Sars-Cov-2 Infection in Patients on Long-Term Treatment with Macrolides in Spain: A National Cross-Sectional Study.

The aim of this study was to know the prevalence and severity of COVID-19 in patients treated with long-term macrolides and to describe the factors associated with worse outcomes. A cross-sectional study was conducted in Primary Care setting. Patients with macrolides dispensed continuously from 1 October 2019 to 31 March 2020, were considered. Main outcome: diagnosis of coronavirus disease-19 (COVID-19). Secondary outcomes: symptoms, severity, characteristics of patients, comorbidities, concomitant treatments. A total of 3057 patients met the inclusion criteria. Median age: 73 (64-81) years; 55% were men; 62% smokers/ex-smokers; 56% obese/overweight. Overall, 95% of patients had chronic respiratory diseases and four comorbidities as a median. Prevalence of COVID-19: 4.8%. This was in accordance with official data during the first wave of the pandemic. The most common symptoms were respiratory: shortness of breath, cough, and pneumonia. Additionally, 53% percent of patients had mild/moderate symptoms, 28% required hospital admission, and 19% died with COVID-19. The percentage of patients hospitalized and deaths were 2.6 and 5.8 times higher, respectively, in the COVID-19 group (p < 0.001). There was no evidence of a beneficial effect of long-term courses of macrolides in preventing SARS-CoV-2 infection or the progression to worse outcomes in old patients with underlying chronic respiratory diseases and a high burden of comorbidity.

[Elaboration, implementation and follow-up of a postmenopausal osteoporosis protocol: Collaboration between the Primary care and Rheumatology departments]. / Elaboración, implantación y seguimiento de un protocolo de osteoporosis posmenopáusica: colaboración entre Atención Primaria y el Servicio de Reumatología.

OBJECTIVE: To improve the clinical management of postmenopausal osteroporosis, an intervention based on the implementation of a guideline agreed to between the Primary Care and Specialized departments of all centers at "Mutua of Terrassa" was carried out. METHODS: Descriptive and interventional study. The intervention consisted of the elaboration of a consensus guideline that was presented in all centers. Results were assessed from bone densitometry studies requested by family physicians over 1 year. RESULTS: 1.165 densitometric studies were requested, of which 689 were for the diagnosis of new patients. For the evaluation of the guidelines, details were obtained from 560. 502 studies (89,6% IC95% 87,1-92,2) complied with indication criteria established in the guideline. Of the total of patients who received bisphosphonates and other drugs affecting bone metabolism (43 osteopenic and 167 osteoporotic), 83,7% (IC95% 69,3-93,2) and 89,8% (IC95% 85,2-94,4) respectively complied with drug recommendations. Drug consumption during the year 2007 was reduced by 152.745 euros (-6,3%) although the number of patients increased in 565 (+4,9%) with respect to the previous year. 442 (78,9% IC95% 75,6-82,3) densitometries presented a result in the osteopenia or osteroporosis category. There were statistically significant differences of the results according to the patients' age and the motive for the bone densitometry request. CONCLUSIONS: Implementation of the guideline allowed for the effective management of the clinical process of osteroporosis in our field.

[Repeat prescription management systems: strategy for optimising their use]. / Sistemas de gestión para la renovación de recetas médicas: estrategia para optimizar su utilización.

OBJECTIVE: To improve patient compliance with a repeat prescription system. To evaluate the reasons for not being punctual in collecting prescriptions and the non-compliance declared by the patients themselves. DESIGN: Quasi-experimental study before and after intervention including a control group. SETTING: Primary health care centre which serves a population of 62,981 inhabitants. PARTICIPANTS: Patients with chronic diseases included in the repeat prescription management system (100 in the control group and 100 in the intervention group) who were unpunctual in collecting their prescriptions. INTERVENTIONS: An informative-educational session consisting of a short interview with the pharmacist from Primary Health Care Centre, in which the patient was educated on compliance of the repeat prescription system and treatment. The reasons for the unpunctuality were identified and the Moriskey-Green test was performed. MAIN MEASUREMENTS: Punctuality of the patients in collecting their prescriptions after the intervention. Reasons for unpunctuality recorded at recruitment. Therapeutic compliance according to the Moriskey-Green test. RESULTS: There was an overall absolute improvement of 17% in punctuality in the intervention group (60% of the patients in the intervention group and 43% in the control group were punctual in the first as well as in the second follow up. Women were more punctual in the intervention group. There were no differences seen due to age, number of medications or reason for unpunctuality. CONCLUSIONS: It is possible to improve patient compliance with the prescription renewal system using a simple informative-educational intervention.

[Management systems for the renewal of medical prescriptions: the vision of users and health professionals]. / Sistemas de gestión para la renovación de recetas médicas: la visión del usuario y del profesional sanitario.

OBJECTIVE: To find the degree of satisfaction of users and doctors who use the repeat medical prescription system. DESIGN: Multi-centre, cross-sectional study. SETTING: Four primary care centres covering 160 000 inhabitants. PARTICIPANTS: Users included in the repeat medical prescription system and doctors who use it. MAIN MEASUREMENTS: Questionnaire on satisfaction. MAIN RESULTS: Users (52.4% women) filled in 429 questionnaires (mean age, 64.2; SD, 13.98). Average medicines taken were 4.4 (SD, 3.04). The period established for picking up prescriptions was usually 60 days (77.4%). 83.9% (95% CI, 80.4-87.4) of those questioned stated they had no problems, with a mean degree of satisfaction at 8.4 (SD, 1.52). There were no significant differences for gender (P=.53). There was a very weak but significant positive correlation between the score and the age of those questioned (r(2)=1%; P=.03). Mean score of satisfaction had statistically significant differences, depending on the PCC. 86.9% (95% CI, 83.8-90.1) of users collected the prescriptions within the term set. The factors associated with greater adherence were age and a greater number of medicines per person. Doctors filled in 47 questionnaires. Mean score was 7.42 (SD, 1.09) and all except one (98%; 95% CI, 89.1-99.9) thought that the system meant an improvement in clinical management. CONCLUSION: Users are very satisfied, although they believe certain organisational points should be improved in order to improve accessibility.