% (p < 0001), waiting time was 27.6±12.1 vs. 12.1±5.4 minutes (p < 0.0001), documentation of pharmaceutical care in the clinical record was of 2.3% vs. 9.81% (p < 0.0001), and the overall satisfaction perceived by the patients was 6.63±2.36 vs. 9.16±1.27 (p< 0.01). Conclusions: The model of Specialized Pharmaceutical Care Hospital Outpatient Clinics exposed, focused on the patient and with continuity of care, has improved the quality of care and the quality perceived by the patients and it´s in optimal conditions to investigate its contribution on health outcomes and on the health system through a better quality, safety and efficiency of pharmacotherapy (AU)

Study on adherence to treatment with imatinib in chronic myeloid leukaemia and its association with therapeutic response / Estudio de adhesión a imatinib en la leucemia mieloide crónica y su relación con la respuesta terapéutica

Objective: To assess the level of adherence to treatment with imatinib in patients with chronic myeloid leukaemia and its association with therapeutic response. Materials and methods: Study conducted on October, 2013 - March, 2014, including patients diagnosed with Chronic Myeloid Leukaemia on treatment with imatinib in the hospital. Therapeutic adherence was assessed through the standard Morisky-Green Questionnaire and the medication dispensing record. Those patients who did not complete 6 months of treatment and/or did not complete the questionnaire were excluded. Therapeutic response was assessed following clinical guidelines. The descriptive analysis of variables and correlation was conducted through Pearsons’s Chi-Square Test. Results: The study included 31 patients. When assessing the level of association between response variables and therapeutic adherence: 1. The highest molecular response was reached by 68.4% of those patients with high adherence, and by 75% of those patients with intermediate adherence. 2. Complete molecular response was achieved by 57.9% of patients with high adherence, and by 58.3% of patients with intermediate adherence. No statistically significant differences were found in response variables between patients with high and intermediate therapeutic adherence. No association was observed between level of adherence and therapeutic response. Conclusions: We cannot confirm that a different level of therapeutic adherence might have an impact on response to imatinib, though this should be taken into account in cases of therapeutic failure or sub-optimal response (AU)

Objetivo: El objetivo es evaluar el grado de adhesión terapéutica a imatinib en pacientes con leucemia mieloide crónica y su relación con la respuesta terapéutica. Material y métodos: Estudio realizado en octubre 2013-marzo 2014 que incluye a pacientes diagnosticados de leucemia mieloide crónica en tratamiento con imatinib en el hospital. Se evaluó la adhesión terapéutica mediante el cuestionario estandarizado Morisky-Green y el registro de dispensaciones de medicación. Se excluyeron aquellos que no completaron 6 meses de tratamiento y/o no realizaron el cuestionario. La respuesta terapéutica se evaluó siguiendo guías clínicas. Se realizó el análisis descriptivo de variables y correlación mediante test Chi-cuadrado de Pearson. Resultados: Se incluyeron 31 pacientes. Al evaluar el grado de asociación entre variables de respuesta y adhesión terapéutica: 1. La respuesta molecular mayor fue alcanzada por el 68,4% de los pacientes con alta adhesión y por el 75% de los pacientes con adhesión media. 2. La respuesta molecular completa fue alcanzada por el 57,9% de los pacientes con alta adhesión y por el 58,3% de los pacientes con adhesión media. No se observaron diferencias estadísticamente significativas en las variables de respuesta entre pacientes con adhesión terapéutica alta y media. No se observó asociación entre el grado de adhesión y la respuesta terapéutica. Conclusiones: No podemos afirmar que el distinto grado de adhesión terapéutica influya en la respuesta al imatinib, aunque debería considerarse en casos de fallo terapéutico o respuesta subóptima (AU)