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Moradi G, Piroozi B, Khayyati F, Moradpour F, Safari H, Mohamadi Bolbanabad A, Fattahi H, Younesi F, Ebrazeh A, Shokri A. The effect of COVID-19 on utilization of chronic diseases services. Chronic Illn 2024; 20:309-319. [PMID: 37488977 PMCID: PMC10372501 DOI: 10.1177/17423953231178168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/08/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES The aim of the present study is to evaluate the impact of Covid-19 on utilization of chronic diseases services. METHODS Interrupted time-series design was used to examine the utilization of chronic diseases services before and during the Covid-19 pandemic among hospitals in Iran. Chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes, heart failure, and chemotherapy were selected as a proxy to indicate the impact of Covid-19 on utilization of chronic diseases services. Data were collected in 24 sites from 12 months before the onset of Covid-19 (from March 2019 to February 2020) to 12 months during the Covid-19 pandemic (February 2020 to March 2021). RESULTS A total of 7,039,378 services were provided, of which 51.92% were provided for women and 62.73% for >65 age group. A sudden decrease was observed in monthly utilization of services during the Covid-19 pandemic; ranging from 13.91 (95% CI = -21.73, 6.10, P = 0.001) for chemotherapy to 606.39 (95% CI = -1040.72, 172.06, P = 0.009) for heart failure services per 100 thousand population. A decrease was observed in COPD services; 15.28 services compared with the period before Covid-19. Subsequently, the monthly utilization trends of asthma, type 2 diabetes, and chemotherapy services increased significantly (P < 0.05). DISCUSSION Although chronic diseases are a factor in more severe form of Covid-19, their failure to seek diagnostic, prevention and treatment services has somewhat complicated the issue.
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Affiliation(s)
- Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Bakhtiar Piroozi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fariba Khayyati
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Farhad Moradpour
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hossein Safari
- Health Promotion Research Center, Iran University of Medical Science, Tehran, Iran
| | - Amjad Mohamadi Bolbanabad
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hamed Fattahi
- Centre for Primary Health Care Network Management, Ministry of Health and Medical Education, Tehran Iran
| | - Fatemeh Younesi
- Center for Health Human Resources Research & Studies, Ministry of Health and Medical Education, Tehran, Iran
| | - Ali Ebrazeh
- Department of Public Health, School of Public Health, Qom University of Medical Sciences, Qom, Iran
| | - Azad Shokri
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Au SW, Law MR, Cheng L, McGrail K, Harrison M. The Impact of reference pricing on prescribing patterns, costs, and health services utilization of proton pump inhibitors: A quasi-experimental study in British Columbia, Canada. Health Policy 2024; 144:105061. [PMID: 38676977 DOI: 10.1016/j.healthpol.2024.105061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION The Reference Drug Program (RDP) was established to steer patients toward equally safe and cost-effective medication under British Columbia's public drug coverage. Each RDP class covers at least one reference drug, and non-reference drugs are reimbursed up to the cost of the reference drug. In 2016, the RDP updated to include proton pump inhibitors (PPIs). This study evaluated the impact on drug expenditures, prescription patterns, and health services utilization. METHODS We identified a cohort of individuals covered by Fair Pharmacare who used PPIs, and a control group of H2 Blockers users. We used interrupted time series analysis on administrative data from June 2014 to December 2019 on the following outcomes: new users, day supply, expenditures, drug costs, reference drug use, and physician visits and costs. RESULTS The RDP had little impact on overall PPI use patterns. We did not observe any changes in reference drug uptake, new users, physician visits, cost-savings, or significant changes to days supplied post-policy. Cost expenditure results were likely biased due to co-occurring changes to drug prices. CONCLUSION Inclusion of PPIs to the RDP saw no cost-savings for the provincial drug program and had little impact on prescribing patterns. Overall, our findings are consistent with existing evidence that the RDP is safe for similar therapeutic alternatives, but the impact on PPI costs remains unclear.
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Affiliation(s)
- Shania Ws Au
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - Michael R Law
- The Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lucy Cheng
- The Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberlyn McGrail
- The Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Harrison
- Centre for Health Evaluation and Outcome Sciences, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
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Wrenn RH, Slaton CN, Diez T, Turner NA, Yarrington ME, Anderson DJ, Moehring RW. The devil's in the defaults: An interrupted time-series analysis of the impact of default duration elimination on exposure to fluoroquinolone therapy. Infect Control Hosp Epidemiol 2024; 45:733-739. [PMID: 38347810 DOI: 10.1017/ice.2024.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To determine whether removal of default duration, embedded in electronic prescription (e-script), influenced antibiotic days of therapy. DESIGN Interrupted time-series analysis. SETTING The study was conducted across 2 community hospitals, 1 academic hospital, 3 emergency departments, and 86 ambulatory clinics. PATIENTS Adults prescribed a fluoroquinolone with a duration <31 days. INTERVENTIONS Removal of standard 10-day fluoroquinolone default duration and addition of literature-based duration guidance in the order entry on December 19, 2017. The study period included data for 12 months before and after the intervention. RESULTS The study included 35,609 fluoroquinolone e-scripts from the preintervention period and 31,303 fluoroquinolone e-scripts from the postintervention period, accounting for 520,388 cumulative fluoroquinolone DOT. Mean durations before and after the intervention were 7.8 (SD, 4.3) and 7.7 (SD, 4.5), a nonsignificant change. E-scripts with a 10-day duration decreased prior to and after the default removal. The inpatient setting showed a significant 8% drop in 10-day e-scripts after default removal and a reduced median duration by 1 day; 10-day scripts declined nonsignificantly in ED and ambulatory settings. In the ambulatory settings, both 7- and 14-day e-script durations increased after default removal. CONCLUSION Removal of default 10-day antibiotic durations did not affect overall mean duration but did shift patterns in prescribing, depending on practice setting. Stewardship interventions must be studied in the context of practice setting. Ambulatory stewardship efforts separate from inpatient programs are needed because interventions cannot be assumed to have similar effects.
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Affiliation(s)
- Rebekah H Wrenn
- Duke University Medical Center, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Cara N Slaton
- Orlando Health Orlando Regional Medical Center, Orlando, Florida
| | - Tony Diez
- Duke University Medical Center, Durham, North Carolina
| | | | | | | | - Rebekah W Moehring
- Duke University Medical Center, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
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Mallama C, Karami S, Zhang D, Zhao Y, Yang Y, Woods C, Ding Y, Meyer T, McAninch J. The impact of more restrictive hydrocodone rescheduling on unintentional pediatric opioid exposures. Pharmacoepidemiol Drug Saf 2024; 33:e5793. [PMID: 38783553 DOI: 10.1002/pds.5793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/15/2024] [Accepted: 03/28/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To evaluate the impact of rescheduling hydrocodone combination products (HCPs) from schedule III of the Controlled Substances Act to the more restrictive schedule II on unintentional pediatric exposures (≤5 years old). METHODS Using U.S. data on outpatient retail pharmacy dispensing, emergency department (ED) visits, and poison center (PC) exposure cases, we assessed trends in prescriptions dispensed and unintentional pediatric exposure cases involving hydrocodone (rescheduled from III to II) compared to oxycodone (schedule II) and codeine (schedule III for combination products) using descriptive and interrupted time-series (ITS) analyses during the 16 quarters before and after the October 2014 rescheduling of HCPs. RESULTS Dispensing of hydrocodone products was declining before rescheduling but declined more steeply post-rescheduling. In ITS analyses, both hydrocodone and oxycodone had significant slope decreases in PC case rates in the post versus pre-period that was larger for hydrocodone, while codeine had a small but significant slope increase in PC case rates. An estimated 4202 ED visits for pediatric hydrocodone exposures occurred in the pre-period and 2090 visits occurred in the post-period, a significant decrease of 50.3%. Oxycodone exposures showed no significant decrease. CONCLUSIONS Pediatric hydrocodone unintentional exposure ED visits and PC cases decreased after HCP rescheduling more than would be expected had the pre-rescheduling trend continued; the acceleration in the decrease in hydrocodone PC cases was partially offset by a slowing in the decrease in codeine-involved cases. The trend changes were likely due to multiple factors, including changes in dispensing that followed the rescheduling. Unintentional pediatric medication exposures and poisonings remain a public health concern requiring ongoing, multifaceted mitigation efforts.
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Affiliation(s)
- Celeste Mallama
- Office of Pharmacovigilance and Epidemiology (OPE), Office of Surveillance and Epidemiology (OSE), Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Sara Karami
- Office of Pharmacovigilance and Epidemiology (OPE), Office of Surveillance and Epidemiology (OSE), Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Di Zhang
- Office of Biostatistics (OB), Office of Translational Science (OTS), Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Yueqin Zhao
- Office of Biostatistics (OB), Office of Translational Science (OTS), Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Yuze Yang
- Office of Pharmacovigilance and Epidemiology (OPE), Office of Surveillance and Epidemiology (OSE), Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Corinne Woods
- Office of Pharmacovigilance and Epidemiology (OPE), Office of Surveillance and Epidemiology (OSE), Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Yulan Ding
- Office of Pharmacovigilance and Epidemiology (OPE), Office of Surveillance and Epidemiology (OSE), Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Tamra Meyer
- Office of Pharmacovigilance and Epidemiology (OPE), Office of Surveillance and Epidemiology (OSE), Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Jana McAninch
- Office of Pharmacovigilance and Epidemiology (OPE), Office of Surveillance and Epidemiology (OSE), Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, Maryland, USA
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Owen VS, Sinnadurai S, Morrissey J, Colaco H, Wickson P, Dyjur D, Redlich M, O'Neill B, Zygun DA, Doig CJ, Harris J, Zuege DJ, Stelfox HT, Faris PD, Fiest KM, Niven DJ. Multicentre implementation of a quality improvement initiative to reduce delirium in adult intensive care units: An interrupted time series analysis. J Crit Care 2024; 81:154524. [PMID: 38199062 DOI: 10.1016/j.jcrc.2024.154524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
PURPOSE The ABCDEF bundle may improve delirium outcomes among intensive care unit (ICU) patients, however population-based studies are lacking. In this study we evaluated effects of a quality improvement initiative based on the ABCDEF bundle in adult ICUs in Alberta, Canada. MATERIAL AND METHODS We conducted a pre-post, registry-based clinical trial, analysed using interrupted time series methodology. Outcomes were examined via segmented linear regression using mixed effects models. The main data source was a population-based electronic health record. RESULTS 44,405 consecutive admissions (38,400 unique patients) admitted to 15 general medical/surgical and/or neurologic adult ICUs between 2014 and 2019 were included. The proportion of delirium days per ICU increased from 30.24% to 35.31% during the pre-intervention period. After intervention implementation it decreased significantly (bimonthly decrease of 0.34%, 95%CI 0.18-0.50%, p < 0.01) from 33.48% (95%CI 29.64-37.31%) in 2017 to 28.74% (95%CI 25.22-32.26%) in 2019. The proportion of sedation days using midazolam demonstrated an immediate decrease of 7.58% (95%CI 4.00-11.16%). There were no significant changes in duration of invasive ventilation, proportion of partial coma days, ICU mortality, or potential adverse events. CONCLUSIONS An ABCDEF delirium initiative was implemented on a population-basis within adult ICUs and was successful at reducing the prevalence of delirium.
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Affiliation(s)
- Victoria S Owen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Selvi Sinnadurai
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Jeanna Morrissey
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Heather Colaco
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Patty Wickson
- Health Innovation and Evidence, Provincial Clinical Excellence, Alberta Health Services, Alberta, Canada
| | - Donalda Dyjur
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Melissa Redlich
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Barbara O'Neill
- Cancer Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - David A Zygun
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher J Doig
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jo Harris
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Danny J Zuege
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Peter D Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Analytics, Alberta Health Services, Alberta, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J Niven
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Ndai AM, Allen BR, Wynn TT, Rajasekhar A, Saqr Z, Sandeli I, Vouri SM, Reise R. Rapid recognition and optimal management of hemophilia in the emergency department: A quality improvement project. J Am Coll Emerg Physicians Open 2024; 5:e13168. [PMID: 38699223 PMCID: PMC11065154 DOI: 10.1002/emp2.13168] [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] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/05/2024] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives This study aimed to assess the effectiveness of a continuous quality improvement initiative at the University of Florida Health Physicians practice in reducing the time to administer factor replacement therapy (FRT) for hemophilia patients presenting with bleeding in the emergency department (ED). Methods The study, a quasi-experimental, interventional design, was conducted between January 2020 and January 2023. The intervention, implemented in September 2021, involved training ED physicians, creating a specialized medication order set within the electronic health record (EHR), and a rapid triage system. The effectiveness was measured by comparing the time from ED arrival to factor administration before and after the intervention and benchmarking it against the National Bleeding Disorders Foundation's Medical and Scientific Advisory Council (MASAC)-recommended 1-hour timeline for factor administration. An interrupted time series (ITS) analysis with a generalized least squares model assessed the intervention's impact. Results A total of 43 ED visits (22 pre-intervention and 21 post-intervention) were recorded. Post-intervention, the average time from ED arrival to factor administration decreased from 5.63 to 3.15 hours. There was no significant increase (27% vs. 29%) in the patients receiving factor within 1-hour of ED arrival. The ITS analysis predicted a 20-hour reduction in the average quarterly time to administer factor by the end of the study, an 84% decrease. Conclusions The quality improvement program decreased the time to administer FRT for patients with hemophilia in the ED. However, the majority of patients did not achieve the 1-hour MASAC-recommended timeline for factor administration after ED arrival.
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Affiliation(s)
- Asinamai M. Ndai
- Department of Pharmaceutical Outcomes and PolicyCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
- University of Florida Health PhysiciansGainesvilleFloridaUSA
| | - Brandon R. Allen
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Tung T. Wynn
- Division of Pediatric Hematology/OncologyDepartment of PediatricsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Anita Rajasekhar
- Division of Hematology/OncologyDepartment of MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Ziad Saqr
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Ina Sandeli
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Scott M. Vouri
- Department of Pharmaceutical Outcomes and PolicyCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
- University of Florida Health PhysiciansGainesvilleFloridaUSA
| | - Rachel Reise
- Department of Pharmaceutical Outcomes and PolicyCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
- University of Florida Health PhysiciansGainesvilleFloridaUSA
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Saunders M, Ojha S, Szatkowski L. Impact of NICE clinical guidelines for prevention and treatment of neonatal infections on antibiotic use in very preterm infants in England and Wales: an interrupted time series analysis. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-326983. [PMID: 38802167 DOI: 10.1136/archdischild-2024-326983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To assess the impact of publication of UK National Institute for Health and Care Excellence (NICE) guidelines on the prevention and treatment of early-onset infections (EOIs) in neonates (clinical guideline 149 (CG149), published in 2012, and its 2021 update (NG195) on antibiotic use in very preterm infants. DESIGN Interrupted time series analysis using data from the National Neonatal Research Database. SETTING Neonatal units in England and Wales. PARTICIPANTS Infants born at 22-31 weeks' gestation from 1 January 2010 to 31 December 2022 and survived to discharge. INTERVENTIONS Publication of CG149 (August 2012) and NG195 (April 2021). MAIN OUTCOME MEASURES Measures of antibiotic use, aggregated by month of birth: antibiotic use rate (AUR), the proportion of care days in receipt of at least one antibiotic; percentage of infants who received ≥1 day of antibiotics on days 1-3 for EOI and after day 3 for late-onset infection (LOI); percentage who received ≥1 prolonged antibiotic course ≥5 days for EOI and LOI. RESULTS 96% of infants received an antibiotic during inpatient stay. AUR declined at publication of CG149, without further impact at NG195 publication. There was no impact of CG149 on the underlying trend in infants receiving ≥1 day antibiotics for EOI or LOI, but post-NG195 the monthly trend began to decline for EOI (-0.20%, -0.26 to -0.14) and LOI (-0.23%, -0.33 to -0.12). Use of prolonged antibiotic courses for EOI and LOI declined at publication of CG149 and for LOI this trend accelerated post-NG195. CONCLUSIONS Publications of NICE guidance were associated with reductions in antibiotic use; however neonatal antibiotic exposure remains extremely high.
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Affiliation(s)
- Mike Saunders
- University of Nottingham School of Medicine, Nottingham, UK
| | - Shalini Ojha
- Centre for Perinatal Research, University of Nottingham School of Medicine, Nottingham, UK
- Neonatal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Lisa Szatkowski
- Centre for Perinatal Research, University of Nottingham School of Medicine, Nottingham, UK
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de Lemos J, Sharaf M, Moadebi S, Low-Beer S, Cassidy B, Sutherland JM, Deziel C, Nagendran S. Replacing the Clinical Institute Withdrawal Assessment-Alcohol revised with the modified Richmond Agitation and Sedation Scale for alcohol withdrawal to support management of alcohol withdrawal symptoms: potential impact on length of stay and complications. CAN J EMERG MED 2024:10.1007/s43678-024-00710-7. [PMID: 38796808 DOI: 10.1007/s43678-024-00710-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/27/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE We evaluated impact on length of stay and possible complications of replacing the Clinical Institute Withdrawal Assessment-Alcohol Revised (CIWA-Ar) scale with a slightly modified Richmond Agitation and Sedation Scale (mRASS-AW) to support managing patients admitted with alcohol withdrawal symptoms in a community hospital. Since mRASS-AW is viewed as easier and quicker to use than CIWA-Ar, provided use of mRASS-AW does not worsen outcomes, it could be a safe alternative in a busy ED environment and offer an opportunity to release nursing time to care. METHODS Retrospective time-series analysis of mean quarterly length of stay. All analyses exclusively used our hospital's administrative discharge diagnoses database. During April 1st 2012 to December 14th 2014, the CIWA-Ar was used in the ED and in-patient units to guide benzodiazepine dosing decisions for alcohol withdrawal symptoms. After this point, CIWA-Ar was replaced with mRASS-AW. Data was evaluated until December 31st 2020. PRIMARY OUTCOME mean quarterly length of stay. SECONDARY OUTCOMES delirium, intensive care unit (ICU) admission, other post-admission complications, mortality. RESULTS N = 1073 patients. No association between length of stay and scale switch (slope change 0.3 (95% CI - 0.03 to 0.6), intercept change, 0.06 (- 0.03 to 0.2). CIWA-Ar (n = 317) mean quarterly length of stay, 5.7 days (95% 4.2-7.1), mRASS-AW (n = 756) 5.0 days (95% CI 4.3-5.6). Incidence of delirium, ICU admission or mortality was not different. However, incidence of other post-admission complications was higher with CIWA-Ar (6.6%) than mRASS-AW (3.4%) (p = 0.020). CONCLUSIONS This was the first study to compare patient outcomes associated with using mRASS-AW for alcohol withdrawal symptoms outside the ICU. Replacing CIWA-Ar with mRASS-AW did not worsen length of stay or complications. These findings provide some evidence that mRASS-AW could be considered an alternative to CIWA-Ar and potentially may provide an opportunity to release nursing time to care.
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Affiliation(s)
- Jane de Lemos
- BCCancer Provincial (Pharmacy), 750-600 W Broadway, Vancouver, BC, Canada.
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
| | - Mazen Sharaf
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- UBC Hospital (Pharmacy), Vancouver, BC, Canada
| | - Susanne Moadebi
- University of British Columbia (Pharmacist Clinic), Vancouver, BC, Canada
- Island Health Authority, (Primary Care Pharmacy), Victoria, BC, Canada
| | - Sophie Low-Beer
- Richmond Hospital (Emergency Medicine), Richmond, BC, Canada
| | - Brighid Cassidy
- Lions Gate Hospital (Emergency Medicine), North Vancouver, BC, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Christine Deziel
- Richmond Hospital (Drug and Alcohol Resource Team), Richmond, BC, Canada
| | - Sree Nagendran
- Richmond Hospital (Drug and Alcohol Resource Team), Richmond, BC, Canada
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Freeman SJ, Nisenbaum R, Jegathesan T, Sgro MD. Healthcare visits for new neurodevelopmental problems before and during the COVID-19 pandemic. Pediatr Res 2024:10.1038/s41390-024-03279-0. [PMID: 38796534 DOI: 10.1038/s41390-024-03279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/11/2024] [Accepted: 05/06/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND The COVID-19 pandemic disrupted healthcare delivery. We hypothesized that children with neurodevelopmental problems would have reduced healthcare utilization during the pandemic compared to before the pandemic. METHODS We conducted a population-based study of healthcare visits for new neurodevelopmental problems among children ages 0-6 years in Ontario, Canada. Our outcome measure was rate per 1000 children-months for healthcare visits for new neurodevelopmental problems. We compared changes in monthly rates before and during the pandemic using interrupted time series analysis (ITSA). RESULTS The rate of new neurodevelopmental problems before the pandemic was 6.31 per 1000 children-months and during the pandemic was 6.58 per 1000 children-months. However, using ITSA, there were no differences in monthly rates of healthcare visits for new neurodevelopmental problems before and during the pandemic. The observed rate during the first 30 days of the pandemic dropped to 3.40 per 1000 children-months. CONCLUSION We found no significant difference in rates of healthcare visits for new neurodevelopmental problems before and during the pandemic. There was a decrease in the number of visits during the first 30 days of the pandemic compared to all months prior. IMPACT This study found no significant difference in rates of healthcare visits for new neurodevelopmental problems before and during the pandemic. There was a decrease in the number of visits during the first 30 days of the pandemic compared to all months prior. This study adds information on healthcare access for children during the COVID-19 pandemic. The rapid deployment of virtual healthcare delivery in Ontario, Canada may explain the fast recovery of healthcare utilization for children with neurodevelopmental problems.
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Affiliation(s)
- Sloane J Freeman
- Women and Children's Health Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Thivia Jegathesan
- Women and Children's Health Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michael D Sgro
- Women and Children's Health Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
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10
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Lindsey ML, Harris BJ, Dahm LE, Woods L. Establishing the short course in transferable skills training program. J Cell Physiol 2024. [PMID: 38785335 DOI: 10.1002/jcp.31324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
While PhD programs prepare graduate students to perform biomedical research, a defined systematic training program for transferable skills is generally lacking. When provided, this training is often informal, unstructured, or inconsistent. Therefore, there is a need to provide critical skills in marketing, relationship building, project management, and budgeting to prepare trainees to navigate into a productive, engaging, and rewarding biomedical research career. To address this gap in training, the School of Graduate Studies at Meharry Medical College has developed the SHort Course In transFerable skills Training (SHIFT) Program, a 1-year professional development program accessible to graduate students in the United States who are enrolled in graduate biomedical research related programs. The SHIFT Program has been launched to equip trainees with skills essential for success in all biomedical science careers. PhD students will be taught the primary constituents of career management through the use of four training modules. In Module I, students complete self-assessments and are assigned to a small peer-mentoring team with mentors. Module II consists of a 5-day workshop that encompasses instruction on the transferable skills identified as essential for career success. Module III entails monthly interactive discussions over a 6-month period involving case study review and mentor-guided discussions to further reinforce skills learned. In Module IV, students compile the information learned from Modules I-III to develop an Individual Development Plan that incorporates 3-5 specific, measurable, attainable, relevant, and time-based career goals. Collectively, the SHIFT Program will allow participants to train, practice, and refresh skills, empowering them to navigate career transitions and obtain success in the career of their choice.
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Affiliation(s)
- Merry L Lindsey
- School of Graduate Studies, Meharry Medical College, Nashville, Tennessee, USA
- Research Service, Nashville VA Medical Center, Nashville, Tennessee, USA
| | - Brandon J Harris
- School of Graduate Studies, Meharry Medical College, Nashville, Tennessee, USA
| | - Lauren E Dahm
- School of Graduate Studies, Meharry Medical College, Nashville, Tennessee, USA
| | - Letha Woods
- School of Graduate Studies, Meharry Medical College, Nashville, Tennessee, USA
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11
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Xia H, Li J, Yang X, Zeng Y, Shi L, Li X, Qiu S, Yang S, Zhao M, Chen J, Yang L. Impacts of pharmacist-led multifaceted antimicrobial stewardship on antibiotic use and clinical outcomes in urology department of a tertiary hospital in Guangzhou, China: an interrupted time series study. J Hosp Infect 2024:S0195-6701(24)00171-3. [PMID: 38795904 DOI: 10.1016/j.jhin.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/15/2024] [Accepted: 05/01/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Limited research has explored the effectiveness of pharmacist-led antimicrobial stewardship programs (ASPs) in the urology department. OBJECTIVE To evaluate the impact of pharmacist-led multifaceted ASPs on antibiotic use and clinical outcomes. METHODS We conducted a prescription review of inpatients receiving one or more antibiotics in the urology department of a large teaching hospital in Guangzhou, China, from April 2019 to March 2023. The pharmacist-led multifaceted ASPs intervention included guidelines development, training, medication consultation, review of medical orders, indicator monitoring, and consultation. Our primary outcome was antibiotic consumption. The data was analysed using interrupted time series (ITS) analysis. RESULTS Following the implementation of ASPs, we observed an immediate decrease in total antibiotic consumption (β = -32.42 DDDs/100PD and -36.24 DOT/100PD, P < 0.001), Antibiotic use rate (β = -7.87 %, P = 0.002), Second-generation cephalosporins (β = -12.43 DDDs/100PD and -15.18 DOT/100PD, P < 0.001), Third-generation cephalosporins (β = -5.13 DDDs/100PD, P = 0.001 and -6.16 DOT/100PD, P = 0.002), Fluoroquinolones (β = -12.26 DDDs/100PD and -12.70 DOT/100PD, P < 0.001), and WHO Watch category antibiotics (β = -32.07 DDDs/100PD and -34.96 DOT/100PD, P < 0.001). There were no differences observed in mortality rate before and after the intervention, and no significant short-term or long-term effects were found on length of hospital stay (LOS) using ITS. However, there was a significant short-term effect on average antibiotic cost (β = -446.83 RMB, P = 0.004). CONCLUSION The implementation of pharmacist-led multifaceted ASPs had positive impacts on reducing antimicrobial consumption without increasing LOS, antibiotic cost, or mortality rate.
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Affiliation(s)
- Haohai Xia
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jia Li
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xinyi Yang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yingchao Zeng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lin Shi
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiying Li
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shenyue Qiu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shifang Yang
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Manzhi Zhao
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jie Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lianping Yang
- School of Public Health, Sun Yat-sen University, Guangzhou, China; Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China; Institute for Global Health and Development, Peking University, Beijing, China.
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12
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McGrath BM, Goueth R, Jones MWH, Cook N, Navale SM, Zyzanski SJ, Bensken WP, Templeton AR, Koroukian SM, Crist RL, Stange KC. Care Quality and Equity in Health Centers During and After the COVID-19 Pandemic. Am J Prev Med 2024:S0749-3797(24)00168-5. [PMID: 38788862 DOI: 10.1016/j.amepre.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Federally Qualified Community Health Centers (FQHCs) are on the frontline of efforts to improve healthcare equity and reduce disparities exacerbated by the COVID-19 pandemic. This study assesses the provision and equity of preventive care and chronic disease management by FQHCs before, during, and after the pandemic. METHODS Using electronic health record data from 210 FQHCs nationwide and employing segmented regression in an interrupted time series design, preventive screening and chronic disease management were assessed for 939,053 patients from 2019 to 2022. Care measures included cancer screenings, blood pressure control, diabetes control, and childhood immunizations; patient-level factors including race and ethnicity, language preference, and multimorbidity status were analyzed for equitable care provision. Analyses were conducted in 2023-2024. RESULTS Cancer screening rates and blood pressure control initially declined after the onset of the pandemic but later rebounded, while diabetes control showed a slight increase, later stabilizing. Racial and ethnic disparities persisted, with Asian individuals having a higher prevalence of screenings and blood pressure control, and Black/African American individuals facing a lower prevalence for most screenings but a higher prevalence for cervical cancer screening. Hispanic/Latino individuals had a higher prevalence of various screenings and diabetes control. Disparities persisted for Native Hawaiian/Other Pacific Islander and American Indian/Alaska Native individuals and were observed based on language and multimorbidity status. CONCLUSIONS While preventive screening and chronic disease management in FQHCs have largely rebounded to pre-pandemic levels following an initial decline, persistent disparities highlight the need for targeted interventions to support FQHCs in addressing healthcare inequities.
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Affiliation(s)
| | - Rose Goueth
- OCHIN, Inc., Research Department, Portland, OR
| | | | - Nicole Cook
- OCHIN, Inc., Research Department, Portland, OR
| | | | - Stephen J Zyzanski
- Center for Community Health Integration and Departments of Family Medicine & Community Health and Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | | | | | - Siran M Koroukian
- Center for Community Health Integration and Departments of Family Medicine & Community Health and Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Rae L Crist
- OCHIN, Inc., Research Department, Portland, OR
| | - Kurt C Stange
- OCHIN, Inc., Research Department, Portland, OR; Center for Community Health Integration and Departments of Family Medicine & Community Health and Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
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13
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West LM, Mooney SJ, Chavez L, Beck A, Clarke GN, Pabiniak CJ, Renz AD, Penfold RB. Evaluation of the Safer Use of Antipsychotics in Youth Study on Population Level Antipsychotic Initiation: An Interrupted Time Series Analysis. J Child Adolesc Psychopharmacol 2024. [PMID: 38743639 DOI: 10.1089/cap.2024.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background: Antipsychotics carry a higher-risk profile than other psychotropic medications and may be prescribed for youth with conditions in which other first-line treatments are more appropriate. This study aimed to evaluate the population-level effect of the Safer Use of Antipsychotics in Youth (SUAY) trial, which aimed to reduce person-days of antipsychotic use among participants. Methods: We conducted an interrupted time series analysis using segmented regression to measure changes in prescribing trends of antipsychotic initiation rates pre-SUAY and post-SUAY trial at four U.S. health systems between 2013 and 2020. Results: In our overall model, adjusted for age and insurance type, antipsychotic initiation rates decreased by 0.73 (95% confidence interval [CI]: 0.30, 1.16, p = 0.002) prescriptions per 10,000 person-months before the SUAY trial. In the first quarter following the start of the trial, there was an immediate decrease in the rate of antipsychotic initiations of 6.57 (95% CI: 0.99, 12.15) prescriptions per 10,000 person-months. When comparing the posttrial period to the pretrial period, there was an increase of 1.09 (95% CI: 0.32, 1.85) prescriptions per 10,000 person-months, but the increasing rate in the posttrial period alone was not statistically significant (0.36 prescriptions per 10,000 person-months, 95% CI: -0.27, 0.99). Conclusion: The declining trend of antipsychotic initiation seen between 2013 and 2018 (pre-SUAY trial) may have naturally reached a level at which prescribing was clinically warranted and appropriate, resulting in a floor effect. The COVID-19 pandemic, which began in the final three quarters of the posttrial period, may also be related to increased antipsychotic medication initiation.
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Affiliation(s)
- Laura M West
- Department of Epidemiology, University of Washington Seattle, Seattle, Washington, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Stephen J Mooney
- Department of Epidemiology, University of Washington Seattle, Seattle, Washington, USA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA
| | - Laura Chavez
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, Denver, Colorado, USA
| | - Gregory N Clarke
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Chester J Pabiniak
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Anne D Renz
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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14
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Sieleunou I, Enok Bonong RP. Does health voucher intervention increase antenatal consultations and skilled birth attendances in Cameroon? Results from an interrupted time series analysis. BMC Health Serv Res 2024; 24:602. [PMID: 38720364 PMCID: PMC11080306 DOI: 10.1186/s12913-024-10962-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Limited access to health services during the antenatal period and during childbirth, due to financial barriers, is an obstacle to reducing maternal and child mortality. To improve the use of health services in the three regions of Cameroon, which have the worst reproductive, maternal, neonatal, child and adolescent health indicators, a health voucher project aiming to reduce financial barriers has been progressively implemented since 2015 in these three regions. Our research aimed to assess the impact of the voucher scheme on first antenatal consultation (ANC) and skilled birth attendance (SBA). METHODS Routine aggregated data by month over the period January 2013 to May 2018 for each of the 33 and 37 health facilities included in the study sample were used to measure the effect of the voucher project on the first ANC and SBA, respectively. We estimated changes attributable to the intervention in terms of the levels of outcome indicators immediately after the start of the project and over time using an interrupted time series regression. A meta-analysis was used to obtain the overall estimates. RESULTS Overall, the voucher project contributed to an immediate and statistically significant increase, one month after the start of the project, in the monthly number of ANCs (by 26%) and the monthly number of SBAs (by 57%). Compared to the period before the start of the project, a statistically significant monthly increase was observed during the project implementation for SBAs but not for the first ANCs. The results at the level of health facilities (HFs) were mixed. Some HFs experienced an improvement, while others were faced with the status quo or a decrease. CONCLUSIONS Unlike SBAs, the voucher project in Cameroon had mixed results in improving first ANCs. These limited effects were likely the consequence of poor design and implementation challenges.
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Affiliation(s)
- Isidore Sieleunou
- The Global Financing Facility (GFF), Dakar, Senegal.
- Research for Development International, 30883, Yaoundé, Cameroon.
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15
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Theophanous R, Ramos J, Calland AR, Krcmar R, Shah P, da Matta LT, Shaheen S, Wrenn RH, Seidelman J. Blood culture algorithm implementation in emergency department patients as a diagnostic stewardship intervention. Am J Infect Control 2024:S0196-6553(24)00472-3. [PMID: 38719159 DOI: 10.1016/j.ajic.2024.04.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE Blood cultures (BCx) are important for selecting appropriate antibiotic treatment. Ordering BCx for conditions with a low probability of bacteremia has limited utility, thus improved guidance for ordering BCx is needed. Inpatient studies have implemented BCx algorithms, but no studies examine the intervention in an Emergency Department (ED) setting. METHODS We performed a quasi-experimental pre and postintervention study from January 12, 2020, to October 31, 2023, at a single academic adult ED and implemented a BCx algorithm. The primary outcome was the blood culture event rates (BCE per 100 ED admissions) pre and postintervention. Secondary outcomes included adverse event rates (30-day ED and hospital readmission and antibiotic days of therapy). Seven ED physicians and APP reviewed BCx for appropriateness, with monthly feedback provided to ED leadership and physicians. RESULTS After the BCx algorithm implementation, the BCE rate decreased from 12.17 BCE/100 ED admissions to 10.50 BCE/100 ED admissions. Of the 3,478 reviewed BCE, we adjudicated 2,153 BCE (62%) as appropriate, 653 (19%) as inappropriate, and 672 (19%) as uncertain. Adverse safety events were not statistically different pre and postintervention. CONCLUSIONS Implementation of an ED BCx algorithm demonstrated a reduction in BCE, without increased adverse safety events. Future studies should compare outcomes of BCx algorithm implementation in a community hospital ED without intensive chart review.
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Affiliation(s)
- Rebecca Theophanous
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC
| | - John Ramos
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC
| | - Alyssa R Calland
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC
| | - Rachel Krcmar
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC
| | - Priya Shah
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC
| | - Lucas T da Matta
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC
| | - Stephen Shaheen
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC
| | - Rebekah H Wrenn
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, NC; Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC
| | - Jessica Seidelman
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, NC; Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC.
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Kang HA, Wang B, Barner JC, Ataga KI, Mignacca RC, Chang A, Zhang Y. Opioid Prescribing and Outcomes in Patients With Sickle Cell Disease Post-2016 CDC Guideline. JAMA Intern Med 2024; 184:510-518. [PMID: 38466269 PMCID: PMC10928539 DOI: 10.1001/jamainternmed.2023.8538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/10/2023] [Indexed: 03/12/2024]
Abstract
Importance Although the intention of the 2016 US Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain was not to limit pain treatment for patients with sickle cell disease (SCD), clinicians and patients have recognized the possibility that the guideline may have altered outcomes for this population. However, the outcomes of the 2016 guideline for this patient population are unknown. Objective To examine changes in opioid prescribing patterns and health outcomes among patients with SCD before and after the release of the 2016 CDC guideline. Design, Setting, and Participants This retrospective cohort study conducted interrupted time series analysis of claims data from the Merative MarketScan Commercial Database from January 1, 2011, to December 31, 2019. In this population-based study in the US, individuals with SCD who were at least 1 year of age, had no cancer diagnosis, and had pharmacy coverage for the month of measurement were included. The data were analyzed from January 2021 to November 2023. Exposure The CDC Guideline for Prescribing Opioids for Chronic Pain released in March 2016. Main Outcomes and Measures The main variables measured in this study included the practice of opioid prescribing among patients with SCD (ie, rate of opioid prescriptions dispensed, mean number of days supplied, mean total morphine milligram equivalents [MME] per patient, and mean daily MME per opioid prescription) and pain-related health outcomes (rates of emergency department visits related to vaso-occlusive crises [VOC] and hospitalizations related to VOC). Results The cohort included 14 979 patients with SCD (mean [SD] age, 25.9 [16.9] years; 8520 [56.9%] female). Compared with the preguideline trends, the following changes were observed after the guideline was released: significant decreases in the coefficient for change in slope of the opioid dispensing rate (-0.29 [95% CI, -0.39 to -0.20] prescriptions per 100 person-month; P < .001), the number of days supplied per prescription (-0.05 [95% CI, -0.06 to -0.04] days per prescription-month; P < .001), and opioid dosage (-141.0 [95% CI, -219.5 to -62.5] MME per person-month; P = .001; -10.1 [95% CI, -14.6 to -5.6] MME/prescription-month; P < .001). Conversely, a significant increase in VOC-related hospitalizations occurred after the guideline release (0.16 [95% CI, 0.07-0.25] hospitalizations per 100 person-month; P = .001). These changes were observed to a greater extent among adult patients, but pediatric patients experienced similar changes in several measures, even though the guideline focused exclusively on adult patients. Conclusions and Relevance This retrospective cohort study showed that the 2016 CDC guideline may have had unintended negative outcomes on the patient population living with SCD.
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Affiliation(s)
- Hyeun Ah Kang
- Division of Health Outcomes, College of Pharmacy, The University of Texas at Austin
| | - Bofei Wang
- Computational Sciences Program, The University of Texas at El Paso
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Jamie C. Barner
- Division of Health Outcomes, College of Pharmacy, The University of Texas at Austin
| | - Kenneth I. Ataga
- Center for Sickle Cell Disease, Department of Medicine, The University of Tennessee Health Science Center at Memphis
| | - Robert C. Mignacca
- Department of Pediatrics, The University of Texas at Austin
- Children’s Blood and Cancer Center at Dell Children’s Hospital, Austin, Texas
| | - Alicia Chang
- Department of Pediatrics, The University of Texas at Austin
- Children’s Blood and Cancer Center at Dell Children’s Hospital, Austin, Texas
| | - Yahan Zhang
- Division of Health Outcomes, College of Pharmacy, The University of Texas at Austin
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Bentvelsen RG, Laan BJ, Bonten T, van der Vaart R, Hetem DJ, Soetekouw R, Geerlings SE, Chavannes NH, Veldkamp KE. Patient engagement to counter catheter-associated urinary tract infections with an app (PECCA): a multicentre, prospective, interrupted time-series and before-and-after study. J Hosp Infect 2024; 147:98-106. [PMID: 38040039 DOI: 10.1016/j.jhin.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/11/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND The risk of urinary tract infections (UTIs) is increased by unnecessary placement and prolonged use of urinary catheters. AIM To assess whether inappropriate use of catheters and catheter-associated UTI were reduced through patient participation. METHODS In this multicentre, interrupted time-series and before-and-after study, we implemented a patient-centred app which provides catheter advice for patients, together with clinical lessons, feedback via e-mails and support rounds for staff members. Data on catheter use and infections were collected during a six-month baseline and a six-month intervention period on 13 wards in four hospitals in the Netherlands. Dutch Trial Register: NL7178. FINDINGS Between June 25th, 2018 and August 1st, 2019, 6556 patients were included in 24 point-prevalence surveys, 3285 (50%) at baseline and 3271 (50%) during the intervention. During the intervention 249 app users and a median of seven new app users per week were registered (interquartile range: 5.5-13.0). At baseline, inappropriate catheter use was registered for 175 (21.9%) out of 798 catheters, compared to 55 (7.0%) out of 786 during the intervention. Time-series analysis showed a non-significant decrease of inappropriate use of 5.8% (95% confidence interval: -3.76 to 15.45; P = 0.219), with an odds ratio of 0.27 (0.19-0.37; P < 0.001). Catheter-associated UTI decreased by 3.0% (1.3-4.6; P = 0.001), with odds ratio 0.541 (0.408-0.716; P < 0.001). CONCLUSION Although UTI significantly decreased after the implementation, patient participation did not significantly reduce the prevalence of inappropriate urinary catheter use. However, the inappropriate catheter reduction of 5.8% and an odds ratio of 0.27 suggest a positive trend. Patient participation appears to reduce CAUTI and could reduce other healthcare-associated infections.
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Affiliation(s)
- R G Bentvelsen
- Clinical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands; Microvida Laboratory for Microbiology and Immunology, Amphia Hospital Breda, Breda, The Netherlands.
| | - B J Laan
- Infectious Diseases, Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - T Bonten
- Public Health and Primary Care, National eHealth Living Lab, Leiden University Medical Centre, Leiden, The Netherlands
| | - R van der Vaart
- Unit of Health, Medical and Neuropsychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - D J Hetem
- Clinical Microbiology, Haaglanden Medical Centre, The Hague, The Netherlands
| | - R Soetekouw
- Internal Medicine, Spaarne Gasthuis, Haarlem/Hoofddorp, The Netherlands
| | - S E Geerlings
- Infectious Diseases, Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - N H Chavannes
- Public Health and Primary Care, National eHealth Living Lab, Leiden University Medical Centre, Leiden, The Netherlands
| | - K E Veldkamp
- Clinical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands
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Wheeler SM, Truong T, Unnithan S, Hong H, Myers E, Swamy GK. Obstetric Racial Disparities in the Era of the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) Trial and the Coronavirus Disease 2019 (COVID-19) Pandemic. Obstet Gynecol 2024; 143:690-699. [PMID: 38547489 PMCID: PMC11031288 DOI: 10.1097/aog.0000000000005564] [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: 11/10/2023] [Accepted: 02/01/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To evaluate the influence of the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial and the coronavirus disease 2019 (COVID-19) pandemic on racial and ethnic differences in labor induction, pregnancy-associated hypertension, and cesarean delivery among non-Hispanic Black and non-Hispanic White low-risk, first-time pregnancies. METHODS We conducted an interrupted time series analysis of U.S. birth certificate data from maternal non-Hispanic Black and non-Hispanic White race and ethnicity, first pregnancy, 39 or more weeks of gestation, with no documented contraindication to vaginal delivery or expectant management beyond 39 weeks. We compared the rate of labor induction (primary outcome), pregnancy-associated hypertension, and cesarean delivery during three time periods: pre-ARRIVE (January 1, 2015-July 31, 2018), post-ARRIVE (November 1, 2018-February 29, 2020), and post-COVID-19 (March 1, 2020-December 31, 2021). RESULTS In the post-ARRIVE period, the rate of labor induction increased in both non-Hispanic White and non-Hispanic Black patients, with no statistically significant difference in the magnitude of increase between the two groups (rate ratio for race [RR race ] 0.98, 95% CI, 0.95-1.02, P =.289). Post-COVID-19, the rate of labor induction increased in non-Hispanic White but not non-Hispanic Black patients. The magnitude of the rate change between non-Hispanic White and non-Hispanic Black patients was significant (RR race 0.95, 95% CI, 0.92-0.99, P =.009). Non-Hispanic Black pregnant people were more likely to have pregnancy-associated hypertension and more often delivered by cesarean at all time periods. CONCLUSION Changes in obstetric practice after both the ARRIVE trial and the COVID-19 pandemic were not associated with changes in Black-White racial differences in labor induction, cesarean delivery, and pregnancy-associated hypertension.
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Affiliation(s)
- Sarahn M Wheeler
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, the Department of Biostatics and Bioinformatics, and the Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
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19
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Riley T, Fiastro AE, Benson LS, Khattar A, Prager S, Godfrey EM. Abortion Provision and Delays to Care in a Clinic Network in Washington State After Dobbs. JAMA Netw Open 2024; 7:e2413847. [PMID: 38809551 PMCID: PMC11137636 DOI: 10.1001/jamanetworkopen.2024.13847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/24/2024] [Indexed: 05/30/2024] Open
Abstract
Importance The Supreme Court decision Dobbs v Jackson Women's Health Organization (Dobbs) overturned federal protections to abortion care and altered the reproductive health care landscape. Thus far, aggregated state-level data reveal increases in the number of abortions in states where abortion is still legal, but there is limited information on delays to care and changes in the characteristics of people accessing abortion in these states after Dobbs. Objective To examine changes in abortion provision and delays to care after Dobbs. Design, Setting, and Participants Retrospective cohort study of all abortions performed at an independent, high-volume reproductive health care clinic network in Washington state from January 1, 2017, to July 31, 2023. Using an interrupted time series, the study assessed changes in abortion care after Dobbs. Exposure Abortion care obtained after (June 24, 2022, to July 31, 2023) vs before (January 1, 2017, to June 23, 2022) Dobbs. Main Outcome and Measure Primary outcomes included weekly number of abortions and out-of-state patients and weekly average of gestational duration (days) and time to appointment (days). Results Among the 18 379 abortions during the study period, most were procedural (13 192 abortions [72%]) and funded by public insurance (11 412 abortions [62%]). The mean (SD) age of individuals receiving abortion care was 28.5 (6.44) years. Following Dobbs, the number of procedural abortions per week increased by 6.35 (95% CI, 2.83-9.86), but then trended back toward pre-Dobbs levels. The number of out-of-state patients per week increased by 2 (95% CI, 1.1-3.6) and trends remained stable. The average gestational duration per week increased by 6.9 (95% CI, 3.6-10.2) days following Dobbs, primarily due to increased gestations of procedural abortions. The average gestational duration among out-of-state patients did not change following Dobbs, but it did increase by 6 days for in-state patients (5.9; 95% CI, 3.2-8.6 days). There were no significant changes in time to appointment. Conclusions and Relevance These findings provide a detailed picture of changes in abortion provision and delays to care after Dobbs in a state bordering a total ban state. In this study, more people traveled from out of state to receive care and in-state patients sought care a week later in gestation. These findings can inform interventions and policies to improve access for all seeking abortion care.
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Affiliation(s)
- Taylor Riley
- Department of Epidemiology, University of Washington, Seattle
| | - Anna E. Fiastro
- Department of Family Medicine, University of Washington, Seattle
| | - Lyndsey S. Benson
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | | | - Sarah Prager
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Emily M. Godfrey
- Department of Family Medicine, University of Washington, Seattle
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Cerecero-García D, Macías-González F, Muñoz-Aguirre P, Huerta-Gutierrez R, Zapata M, Rivera-Luna R, Lajous M, Bautista-Arredondo S. Impact of Fee For Service on the Efficiency and Survival of Seguro Popular's Patients With Acute Lymphoblastic Leukemia in Mexico. JCO Glob Oncol 2024; 10:e2300060. [PMID: 38754053 DOI: 10.1200/go.23.00060] [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: 03/06/2023] [Revised: 10/15/2023] [Accepted: 02/02/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE Cost containment and efficiency in the provision of health care are primary concerns for health systems that aim to provide affordable, high-quality care. Between 2005 and 2015, Seguro Poplar's Fund against Catastrophic Expenditures (FPGC) funded ALL treatment in Mexico. Before January 1, 2011, FPGC reimbursed a fixed amount per patient according to risk. In 2011, the per capita reimbursement method changed to fee for service. We used this natural experiment to estimate the impact of the reimbursement policy change on average expenditure and quality of care for ALL treatment in Mexico. METHODS We used nationwide reimbursement data from the Seguro Poplar's FPGC from 2005 to 2015. We created a patient cohort to assess 3-year survival and estimate the average reimbursement before and after the fee-for-service policy. We examined survival and expenditure impacts, controlling for patients' and providers' characteristics, including sex, risk (standard and high), the volume of patients served, type of institution (federally funded v other), and level of care. To quantify the impact, we used a regression discontinuity approach. RESULTS The average reimbursement for standard-risk patients in the 3-year survival cohort was $16,512 US dollars (USD; 95% CI, 16,042 to 17,032) before 2011 and $10,205 USD (95% CI, 4,659 to 12,541) under the fee-for-service reimbursement scheme after 2011. The average annual reimbursement per patient decreased by 136% among high-risk patients. The reduction was also significant for the standard-risk cohort, although the magnitude was substantially smaller (34%). CONCLUSION As Mexico's government is currently restructuring the health system, our study provides evidence of the efficiency and effectiveness of the funding mechanism in the Mexican context. It also serves as a proof of concept for using administrative data to evaluate economic performance and quality of care of publicly funded health programs.
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Affiliation(s)
- Diego Cerecero-García
- Centre for Research on Evaluation and Surveys, National Institute of Public Health (INSP-Instituto Nacional de Salud Pública), Cuernavaca, Mexico
| | - Fernando Macías-González
- Centre for Research on Evaluation and Surveys, National Institute of Public Health (INSP-Instituto Nacional de Salud Pública), Cuernavaca, Mexico
| | - Paloma Muñoz-Aguirre
- Centre for Research on Population Health, National Institute of Public Health (INSP-Instituto Nacional de Salud Pública), Cuernavaca, Mexico
- National Council for Science and Technology (Conacyt), Mexico City, Mexico
| | - Rodrigo Huerta-Gutierrez
- Centre for Research on Population Health, National Institute of Public Health (INSP-Instituto Nacional de Salud Pública), Cuernavaca, Mexico
| | - Martha Zapata
- Research Coordination, Fundación IMSS, A.C., Mexico City, Mexico
| | - Roberto Rivera-Luna
- Department of Oncology, National Institute of Pediatrics, Mexico City, Mexico
| | - Martin Lajous
- Centre for Research on Population Health, National Institute of Public Health (INSP-Instituto Nacional de Salud Pública), Cuernavaca, Mexico
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sergio Bautista-Arredondo
- Centre for Research on Evaluation and Surveys, National Institute of Public Health (INSP-Instituto Nacional de Salud Pública), Cuernavaca, Mexico
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21
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Tverdek FP, Aitken SL, Mulanovich VE, Adachi J, Wu C, Cantu SS, McDaneld PM, Chemaly RF. Implementation of an Automated Antibiotic Time-out at a Comprehensive Cancer Center. Open Forum Infect Dis 2024; 11:ofae235. [PMID: 38798895 PMCID: PMC11127483 DOI: 10.1093/ofid/ofae235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Background Antimicrobial stewardship programs can optimize antimicrobial use and have been federally mandated in all hospitals. However, best stewardship practices in immunocompromised patients with cancer are not well established. Methods An antimicrobial time out, in the form of an email, was sent to physicians caring for hospitalized patients reaching 5 days of therapy for targeted antimicrobials (daptomycin, linezolid, tigecycline, vancomycin, imipenem/cilastatin, meropenem) in a comprehensive cancer center. Physicians were to discontinue the antimicrobial if unnecessary or document a rationale for continuation. This is a quasi-experimental, interrupted time series analysis assessing antimicrobial use during the following times: period 1 (before time-out: January 2007-June 2010) and period 2 (after time-out: July 2010-March/2015). The primary antimicrobial consumption metric was mean duration of therapy. Days of therapy per 1000 patient-days were also assessed. Results Implementation of the time-out was associated with a significant decrease in mean duration of therapy for the following antimicrobials; daptomycin: -0.89 days (95% confidence interval [CI], -1.38 to -.41); linezolid: -0.89 days (95% CI, -1.27 to -.52); meropenem: -0.97 days (95% CI, -1.39 to -.56); tigecycline: -1.41 days (95% CI, -2.19 to -.63); P < .001 for each comparison. Days of therapy/1000 patient-days decreased significantly for meropenem (-43.49; 95% CI, -58.61 to -28.37; P < .001), tigecycline (-35.47; 95% CI, -44.94 to -26.00; P < .001), and daptomycin (-9.47; 95% CI, -15.25 to -3.68; P = .002). Discussion A passive day 5 time-out was associated with reduction in targeted antibiotic use in a cancer center and could potentially be successfully adopted to several settings and electronic health records.
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Affiliation(s)
- Frank P Tverdek
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Samuel L Aitken
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, UTHealth McGovern Medical School, Houston, Texas, USA
| | - Victor E Mulanovich
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Javier Adachi
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cai Wu
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sherry S Cantu
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick M McDaneld
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Brooks N, Irving SA, Kauffman TL, Vesco KK, Slaughter M, Smith N, Tepper NK, Olson CK, Weintraub ES, Naleway AL. Abnormal uterine bleeding diagnoses and care following COVID-19 vaccination. Am J Obstet Gynecol 2024; 230:540.e1-540.e13. [PMID: 38219855 DOI: 10.1016/j.ajog.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND There is evidence suggesting that COVID-19 vaccination may be associated with small, transitory effects on uterine bleeding, possibly including menstrual timing, flow, and duration, in some individuals. However, changes in health care seeking, diagnosis, and workup for abnormal uterine bleeding in the COVID-19 vaccine era are less clear. OBJECTIVE This study aimed to assess the impact of COVID-19 vaccination on incident abnormal uterine bleeding diagnosis and diagnostic evaluation in a large integrated health system. STUDY DESIGN Using segmented regression, we assessed whether the availability of COVID-19 vaccines was associated with changes in monthly, population-based rates of incident abnormal uterine bleeding diagnoses relative to the prepandemic period in health system members aged 16 to 44 years who were not menopausal. We also compared clinical and demographic characteristics of patients diagnosed with incident abnormal uterine bleeding between December 2020 and October 13, 2021 by vaccination status (never vaccinated, vaccinated in the 60 days before diagnosis, vaccinated >60 days before diagnosis). Furthermore, we conducted detailed chart review of patients diagnosed with abnormal uterine bleeding within 1 to 60 days of COVID-19 vaccination in the same time period. RESULTS In monthly populations ranging from 79,000 to 85,000 female health system members, incidence of abnormal uterine bleeding diagnosis per 100,000 person-days ranged from 8.97 to 19.19. There was no significant change in the level or trend in the incidence of abnormal uterine bleeding diagnoses between the prepandemic (January 2019-January 2020) and post-COVID-19 vaccine (December 2020-December 2021) periods. A comparison of clinical characteristics of 2717 abnormal uterine bleeding cases by vaccination status suggested that abnormal bleeding among recently vaccinated patients was similar or less severe than abnormal bleeding among patients who had never been vaccinated or those vaccinated >60 days before. There were also significant differences in age and race of patients with incident abnormal uterine bleeding diagnoses by vaccination status (Ps<.02). Never-vaccinated patients were the youngest and those vaccinated >60 days before were the oldest. The proportion of patients who were Black/African American was highest among never-vaccinated patients, and the proportion of Asian patients was higher among vaccinated patients. Chart review of 114 confirmed postvaccination abnormal uterine bleeding cases diagnosed from December 2020 through October 13, 2021 found that the most common symptoms reported were changes in timing, duration, and volume of bleeding. Approximately one-third of cases received no diagnostic workup; 57% had no etiology for the bleeding documented in the electronic health record. In 12% of cases, the patient mentioned or asked about a possible link between their bleeding and their recent COVID-19 vaccine. CONCLUSION The availability of COVID-19 vaccination was not associated with a change in incidence of medically attended abnormal uterine bleeding in our population of over 79,000 female patients of reproductive age. In addition, among 2717 patients with abnormal uterine bleeding diagnoses in the period following COVID-19 vaccine availability, receipt of the vaccine was not associated with greater bleeding severity.
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Affiliation(s)
- Neon Brooks
- Kaiser Permanente Center for Health Research, Portland, OR.
| | | | - Tia L Kauffman
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Kimberly K Vesco
- Kaiser Permanente Center for Health Research, Portland, OR; Department of Obstetrics and Gynecology, Kaiser Permanente Northwest, Portland, OR
| | | | - Ning Smith
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Naomi K Tepper
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christine K Olson
- Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Eric S Weintraub
- Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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23
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Chua KP, Bicket MC, Bohnert ASB, Conti RM, Lagisetty P, Nguyen TD. Buprenorphine Dispensing after Elimination of the Waiver Requirement. N Engl J Med 2024; 390:1530-1532. [PMID: 38657250 PMCID: PMC11103581 DOI: 10.1056/nejmc2312906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Kao-Ping Chua
- University of Michigan Medical School, Ann Arbor, MI
| | - Mark C Bicket
- University of Michigan Medical School, Ann Arbor, MI
| | | | - Rena M Conti
- Boston University Questrom School of Business, Boston, MA
| | | | - Thuy D Nguyen
- University of Michigan School of Public Health, Ann Arbor, MI
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24
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Chua KP, Fischer MA, Rahman M, Linder JA. Changes in the Appropriateness of US Outpatient Antibiotic Prescribing After the Coronavirus Disease 2019 Outbreak: An Interrupted Time Series Analysis of 2016-2021 Data. Clin Infect Dis 2024:ciae135. [PMID: 38648159 DOI: 10.1093/cid/ciae135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND No national study has evaluated changes in the appropriateness of US outpatient antibiotic prescribing across all conditions and age groups after the coronavirus disease 2019 (COVID-19) outbreak in March 2020. METHODS This was an interrupted time series analysis of Optum's de-identified Clinformatics Data Mart Database, a national commercial and Medicare Advantage claims database. Analyses included prescriptions for antibiotics dispensed to children and adults enrolled during each month during 2017-2021. For each prescription, we applied our previously developed antibiotic appropriateness classification scheme to International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes on medical claims occurring on or during the 3 days prior to dispensing. Outcomes included the monthly proportion of antibiotic prescriptions that were inappropriate and the monthly proportion of enrollees with ≥1 inappropriate prescription. Using segmented regression models, we assessed for level and slope changes in outcomes in March 2020. RESULTS Analyses included 37 566 581 enrollees, of whom 19 154 059 (51.0%) were female. The proportion of enrollees with ≥1 inappropriate prescription decreased in March 2020 (level decrease: -0.80 percentage points [95% confidence interval {CI}, -1.09% to -.51%]) and subsequently increased (slope increase: 0.02 percentage points per month [95% CI, .01%-.03%]), partly because overall antibiotic dispensing rebounded and partly because the proportion of antibiotic prescriptions that were inappropriate increased (slope increase: 0.11 percentage points per month [95% CI, .04%-.18%]). In December 2021, the proportion of enrollees with ≥1 inappropriate prescription equaled the corresponding proportion in December 2019. CONCLUSIONS Despite an initial decline, the proportion of enrollees exposed to inappropriate antibiotics returned to baseline levels by December 2021. Findings underscore the continued importance of outpatient antibiotic stewardship initiatives.
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Affiliation(s)
- Kao-Ping Chua
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Michael A Fischer
- Section of General Internal Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Moshiur Rahman
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jeffrey A Linder
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Noh JW, Cheon J, Seong H, Kwon YD, Yoo KB. Impacts of Smoking Ban Policies on Billiard Hall Sales in South Korea Using Objective Sales Information of a Credit Card Company: Quasi-Experimental Study. JMIR Public Health Surveill 2024; 10:e50466. [PMID: 38630526 PMCID: PMC11063889 DOI: 10.2196/50466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 01/01/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Smoking ban policies (SBPs) are potent health interventions and offer the potential to influence antismoking behavior. The Korean government completely prohibited smoking in indoor sports facilities, including billiard halls, since the government revised the National Health Promotion Act in December 2017. OBJECTIVE This study aimed to examine the impact of the SBP on the economic outcomes of indoor sports facilities, particularly billiard halls. METHODS This study used credit card sales data from the largest card company in South Korea. Data are from January 2017 to December 2018. Monthly sales data were examined across 23 administrative neighborhoods in Seoul, the capital city of South Korea. We conducted the interrupted time series model using the fixed effects model and the linear regression with panel-corrected standard errors (PCSE). RESULTS The sales and transactions of billiard halls were not significantly changed after the introduction of the SBP in the full PCSE models. The R2 of the full PCSE model was 0.967 for sales and 0.981 for transactions. CONCLUSIONS The introduction of the SBP did not result in substantial economic gains or losses in the sales of billiard halls. In addition to existing price-based policies, the enhanced SBP in public-use facilities, such as billiard halls, can have a positive synergistic effect on reducing smoking prevalence and preventing secondhand smoke. Health policy makers can actively expand the application of SBPs and make an effort to enhance social awareness regarding the necessity and benefits of public SBPs for both smokers and the owners of hospitality facilities.
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Affiliation(s)
- Jin-Won Noh
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Jooyoung Cheon
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
| | - Hohyun Seong
- College of Nursing, Keimyung University, Daegu, Republic of Korea
| | - Young Dae Kwon
- Department of Humanities and Social Medicine, College of Medicine and Catholic Institute for Public Health and Healthcare Management, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Bong Yoo
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
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Piroozi B, Moradi G, Khoramipoor K, Mahmoodi H, Zandvakili F, Ebrazeh A, Shokri A, Moradpour F. Is the surge in cesarean section rates during the COVID-19 pandemic truly substantiated? BMC Pregnancy Childbirth 2024; 24:275. [PMID: 38609859 PMCID: PMC11015671 DOI: 10.1186/s12884-024-06492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/07/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Cesarean section (C-section) rates, deemed a critical health indicator, have experienced a historical increase. The advent of the COVID-19 pandemic significantly impacted healthcare patterns including delays or lack of follow-up in treatment and an increased number of patients with acute problems in hospitals. This study aimed to explore whether the observed surge is a genuine consequence of pandemic-related factors. METHODS This study employs an Interrupted Time Series (ITS) design to analyze monthly C-section rates from March 2018 to January 2023 in Kurdistan province, Iran. Segmented regression modeling is utilized for robust data analysis. RESULTS The C-section rate did not show a significant change immediately after the onset of COVID-19. However, the monthly trend increased significantly during the post-pandemic period (p < 0.05). Among primigravid women, a significant monthly increase was observed before February 2020 (p < 0.05). No significant change was observed in the level or trend of C-section rates among primigravid women after the onset of COVID-19. CONCLUSION This study underscores the significant and enduring impact of the COVID-19 pandemic in further increasing the C-section rates over the long term, the observed variations in C-section rates among primigravid women indicate that the COVID-19 pandemic had no statistically significant impact.
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Affiliation(s)
- Bakhtiar Piroozi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Kimya Khoramipoor
- Department of Nursing, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hassan Mahmoodi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Farnaz Zandvakili
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ali Ebrazeh
- Department of Public Health, School of Public Health, Qom University of Medical Sciences, Qom, Iran
| | - Azad Shokri
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Farhad Moradpour
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Zewde HK. Using the WHO individual near miss case review (NMCR) cycle to improve quality of emergency obstetric care and maternal outcome in Keren hospital, Eritrea: an interrupted time series analysis. BMC Pregnancy Childbirth 2024; 24:266. [PMID: 38605302 PMCID: PMC11010365 DOI: 10.1186/s12884-024-06482-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND In 2016, the WHO regional office for Europe prepared a manual for conducting routine facility based individual near miss case review cycle. This study evaluates the effectiveness of the individual near miss case review (NMCR) cycle in improving quality of emergency obstetric care and maternal outcome in Keren hospital. METHODS An interrupted time series design was used to achieve the objectives of this study. Monthly data on women with potentially life-threatening conditions (PLTCs) admitted between April 2018 and October 2022 (i.e. 33 months pre-implementation and 22 months post-implementation) were collected from medical records. Segmented regression analysis was used to assess the intervention's effect on three process and outcome measures, namely, SMO, delayed care, and substandard care. The intervention was expected a priori to show immediate improvements without time-lag followed by gradual increment in slope. Segmented regression analyses were performed using the "itsa' command in STATA. RESULTS During the entire study period, 4365 women with potentially life threatening conditions were identified. There was a significant reduction in the post-implementation period in the proportion of mothers with PLTC who experienced SMO (- 8.86; p < 0.001), delayed care (- 8.76; p < 0.001) and substandard care (- 5.58; p < 0.001) compared to pre-implementation period. Results from the segmented regression analysis revealed that the percentage of women with SMO showed a significant 4.75% (95% CI: - 6.95 to - 2.54, p < 0.001) reduction in level followed by 0.28 percentage points monthly (95% CI: - 0.37 to - 0.14, p < 0.001) drop in trend. Similarly, a significant drop of 3.50% (95% CI: - 4.74 to - 2.26, p < 0.001) in the level of substandard care along with a significant decrease of 0.21 percentage points (95% CI: - 0.28 to - 0.14, p < 0.001) in the slope of the regression line was observed. The proportion of women who received delayed care also showed a significant 7% (95% CI: - 9.28 to - 4.68, p < 0.001) reduction in post-implementation level without significant change in slope. CONCLUSIONS Our findings suggest that the WHO individual NMCR cycle was associated with substantial improvements in quality of emergency obstetric care and maternal outcome. The intervention also bears a great potential for scaling-up following the guidance provided in the WHO NMCR manual.
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Affiliation(s)
- Henos Kiflom Zewde
- Department of Family and Community Health, Ministry of Health Anseba Region Branch, Keren, Anseba, Eritrea.
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Wai GJ, Lu Z, Gill S, Henderson I, Auais M. Impact of the End PJ Paralysis interventions on patient health outcomes at the participating hospitals in Alberta, Canada. Disabil Rehabil 2024:1-11. [PMID: 38571404 DOI: 10.1080/09638288.2024.2335662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Multiple hospitals in Alberta implemented the End PJ Paralysis - a multicomponent inpatient ambulation initiative aimed at preventing the adverse physical and psychological effects patients experience due to low mobility during admission. To inform a scale-up strategy, this study assessed the impact of the initiative based on select process and outcome measures. MATERIALS AND METHODS Clinical and administrative data were obtained from the hospital Discharge Abstract Database, Research Electronic Data Capture (Redcaps), and Reporting and Learning System for Patient Safety. The variables explored were length of stay, inpatient falls, discharge disposition, pressure injury, patient ambulation, and patient dressed rates. We then used the Interrupted Time Series design for impact analysis. RESULTS The analysis included discharge abstracts for 32,884 patients and the results showed significant improvements in outcomes at the participating units. The length of stay and inpatient falls were reduced immediately by 1.8 days (B2=-1.80, p = 0.044, 95% CI [-3.54, -0.05]), and 2.2 events (B2=-2.22, p = 005, 95% CI [-3.75, -0.69]). The percentage of patients discharged home increased overtime (B2=.39, p=.006, 95% CI [.11, .66]). Mobilization and dressed rates also improved. CONCLUSIONS The findings imply the interventions safely mitigated the risk of immobility-induced complications, including deconditioning and hospital-acquired disability.
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Affiliation(s)
- Gurech James Wai
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Zihang Lu
- Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Sudeep Gill
- Medicine, Queen's University, Kingston, Canada
| | | | - Mohammad Auais
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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Keenan TDL, Bailey C, Abraham M, Orndahl C, Menezes S, Bellur S, Arunachalam T, Kangale-Whitney C, Srinivas S, Karamat A, Nittala M, Cunningham D, Jeffrey BG, Wiley HE, Thavikulwat AT, Sadda S, Cukras CA, Chew EY, Wong WT. Phase 2 Trial Evaluating Minocycline for Geographic Atrophy in Age-Related Macular Degeneration: A Nonrandomized Controlled Trial. JAMA Ophthalmol 2024; 142:345-355. [PMID: 38483382 PMCID: PMC10941022 DOI: 10.1001/jamaophthalmol.2024.0118] [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: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 03/17/2024]
Abstract
Importance Existing therapies to slow geographic atrophy (GA) enlargement in age-related macular degeneration (AMD) have relatively modest anatomic efficacy, require intravitreal administration, and increase the risk of neovascular AMD. Additional therapeutic approaches are desirable. Objective To evaluate the safety and possible anatomic efficacy of oral minocycline, a microglial inhibitor, for the treatment of GA in AMD. Design, Setting, and Participants This was a phase 2, prospective, single-arm, 45-month, nonrandomized controlled trial conducted from December 2016 to April 2023. Patients with GA from AMD in 1 or both eyes were recruited from the National Institutes of Health (Bethesda, Maryland) and Bristol Eye Hospital (Bristol, UK). Study data were analyzed from September 2022 to May 2023. Intervention After a 9-month run-in phase, participants began oral minocycline, 100 mg, twice daily for 3 years. Main Outcomes and Measures The primary outcome measure was the difference in rate of change of square root GA area on fundus autofluorescence between the 24-month treatment phase and 9-month run-in phase. Results Of the 37 participants enrolled (mean [SD] age, 74.3 [7.6] years; 21 female [57%]), 36 initiated the treatment phase. Of these participants, 21 (58%) completed at least 33 months, whereas 15 discontinued treatment (8 by request, 6 for adverse events/illness, and 1 death). Mean (SE) square root GA enlargement rate in study eyes was 0.31 (0.03) mm per year during the run-in phase and 0.28 (0.02) mm per year during the treatment phase. The primary outcome measure of mean (SE) difference in enlargement rates between the 2 phases was -0.03 (0.03) mm per year (P = .39). Similarly, secondary outcome measures of GA enlargement rate showed no differences between the 2 phases. The secondary outcome measures of mean difference in rate of change between 2 phases were 0.2 letter score per month (95% CI, -0.4 to 0.9; P = .44) for visual acuity and 0.7 μm per month (-0.4 to 1.8; P = .20) for subfoveal retinal thickness. Of the 129 treatment-emergent adverse events among 32 participants, 49 (38%) were related to minocycline (with no severe or ocular events), including elevated thyrotropin level (15 participants) and skin hyperpigmentation/discoloration (8 participants). Conclusions and Relevance In this phase 2 nonrandomized controlled trial, oral minocycline was not associated with a decrease in GA enlargement over 24 months, compared with the run-in phase. This observation was consistent across primary and secondary outcome measures. Oral minocycline at this dose is likely not associated with slower rate of enlargement of GA in AMD.
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Affiliation(s)
| | | | | | | | | | - Sunil Bellur
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | | | - Denise Cunningham
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Brett G. Jeffrey
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Henry E. Wiley
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
- Now with Genentech Inc, South San Francisco, California
| | | | - SriniVas Sadda
- Doheny Eye Institute, Pasadena, California
- University of California, Los Angeles, Los Angeles
| | | | - Emily Y. Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Wai T. Wong
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
- Now with Janssen Research and Development LLC, Brisbane, California
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Park YS, Kim H, Jang SY, Park EC. Trends in private caregiving cost after implementing a comprehensive nursing service covered by national health insurance: Interrupted time series. Int J Nurs Stud 2024; 152:104689. [PMID: 38308934 DOI: 10.1016/j.ijnurstu.2024.104689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 01/01/2024] [Accepted: 01/01/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND The Korean government has implemented a comprehensive nursing care service system (CNS) to mitigate the stress faced by caregivers. OBJECTIVE This study aimed to assess trends in the estimated average costs of private caregiving and determine the difference in costs between those using CNS and those not using it. DESIGN A comparative interrupted time series analysis with a 2-year lag period verified total private caregiving cost trends; biannual differences in costs were evaluated based on using CNS. PARTICIPANTS The main unit of analysis was episode. We extracted a total of 6418 episodes of hospitalization in acute care settings that included the use of caregiving services (formal, informal caregiving and CNS). METHODS We conducted segmented regression to assess the impact of CNS on total private caregiving costs using data from 2012 to 2018, excluding the years 2015 and 2016 of the Korean Health Panel dataset. RESULTS We presented that the immediate mean difference in total private caregiving costs between CNS users and non-users was -444.7 USD two years after the implementation of the CNS policy (95 % CI -714.5 to -174.5, p-value 0.001). Among individuals living in rural areas, two years after the implementation of the CNS policy, there was a significant immediate mean cost difference of -476.9 USD in total private caregiving costs between CNS users and non-users (p-value 0.011). Similarly, for episodes with a Charlson Comorbidity Index (CCI) score of 0 to 1, there was a substantial immediate mean cost difference in total private caregiving costs between CNS users and non-users, amounting to -399.9 USD two years after the CNS policy (p-value 0.008). CONCLUSIONS This study evaluated the trend of total private caregiving costs between groups using and not using CNS. After two years of being covered by CNS health insurance, those who utilized CNS paid $433 less for their total private caregiving cost over a 6-month period, compared to those who did not use CNS. The adoption of CNS may be an effective system for relieving the financial burden on inpatients in need of private caregiving services. TWEETABLE ABSTRACT Korean Comprehensive Nursing Service reduces private caregiving costs.
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Affiliation(s)
- Yu Shin Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hyunkyu Kim
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea; Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Roy PJ, Suda K, Luo J, Lee M, Anderton J, Olejniczak D, Liebschutz JM. Buprenorphine dispensing before and after the April 2021 X-Waiver exemptions: An interrupted time series analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104381. [PMID: 38457960 DOI: 10.1016/j.drugpo.2024.104381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Until the end of 2022, a special registration, known as the X-waiver, was required to prescribe buprenorphine in the US. Before its removal, US federal regulations trialed an X-waiver exemption, initiated on April 28, 2021, which permitted buprenorphine prescribing for up to 30 patients without additional training. We aimed to understand if these regulatory changes impacted buprenorphine dispensing. METHODS We conducted an interrupted time series analysis to understand changes in buprenorphine dispensing during the 26 weeks after the X-waiver exemption compared to the expected baseline trend established in the 26 weeks before using the IQVIA Longitudinal Prescription claims database. The primary outcome was number of new buprenorphine prescribers nationwide (defined as no prior buprenorphine prescription dispensed in the last 26 weeks). Segmented regression estimated relative changes in buprenorphine dispensing at 1, 13, and 26 weeks post-X-waiver change. RESULTS A total of 15,517,525 prescriptions filled for 1,328,172 patients (43.4 % female) ordered by 62,312 providers were included for analysis. At 26 weeks post-X-waiver change, there was no change in the number of new prescribers compared to the expected baseline trend (-2.7 % [95 % CI:-8.3,2.9]). The number of new (15.2 % [4.6,25.8]) and existing (1.7 % [0.9,2.4]) patients and patients per prescriber (4.3 % [3,5.6]) increased. Buprenorphine prescriptions reimbursed by Medicaid increased (7.5 % [6.6,8.4]) while commercial fills decreased (-3.4 % [-5.3,-1.5]). CONCLUSIONS The number of new prescribers did not increase six months post-X-waiver exemption while new patients continued to enter treatment at higher-than-expected rates. These findings suggest that additional interventions beyond the recent X-waiver removal may be needed to increase access to buprenorphine.
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Affiliation(s)
- Payel Jhoom Roy
- Division of General Internal Medicine, Center for Research on Healthcare, Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States.
| | - Katie Suda
- Division of General Internal Medicine, Center for Research on Healthcare, Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States; Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Jing Luo
- Division of General Internal Medicine, Center for Research on Healthcare, Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
| | - MyoungKeun Lee
- Department of Oral and Craniofacial Sciences, Center for Craniofacial and Dental Genetics, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, United States
| | - Joel Anderton
- Department of Oral and Craniofacial Sciences, Center for Craniofacial and Dental Genetics, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, United States
| | - Donna Olejniczak
- Division of General Internal Medicine, Center for Research on Healthcare, Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
| | - Jane M Liebschutz
- Division of General Internal Medicine, Center for Research on Healthcare, Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
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Gagnon H, Pokhrel A, Bush K, Cordoviz M, Ewashko T, Galetta F, Leal J. Limited reduction in Clostridioides difficile and Methicillin-Resistant Staphylococcus aureus with the use of an aerosolized hydrogen peroxide disinfection system in tertiary health care facilities in Alberta, Canada. Am J Infect Control 2024; 52:410-418. [PMID: 37806387 DOI: 10.1016/j.ajic.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Nonmanual room disinfection systems may reduce the transmission of infections. A variety of systems have emerged; however, a paucity of evidence exists to make an evidence-informed decision for the implementation of a specific system. Alberta Health Services assessed one of these systems. METHODS A quasi-experimental prepost design assessed an aerosolized hydrogen peroxide disinfection system on 6 units at 3 acute care facilities in Alberta. To assess clinical effectiveness an interrupted time-series analysis with Poisson distribution compared changes in hospital-acquired Clostridioides difficile infection (HA-CDI) and hospital-acquired Methicillin-resistant Staphylococcus aureus (HA-MRSA) between preintervention, intervention, and postintervention periods. To assess operational feasibility cleaning turnaround time, time to operate, and utilization were considered. A participatory research framework was used to understand the benefits and challenges of operationalization. RESULTS Incidence rate ratio (IRR) of HA-CDI decreased by 25.7% on FMC-A and 6.9% on RAH-B. Following withdrawal, the IRR of HA-CDI continued to decrease. IRR of HA-MRSA decreased by 25.0% on RAH-B. Following withdrawal, the IRR of HA-MRSA continued to decrease. None of the results were statistically significant. The average time to operate was 3.2 hours. Utilization was between 1.7% and 25.6%. Most staff reported benefits and challenges. DISCUSSION None of the changes observed in HA-CDI and HA-MRSA after the introduction of the aerosolized hydrogen peroxide system were statistically significant. While most respondents reported multiple benefits and challenges in using the system, the core challenge was delays in inpatient admissions due to the time operate the system. CONCLUSION Successful implementation of a nonmanual room disinfection system as an addition to standard cleaning and disinfection requires significant investment and must consider a variety of factors.
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Affiliation(s)
- Heather Gagnon
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
| | - Arun Pokhrel
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada; Emergency Medical Services, Alberta Health Services, Alberta, Canada
| | - Kathryn Bush
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
| | - Melody Cordoviz
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada
| | - Tanya Ewashko
- Health Evidence and Innovation, Alberta Health Services, Alberta, Canada
| | - Frank Galetta
- Linen and Environmental Services, Alberta Health Services, Alberta, Canada
| | - Jenine Leal
- Infection Prevention and Control, Alberta Health Services, Alberta, Canada; Department of Community Health Services, Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Alberta, Canada.
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Valtuille Z, Acquaviva E, Trebossen V, Ouldali N, Bourmaud A, Sclison S, Gomez A, Revet A, Peyre H, Delorme R, Kaguelidou F. Psychotropic Medication Prescribing for Children and Adolescents After the Onset of the COVID-19 Pandemic. JAMA Netw Open 2024; 7:e247965. [PMID: 38652474 DOI: 10.1001/jamanetworkopen.2024.7965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Importance Numerous studies have provided evidence for the negative associations of the COVID-19 pandemic with mental health, but data on the use of psychotropic medication in children and adolescents after the onset of the COVID-19 pandemic are lacking. Objective To assess the rates and trends of psychotropic medication prescribing before and over the 2 years after the onset of the COVID-19 pandemic in children and adolescents in France. Design, Setting, and Participants This cross-sectional study used nationwide interrupted time-series analysis of outpatient drug dispensing data from the IQVIA X-ponent database. All 8 839 143 psychotropic medication prescriptions dispensed to children (6 to 11 years of age) and adolescents (12 to 17 years of age) between January 2016 and May 2022 in France were retrieved and analyzed. Exposure Onset of COVID-19 pandemic. Main outcomes and Measures Monthly rates of psychotropic medication prescriptions per 1000 children and adolescents were analyzed using a quasi-Poisson regression before and after the pandemic onset (March 2020), and percentage changes in rates and trends were assessed. After the pandemic onset, rate ratios (RRs) were calculated between estimated and expected monthly prescription rates. Analyses were stratified by psychotropic medication class (antipsychotic, anxiolytic, hypnotic and sedative, antidepressant, and psychostimulant) and age group (children, adolescents). Results In total, 8 839 143 psychotropic medication prescriptions were analyzed, 5 884 819 [66.6%] for adolescents and 2 954 324 [33.4%] for children. In January 2016, the estimated rate of monthly psychotropic medication prescriptions was 9.9 per 1000 children and adolescents, with the prepandemic rate increasing by 0.4% per month (95% CI, 0.3%-0.4%). In March 2020, the monthly prescription rate dropped by 11.5% (95% CI, -17.7% to -4.9%). During the 2 years following the pandemic onset, the trend changed significantly, and the prescription rate increased by 1.3% per month (95% CI, 1.2%-1.5%), reaching 16.1 per 1000 children and adolescents in May 2022. Monthly rates of psychotropic medication prescriptions exceeded the expected rates by 11% (RR, 1.11 [95% CI, 1.08-1.14]). Increases in prescribing trends were observed for all psychotropic medication classes after the pandemic onset but were substantial for anxiolytics, hypnotics and sedatives, and antidepressants. Prescription rates rose above those expected for all psychotropic medication classes except psychostimulants (RR, 1.12 [95% CI, 1.09-1.15] in adolescents and 1.06 [95% CI, 1.05-1.07] in children for antipsychotics; RR, 1.30 [95% CI, 1.25-1.35] in adolescents and 1.11 [95% CI, 1.09-1.12] in children for anxiolytics; RR, 2.50 [95% CI, 2.23-2.77] in adolescents and 1.40 [95% CI, 1.30-1.50] in children for hypnotics and sedatives; RR, 1.38 [95% CI, 1.29-1.47] in adolescents and 1.23 [95% CI, 1.20-1.25] in children for antidepressants; and RR, 0.97 [95% CI, 0.95-0.98] in adolescents and 1.02 [95% CI, 1.00-1.04] in children for psychostimulants). Changes were more pronounced among adolescents than children. Conclusions and Relevance These findings suggest that prescribing of psychotropic medications for children and adolescents in France significantly and persistently increased after the COVID-19 pandemic onset. Future research should identify underlying determinants to improve psychological trajectories in young people.
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Affiliation(s)
- Zaba Valtuille
- Center of Clinical Investigations, Inserm CIC1426, Robert Debré University Hospital, APHP.Nord, Paris, France
- Paris Cité University, EA7323 Perinatal and Pediatric Pharmacology and Therapeutic Assessment, Paris, France
| | - Eric Acquaviva
- Department of Child and Adolescent Psychiatry, Robert Debré University Hospital, APHP.Nord, Paris Cité University, Paris, France
| | - Vincent Trebossen
- Department of Child and Adolescent Psychiatry, Robert Debré University Hospital, APHP.Nord, Paris Cité University, Paris, France
| | - Naim Ouldali
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, APHP.Nord, Paris Cité University, Paris, France
| | - Aurelie Bourmaud
- Clinical Epidemiology Unit, Inserm CIC1426, Robert Debré University Hospital, APHP.Nord, Paris Cité University, Paris, France
| | - Stéphane Sclison
- Consulting Services & Analytics Department, IQVIA, Courbevoie, France
| | - Alexandre Gomez
- Consulting Services & Analytics Department, IQVIA, Courbevoie, France
| | - Alexis Revet
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
- CERPOP, UMR 1295, Inserm, Toulouse III - Paul Sabatier University, Toulouse, France
| | - Hugo Peyre
- Autism Reference Centre of Languedoc-Roussillon CRA-LR, Montpellier University Hospital, Montpellier, France
- Excellence Centre for Autism and Neurodevelopmental disorders- CeAND, MUSE University, Montpellier, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Richard Delorme
- Department of Child and Adolescent Psychiatry, Robert Debré University Hospital, APHP.Nord, Paris Cité University, Paris, France
- Human Genetics & Cognitive Functions, Institut Pasteur, Paris, France
| | - Florentia Kaguelidou
- Center of Clinical Investigations, Inserm CIC1426, Robert Debré University Hospital, APHP.Nord, Paris, France
- Paris Cité University, EA7323 Perinatal and Pediatric Pharmacology and Therapeutic Assessment, Paris, France
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Flyger J, Mejldal A, Nielsen B, Niclasen B, Nielsen AS. A quality assurance study of the development of quality of care in outpatient clinics for treatment of addiction in Greenland. Nord J Psychiatry 2024:1-7. [PMID: 38557415 DOI: 10.1080/08039488.2024.2329583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION In 2016, a new addiction treatment service, Allorfik, was introduced in Greenland. Allorfik has, throughout the implementation and after, used auditing of patient records with feedback to develop the quality of care in treatment. Audits and feedback are routinely done in each treatment center. This study wishes to investigate the development of the quality of treatment through the case notes from the journal audits. METHODOLOGY This study is based on case notes audits from 2019, 2020 and 2021. In the audits, the focus has been on the quality of documentation and content for ten specific areas in each patient record. Each area was scored on a Likert scale of 0-4 for both outcomes. Statistical analyses were done using Stata 17, and P-values < 0.05 were considered statistically significant. We present baseline characteristics for patients and illustrate the development of quality for both outcomes as time trends with scatter plots. RESULTS The analysis was based on data from 454 patients and audits of their case notes. The mean number of weeks in treatment is 12.72, and the mean age for the people in the audited case notes is 39. Time had a positive effect on both outcomes, and so each month, documentation increased by 0.21 points (p-value = <0.001), and content increased by 0.27 points (p-value = <0.001). CONCLUSION For documentation and content, the quality level has increased significantly with time, and the quality of case notes is at an excellent level at the final audits of all treatment centers.
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Affiliation(s)
- Julie Flyger
- Unit of Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Institute of Nursing and Health Science, Ilisimatusarfik - University of Greenland, Greenland, Denmark
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network, The Region of Southern Denmark, Odense, Denmark
| | - Bent Nielsen
- Unit of Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Birgit Niclasen
- Institute of Nursing and Health Science, Ilisimatusarfik - University of Greenland, Greenland, Denmark
- Allorfik - the National Addiction Treatment Services, Greenland, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network, The Region of Southern Denmark, Odense, Denmark
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Felix A, Assad Z, Bidet P, Caseris M, Dumaine C, Faye A, Melki I, Kaguelidou F, Valtuille Z, Ouldali N, Meinzer U. Common Seasonal Pathogens and Epidemiology of Henoch-Schönlein Purpura Among Children. JAMA Netw Open 2024; 7:e245362. [PMID: 38578638 PMCID: PMC10998156 DOI: 10.1001/jamanetworkopen.2024.5362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024] Open
Abstract
Importance Henoch-Schönlein purpura (HSP) is the most common type of vasculitis in children. The factors that trigger the disease are poorly understood. Although several viruses and seasonal bacterial infections have been associated with HSP, differentiating the specific associations of these pathogens with the onset of HSP remains a challenge due to their overlapping seasonal patterns. Objective To analyze the role of seasonal pathogens in the epidemiology of HSP. Design, Setting, and Participants This cohort study comprised an interrupted time-series analysis of patient records from a comprehensive national hospital-based surveillance system. Children younger than 18 years hospitalized for HSP in France between January 1, 2015, and March 31, 2023, were included. Exposure Implementation and relaxation of nonpharmaceutical interventions (NPIs) for the COVID-19 pandemic, such as social distancing and mask wearing. Main Outcomes and Measures The main outcomes were the monthly incidence of HSP per 100 000 children, analyzed via a quasi-Poisson regression model, and the estimated percentage of HSP incidence potentially associated with 14 selected common seasonal pathogens over the same period. Results The study included 9790 children with HSP (median age, 5 years [IQR, 4-8 years]; 5538 boys [56.4%]) and 757 110 children with the infectious diseases included in the study (median age, 0.7 years [IQR, 0.2-2 years]; 393 697 boys [52.0%]). The incidence of HSP decreased significantly after implementation of NPIs in March 2020 (-53.6%; 95% CI, -66.6% to -40.6%; P < .001) and increased significantly after the relaxation of NPIs in April 2021 (37.2%; 95% CI, 28.0%-46.3%; P < .001). The percentage of HSP incidence potentially associated with Streptococcus pneumoniae was 37.3% (95% CI, 22.3%-52.3%; P < .001), the percentage of cases associated with Streptococcus pyogenes was 25.6% (95% CI, 16.7%-34.4%; P < .001), and the percentage of cases associated with human rhino enterovirus was 17.1% (95% CI, 3.8%-30.4%; P = .01). Three sensitivity analyses found similar results. Conclusions and Relevance This study found that significant changes in the incidence of HSP simultaneously with major shifts in circulating pathogens after NPIs for the COVID-19 pandemic indicated that approximately 60% of HSP incidence was potentially associated with pneumococcus and group A streptococcus. This finding suggests that preventive measures against these pathogens could reduce the incidence of pediatric HSP.
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Affiliation(s)
- Arthur Felix
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Competence Centre RAISE Antilles-Guyane, EpiCliV Research Unit, Department of General Pediatrics, Martinique University Hospital, University of French West Indies, Martinique, France
| | - Zein Assad
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Infection, Antimicrobials, Modeling, Evolution, Paris Cité University, INSERM UMR 1137, Paris, France
| | - Philippe Bidet
- Infection, Antimicrobials, Modeling, Evolution, Paris Cité University, INSERM UMR 1137, Paris, France
- Department of Microbiology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marion Caseris
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Dumaine
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Albert Faye
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, INSERM UMR-1123, ECEVE, Paris, France
| | - Isabelle Melki
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Pediatrics, Rheumatology and Pediatric Internal Medicine, Children’s Hospital, Bordeaux, France
| | - Florentia Kaguelidou
- Center of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zaba Valtuille
- Center of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Naïm Ouldali
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Infection, Antimicrobials, Modeling, Evolution, Paris Cité University, INSERM UMR 1137, Paris, France
| | - Ulrich Meinzer
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Recherche sur l’inflammation UMR 1149, Université Paris Cité, INSERM, Paris, France
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Zivin K, Pangori A, Zhang X, Tilea A, Hall SV, Vance A, Dalton VK, Schroeder A, Courant A, Tabb KM. Perinatal Mood And Anxiety Disorders Rose Among Privately Insured People, 2008-20. Health Aff (Millwood) 2024; 43:496-503. [PMID: 38507649 DOI: 10.1377/hlthaff.2023.01437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Nationwide, perinatal mood and anxiety disorder (PMAD) diagnoses among privately insured people increased by 93.3 percent from 2008 to 2020, growing faster in 2015-20 than in 2008-14. Most states and demographic subgroups experienced increases, suggesting worsening morbidity in maternal mental health nationwide. PMAD-associated suicidality and psychotherapy rates also increased nationwide from 2008 to 2020. Relative to 2008-14, psychotherapy rates continued to rise in 2015-20, whereas suicidality rates declined.
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Affiliation(s)
- Kara Zivin
- Kara Zivin , University of Michigan, Veterans Affairs Ann Arbor Healthcare System, and Mathematica, Ann Arbor, Michigan
| | | | | | | | | | - Ashlee Vance
- Ashlee Vance, Henry Ford Health System, Detroit, Michigan
| | | | | | | | - Karen M Tabb
- Karen M. Tabb, University of Illinois at Urbana-Champaign, Champaign, Illinois
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Shin JH, Pyo JY, Han M, Lee M, Lim SM, Baek JY, Lee JY, Kang JM, Jung I, Ahn JG. Incidence and disease burden of autoimmune inflammatory rheumatic diseases after non-pharmaceutical interventions in the COVID-19 era: A nationwide observational study in Korea. Int J Rheum Dis 2024; 27:e15144. [PMID: 38590055 DOI: 10.1111/1756-185x.15144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/04/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Infections are considered risk factors for autoimmune inflammatory rheumatic diseases (AIRDs), the incidence of which is considered to have been impacted by the COVID-19 pandemic. The impact of non-pharmaceutical interventions (NPIs) on the incidence of AIRDs and their associated health care services and medical expenses in Korea was investigated. METHODS We included all AIRD cases reported between January 2016 and February 2021 based on the National Health Insurance Service data. We evaluated changes in incidence trends for each AIRD before and after NPI implementation (Feb 2020 to Feb 2021) using segmented regression analysis. Changes in health care utilization and medical costs for each AIRD before and after NPI implementation were also investigated. RESULTS After NPI implementation, monthly incidence rates declined significantly by 0.205 per 1 000 000 (95% confidence interval [CI], -0.308 to -0.101, p < .001) in patients with systemic lupus erythematosus (SLE). No significant changes in the incidence of all AIRDs other than SLE were observed before and after implementation. Further, annual outpatient department visits per patient were lower during implementation for all diseases, except juvenile idiopathic arthritis (JIA). The prescription days per outpatient visit increased significantly during implementation for all diseases, except JIA and ankylosing spondylitis. During implementation, the total annual medical costs per patient tended to decrease for all diseases, except JIA and mixed connective tissue disease. CONCLUSION Implementation of NPIs to contain the pandemic led to a reduction in the incidence of SLE and changed patterns of medical care utilization and treatment cost for most AIRDs.
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Affiliation(s)
- Je Hee Shin
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung Yoon Pyo
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Minkyung Han
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Myeongjee Lee
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Min Lim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jee Yeon Baek
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Young Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji-Man Kang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - InKyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Gyun Ahn
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
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Stanley J, Sullivan B, Dowsey AW, Jones K, Beck CR. Epidemiology of Escherichia coli bloodstream infection antimicrobial resistance trends across South West England during the first 2 years of the coronavirus disease 2019 pandemic response. Clin Microbiol Infect 2024:S1198-743X(24)00148-4. [PMID: 38527612 DOI: 10.1016/j.cmi.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/08/2024] [Accepted: 03/14/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES Between 2016 and 2019, the proportion of Escherichia coli bloodstream infection (BSI) with resistance to at least one antibiotic increased nationally. Public health interventions implemented in response to the COVID-19 pandemic changed population contact patterns and healthcare systems, with consequent effects on epidemiological trends of numerous pathogens. We investigated the impact of COVID-19 restrictions on epidemiological trends of E. coli BSI antimicrobial resistance (AMR) across South West England. METHODS We undertook a retrospective ecological analysis utilizing routine surveillance data of E. coli BSI cases reported to the UK Health Security Agency between 2016 and 2021. We analysed AMR trends for antimicrobial agents including amoxicillin-clavulanate, ciprofloxacin, piperacillin-tazobactam, gentamicin, third-generation cephalosporins and carbapenems before and after the implementation of COVID-19 restrictions (23 March 2020) using Bayesian segmented regression. RESULTS We identified 19 055 cases. A total of 50.2% were male. Median age was 76 (interquartile range, 65-85 years). Piperacillin-tazobactam (-2.90% [95% highest density interval {HDI} -4.51%, -0.48%]) and ciprofloxacin (-2.40% [95% HDI -4.35%, 0.48%]) resistance demonstrated immediate step changes at the implementation of COVID-19 restrictions. Gentamicin (odds ratio [OR] 0.92 [95% HDI 0.76, 1.12]) and third-generation cephalosporins (OR 0.95 [95% HDI 0.80, 1.14]) exhibited decreasing annual resistance trends after the implementation of COVID-19 restrictions, with moderate evidence for a lower OR after restrictions as compared to the period before (gentamicin Bayes Factor = 5.10, third-generation cephalosporins Bayes Factor = 6.67). DISCUSSION COVID-19 restrictions led to abrupt and longer term changes to E.coli BSI AMR. The immediate effects suggest altered transmission, whereas changes to resistant E. coli reservoirs may explain trend effects.
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Affiliation(s)
- Jack Stanley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Brian Sullivan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew W Dowsey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Koren Jones
- Evaluation & Epidemiological Science Division, Science Group, UK Health Security Agency, Porton Down, UK; Field Services South West, Health Protection Operations, UK Health Security Agency, Bristol, UK
| | - Charles R Beck
- Evaluation & Epidemiological Science Division, Science Group, UK Health Security Agency, Porton Down, UK; Field Services South West, Health Protection Operations, UK Health Security Agency, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
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Sutton RT, Chappell KD, Pincock D, Sadowski D, Baumgart DC, Kroeker KI. The Effect of an Electronic Medical Record-Based Clinical Decision Support System on Adherence to Clinical Protocols in Inflammatory Bowel Disease Care: Interrupted Time Series Study. JMIR Med Inform 2024; 12:e55314. [PMID: 38533825 PMCID: PMC11004614 DOI: 10.2196/55314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/02/2024] [Indexed: 03/28/2024] Open
Abstract
Background Clinical decision support systems (CDSSs) embedded in electronic medical records (EMRs), also called electronic health records, have the potential to improve the adoption of clinical guidelines. The University of Alberta Inflammatory Bowel Disease (IBD) Group developed a CDSS for patients with IBD who might be experiencing disease flare and deployed it within a clinical information system in 2 continuous time periods. Objective This study aims to evaluate the impact of the IBD CDSS on the adherence of health care providers (ie, physicians and nurses) to institutionally agreed clinical management protocols. Methods A 2-period interrupted time series (ITS) design, comparing adherence to a clinical flare management protocol during outpatient visits before and after the CDSS implementation, was used. Each interruption was initiated with user training and a memo with instructions for use. A group of 7 physicians, 1 nurse practitioner, and 4 nurses were invited to use the CDSS. In total, 31,726 flare encounters were extracted from the clinical information system database, and 9217 of them were manually screened for inclusion. Each data point in the ITS analysis corresponded to 1 month of individual patient encounters, with a total of 18 months of data (9 before and 9 after interruption) for each period. The study was designed in accordance with the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI) guidelines for health informatics evaluations. Results Following manual screening, 623 flare encounters were confirmed and designated for ITS analysis. The CDSS was activated in 198 of 623 encounters, most commonly in cases where the primary visit reason was a suspected IBD flare. In Implementation Period 1, before-and-after analysis demonstrates an increase in documentation of clinical scores from 3.5% to 24.1% (P<.001), with a statistically significant level change in ITS analysis (P=.03). In Implementation Period 2, the before-and-after analysis showed further increases in the ordering of acute disease flare lab tests (47.6% to 65.8%; P<.001), including the biomarker fecal calprotectin (27.9% to 37.3%; P=.03) and stool culture testing (54.6% to 66.9%; P=.005); the latter is a test used to distinguish a flare from an infectious disease. There were no significant slope or level changes in ITS analyses in Implementation Period 2. The overall provider adoption rate was moderate at approximately 25%, with greater adoption by nurse providers (used in 30.5% of flare encounters) compared to physicians (used in 6.7% of flare encounters). Conclusions This is one of the first studies to investigate the implementation of a CDSS for IBD, designed with a leading EMR software (Epic Systems), providing initial evidence of an improvement over routine care. Several areas for future research were identified, notably the effect of CDSSs on outcomes and how to design a CDSS with greater utility for physicians. CDSSs for IBD should also be evaluated on a larger scale; this can be facilitated by regional and national centralized EMR systems.
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Affiliation(s)
- Reed Taylor Sutton
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kaitlyn Delaney Chappell
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - David Pincock
- Chief Medical Information Office, Alberta Health Services, Edmonton, AB, Canada
| | - Daniel Sadowski
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Daniel C Baumgart
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen Ivy Kroeker
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Smith JG, Anderson K, Clarke G, Crowe C, Goldsmith LP, Jarman H, Johnson S, Lomani J, McDaid D, Park AL, Turner K, Gillard S. The effect of psychiatric decision unit services on inpatient admissions and mental health presentations in emergency departments: an interrupted time series analysis from two cities and one rural area in England. Epidemiol Psychiatr Sci 2024; 33:e15. [PMID: 38512000 DOI: 10.1017/s2045796024000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
AIMS High-quality evidence is lacking for the impact on healthcare utilisation of short-stay alternatives to psychiatric inpatient services for people experiencing acute and/or complex mental health crises (known in England as psychiatric decision units [PDUs]). We assessed the extent to which changes in psychiatric hospital and emergency department (ED) activity were explained by implementation of PDUs in England using a quasi-experimental approach. METHODS We conducted an interrupted time series (ITS) analysis of weekly aggregated data pre- and post-PDU implementation in one rural and two urban sites using segmented regression, adjusting for temporal and seasonal trends. Primary outcomes were changes in the number of voluntary inpatient admissions to (acute) adult psychiatric wards and number of ED adult mental health-related attendances in the 24 months post-PDU implementation compared to that in the 24 months pre-PDU implementation. RESULTS The two PDUs (one urban and one rural) with longer (average) stays and high staff-to-patient ratios observed post-PDU decreases in the pattern of weekly voluntary psychiatric admissions relative to pre-PDU trend (Rural: -0.45%/week, 95% confidence interval [CI] = -0.78%, -0.12%; Urban: -0.49%/week, 95% CI = -0.73%, -0.25%); PDU implementation in each was associated with an estimated 35-38% reduction in total voluntary admissions in the post-PDU period. The (urban) PDU with the highest throughput, lowest staff-to-patient ratio and shortest average stay observed a 20% (-20.4%, CI = -29.7%, -10.0%) level reduction in mental health-related ED attendances post-PDU, although there was little impact on long-term trend. Pooled analyses across sites indicated a significant reduction in the number of voluntary admissions following PDU implementation (-16.6%, 95% CI = -23.9%, -8.5%) but no significant (long-term) trend change (-0.20%/week, 95% CI = -0.74%, 0.34%) and no short- (-2.8%, 95% CI = -19.3%, 17.0%) or long-term (0.08%/week, 95% CI = -0.13, 0.28%) effects on mental health-related ED attendances. Findings were largely unchanged in secondary (ITS) analyses that considered the introduction of other service initiatives in the study period. CONCLUSIONS The introduction of PDUs was associated with an immediate reduction of voluntary psychiatric inpatient admissions. The extent to which PDUs change long-term trends of voluntary psychiatric admissions or impact on psychiatric presentations at ED may be linked to their configuration. PDUs with a large capacity, short length of stay and low staff-to-patient ratio can positively impact ED mental health presentations, while PDUs with longer length of stay and higher staff-to-patient ratios have potential to reduce voluntary psychiatric admissions over an extended period. Taken as a whole, our analyses suggest that when establishing a PDU, consideration of the primary crisis-care need that underlies the creation of the unit is key.
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Affiliation(s)
- J G Smith
- Population Health Research Institute, St George's, University of London, London, UK
- Clinical Research Unit, South West London & St George's Mental Health Trust, Springfield University Hospital, London, UK
| | - K Anderson
- Department of Psychology, Middlesex University, London, UK
| | - G Clarke
- Improvement Analytics Unit, The Health Foundation, London, UK
| | - C Crowe
- Sunflowers Court Inpatient Unit, North East London NHS Foundation Trust, Goodmayes Hospital, Ilford, UK
| | - L P Goldsmith
- Population Health Research Institute, St George's, University of London, London, UK
| | - H Jarman
- Population Health Research Institute, St George's, University of London, London, UK
- Emergency Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - S Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK
| | - J Lomani
- NHS England and NHS Improvement, London, UK
| | - D McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A L Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - K Turner
- Population Health Research Institute, St George's, University of London, London, UK
| | - S Gillard
- School of Health and Psychological Sciences, City, University of London, London, UK
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Tai T, Motoki T, Yamaguchi K, Watanabe M, Ito T, Yokota K, Ishikawa K, Tanaka H, Muraki Y, Kosaka S, Dainichi T. Enhancing carbapenem antimicrobial dosing optimization: synergy of antimicrobial stewardship teams and ward-based clinical pharmacists. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e33. [PMID: 38533235 PMCID: PMC10964187 DOI: 10.1017/ash.2024.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 03/28/2024]
Abstract
Antimicrobial-product package inserts and insufficient staffing impede routine carbapenem monitoring in the inpatient setting in Japan. The collaboration between antimicrobial stewardship teams and clinical pharmacists was associated with a sustained improvement in carbapenem dosing optimization. Our findings could be of use to countries with inadequate monitoring of carbapenem antimicrobial use.
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Affiliation(s)
- Tatsuya Tai
- Department of Infection Control Service Office, Kagawa University Hospital, Kagawa, Japan
- Department of Pharmacy, Kagawa University Hospital, Kagawa, Japan
| | - Takahiro Motoki
- Department of Infection Control Service Office, Kagawa University Hospital, Kagawa, Japan
- Department of Pharmacy, Kagawa University Hospital, Kagawa, Japan
| | | | - Masahiro Watanabe
- Department of Pharmacology, School of Pharmacy, Shujitsu University, Okayama, Japan
| | - Taichi Ito
- Department of Infection Control Service Office, Kagawa University Hospital, Kagawa, Japan
- Infectious Disease Education Center, Kagawa University Hospital, Kagawa, Japan
| | - Kyoko Yokota
- Department of Infection Control Service Office, Kagawa University Hospital, Kagawa, Japan
- Infectious Disease Education Center, Kagawa University Hospital, Kagawa, Japan
| | - Kaori Ishikawa
- Department of Infection Control Service Office, Kagawa University Hospital, Kagawa, Japan
- Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University Hospital, Kagawa, Japan
| | - Hiroaki Tanaka
- Department of Pharmacy, Kagawa University Hospital, Kagawa, Japan
| | - Yuichi Muraki
- Laboratory of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Shinji Kosaka
- Department of Pharmacy, Kagawa University Hospital, Kagawa, Japan
| | - Teruki Dainichi
- Department of Infection Control Service Office, Kagawa University Hospital, Kagawa, Japan
- Department of Dermatology, Kagawa University Faculty of Medicine, Kagawa, Japan
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Tan V, Ang G, Tan KB, Chen C. Impact of COVID-19 national response on primary care utilisation in Singapore: an interrupted time-series analysis. Sci Rep 2024; 14:6408. [PMID: 38494533 PMCID: PMC10944837 DOI: 10.1038/s41598-024-57142-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 03/14/2024] [Indexed: 03/19/2024] Open
Abstract
Since the start of the pandemic, many national responses, such as nationwide lockdowns, have been implemented to curb the spread of COVID-19. We aim to assess the impact of Singapore's national responses on primary care utilisation. We performed an interrupted time series using acute and chronic primary care data of 3 168 578 visits between 1 September 2019 and 31 August 2020 over four periods: before any measures were put in place, during Disease Outbreak Response System Condition (DORSCON) Orange, when Circuit Breaker was instituted, and when Circuit Breaker was lifted. We found significant mean reductions in acute and chronic primary care visits immediately following DORSCON Orange and Circuit Breaker. DORSCON Orange was associated with - 2020 mean daily visits (95% CI - 2890 to - 1150). Circuit Breaker was associated with a further - 2510 mean daily visits (95% CI - 3660 to - 1360). Primary care utilisation for acute visits remained below baseline levels even after the Circuit Breaker was lifted. These significant reductions were observed in both acute and chronic visits, with acute visits experiencing a steeper drop during DORSCON Orange. Understanding the impact of COVID-19 measures on primary care utilisation will be useful for future public health planning.
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Affiliation(s)
- Vanessa Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #09-01T, Singapore, 117549, Singapore
| | - Gregory Ang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #09-01T, Singapore, 117549, Singapore
- Department of Statistics and Data Science, National University of Singapore, Singapore, Singapore
| | - Kelvin Bryan Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #09-01T, Singapore, 117549, Singapore
- Ministry of Health, Singapore, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #09-01T, Singapore, 117549, Singapore.
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, USA.
- Department of Non-Communicable Disease Epidemiology, The London School of Hygiene and Tropical Medicine, London, UK.
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Gonzalez AV, Silvestri GA, Korevaar DA, Gesthalter YB, Almeida ND, Chen A, Gilbert CR, Illei PB, Navani N, Pasquinelli MM, Pastis NJ, Sears CR, Shojaee S, Solomon SB, Steinfort DP, Maldonado F, Rivera MP, Yarmus LB. Assessment of Advanced Diagnostic Bronchoscopy Outcomes for Peripheral Lung Lesions: A Delphi Consensus Definition of Diagnostic Yield and Recommendations for Patient-centered Study Designs. An Official American Thoracic Society/American College of Chest Physicians Research Statement. Am J Respir Crit Care Med 2024; 209:634-646. [PMID: 38394646 PMCID: PMC10945060 DOI: 10.1164/rccm.202401-0192st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/23/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Advanced diagnostic bronchoscopy targeting the lung periphery has developed at an accelerated pace over the last two decades, whereas evidence to support introduction of innovative technologies has been variable and deficient. A major gap relates to variable reporting of diagnostic yield, in addition to limited comparative studies. Objectives: To develop a research framework to standardize the evaluation of advanced diagnostic bronchoscopy techniques for peripheral lung lesions. Specifically, we aimed for consensus on a robust definition of diagnostic yield, and we propose potential study designs at various stages of technology development. Methods: Panel members were selected for their diverse expertise. Workgroup meetings were conducted in virtual or hybrid format. The cochairs subsequently developed summary statements, with voting proceeding according to a modified Delphi process. The statement was cosponsored by the American Thoracic Society and the American College of Chest Physicians. Results: Consensus was reached on 15 statements on the definition of diagnostic outcomes and study designs. A strict definition of diagnostic yield should be used, and studies should be reported according to the STARD (Standards for Reporting Diagnostic Accuracy Studies) guidelines. Clinical or radiographic follow-up may be incorporated into the reference standard definition but should not be used to calculate diagnostic yield from the procedural encounter. Methodologically robust comparative studies, with incorporation of patient-reported outcomes, are needed to adequately assess and validate minimally invasive diagnostic technologies targeting the lung periphery. Conclusions: This American Thoracic Society/American College of Chest Physicians statement aims to provide a research framework that allows greater standardization of device validation efforts through clearly defined diagnostic outcomes and robust study designs. High-quality studies, both industry and publicly funded, can support subsequent health economic analyses and guide implementation decisions in various healthcare settings.
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Zhang Y, Ren Y, Huang Y, Yao M, Jia Y, Wang Y, Mei F, Zou K, Tan J, Sun X. Design and statistical analysis reporting among interrupted time series studies in drug utilization research: a cross-sectional survey. BMC Med Res Methodol 2024; 24:62. [PMID: 38461257 PMCID: PMC10924989 DOI: 10.1186/s12874-024-02184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/20/2024] [Indexed: 03/11/2024] Open
Abstract
INTRODUCTION Interrupted time series (ITS) design is a commonly used method for evaluating large-scale interventions in clinical practice or public health. However, improperly using this method can lead to biased results. OBJECTIVE To investigate design and statistical analysis characteristics of drug utilization studies using ITS design, and give recommendations for improvements. METHODS A literature search was conducted based on PubMed from January 2021 to December 2021. We included original articles that used ITS design to investigate drug utilization without restriction on study population or outcome types. A structured, pilot-tested questionnaire was developed to extract information regarding study characteristics and details about design and statistical analysis. RESULTS We included 153 eligible studies. Among those, 28.1% (43/153) clearly explained the rationale for using the ITS design and 13.7% (21/153) clarified the rationale of using the specified ITS model structure. One hundred and forty-nine studies used aggregated data to do ITS analysis, and 20.8% (31/149) clarified the rationale for the number of time points. The consideration of autocorrelation, non-stationary and seasonality was often lacking among those studies, and only 14 studies mentioned all of three methodological issues. Missing data was mentioned in 31 studies. Only 39.22% (60/153) reported the regression models, while 15 studies gave the incorrect interpretation of level change due to time parameterization. Time-varying participant characteristics were considered in 24 studies. In 97 studies containing hierarchical data, 23 studies clarified the heterogeneity among clusters and used statistical methods to address this issue. CONCLUSION The quality of design and statistical analyses in ITS studies for drug utilization remains unsatisfactory. Three emerging methodological issues warranted particular attention, including incorrect interpretation of level change due to time parameterization, time-varying participant characteristics and hierarchical data analysis. We offered specific recommendations about the design, analysis and reporting of the ITS study.
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Affiliation(s)
- Yuanjin Zhang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Yan Ren
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Yunxiang Huang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Minghong Yao
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Yulong Jia
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Yuning Wang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Fan Mei
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Kang Zou
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China
| | - Jing Tan
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China.
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China.
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China.
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China.
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China.
- Hainan Healthcare Security Administration Key Laboratory for Real World Data Research, Chengdu, China.
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Lavikainen P, Heiskanen J, Jalkanen K, Lehtimäki AV, Vehkala S, Kangas P, Husman K, Vohlonen I, Martikainen J. Effectiveness of the Coordinated Return to Work model after orthopaedic surgery for lumbar discectomy and hip and knee arthroplasty: a register-based study. Occup Environ Med 2024; 81:150-157. [PMID: 38331568 PMCID: PMC10958326 DOI: 10.1136/oemed-2023-109276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/27/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES This study examined the effectiveness of an individualised Coordinated Return to Work (CRtW) model on the length of the return to work (RTW) period compared with a standard prescription of 2-3 months RTW during recovery after lumbar discectomy and hip and knee arthroplasty among Finnish working-age population. METHODS Cohorts on patients aged 18-65 years old with lumbar discectomy or hip or knee arthroplasty were extracted from the electronic health records of eight Finnish hospital districts in 2015-2021 and compiled with retirement and sickness benefits. The overall effect of the CRtW model on the average RTW period was calculated as a weighted average of area-specific mean differences in RTW periods between 1 year before and 1 year after the implementation. Longer-term effects of the model were examined with an interrupted time series design estimated with a segmented regression model. RESULTS During the first year of the CRtW model, the average RTW period shortened by 9.1 days (95% CI 4.1 to 14.1) for hip arthroplasty and 14.4 days (95% CI 7.5 to 21.3) for knee arthroplasty. The observed differences were sustained over longer follow-up times. For lumbar discectomy, the first-year decrease was not statistically significant, but the average RTW had shortened by 36.2 days (95% CI 33.8 to 38.5) after 4.5 years. CONCLUSIONS The CRtW model shortened average RTW periods among working-age people during the recovery period. Further research with larger samples and longer follow-up times is needed to ensure the effectiveness of the model as a part of the Finnish healthcare system.
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Affiliation(s)
- Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Heiskanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Kari Jalkanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | - Saara Vehkala
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | - Kaj Husman
- University of Eastern Finland, Kuopio, Finland
| | - Ilkka Vohlonen
- Department of Public Health, University of Eastern Finland, Kuopio, Finland
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Tiruneh GT, Odwe G, Kamberos AH, K'Oduol K, Fesseha N, Moraa Z, Gwaro H, Emaway D, Magge H, Nisar YB, Hirschhorn LR. Optimizing integration of community-based management of possible serious bacterial infection (PSBI) in young infants into primary healthcare systems in Ethiopia and Kenya: successes and challenges. BMC Health Serv Res 2024; 24:280. [PMID: 38443956 PMCID: PMC10916061 DOI: 10.1186/s12913-024-10679-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Ethiopia and Kenya have adopted the community-based integrated community case management (iCCM) of common childhood illnesses and newborn care strategy to improve access to treatment of infections in newborns and young infants since 2012 and 2018, respectively. However, the iCCM strategy implementation has not been fully integrated into the health system in both countries. This paper describes the extent of integration of iCCM program at the district/county health system level, related barriers to optimal integration and implementation of strategies. METHODS From November 2020 to August 2021, Ethiopia and Kenya implemented the community-based treatment of possible serious bacterial infection (PSBI) when referral to a higher facility is not possible using embedded implementation research (eIR) to mitigate the impact of COVID-19 on the delivery of this life-saving intervention. Both projects conducted mixed methods research from April-May 2021 to identify barriers and facilitators and inform strategies and summative evaluations from June-July 2022 to monitor the effectiveness of implementation outcomes including integration of strategies. RESULTS Strategies identified as needed for successful implementation and sustainability of the management of PSBI integrated at the primary care level included continued coaching and support systems for frontline health workers, technical oversight from the district/county health system, and ensuring adequate supply of commodities. As a result, support and technical oversight capacity and collaborative learning were strengthened between primary care facilities and community health workers, resulting in improved bidirectional linkages. Improvement of PSBI treatment was seen with over 85% and 81% of estimated sick young infants identified and treated in Ethiopia and Kenya, respectively. However, perceived low quality of service, lack of community trust, and shortage of supplies remained barriers impeding optimal PSBI services access and delivery. CONCLUSION Pragmatic eIR identified shared and unique contextual challenges between and across the two countries which informed the design and implementation of strategies to optimize the integration of PSBI management into the health system during the COVID-19 pandemic. The eIR participatory design also strengthened ownership to operationalize the implementation of identified strategies needed to improve the health system's capacity for PSBI treatment.
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Affiliation(s)
- Gizachew Tadele Tiruneh
- The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc, Addis Ababa, Ethiopia.
| | | | - Alexandra Haake Kamberos
- Feinberg School of Medicine and Havey Institute of Global Health, Northwestern University, Chicago, IL, USA
| | | | - Nebreed Fesseha
- The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc, Addis Ababa, Ethiopia
| | | | | | - Dessalew Emaway
- The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc, Addis Ababa, Ethiopia
| | - Hema Magge
- Bill & Melinda Gates Foundation, Seattle, USA
| | - Yasir Bin Nisar
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Lisa R Hirschhorn
- Feinberg School of Medicine and Havey Institute of Global Health, Northwestern University, Chicago, IL, USA
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Bovell-Ammon BJ, Yan S, Dunn D, Evans EA, Friedmann PD, Walley AY, LaRochelle MR. Prison Buprenorphine Implementation and Postrelease Opioid Use Disorder Outcomes. JAMA Netw Open 2024; 7:e242732. [PMID: 38497959 PMCID: PMC10949092 DOI: 10.1001/jamanetworkopen.2024.2732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/24/2024] [Indexed: 03/19/2024] Open
Abstract
Importance Agonist medications for opioid use disorder (MOUD), buprenorphine and methadone, in carceral settings might reduce the risk of postrelease opioid overdose but are uncommonly offered. In April 2019, the Massachusetts Department of Correction (MADOC), the state prison system, provided buprenorphine for incarcerated individuals in addition to previously offered injectable naltrexone. Objective To evaluate postrelease outcomes after buprenorphine implementation. Design, Setting, and Participants This cohort study with interrupted time-series analysis used linked data across multiple statewide data sets in the Massachusetts Public Health Data Warehouse stratified by sex due to differences in carceral systems. Eligible participants were individuals sentenced and released from a MADOC facility to the community. The study period for the male sample was January 2014 to November 2020; for the female sample, January 2015 to October 2019. Data were analyzed between February 2022 and January 2024. Exposure April 2019 implementation of buprenorphine during incarceration. Main Outcomes and Measures Receipt of MOUD within 4 weeks after release, opioid overdose, and all-cause mortality within 8 weeks after release, each measured as a percentage of monthly releases who experienced the outcome. Segmented linear regression analyzed changes in outcome rates after implementation. Results A total of 15 225 individuals were included. In the male sample there were 14 582 releases among 12 688 individuals (mean [SD] age, 35.0 [10.8] years; 133 Asian and Pacific Islander [0.9%], 4079 Black [28.0%], 4208 Hispanic [28.9%], 6117 White [41.9%]), a rate of 175.7 releases per month; the female sample included 3269 releases among 2537 individuals (mean [SD] age, 34.9 [9.8] years; 328 Black [10.0%], 225 Hispanic [6.9%], 2545 White [77.9%]), a rate of 56.4 releases per month. Among male participants at 20 months postimplementation, the monthly rate of postrelease buprenorphine receipt was higher than would have been expected under baseline trends (21.2% vs 10.6% of monthly releases; 18.6 additional releases per month). Naltrexone receipt was lower than expected (1.0% vs 6.0%; 8.8 fewer releases per month). Monthly rates of methadone receipt (1.4%) and opioid overdose (1.8%) were not significantly different than expected. All-cause mortality was lower than expected (1.9% vs 2.8%; 1.5 fewer deaths per month). Among female participants at 7 months postimplementation, buprenorphine receipt was higher than expected (31.6% vs 9.5%; 12.4 additional releases per month). Naltrexone receipt was lower than expected (3.4% vs 7.2%) but not statistically significantly different. Monthly rates of methadone receipt (1.1%), opioid overdose (4.8%), and all-cause mortality (1.6%) were not significantly different than expected. Conclusions and Relevance In this cohort study of state prison releases, postrelease buprenorphine receipt increased and naltrexone receipt decreased after buprenorphine became available during incarceration.
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Affiliation(s)
- Benjamin J. Bovell-Ammon
- Departments of Medicine and of Healthcare Delivery and Population Sciences, Baystate Health, Springfield, Massachusetts
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Shapei Yan
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Devon Dunn
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Elizabeth A. Evans
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health & Health Sciences, Amherst
| | - Peter D. Friedmann
- Office of Research and Department of Medicine, University of Massachusetts Chan Medical School—Baystate and Baystate Health, Springfield
| | - Alexander Y. Walley
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Marc R. LaRochelle
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Chua KP, Volerman A, Zhang J, Hua J, Conti RM. Antidepressant Dispensing to US Adolescents and Young Adults: 2016-2022. Pediatrics 2024; 153:e2023064245. [PMID: 38404197 PMCID: PMC10904889 DOI: 10.1542/peds.2023-064245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Mental health worsened in adolescents and young adults after the coronavirus disease 2019 (COVID-19) outbreak in March 2020, but whether antidepressant dispensing to this population changed is unknown. METHODS We identified antidepressant prescriptions dispensed to US individuals aged 12 to 25 years from 2016 to 2022 using the IQVIA Longitudinal Prescription Database, an all-payer national database. The outcome was the monthly antidepressant dispensing rate, defined as the monthly number of individuals with ≥1 dispensed antidepressant prescription per 100 000 people. We fitted linear segmented regression models assessing for level or slope changes during March 2020 and conducted subgroup analyses by sex and age group. RESULTS Between January 2016 and December 2022, the monthly antidepressant dispensing rate increased 66.3%, from 2575.9 to 4284.8. Before March 2020, this rate increased by 17.0 per month (95% confidence interval: 15.2 to 18.8). The COVID-19 outbreak was not associated with a level change but was associated with a slope increase of 10.8 per month (95% confidence interval: 4.9 to 16.7). The monthly antidepressant dispensing rate increased 63.5% faster from March 2020 onwards compared with beforehand. In subgroup analyses, this rate increased 129.6% and 56.5% faster from March 2020 onwards compared with beforehand among females aged 12 to 17 years and 18 to 25 years, respectively. In contrast, the outbreak was associated with a level decrease among males aged 12 to 17 years and was not associated with a level or slope change among males aged 18 to 25 years. CONCLUSIONS Antidepressant dispensing to adolescents and young adults was rising before the COVID-19 outbreak and rose 63.5% faster afterward. This change was driven by increased antidepressant dispensing to females and occurred despite decreased dispensing to male adolescents.
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Affiliation(s)
- Kao-Ping Chua
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, Illinois
| | - Jason Zhang
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Joanna Hua
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, Illinois
| | - Rena M. Conti
- Department of Markets, Public Policy, and Law, Questrom School of Business, Boston University, Boston, Massachusetts
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Aghlmandi S, Halbeisen FS, Godet P, Signorell A, Sigrist S, Saccilotto R, Widmer AF, Zeller A, Bielicki J, Bucher HC. Impact of the COVID-19 pandemic on antibiotic prescribing in high-prescribing primary care physicians in Switzerland. Clin Microbiol Infect 2024; 30:353-359. [PMID: 38000535 DOI: 10.1016/j.cmi.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate antibiotic prescribing of medium-to-high prescribing primary care physicians being followed up after the completion of a Swiss national intervention trial of antibiotic prescription audit and feedback in the first SARS-CoV-2 pandemic year. METHODS We used health insurer based claims data to calculate monthly antibiotic prescription rates per 100 consultations (primary endpoint) and applying interrupted time series (ITS) analysis methods, we estimated the immediate (step change) and sustained effects (slope) of the SARS-CoV-2 epidemic in 2020 on antibiotic prescribing compared to the pre-pandemic trial period from 2017-2019. RESULTS We analysed data of 2945 of 3426 physicians (86.0%) from the trial with over 4 million consultations annually, who were in 2020 still in practice. Consultations dropped by 43% during the first pandemic year compared with 2017. Median monthly antibiotic prescription rates per 100 consultations in 2017 were 8.44 (Interquartile range [IQ] 6.32-11.50) and 8.35 (6.34-11.74) in the intervention and control groups, respectively, and increased to 15.63 (10.69-23.81) and 16.31 (10.65-24.72) per 100 consultations in 2020. ITS-derived incidence rate ratios for overall antibiotic prescriptions were 2.32 (95% CI 2.07-2.59) for the immediate pandemic effect, and 0.96 (0.95-0.98) for the sustained effect (change in slope in 2020 compared with 2017-2019). DISCUSSION The SARS-CoV-2 pandemic had a major impact on antibiotic prescription patterns in primary care in Switzerland. For future viral pandemics, intervention plans with timely activation steps to minimize unjustified antibiotic consumption in primary care should be prepared.
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Affiliation(s)
- Soheila Aghlmandi
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland; Paediatric Research Center, University Children's Hospital Basel (UKBB), Basel, Switzerland.
| | - Florian S Halbeisen
- Surgical Outcome Research Center, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | | | | | | | - Ramon Saccilotto
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Andreas F Widmer
- Division of Infectious Diseases and Hospital Hygiene, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Julia Bielicki
- Infectious Diseases and Paediatric Research Centre University of Basel Children's Hospital and University of Basel, Basel, Switzerland; Centre for Neonatal and Paediatric Infection, St. George's University, London, UK
| | - Heiner C Bucher
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
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Saha AK, Segal S. A Quality Improvement Initiative to Reduce Adverse Effects of Transitions of Anesthesia Care on Postoperative Outcomes: A Retrospective Cohort Study. Anesthesiology 2024; 140:387-398. [PMID: 37976442 DOI: 10.1097/aln.0000000000004839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND An intraoperative transfer of care from one anesthesia provider to another, or handover, may result in information loss and contribute to adverse patient outcomes. In 2019 the authors undertook a quality improvement effort to increase the use of a structured intraoperative handover tool incorporated in the electronic medical record. The authors hypothesized that intraoperative handovers of anesthesia care would be associated with adverse patient outcomes, and that increased use of a structured tool would attenuate this effect. METHODS This study included adult patients undergoing noncardiac surgery of at least 1 h duration performed during the period 2016 to 2021. Cases with a handover were identified if either there was a change of attending anesthesiologist or change of nurse anesthetist or resident for more than 35 min. The primary outcome was the occurrence of a composite of postoperative mortality and major postoperative morbidity. The effect of the intervention was analyzed by examining the quarterly change in odds ratio for the primary outcome for cases with and without a handover. RESULTS A total of 121,077 cases, 40.4% of which had a handover, were included. After weighting, the composite outcome was statistically associated with handovers (3,517 of 48,986 [7.2%] in handover cases vs. 4,470 of 72,091 [6.2%] in nonhandover cases; odds ratio, 1.08; 95% CI, 1.04 to 1.12). Time series analysis showed a marked increase in usage of the structured tool after the initial intervention. The odds ratio for the composite outcome showed a significant decrease over time after the initial intervention (t = -3.97; P < 0.001), with the slope of the odds ratio versus time curve decreasing from 0.002 (95% CI, 0.001 to 0.004; P = 0.018) to -0.011 (95% CI, -0.01 to -0.018; P < 0.001). CONCLUSIONS Intraoperative handovers are significantly associated with adverse outcomes even after controlling for multiple confounding variables. Use of a structured handover tool during anesthesia care may attenuate the adverse effect. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Amit K Saha
- Department of Anesthesiology, and Perioperative Outcomes and Informatics Collaborative, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Scott Segal
- Department of Anesthesiology, and Perioperative Outcomes and Informatics Collaborative, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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