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Rzepka AM, Cheung AM, Kim S, Gomes T, Cadarette SM. On-time denosumab dosing recovered rapidly during the COVID-19 pandemic, yet remains suboptimal. JBMR Plus 2024; 8:ziae027. [PMID: 38623483 PMCID: PMC11018358 DOI: 10.1093/jbmrpl/ziae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 04/17/2024] Open
Abstract
Timely administration of denosumab every 6 mo is critical in osteoporosis treatment to avoid multiple vertebral fracture risk upon denosumab discontinuation or delay. This study aimed to estimate the immediate and prolonged impact of the COVID-19 pandemic on the timing of denosumab doses. We identified older adults (≥66 yr) residing in the community who were due to receive denosumab between January 2016 and December 2020 using Ontario Drug Benefit data. We completed an interrupted time-series analysis to estimate the impact of the COVID-19 pandemic (March 2020) on the monthly proportion of on-time denosumab doses (183 +/-30 d). Analyses were stratified by user type: patients due for their second dose (novice users), third or fourth dose (intermediate users), or ≥5th dose (established users). In additional analyses, we considered patients living in nursing homes, switching to other osteoporosis drugs, and reported trends until February 2022. We studied 148 554 patients (90.9% female, mean [SD] age 79.6 [8.0] yr) receiving 648 221 denosumab doses. The average pre-pandemic proportion of on-time therapy was steady in the community, yet differed by user type: 64.9% novice users, 72.3% intermediate users, and 78.0% established users. We identified an immediate overall decline in the proportion of on-time doses across all user types at the start of the pandemic: -17.8% (95% CI, -19.6, -16.0). In nursing homes, the pre-pandemic proportion of on-time therapy was similar across user types (average 83.5%), with a small decline at the start of the pandemic: -3.2% (95% CI, -5.0, -1.2). On-time therapy returned to pre-pandemic levels by October 2020 and was not impacted by therapy switching. Although on-time dosing remains stable as of February 2022, approximately one-fourth of patients in the community do not receive denosumab on-time. In conclusion, although pandemic disruptions to denosumab dosing were temporary, levels of on-time therapy remain suboptimal.
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Affiliation(s)
- Anna M Rzepka
- Leslie Dan Faculty of Pharmacy, Graduate Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Angela M Cheung
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Sandra Kim
- Leslie Dan Faculty of Pharmacy, Graduate Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON M5S 3M2, Canada
- Division of Endocrinology and Metabolism, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, Graduate Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON M5S 3M2, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- ICES, Toronto, ON, Canada
| | - Suzanne M Cadarette
- Leslie Dan Faculty of Pharmacy, Graduate Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON M5S 3M2, Canada
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, ON M5T 3M7, Canada
- Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Chapel Hill, NC 27599-7355, United States
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Barría-Sandoval C, Ferreira G, Navarrete JP, Farhang M. The impact of COVID-19 on deaths from dementia and Alzheimer's disease in Chile: an analysis of panel data for 16 regions, 2017-2022. LANCET REGIONAL HEALTH. AMERICAS 2024; 33:100726. [PMID: 38584874 PMCID: PMC10993180 DOI: 10.1016/j.lana.2024.100726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
Background Although several studies have documented the detrimental impacts of global COVID-19 containment measures on individuals with Alzheimer's disease and dementia, a comprehensive analysis of mortality rates for these conditions within the Chilean population is notably lacking. This study aimed to analyze the impact of COVID-19 on mortality rates among individuals with dementia and Alzheimer's disease in Chile. Methods A retrospective longitudinal cross-sectional study was conducted, considering mortality data for specific mental health conditions during the pre-pandemic and pandemic contexts of COVID-19 in Chile. Quantile regression techniques were employed to analyze the existence of differences between the two periods, while non-observable heterogeneity models for panel data methods were used to evaluate the effect of COVID-19 mortality on crude mortality rates. Findings Statistically significant differences were observed in the number of deaths from dementia and Alzheimer's disease between the pre-pandemic and COVID-19 pandemic periods. Specifically, crude mortality rates decreased by 10% (-0.10 [95% CI: -0.16, -0.05]) during the pandemic period. Furthermore, the number of deaths from COVID-19 during the pandemic period has a very weak incidence of deaths from mental health conditions such as dementia and Alzheimer's. Specifically, a unit percentage increase in confirmed cases from COVID-19 would result in a 7% (-0.07 [95% CI: -0.13, -0.001]) decrease in the number of deaths from dementia and Alzheimer's. These findings are supported by the application of panel regression with one-way random effects models. Interpretation The study findings indicate a reduction in mortality rates attributed to dementia and Alzheimer's disease during the COVID-19 pandemic in Chile. This decline could be attributed to the potential underreporting of mental illness as the cause of death during the pandemic period. Several studies have highlighted that approximately 30% of death certificates fail to document the presence of a dementia syndrome. Moreover, the cause of death recorded for individuals with mental health conditions may be influenced by the physician's familiarity with the patient or reflect the prevailing approach to managing end-stage dementia patients. Funding This work received no funding.
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Affiliation(s)
- Claudia Barría-Sandoval
- Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastián, Concepción, Chile
| | | | - Jean Paul Navarrete
- Department of Statistics, Universidad de Concepción, Concepción, Chile
- Department of Industrial Engineering, Universidad de Concepción, Concepción, Chile
| | - Maryam Farhang
- Facultad de Salud y Ciencias Sociales, Universidad de Las Américas, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
- Millennium Institute for Care Research (MICARE), Santiago, Chile
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Zeitouny S, Cheung DC, Bremner KE, Pataky RE, Pequeno P, Matelski J, Peacock S, Del Giudice ME, Lapointe-Shaw L, Tomlinson G, Mendlowitz AB, Mulder C, Tsui TCO, Perlis N, Walker JD, Sander B, Wong WWL, Krahn MD, Kulkarni GS. The impact of the early COVID-19 pandemic on healthcare system resource use and costs in two provinces in Canada: An interrupted time series analysis. PLoS One 2023; 18:e0290646. [PMID: 37682823 PMCID: PMC10490868 DOI: 10.1371/journal.pone.0290646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION The aim of our study was to assess the initial impact of COVID-19 on total publicly-funded direct healthcare costs and health services use in two Canadian provinces, Ontario and British Columbia (BC). METHODS This retrospective repeated cross-sectional study used population-based administrative datasets, linked within each province, from January 1, 2018 to December 27, 2020. Interrupted time series analysis was used to estimate changes in the level and trends of weekly resource use and costs, with March 16-22, 2020 as the first pandemic week. Also, in each week of 2020, we identified cases with their first positive SARS-CoV-2 test and estimated their healthcare costs until death or December 27, 2020. RESULTS The resources with the largest level declines (95% confidence interval) in use in the first pandemic week compared to the previous week were physician services [Ontario: -43% (-49%,-37%); BC: -24% (-30%,-19%) (both p<0.001)] and emergency department visits [Ontario: -41% (-47%,-35%); BC: -29% (-35%,-23%) (both p<0.001)]. Hospital admissions declined by 27% (-32%,-23%) in Ontario and 21% (-26%,-16%) in BC (both p<0.001). Resource use subsequently rose but did not return to pre-pandemic levels. Only home care and dialysis clinic visits did not significantly decrease compared to pre-pandemic. Costs for COVID-19 cases represented 1.3% and 0.7% of total direct healthcare costs in 2020 in Ontario and BC, respectively. CONCLUSIONS Reduced utilization of healthcare services in the overall population outweighed utilization by COVID-19 patients in 2020. Meeting the needs of all patients across all services is essential to maintain resilient healthcare systems.
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Affiliation(s)
- Seraphine Zeitouny
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas C. Cheung
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen E. Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Reka E. Pataky
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - M. Elisabeth Del Giudice
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Andrew B. Mendlowitz
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carol Mulder
- Chiefs of Ontario, Toronto, Ontario, Canada
- Queen’s University, Kingston, Ontario, Canada
| | - Teresa C. O. Tsui
- ICES, Toronto, Ontario, Canada
- Child Health and Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada
| | - Nathan Perlis
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Sprott Department of Surgery, University Health Network, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jennifer D. Walker
- ICES, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - William W. L. Wong
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Murray D. Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Girish S. Kulkarni
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Urology, Sprott Department of Surgery, University Health Network, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Gellert P, Kohl R, Jürchott K, Noack B, Hering C, Gangnus A, Steinhagen-Thiessen E, Herrmann WJ, Kuhlmey A, Schwinger A. Hospital admissions and deaths due to acute cardiovascular events during the COVID-19 pandemic in residents of long-term care facilities. Sci Rep 2023; 13:8544. [PMID: 37237025 DOI: 10.1038/s41598-023-35816-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/24/2023] [Indexed: 05/28/2023] Open
Abstract
Hospital admissions due to acute cardiovascular events dropped during the COVID-19 pandemic in the general population; however, evidence for residents of long-term care facilities (LTCF) is sparse. We investigated rates of hospital admissions and deaths due to myocardial infarction (MI) and stroke in LTCF residents during the pandemic. Our nationwide cohort study used claims data. The sample comprised 1,140,139 AOK-ensured LTCF residents over 60 years of age (68.6% women; age 85.3 ± 8.5 years) from the largest statutory health insurance in Germany (AOK), which is not representative for all LTCF residents. We included MI and stroke admission and compared numbers of in-hospital deaths from January 2020 to end of April 2021 (i.e., during the first three waves of the pandemic) with the number of incidences in 2015-2019. To estimate incidence risk ratios (IRR), adjusted Poisson regression analyses were applied. During the observation period (2015-2021), there were 19,196 MI and 73,953 stroke admissions. MI admissions declined in the pandemic phase by 22.5% (IRR = 0.68 [CI 0.65-0.72]) compared to previous years. This decline was slightly more pronounced for NSTEMI than for STEMI. MI fatality risks remained comparable across years (IRR = 0.97 [CI95% 0.92-1.02]). Stroke admissions dropped by 15.1% (IRR = 0.75 [CI95% 0.72-0.78]) in the pandemic. There was an elevated case fatality risk for haemorrhagic stroke (IRR = 1.09 [CI95% 1.03-1.15]) but not for other stroke subtypes compared to previous years. This study provides first evidence of declines in MI and stroke admissions and in-hospital deaths among LTCF residents during the pandemic. The figures are alarming given the acute nature of the conditions and the vulnerability of the residents.
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Affiliation(s)
- Paul Gellert
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Raphael Kohl
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Betty Noack
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christian Hering
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Annabell Gangnus
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Wolfram J Herrmann
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Adelheid Kuhlmey
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Jones A, Bronskill SE, Maclagan LC, Jaakkimainen L, Kirkwood D, Mayhew A, Costa AP, Griffith LE. Examining the immediate and ongoing impact of the COVID-19 pandemic on population-based estimates of dementia: a population-based time series analysis in Ontario, Canada. BMJ Open 2023; 13:e067689. [PMID: 36639204 PMCID: PMC9842601 DOI: 10.1136/bmjopen-2022-067689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Population-based chronic disease surveillance systems were likely disrupted by the COVID-19 pandemic. The objective of this study was to examine the immediate and ongoing impact of the COVID-19 pandemic on the claims-based incidence of dementia. METHODS We conducted a population-based time series analysis from January 2015 to December 2021 in Ontario, Canada. We calculated the monthly claims-based incidence of dementia using a validated case ascertainment algorithm drawing from routinely collected health administrative data. We used autoregressive linear models to compare the claims-based incidence of dementia during the COVID-19 period (2020-2021) to the expected incidence had the pandemic not occurred, controlling for seasonality and secular trends. We examined incidence by source of ascertainment and across strata of sex, age, community size and number of health conditions. RESULTS The monthly claims-based incidence of dementia dropped from a 2019 average of 11.9 per 10 000 to 8.5 per 10 000 in April 2020 (32.6% lower than expected). The incidence returned to expected levels by late 2020. Across the COVID-19 period there were a cumulative 2990 (95% CI 2109 to 3704) fewer cases of dementia observed than expected, equivalent to 1.05 months of new cases. Despite the overall recovery, ascertainment rates continued to be lower than expected among individuals aged 65-74 years and in large urban areas. Ascertainment rates were higher than expected in hospital and among individuals with 11 or more health conditions. CONCLUSIONS The claims-based incidence of dementia recovered to expected levels by late 2020, suggesting minimal long-term changes to population-based dementia surveillance. Continued monitoring of claims-based incidence is necessary to determine whether the lower than expected incidence among individuals aged 65-74 and in large urban areas, and higher than expected incidence among individuals with 11 or more health conditions, is transitory.
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Affiliation(s)
- Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Liisa Jaakkimainen
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Alexandra Mayhew
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Jones A, Mowbray FI, Falk L, Stall NM, Brown KA, Malikov K, Malecki SL, Lail S, Jung HY, Costa AP, Verma AA, Razak F. Variations in long-term care home resident hospitalizations before and during the COVID-19 pandemic in Ontario. PLoS One 2022; 17:e0264240. [PMID: 36331926 PMCID: PMC9635742 DOI: 10.1371/journal.pone.0264240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To examine how the COVID-19 pandemic affected the demographic and clinical characteristics, in-hospital care, and outcomes of long-term care residents admitted to general medicine wards for non-COVID-19 reasons. METHODS We conducted a retrospective cohort study of long-term care residents admitted to general medicine wards, for reasons other than COVID-19, in four hospitals in Toronto, Ontario between January 1, 2018 and December 31, 2020. We used an autoregressive linear model to estimate the change in monthly admission volumes during the pandemic period (March-December 2020) compared to the previous two years, adjusting for any secular trend. We summarized and compared differences in the demographics, comorbidities, interventions, diagnoses, imaging, psychoactive medications, and outcomes of residents before and during the pandemic. RESULTS Our study included 2,654 long-term care residents who were hospitalized for non-COVID-19 reasons between January 2018 and December 2020. The crude rate of hospitalizations was 79.3 per month between March-December of 2018-2019 and 56.5 per month between March-December of 2020. The was an adjusted absolute difference of 27.0 (95% CI: 10.0, 43.9) fewer hospital admissions during the pandemic period, corresponding to a relative drop of 34%. Residents admitted during the pandemic period had similar demographics and clinical characteristics but were more likely to be admitted for delirium (pandemic: 7% pre-pandemic: 5%, p = 0.01) and were less likely to be admitted for pneumonia (pandemic: 3% pre-pandemic: 6%, p = 0.004). Residents admitted during the pandemic were more likely to be prescribed antipsychotics (pandemic: 37%, pre-pandemic: 29%, p <0.001) and more likely to die in-hospital (pandemic:14% pre-pandemic: 10%, p = 0.04). CONCLUSIONS AND IMPLICATIONS Better integration between long-term care and hospitals systems, including programs to deliver urgent medical care services within long-term care homes, is needed to ensure that long-term care residents maintain equitable access to acute care during current and future public health emergencies.
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Affiliation(s)
- Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- * E-mail: (AJ); (FR)
| | - Fabrice I. Mowbray
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lindsey Falk
- Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Nathan M. Stall
- Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Hospital Research Institute, Toronto, Ontario, Canada
| | - Kevin A. Brown
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kamil Malikov
- Health Data Science Branch, Capacity Planning and Analytics Divisions, Ontario Ministry of Health, Toronto, ON, Canada
| | - Sarah L. Malecki
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharan Lail
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Hae Young Jung
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew P. Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Amol A. Verma
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Fahad Razak
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- * E-mail: (AJ); (FR)
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Maclagan LC, Wang X, Emdin A, Jones A, Jaakkimainen RL, Schull MJ, Sourial N, Vedel I, Swartz RH, Bronskill SE. Visits to the emergency department by community-dwelling people with dementia during the first 2 waves of the COVID-19 pandemic in Ontario: a repeated cross-sectional analysis. CMAJ Open 2022; 10:E610-E621. [PMID: 35790227 PMCID: PMC9262349 DOI: 10.9778/cmajo.20210301] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Community-dwelling people with dementia have been affected by COVID-19 pandemic health risks and control measures that resulted in worsened access to health care and service cancellation. One critical access point in health systems is the emergency department. We aimed to determine the change in weekly rates of visits to the emergency department of community-dwelling people with dementia in Ontario during the first 2 waves of the COVID-19 pandemic compared with historical patterns. METHODS We conducted a population-based repeated cross-sectional study and used health administrative databases to compare rates of visits to the emergency department among community-dwelling people with dementia who were aged 40 years and older in Ontario during the first 2 waves of the COVID-19 pandemic (March 2020-February 2021) with the rates of a historical period (March 2019-February 2020). Weekly rates of visits to the emergency department were evaluated overall, by urgency and by chapter from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. We used Poisson models to compare pandemic and historical rates at the week of the lowest rate during the pandemic period and the latest week. RESULTS We observed large immediate declines in rates of visits to the emergency department during the COVID-19 pandemic (rate ratio [RR] 0.50, 95% confidence interval [CI] 0.47-0.53), which remained below historical levels by the end of the second wave (RR 0.88, 95% CI 0.83-0.92). Rates of both nonurgent (RR 0.33, 95% CI 0.28-0.39) and urgent (RR 0.51, 95% CI 0.48-0.55) visits to the emergency department also declined and remained low (RR 0.68, 95% CI 0.59-0.79, RR 0.91, 95% CI 0.86-0.96), respectively. Visits for injuries, and circulatory, respiratory and musculoskeletal diseases declined and remained below historical levels. INTERPRETATION Prolonged reductions in visits to the emergency department among people with dementia during the first 2 pandemic waves raise concerns about patients who delay seeking acute care services. Understanding the long-term effects of these reductions requires further research.
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Affiliation(s)
- Laura C Maclagan
- ICES Central (Maclagan, Wang, Emdin, Jones, Jaakkimainen, Schull, Swartz, Bronskill); Dalla Lana School of Public Health (Emdin, Schull, Bronskill), Department of Family and Community Medicine (Jaakkimainen) and Division of Neurology (Swartz), Department of Medicine, University of Toronto; Sunnybrook Research Institute (Jaakkimainen, Schull, Bronskill), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Swartz), McMaster University, Hamilton, Ont.; Department of Health Management, Evaluation and Policy (Sourial), School of Public Health, University of Montreal; Department of Family Medicine (Vedel), McGill University, Montréal, Que
| | - Xuesong Wang
- ICES Central (Maclagan, Wang, Emdin, Jones, Jaakkimainen, Schull, Swartz, Bronskill); Dalla Lana School of Public Health (Emdin, Schull, Bronskill), Department of Family and Community Medicine (Jaakkimainen) and Division of Neurology (Swartz), Department of Medicine, University of Toronto; Sunnybrook Research Institute (Jaakkimainen, Schull, Bronskill), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Swartz), McMaster University, Hamilton, Ont.; Department of Health Management, Evaluation and Policy (Sourial), School of Public Health, University of Montreal; Department of Family Medicine (Vedel), McGill University, Montréal, Que
| | - Abby Emdin
- ICES Central (Maclagan, Wang, Emdin, Jones, Jaakkimainen, Schull, Swartz, Bronskill); Dalla Lana School of Public Health (Emdin, Schull, Bronskill), Department of Family and Community Medicine (Jaakkimainen) and Division of Neurology (Swartz), Department of Medicine, University of Toronto; Sunnybrook Research Institute (Jaakkimainen, Schull, Bronskill), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Swartz), McMaster University, Hamilton, Ont.; Department of Health Management, Evaluation and Policy (Sourial), School of Public Health, University of Montreal; Department of Family Medicine (Vedel), McGill University, Montréal, Que
| | - Aaron Jones
- ICES Central (Maclagan, Wang, Emdin, Jones, Jaakkimainen, Schull, Swartz, Bronskill); Dalla Lana School of Public Health (Emdin, Schull, Bronskill), Department of Family and Community Medicine (Jaakkimainen) and Division of Neurology (Swartz), Department of Medicine, University of Toronto; Sunnybrook Research Institute (Jaakkimainen, Schull, Bronskill), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Swartz), McMaster University, Hamilton, Ont.; Department of Health Management, Evaluation and Policy (Sourial), School of Public Health, University of Montreal; Department of Family Medicine (Vedel), McGill University, Montréal, Que
| | - R Liisa Jaakkimainen
- ICES Central (Maclagan, Wang, Emdin, Jones, Jaakkimainen, Schull, Swartz, Bronskill); Dalla Lana School of Public Health (Emdin, Schull, Bronskill), Department of Family and Community Medicine (Jaakkimainen) and Division of Neurology (Swartz), Department of Medicine, University of Toronto; Sunnybrook Research Institute (Jaakkimainen, Schull, Bronskill), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Swartz), McMaster University, Hamilton, Ont.; Department of Health Management, Evaluation and Policy (Sourial), School of Public Health, University of Montreal; Department of Family Medicine (Vedel), McGill University, Montréal, Que
| | - Michael J Schull
- ICES Central (Maclagan, Wang, Emdin, Jones, Jaakkimainen, Schull, Swartz, Bronskill); Dalla Lana School of Public Health (Emdin, Schull, Bronskill), Department of Family and Community Medicine (Jaakkimainen) and Division of Neurology (Swartz), Department of Medicine, University of Toronto; Sunnybrook Research Institute (Jaakkimainen, Schull, Bronskill), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Swartz), McMaster University, Hamilton, Ont.; Department of Health Management, Evaluation and Policy (Sourial), School of Public Health, University of Montreal; Department of Family Medicine (Vedel), McGill University, Montréal, Que
| | - Nadia Sourial
- ICES Central (Maclagan, Wang, Emdin, Jones, Jaakkimainen, Schull, Swartz, Bronskill); Dalla Lana School of Public Health (Emdin, Schull, Bronskill), Department of Family and Community Medicine (Jaakkimainen) and Division of Neurology (Swartz), Department of Medicine, University of Toronto; Sunnybrook Research Institute (Jaakkimainen, Schull, Bronskill), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Swartz), McMaster University, Hamilton, Ont.; Department of Health Management, Evaluation and Policy (Sourial), School of Public Health, University of Montreal; Department of Family Medicine (Vedel), McGill University, Montréal, Que
| | - Isabelle Vedel
- ICES Central (Maclagan, Wang, Emdin, Jones, Jaakkimainen, Schull, Swartz, Bronskill); Dalla Lana School of Public Health (Emdin, Schull, Bronskill), Department of Family and Community Medicine (Jaakkimainen) and Division of Neurology (Swartz), Department of Medicine, University of Toronto; Sunnybrook Research Institute (Jaakkimainen, Schull, Bronskill), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Swartz), McMaster University, Hamilton, Ont.; Department of Health Management, Evaluation and Policy (Sourial), School of Public Health, University of Montreal; Department of Family Medicine (Vedel), McGill University, Montréal, Que
| | - Richard H Swartz
- ICES Central (Maclagan, Wang, Emdin, Jones, Jaakkimainen, Schull, Swartz, Bronskill); Dalla Lana School of Public Health (Emdin, Schull, Bronskill), Department of Family and Community Medicine (Jaakkimainen) and Division of Neurology (Swartz), Department of Medicine, University of Toronto; Sunnybrook Research Institute (Jaakkimainen, Schull, Bronskill), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Swartz), McMaster University, Hamilton, Ont.; Department of Health Management, Evaluation and Policy (Sourial), School of Public Health, University of Montreal; Department of Family Medicine (Vedel), McGill University, Montréal, Que
| | - Susan E Bronskill
- ICES Central (Maclagan, Wang, Emdin, Jones, Jaakkimainen, Schull, Swartz, Bronskill); Dalla Lana School of Public Health (Emdin, Schull, Bronskill), Department of Family and Community Medicine (Jaakkimainen) and Division of Neurology (Swartz), Department of Medicine, University of Toronto; Sunnybrook Research Institute (Jaakkimainen, Schull, Bronskill), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Swartz), McMaster University, Hamilton, Ont.; Department of Health Management, Evaluation and Policy (Sourial), School of Public Health, University of Montreal; Department of Family Medicine (Vedel), McGill University, Montréal, Que.
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Bacsu JDR, O'Connell ME, Cammer A, Ahmadi S, Berger C, Azizi M, Gowda-Sookochoff R, Grewal KS, Green S, Knight S, Spiteri RJ. Examining the COVID-19 Impact on People with Dementia from the Perspective of Family and Friends. JMIR Aging 2022; 5:e38363. [PMID: 35667087 PMCID: PMC9239564 DOI: 10.2196/38363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/25/2022] [Accepted: 06/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background The COVID-19 pandemic is taking a serious toll on people with dementia. Given the rapidly evolving COVID-19 context, policymakers and practitioners require timely, evidence-informed research to address the changing needs and challenges of people with dementia and their family care partners. Objective Using Twitter data, the objective of this study was to examine the COVID-19 impact on people with dementia from the perspective of their family members and friends. Methods Using the Twint application in Python, we collected 6243 relevant tweets over a 15-month time frame. The tweets were divided among 11 coders and analyzed using a 6-step thematic analysis process. Results Based on our analysis, 3 main themes were identified: (1) frustration and structural inequities (eg, denied dignity and inadequate supports), (2) despair due to loss (eg, isolation, decline, and death), and (3) resiliency, survival, and hope for the future. Conclusions As the COVID-19 pandemic persists and new variants emerge, people with dementia and their family care partners are facing complex challenges that require timely interventions. More specifically, tackling COVID-19 challenges requires revisiting pandemic policies and protocols to ensure equitable access to health and support services, recognizing the essential role of family care partners, and providing financial assistance and resources to help support people with dementia in the pandemic. Revaluating COVID-19 policies is critical to mitigating the pandemic’s impact on people with dementia and their family care partners.
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Affiliation(s)
- Juanita-Dawne R Bacsu
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, CA
| | - Megan E O'Connell
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, CA
| | - Allison Cammer
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, CA
| | - Soheila Ahmadi
- Department of Computer Science, University of Saskatchewan, Saskatoon, CA
| | - Corinne Berger
- Department of Computer Science, University of Saskatchewan, Saskatoon, CA
| | - Mehrnoosh Azizi
- Department of Computer Science, University of Saskatchewan, Saskatoon, CA
| | | | - Karl S Grewal
- Department of Psychology, University of Saskatchewan, Saskatoon, CA
| | - Shoshana Green
- Department of Psychology, University of Saskatchewan, Saskatoon, CA
| | - Sheida Knight
- Department of Computer Science, University of Saskatchewan, Saskatoon, CA
| | - Raymond J Spiteri
- Department of Computer Science, University of Saskatchewan, Saskatoon, CA
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