RESUMO
Introduction: During the lockdown enforced from March to June 2020 by authorities due to the COVID19 pandemic in Switzerland, patients included in the Interprofessional Medication Adherence Programme (IMAP) in Lausanne and Bern continued to use electronic monitors (EM), which register daily doses intake. Objective(s): The aim of this study is to use EM data to understand to what extent patients' medication implementation, described as the extent to which the patient takes the daily prescribed regimen, was impacted by the lockdown. The authors hypothesised that medication implementation might be lower during and after the lockdown compared to before. Method(s): Included participants attending the IMAP were diagnosed with diabetic kidney disease (DKD), solid cancer, HIV and miscellaneous long-term diseases. Patients' implementation was defined through a proxy: if all EM of each patient were at least opened once daily, implementation was considered optimal (= 1);and suboptimal (= 0) otherwise. 1) Implementation before (from December 2019 to March 2020), during (March to June 2020) and after (June to September 2020) the lockdown was compared. Subanalyses were also performed according to sub-groups of patients. 2) As comparison, implementation of included patients using at least one EM the year before, in 2019, during the same time frame, defined as winter, spring and summer periods, was analysed. A logistic regression model was used to estimate medication implementation according to the period, using 'before the lockdown' or 'winter' as the reference. The model was fitted using generalized estimating equation. Result(s): 1) In 2020, implementation of the 118 patients did not differ statistically before and during (OR = 0.97, CI: 0.84 - 1.15, p = 0.789), and before and after (OR = 0.91, CI: 0.79 - 1.06, p = 0.217) the lockdown. These findings remain stable even when analysing separately the implementation of patients with HIV (n = 61), DKD (n = 25) or miscellaneous long-term diseases (n = 22). Too few patients with cancer (n = 10) were included in the analysis to interpret their results. 2) In 2019, implementation of the 61/118 (51.7%) patients was statistically significantly lower during summertime compared to winter (OR = 0.73, CI: 0.59 - 0.89, p = 0.002). Conclusion(s): The authors results infirm their hypothesis as the implementation remained steady during and after the lockdown in 2020 in comparison to the period before. Still, adherence in 2020 was different compared to 2019 as the decreased implementation during summertime 2019 was not observed after the lockdown in summer 2020. Because of the COVID-19 pandemic, many patients slowed down their activities, travelled less, and may have been more cautious in managing their treatment due to the fear of developing a complication of their disease in a difficult sanitary context. Moreover, during the pandemic, continuity of care was ensured by medical teleconsultation between patients and their health care providers, mailing medications to patients' home by the pharmacy and leading interviews by phone calls for patients included in IMAP. The IMAP before, during and after the lockdown may have supported the adherence of complex patients across the pandemic in 2020. Interprofessional adherence programmes should support patients during routine-disturbance periods, such as a lockdown in a pandemic context or during summertime.
RESUMO
ACE2 is not only an enzyme that counters the effects of the renin-angiotensin-aldosterone system (RAAS) but is also the entry receptor for SARS-CoV-2, the virus of the Covid-19 pandemic. Some experimental data suggest that ACE inhibitors and ARBs increase ACE2 levels, thus raising concerns on their security in Covid-19 positive patients. However, some studies have shown protection by these drugs in lower tract respiratory infections and ARDS. The actual consensus is to continue the treatment with RAAS inhibitors, abrupt withdrawal, especially in patients with cardiac or renal conditions, being hazardous in terms of cardiovascular outcomes, except in patients hospitalized in intensive care with hemodynamic instability. This position statement is actually unanimous among all international learned societies.