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Camacho X, Schaffer AL, Brett J, Pratt N, Buckley NA, Henry D, Pearson SA. Quality use of publicly subsidised tapentadol in Australia: a population-based analysis. Intern Med J 2024. [PMID: 38299430 DOI: 10.1111/imj.16335] [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: 04/04/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Sustained-release (SR) tapentadol was listed on Australia's Pharmaceutical Benefits Scheme (PBS) in 2014 for chronic severe pain requiring long-term opioid treatment. Dispensings have increased since listing despite declining trends in other PBS-listed opioids. Preferential prescribing of SR opioids may increase the risk of dependence and accidental overdose, particularly when used to treat acute pain. AIMS To explore the quality use of publicly subsidised tapentadol in Australia. METHODS We examined annual initiation rates and patterns of use of tapentadol (SR) in the dispensing records of a 10% random sample of PBS-eligible Australians (2014-2021). We used national tapentadol sales data to assess the proportion of sales attributable to the PBS. RESULTS Tapentadol initiation increased from 2014, peaking at 7.5/1000 adult population in 2019 before declining to 5.3/1000 in 2021. We identified 63 766 new users between 2014 and 2020, of whom 92.8% discontinued in the first year following initiation, 58.0% had only a single dispensing and 34.3% had no other opioids dispensed in the 3 months before or after initiation. 27.8% of new users were dispensed tapentadol on the same day as potentially interacting medicines. There was a sustained drop in the proportion of sales attributable to the PBS from June 2020 onwards, from an average of 69.1%, to 63.9% of pack sales. CONCLUSIONS Patterns of use suggest tapentadol (SR) is generally used for short duration. Although most tapentadol sold in Australia is subsidised, there is evidence of a shift towards private sales.
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Affiliation(s)
- Ximena Camacho
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, New South Wales, Australia
| | - Andrea L Schaffer
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, New South Wales, Australia
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jonathan Brett
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, New South Wales, Australia
- Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Nicole Pratt
- NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, New South Wales, Australia
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Nicholas A Buckley
- NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, New South Wales, Australia
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Henry
- NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, New South Wales, Australia
- Institute for Evidence Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Sallie-Anne Pearson
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, New South Wales, Australia
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Šutej I, Lepur D, Bašić K, Šimunović L, Peroš K. Changes in Medication Prescribing Due to COVID-19 in Dental Practice in Croatia-National Study. Antibiotics (Basel) 2023; 12:antibiotics12010111. [PMID: 36671312 PMCID: PMC9854617 DOI: 10.3390/antibiotics12010111] [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: 11/30/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
The 2019 coronavirus pandemic (COVID-19) has affected clinical practice and, consequently, drug prescribing in dental practice. We investigated how the pandemic affected the prescribing behavior of dentists in Croatia. Data on prescribing practices for this study were provided by the Croatian Health Insurance Institute. The analysis included the number of prescriptions, costs, and the number of packages prescribed. The World Health Organization's defined daily dose per 1000 inhabitants (DID) per day was used as an objective utilization comparison. During the first pandemic year, prescribing practice changed the most. Wide-spectrum antibiotics, analgesics, and antiseptics showed the highest trend in change. A statistically significant change in prescribing practices during the pandemic period was noted for amoxicillin with clavulanic acid, ibuprofen, and ketoprofen which showed an increase in trend, while cephalexin and diclofenac showed a statistically significant decrease. The highest increase in trend was recorded for azithromycin, at +39.3%. The COVID-19 pandemic has been associated with a marked increase in medication utilization, especially in the first year of the pandemic. The increase in wide-spectrum antibiotic classes needs to be addressed and regulated so that patients accept that antibiotics are not a substitute for dental treatment and dentists always start treatment with narrow-spectrum antibiotics regardless of specific times, as is the case with the pandemic.
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Affiliation(s)
- Ivana Šutej
- Department of Pharmacology, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence: ; Tel.: +385-98739248
| | - Dragan Lepur
- Department of Infectious Diseases, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia
| | - Krešimir Bašić
- Department of Pharmacology, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Luka Šimunović
- Department of Orthodontics, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Kristina Peroš
- Department of Pharmacology, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Darak HL, Osiro OA, K'Owino DO, Mua BN. Trends of patients' visit at the University Dental Hospital prior to and during the COVID-19 pandemic: a cross-sectional study. Pan Afr Med J 2023; 44:87. [PMID: 37193107 PMCID: PMC10182371 DOI: 10.11604/pamj.2023.44.87.37372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/05/2023] [Indexed: 05/18/2023] Open
Affiliation(s)
- Halima Leruk Darak
- Department of Dental Sciences, University of Nairobi Dental Hospital, Nairobi, Kenya
| | - Olivia Awino Osiro
- Department of Dental Sciences, University of Nairobi Dental Hospital, Nairobi, Kenya
- Corresponding author: Olivia Awino Osiro, Department of Dental Sciences, University of Nairobi Dental Hospital, Nairobi, Kenya.
| | | | - Bernard Nzioka Mua
- Department of Dental Sciences, University of Nairobi Dental Hospital, Nairobi, Kenya
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Lavu A, Janzen D, Aboulatta L, Peymani P, Haidar L, Desrochers B, Alessi-Severini S, Eltonsy S. Prescription trends of antiseizure medications before and during the COVID-19 pandemic. Front Neurol 2023; 14:1135962. [PMID: 37064207 PMCID: PMC10101333 DOI: 10.3389/fneur.2023.1135962] [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: 01/02/2023] [Accepted: 03/06/2023] [Indexed: 04/18/2023] Open
Abstract
Introduction Given the lack of evidence on how the COVID-19 pandemic impacted antiseizure medication (ASM) use, we examined the trends of ASMs before and during COVID-19. Methods We conducted a population-based study using provincial-level health databases from Manitoba, Canada, between 1 June 2016 and 1 March 2021. We used interrupted time series autoregressive models to examine changes in the prevalence and incidence of ASM prescription rates associated with COVID-19 public health restrictions. Results Among prevalent users, the COVID-19 pandemic led to a significant increase in new-generation ASMs with a percentage change of 0.09% (p = 0.03) and a significant decrease in incidence use of all ASMs with a percentage change of -4.35% (p = 0.04). Significant trend changes were observed in the prevalent use of new-generation ASMs (p = 0.04) and incidence use of all (p = 0.04) and new-generation ASMs (p = 0.02). Gabapentin and clonazepam prescriptions contributed 37% of prevalent and 54% of incident use. Conclusion With the introduction of public health measures during COVID-19, small but significant changes in the incident and prevalent use of ASM prescriptions were observed. Further studies are needed to examine whether barriers to medication access were associated with potential deterioration in seizure control among patients. Conference presentation The results from this study have been presented as an oral presentation at the 38th ICPE, International Society of Pharmacoepidemiology (ISPE) annual conference in Copenhagen.
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Aboulatta L, Peymani P, Vaccaro C, Leong C, Kowalec K, Delaney J, Falk J, Alessi-Severini S, Aloud B, Eltonsy S. Drug utilization patterns before and during COVID-19 pandemic in Manitoba, Canada: A population-based study. PLoS One 2022; 17:e0278072. [PMID: 36441676 PMCID: PMC9704650 DOI: 10.1371/journal.pone.0278072] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has led the Canadian provincial governments to take unprecedented measures, including restrictions to healthcare services and pharmacists. Limited evidence exists on changes in prescription trends in Canada during the pandemic period. OBJECTIVES To examine the trend of prescription medications' utilization before and during COVID-19, among incident and prevalent users in the general population. We examined 18 major classes of medications. METHODS We used the administrative health databases from the province of Manitoba, Canada, to conduct a province-wide cross-sectional study. Incident and prevalent use was compared between two time periods; pre-COVID-19: July 2016-March 2020 and during COVID-19: April 2020-March 2021. Interrupted time series analysis using autoregressive models was used to quantify the change in level and slope in quarterly medication use among incident and prevalent users. RESULTS The quarterly study population ranged from 1,353,485 to 1,411,630 Manitobans. The most common comorbidities were asthma (26.67%), hypertension (20.64%), and diabetes (8.31%). On average, the pandemic restrictions resulted in a 45.55% and 12.17% relative decline in the aggregated utilization of all drugs among both incident and prevalent users, respectively. Subclass analysis showed a 46.83%, 23.05%, and 30.98% relative drop among incident users of antibiotics, cardiovascular drugs and opioids use, respectively. We observed a significant slope increase during COVID-19 among the quarterly cardiovascular, antidiabetics, alpha-1 blockers, and statins incident users compared to the pre-COVID-19 period. We noted a significant decrease in level among NSAIDs, opioids, and antibiotic prevalent users, however, no significant changes in slope were observed. CONCLUSION Our findings show a significant impact of COVID-19 measures on prescription trends in the general population. The observed decline among several medication classes was temporary. Further research is needed to monitor prescription trends and better understand if those changes were associated with increased health services and worsened outcomes.
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Affiliation(s)
- Laila Aboulatta
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Payam Peymani
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Christine Vaccaro
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Christine Leong
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Psychiatry, College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kaarina Kowalec
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Joseph Delaney
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Jamie Falk
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, Winnipeg, Canada
| | - Basma Aloud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sherif Eltonsy
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
- * E-mail:
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Understanding the impact of COVID-19 on dental antibiotic prescribing across England: 'it was a minefield'. Br Dent J 2022; 233:653-658. [PMID: 36307710 PMCID: PMC9615612 DOI: 10.1038/s41415-022-5104-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/26/2022] [Indexed: 11/27/2022]
Abstract
Introduction The COVID-19 pandemic impacted significantly on dental service delivery across England. Objective To explore how and why the pandemic affected antibiotic prescribing by primary care dentists. Methods Mixed-methods study: secondary analysis of routinely collected NHS dental antibiotic prescribing data from before and during the pandemic; and an online survey of dentists (NHS and private) across England's regions. Results Dental antibiotic prescribing increased 22% in the pandemic's first year, with regional variation from a 12.1% increase in London to 29.1% in East of England. Of 159 dentists surveyed, 60% had prescribed 'many more' antibiotics. Some urgent dental centres required antibiotics before accepting referrals, irrespective of clinical appropriateness. Diagnosing remotely was hard. Antibiotics were used to delay aerosol generating procedures and fill gaps in services. Widespread frustration existed. Discussion Maintaining access to urgent dental care during a future pandemic would include availability of high-grade personal protective equipment for dental teams. Everyone must understand the impact of restricted dental access on antibiotic overprescribing and hence antibiotic resistance. Conclusion Reduced dental access and changes in dental service delivery because of the pandemic increased antibiotic prescribing. Ensuring uninterrupted access for all to effective urgent dental care is an important element of global efforts to tackle antibiotic resistance. Remote management of patients during the COVID-19 pandemic resulted in increased antibiotic prescribing in each of England's regions. Most dentists were not confident managing patients with acute dental conditions remotely. Ensuring access to face-to-face dentistry is an important part of efforts to tackle antibiotic resistance. Dentists felt frustrated about being prevented from providing the dental procedures needed to provide safe and effective care to people in pain. Many also expressed concern about the impact of increased antibiotic prescribing on antibiotic resistance and their experience of increased patient expectation that antibiotics are appropriate for toothache. Preparedness plans for future pandemics should recognise that antibiotics are not a substitute for dental procedures and dentistry was the only part of the NHS to experience an increase in antibiotic prescribing during the COVID-19 pandemic. Planners should aim to ensure sufficient face-to-face urgent dental care provision immediately upon implementation of pandemic restrictions.
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The impact of COVID-19 on individual oral health: a scoping review. BMC Oral Health 2022; 22:422. [PMID: 36138456 PMCID: PMC9502893 DOI: 10.1186/s12903-022-02463-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor oral health due to dental caries is one of the most prevalent non-communicable diseases worldwide. It has a significant impact on individuals across the lifespan and is a leading cause of preventable hospitalizations. The impacts of COVID-19 on oral health at the practice level are well documented, but gaps in understanding the impact on individual oral health remain. This review addresses this gap. METHODS Using a JBI scoping review process we mapped and summarized the evidence to identify the impact of COVID-19 on individual oral health. Key search terms were developed, and searches were undertaken by an experienced research librarian. RESULTS The 85 included studies were conducted in 23 countries from 5 regions across the world classified using the United Nations Geoscheme system. The majority (82/85) were quantitative, 2 were reviews and there was one qualitative interview study. Cross-sectional surveys were the most common data collection approach followed by an analysis of clinical data, analysis of internet trends and other online methods. Five key areas were identified including changes to the provision of emergency dental services, provision of routine oral health services, oral hygiene maintenance at home, changes in dietary preferences, alternative models of dental provision and help-seeking and attitudes towards dental care in the future. CONCLUSIONS This scoping review has demonstrated that the pandemic has impacted on oral health at the individual level. It is important that we are aware of these impacts and ensure that support systems are in place to overcome future periods where access to dental care might be compromised. The provision of preventive care remains a vital first step in ensuring good overall oral health as is paramount during periods where access to dental treatment might be limited.
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Impact of the COVID-19 Pandemic on Antibiotic Prescribing by Dentists in Galicia, Spain: A Quasi-Experimental Approach. Antibiotics (Basel) 2022; 11:antibiotics11081018. [PMID: 36009887 PMCID: PMC9404831 DOI: 10.3390/antibiotics11081018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Antibiotic resistance is one of the most pressing public health problems. Health authorities, patients, and health professionals, including dentists, are all involved in its development. COVID-19 pandemic restrictions on dental care may have had repercussions on antibiotic prescribing by dentists. The aim of this study was to assess the impact of the COVID-19 pandemic on antibiotic prescribing by dentists, and to review antibiotic consumption according to the WHO Access, Watch, Reserve classification. We conducted a natural, before-and-after, quasi-experimental study, using antibiotic prescription data covering the period from January 2017 to May 2021. A segmented regression analysis with interrupted time series data was used to analyse the differences between the numbers of defined daily doses (DDD) of antibiotics prescribed monthly. The outcomes showed an immediate significant decrease in overall antibiotic prescribing by primary-care dentists during lockdown, followed by a non-significant upward trend for the next year. This same pattern was, likewise, observed for Access and Watch antibiotics. COVID-19 pandemic restrictions on dental care influenced the prescription of antibiotics. During confinement, an initial decrease was observed, this trend changed when in person consultations were recovered. It might be beneficial to analyse the prescription of antibiotics using the WHO AWaRe classification, in order to monitor their appropriate use.
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Changes in the Profile of Antibiotic Prescriptions by Dentists in Brazil during the Pandemic. Int J Dent 2022; 2022:6570812. [PMID: 35685911 PMCID: PMC9172209 DOI: 10.1155/2022/6570812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
During the COVID-19 pandemic, people worldwide, including the scientific community, were insecure and fearful. The lack of vaccines at the beginning of the pandemic and the high mortality rate led to a search for alternative treatments for COVID-19. Among these proposals, a postulated activity of azithromycin was frequently studied in early treatment. In view of this, many countries saw an increase in the consumption of this antibiotic. Thus, the objective of this study was to evaluate, in Brazil, whether there was an increase in azithromycin prescriptions made by dentists, as they may have been prescribing this antibiotic as a probable treatment for COVID-19. This is an interrupted time series that analyzed antimicrobial prescriptions data between January 2014 and July 2021. The data were taken from the National System of Controlled Products Management, and pre- and postpandemic periods were compared. To assess changes in azithromycin consumption, Joinpoint regression and analysis of variance, followed by Dunnett’s test, were used. More than 38 million prescriptions written during the period were analyzed. Amoxicillin (72.3%), azithromycin (18.0%), cephalexin (6.1%), and metronidazole (3.58%) were the most prescribed antibiotics. At the beginning of the pandemic, there was a drop in amoxicillin prescriptions motivated by a decrease in consultations, but conversely, in less than three months, azithromycin prescriptions grew by more than 100%. The exaggerated use of this antibiotic during the pandemic will certainly have consequences in the short and medium term on indicators of bacterial resistance. The use of guidelines and respect for the therapeutic protocols of government agencies should be fundamental for collective and strategic action in the fight against health emergencies.
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Outpatient Antibiotic Prescriptions in France: Patients and Providers Characteristics and Impact of the COVID-19 Pandemic. Antibiotics (Basel) 2022; 11:antibiotics11050643. [PMID: 35625287 PMCID: PMC9137595 DOI: 10.3390/antibiotics11050643] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
In France, despite several successive plans to control antimicrobial resistance, antibiotic use remains high in the outpatient setting. This study aims to better understand outpatient antibiotic use and prescription in order to identify tailored targets for future public health actions. Using data from the French National Health Data System, we described and compared the individual characteristics of patients with and without an antibiotic prescription. The prescribed antibiotics (ATC-J01) were detailed and compared between 2019 and 2020. Antibiotic prescribing indicators that take prescriber activity into account were estimated and compared. Patients who were female, advanced age, and the presence of comorbidities were associated with antibiotic prescriptions. The overall prescription rate was estimated at 134 per 1000 consultations and 326 per 1000 patients seen in 2019. General practitioners (GPs), dentists and paediatricians were associated with 78.0%, 12.2% and 2.2% of antibiotic prescriptions, respectively, with high prescription rates (391, 447, and 313 p. 1000 patients seen, respectively). In comparison with 2019, this rate decreased in 2020 for paediatricians (−30.4%) and GPs (−17.9%) whereas it increased among dentists (+17.9%). The reduction was twice as high among the male prescribers than among their female counterparts (−26.6 and −12.0, respectively). The reduction in prescriptions observed in 2020 (−18.2%) was more marked in children (−35.8%) but less so among individuals ≥65 years (−13.1%) and those with comorbidities (−12.5%). The decrease in penicillin prescriptions represents 67.3% of the overall reduction observed in 2020. The heterogeneous decrease in prescriptions by age and antibiotic class could be explained by the impact of COVID-19 control measures on the spread of respiratory viruses; thus, a substantial proportion of the prescriptions avoided in 2020 is likely inappropriate, particularly among children. In order to keep the rate of prescriptions comparable to that observed in 2020, male prescribers, paediatricians and GPs should be encouraged to maintain that level, while a campaign to raise awareness of the appropriate use of antibiotics should be aimed at dentists in particular.
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Gillies MB, Burgner DP, Ivancic L, Nassar N, Miller JE, Sullivan SG, Todd IMF, Pearson S, Schaffer AL, Zoega H. Changes in antibiotic prescribing following COVID-19 restrictions: Lessons for post-pandemic antibiotic stewardship. Br J Clin Pharmacol 2022; 88:1143-1151. [PMID: 34405427 PMCID: PMC8444718 DOI: 10.1111/bcp.15000] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 01/19/2023] Open
Abstract
AIMS Public health responses to reduce SARS-CoV-2 transmission have profoundly affected the epidemiology and management of other infections. We examined the impact of COVID-19 restrictions on antibiotic dispensing in Australia. METHODS We used national claims data to investigate antibiotic dispensing trends from November 2015 to October 2020 and whether changes reflected reductions in primary care consultations. We used interrupted time series analysis to quantify changes in monthly antibiotic dispensing and face-to-face and telehealth GP consultations and examined changes by recipient age, pharmacy State and prescriber specialty. RESULTS Over the study period, an estimated 19 921 370 people had 125 495 137 antibiotic dispensings, 71% prescribed by GPs. Following COVID-19 restrictions, we observed a sustained 36% (95% CI: 33-40%) reduction in antibiotic dispensings from April 2020. Antibiotics recommended for managing respiratory tract infections showed large reductions (range 51-69%), whereas those recommended for non-respiratory infections were unchanged. Dispensings prescribed by GPs decreased from 63.5 per 1000 population for April-October 2019 to 37.0 per 1000 for April-October 2020. Total GP consultation rates remained stable, but from April 2020, 31% of consultations were telehealth. CONCLUSION In a setting with a low COVID-19 incidence, restrictions were associated with a substantial reduction in community dispensings of antibiotics primarily used to treat respiratory infections, coincident with reported reductions in respiratory viral infections. Our findings are informative for post-pandemic antimicrobial stewardship and highlight the potential to reduce inappropriate prescribing by GPs and specialists for respiratory viral infections.
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Affiliation(s)
- Malcolm B. Gillies
- Centre for Big Data Research in Health, Faculty of MedicineUNSW SydneySydneyAustralia
| | - David P. Burgner
- Infection and Immunity, Murdoch Children's Research InstituteRoyal Children's HospitalParkvilleAustralia,Department of PaediatricsUniversity of MelbourneParkvilleAustralia
| | - Lorraine Ivancic
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
| | - Natasha Nassar
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyAustralia,Menzies Centre for Health Policy and Economics, Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
| | - Jessica E. Miller
- Infection and Immunity, Murdoch Children's Research InstituteRoyal Children's HospitalParkvilleAustralia,Department of PaediatricsUniversity of MelbourneParkvilleAustralia
| | - Sheena G. Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, and Department of Infectious Diseases, University of Melbourneat the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - Isobel M. F. Todd
- Infection and Immunity, Murdoch Children's Research InstituteRoyal Children's HospitalParkvilleAustralia
| | - Sallie‐Anne Pearson
- Centre for Big Data Research in Health, Faculty of MedicineUNSW SydneySydneyAustralia
| | - Andrea L. Schaffer
- Centre for Big Data Research in Health, Faculty of MedicineUNSW SydneySydneyAustralia
| | - Helga Zoega
- Centre for Big Data Research in Health, Faculty of MedicineUNSW SydneySydneyAustralia,Centre of Public Health Sciences, Faculty of MedicineUniversity of IcelandReykjavikIceland
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Kitano T, Brown KA, Daneman N, MacFadden DR, Langford BJ, Leung V, So M, Leung E, Burrows L, Manuel D, Bowdish DME, Maxwell CJ, Bronskill SE, Brooks JI, Schwartz KL. The Impact of COVID-19 on Outpatient Antibiotic Prescriptions in Ontario, Canada; An Interrupted Time Series Analysis. Open Forum Infect Dis 2021; 8:ofab533. [PMID: 34805442 PMCID: PMC8601042 DOI: 10.1093/ofid/ofab533] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has potentially impacted outpatient antibiotic prescribing. Investigating this impact may identify stewardship opportunities in the ongoing COVID-19 period and beyond. Methods We conducted an interrupted time series analysis on outpatient antibiotic prescriptions and antibiotic prescriptions/patient visits in Ontario, Canada, between January 2017 and December 2020 to evaluate the impact of the COVID-19 pandemic on population-level antibiotic prescribing by prescriber specialty, patient demographics, and conditions. Results In the evaluated COVID-19 period (March–December 2020), there was a 31.2% (95% CI, 27.0% to 35.1%) relative reduction in total antibiotic prescriptions. Total outpatient antibiotic prescriptions decreased during the COVID-19 period by 37.1% (95% CI, 32.5% to 41.3%) among family physicians, 30.7% (95% CI, 25.8% to 35.2%) among subspecialist physicians, 12.1% (95% CI, 4.4% to 19.2%) among dentists, and 25.7% (95% CI, 21.4% to 29.8%) among other prescribers. Antibiotics indicated for respiratory infections decreased by 43.7% (95% CI, 38.4% to 48.6%). Total patient visits and visits for respiratory infections decreased by 10.7% (95% CI, 5.4% to 15.6%) and 49.9% (95% CI, 43.1% to 55.9%). Total antibiotic prescriptions/1000 visits decreased by 27.5% (95% CI, 21.5% to 33.0%), while antibiotics indicated for respiratory infections/1000 visits with respiratory infections only decreased by 6.8% (95% CI, 2.7% to 10.8%). Conclusions The reduction in outpatient antibiotic prescribing during the COVID-19 pandemic was driven by less antibiotic prescribing for respiratory indications and largely explained by decreased visits for respiratory infections.
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Affiliation(s)
- Taito Kitano
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Kevin A Brown
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Derek R MacFadden
- ICES, Toronto, Ontario, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Valerie Leung
- Public Health Ontario, Toronto, Ontario, Canada.,Toronto East Health Network, Michael Garron Hospital, Toronto, Ontario, Canada
| | - Miranda So
- Sinai Health System-University Health Network Antimicrobial Stewardship Program, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Leung
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Unity Health Toronto, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Lori Burrows
- Department of Biochemistry and Biomedical Sciences and the Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
| | - Douglas Manuel
- ICES, Toronto, Ontario, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Dawn M E Bowdish
- Michael DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Colleen J Maxwell
- ICES, Toronto, Ontario, Canada.,Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada
| | - James I Brooks
- Public Health Agency of Canada, Ottawa, Ontario, Canada.,Division of Infectious Diseases, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin L Schwartz
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Unity Health Network, St. Joseph Health Centre, Toronto, Ontario, Canada
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Thompson W, Sandoe J, Pavitt S, Walsh T, Byrne-Davis L. Co-Developing an Antibiotic Stewardship Tool for Dentistry: Shared Decision-Making for Adults with Toothache or Infection. Antibiotics (Basel) 2021; 10:antibiotics10111345. [PMID: 34827283 PMCID: PMC8615064 DOI: 10.3390/antibiotics10111345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
Dentistry is responsible for around 10% of antibiotic prescribing across global healthcare, with up to 80% representing inappropriate use. Facilitating shared decision-making has been shown to optimise antibiotic prescribing (antibiotic stewardship) in primary medical care. Our aim was to co-develop a shared decision-making antibiotic stewardship tool for dentistry. Dentists, patients and other stakeholders prioritised factors to include in the new tool, based on previous research (a systematic review and ethnographic study) about dentists’ decision-making during urgent appointments. Candidate behaviour-change techniques were identified using the Behaviour Change Wheel and selected based on suitability for a shared decision-making approach. A ‘think aloud’ study helped fine-tune the tool design and Crystal Marking ensured clarity of messaging. The resulting paper-based worksheet for use at point-of-care incorporated various behaviour change techniques, such as: ’information about (and salience of) health consequences’, ‘prompts and cues’, ‘restructuring the physical (and social) environment’ and ‘credible sources’. The think aloud study confirmed the tool’s acceptability to dentists and patients, and resulted in the title: ‘Step-by-step guide to fixing your toothache.’ Further testing will be necessary to evaluate its efficacy at safely reducing dental antibiotic prescribing during urgent dental appointments in England and, with translation, to other dental contexts globally.
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Affiliation(s)
- Wendy Thompson
- Division of Dentistry, University of Manchester, Manchester M13 9PL, UK;
- School of Dentistry, University of Leeds, Leeds LS2 9JT, UK;
- Correspondence: ; Tel.: +44-7837-190-387
| | | | - Sue Pavitt
- School of Dentistry, University of Leeds, Leeds LS2 9JT, UK;
| | - Tanya Walsh
- Division of Dentistry, University of Manchester, Manchester M13 9PL, UK;
| | - Lucie Byrne-Davis
- Division of Medical Education, University of Manchester, Manchester M13 9PL, UK;
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