SARS-CoV-2 infections and impact of the COVID-19 pandemic in pregnancy and breastfeeding: Results from an observational study in primary care in Belgium

COVID-19 also affects pregnant and breastfeeding women. Hence, clinicians and policymakers require reliable evidence on COVID-19 epidemiology and consequences in this population. We aimed to assess the susceptibility of pregnant women to SARS-CoV-2 and women’s perceived impact of the pandemic on their breastfeeding practices, medical counseling and social support. We performed a cross-sectional study using an online survey in primary care in Belgium. Pregnant and breastfeeding women and women who breastfed in the preceding four weeks were eligible to participate. The survey was distributed through social media in April 2020. In total, 6470 women participated (i.e., 2647 pregnant and 3823 breastfeeding women). Overall, 0.3% of all respondents reported to have tested positive for SARS-CoV-2, not indicating a higher susceptibility of pregnant women to contracting COVID-19. More than 90% refuted that the pandemic affected their breastfeeding practices, nor indicated that the coronavirus was responsible for breastfeeding cessation. Half of the women even considered giving longer breastmilk because of the coronavirus. In contrast, women’s medical counseling and social support were negatively affected by the lockdown. Women without previous breastfeeding experience and in the early postpartum period experienced a higher burden in terms of reduced medical counseling and support. In the future, more consideration and alternative supportive measures such as tele-visits by midwives or perinatal organizations are required for these women

Evaluation of drug related problems in Belgium: focus on corticosteroids

Background: Pharmacists have an important role to play in detecting and resolving drug-related problems (DRPs). Most studies have shown that DRPs have a negative impact on clinical results and quality of life as well as on health care costs. Corticosteroids are often implicated in DRPs, in particular because of their side effects, incorrect use of the inhalation device or lack of adherence to the prescribed regimen.Purpose: The purpose of this work is to identify causes of DRPs and interventions performed by pharmacists on corticosteroid-related problems and to distinguish between problems related to inhaled and general corticosteroids.Methods: During 5 days of their internship, 530 final year students of pharmaceutical sciences in six Belgian universities collected DRPs encountered in community pharmacies, as well as related interventions performed by pharmacists. The DRPs’ electronic registration was done through an adapted tool based on the classification of Pharmaceutical Care Network Europe (PCNE - v 6.2). This tool was validated by pharmacists and allowed to measure the frequency and nature of DRPs.Findings: Pharmacists detected 16 733 DRPs in total. 555 DRPs (3.3%) related to corticosteroids, of which 115 were inhaled corticosteroids. The most common causes of corticosteroid-related problems (55%) were administrative and logistical factors and fraud. More than a half of the technical causes were incomplete prescriptions. Concerning clinical causes, 28% related to drug/device-use problems for inhaled corticosteroids, with 88% related to incorrect use of the inhalation device. For general corticosteroids, the most common clinical causes were drug choice (37%), including medication interaction (58%) and inappropriate medication (contraindications, side effects: 14%). Pharmacists’ intervention was similar for inhaled and general corticosteroids. Pharmacists intervened with the patient orally in 38% of total interventions, and in writing in more than 14% of interventions. Pharmacists did not react in 14% (inhaled corticosteroids) and 16% (general corticosteroids) of corticosteroid-related problems. These non-interventions covered, for example, interactions and incomplete prescriptions.Conclusion: Several corticosteroid-related problems were detected and solved. However, pharmacists barely intervened for non-observance and drug interactions. The introduction of a structured interview between the patient and the pharmacist would enable the patient to be educated and informed about his disease and treatment. Therefore, pharmacists’ training is essential to performing these interviews. More randomized studies should be done in community pharmacies to evaluate the impact of these interviews on patients and on therapeutic adherence in real time.info:eu-repo/semantics/publishe

Hoe kan de continuïteit van de medica-menteuze behandeling tussen zieken-huis en thuis geoptimaliseerd worden?

The continuity of pharmacotherapy is of vital importance when patients move from one health care setting to another. Unfortunately, this continuity is not always guaranteed. The aim of this study is to propose solutions to enhance the continuity of pharmacotherapy at hospital admission and discharge. The study consists of a systematic review of the international literature and an analysis of seamless care initiatives in seven selected countries; a summary of Belgian data on problems as well as solutions with regard to continuity of care; a quantification of the extent of medication changes as a result of a hospital stay in Belgium; and a qualitative analysis of the perception of Belgian health care professionals (HCPs) on approaches to improve seamless care. The literature review yielded 15 papers of sufficient quality. However, this review did not generate definitive conclusions on the clinical impact and the cost-effectiveness of interventions aiming to enhance the continuity of pharmacotherapy. The most important initiatives that have been put in practice in foreign countries include the development and implementation of guidelines for HCPs; national information campaigns; education of HCPs; and the development of information technologies as to share patient and prescription data between settings of care. For Belgium, 66 seamless care initiatives were identified. The high number and variety of projects show the interest for this topic as well as the involvement of various HCPs from diverse settings in the development of solutions. Based on this research, and the solutions discussed in the focus groups, the following elements are proposed to enhance the continuity of pharmacotherapy: a national guideline governing the continuity of pharmacotherapy; a national campaign to sensitize HCPs and patients in this area; the availability of a comprehensive and up to date medication list for each patient; and electronic healthcare infrastructure that facilitates sharing of information.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Comment optimiser la continuité du traitement médicamenteux entre l'hôpital et le domicile

The continuity of pharmacotherapy is of vital importance when patients move from one health care setting to another. Unfortunately, this continuity is not always guaranteed. The aim of this study is to propose solutions to enhance the continuity of pharmacotherapy at hospital admission and discharge. The study consists of a systematic review of the international literature and an analysis of seamless care initiatives in seven selected countries; a summary of Belgian data on problems as well as solutions with regard to continuity of care; a quantification of the extent of medication changes as a result of a hospital stay in Belgium; and a qualitative analysis of the perception of Belgian health care professionals (HCPs) on approaches to improve seamless care. The literature review yielded 15 papers of sufficient quality. However, this review did not generate definitive conclusions on the clinical impact and the cost-effectiveness of interventions aiming to enhance the continuity of pharmacotherapy. The most important initiatives that have been put in practice in foreign countries include the development and implementation of guidelines for HCPs; national information campaigns; education of HCPs; and the development of information technologies as to share patient and prescription data between settings of care. For Belgium, 66 seamless care initiatives were identified. The high number and variety of projects show the interest for this topic as well as the involvement of various HCPs from diverse settings in the development of solutions. Based on this research, and the solutions discussed in the focus groups, the following elements are proposed to enhance the continuity of pharmacotherapy: a national guideline governing the continuity of pharmacotherapy; a national campaign to sensitize HCPs and patients in this area; the availability of a comprehensive and up to date medication list for each patient; and electronic healthcare infrastructure that facilitates sharing of information.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

High adherence to oral anticancer treatment in patients with metastatic renal cancer

Abstract: Background & Objectives Patient adherence to oral therapy is an emerging issue in cancer treatment. Therefore, the aim of the IPSOC-study (Investigating Patient Satisfaction with Oral anti-Cancer treatment) is to investigate the prevalence and severity of nonadherence to oral anticancer drugs (OAD) in metastatic renal cell cancer (mRCC) and to identify factors predictive of nonadherence. Settings & Method Prospective observational multicenter trial performed at 11 Belgian hospitals. All patients with mRCC starting OADs are eligible for the study. Patients are contacted by phone at baseline and at 1, 3, 6 and 12 months. At each contact, patients are asked to complete questionnaires investigating 1) medication adherence (MMAS), 2) patient satisfaction with treatment (CTSQ) and with treatment education (PS-CaTE), 3) extent of information desire (EID) and 4) quality of life (FACT-G). Adherence is measured with MEMS® (Aardex). Main outcome measures Adherence to OAD Results Between 02/2011 and 05/2012, 80 patients with a median age of 65 years have participated in the IPSOC-study. With a median follow-up of 150 days (range 3 - 465), 87% of patients claimed to be fully adherent (based on MMAS and CTSQ data). Ten patients indicated to have missed at least one dose, for which the most important reasons were forgetting (38% of cases) and side effects (31%). Based on MEMS® data, mean adherence, defined as the percentage of days with at least the prescribed number of dosage taken, was 97.95%. Interestingly, the prescribed regimen was changed or interrupted by the treating oncologist in 36% of cases. Median EID and FACT-G scores were significantly higher at baseline compared to 1 month of treatment (p<0,05). The mean score for the CTSQ subdomain ‘satisfaction with treatment’ was higher at month 3 compared to month 1 (p<0,05) while the mean score for ‘feelings about side effects’ decreased significantly between month 1 and 3. Conclusion The IPSOC study, the first to examine adherence to OAD among mRCC patients, shows that mRCC patients are almost fully adherent to treatment recommendations. This seems to be in contrast to adherence data for other, long-lasting, anticancer treatments.status: publishe