1
|
Penner LS, Armitage CJ, Thornley T, Whelan P, Chuter A, Allen T, Elliott RA. What affected UK adults' adherence to medicines during the COVID-19 pandemic? Cross-sectional survey in a representative sample of people with long-term conditions. Z Gesundh Wiss 2023; 32:1-14. [PMID: 36691578 PMCID: PMC9849112 DOI: 10.1007/s10389-022-01813-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/19/2022] [Indexed: 01/20/2023]
Abstract
Aim Medicines non-adherence is associated with poorer outcomes and higher costs. COVID-19 affected access to healthcare, with increased reliance on remote methods, including medicines supply. This study aimed to identify what affected people's adherence to medicines for long-term conditions (LTCs) during the pandemic. Subject and methods Cross-sectional online survey of UK adults prescribed medicines for LTCs assessing self-reported medicines adherence, reasons for non-adherence (using the capability, opportunity and motivation model of behaviour [COM-B]), medicines access and COVID-19-related behaviours. Results The 1746 respondents reported a mean (SD) of 2.5 (1.9) LTCs, for which they were taking 2.4 (1.9) prescribed medicines, 525 (30.1%) reported using digital tools to support ordering or taking medicines and 22.6% reported medicines non-adherence. No access to at least one medicine was reported by 182 (10.4%) respondents; 1048 (60.0%) reported taking at least one non-prescription medicine as a substitute; 409 (23.4%) requested emergency supply from pharmacy for at least one medicine. Problems accessing medicines, being younger, male, in the highest socioeconomic group and working were linked to poorer adherence. Access problems were mostly directly or indirectly related to the COVID-19 pandemic. Respondents were generally lacking in capabilities and opportunities, but disruptions to habits (automatic motivation) was the major reason for non-adherence. Conclusion Navigating changes in how medicines were accessed, and disruption of habits during the COVID-19 pandemic, was associated with suboptimal adherence. People were resourceful in overcoming barriers to access. Solutions to support medicines-taking need to take account of the multiple ways that medicines are prescribed and supplied remotely. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01813-0.
Collapse
Affiliation(s)
- L. S. Penner
- Janssen-Cilag GmbH, Johnson & Johnson Platz 1, 41470 Neuss, Germany
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 4th Floor, Jean McFarlane Building, Manchester, M13 9PL UK
| | - C. J. Armitage
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Coupland Building 1, Manchester, M13 9PL; Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, M13 9PT; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Coupland Building 1, Manchester, M13 9PL UK
| | - T. Thornley
- School of Pharmacy, University of Nottingham, University Park, Nottingham, NG7 2RD UK
| | - P. Whelan
- Digital Health Technical Lead, Centre for Health Informatics, Division of Informatics, Imaging and Data Science| School of Health Sciences | Faculty of Biology, Medicine and Health, University of Manchester, Vaughan House, Manchester, M13 9PL UK
| | - A. Chuter
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 4th Floor, Jean McFarlane Building, Manchester, M13 9PL UK
| | - T. Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 4th Floor, Jean McFarlane Building, Manchester, M13 9PL UK
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - R. A. Elliott
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 4th Floor, Jean McFarlane Building, Manchester, M13 9PL UK
| |
Collapse
|
2
|
Bradley DT, Murphy S, McWilliams P, Arnold S, Lavery S, Murphy J, de Lusignan S, Hobbs R, Tsang RSM, Akbari A, Torabi F, Beggs J, Chuter A, Shi T, Vasileiou E, Robertson C, Sheikh A, Reid H, O'Reilly D. Investigating the association between COVID-19 vaccination and care home outbreak frequency and duration. Public Health 2022; 203:110-115. [PMID: 35038629 PMCID: PMC8683272 DOI: 10.1016/j.puhe.2021.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES At the end of 2020, many countries commenced a vaccination programme against SARS-CoV-2. Public health authorities aim to prevent and interrupt outbreaks of infectious disease in social care settings. We aimed to investigate the association between the introduction of the vaccination programme and the frequency and duration of COVID-19 outbreaks in Northern Ireland (NI). STUDY DESIGN We undertook an ecological study using routinely available national data. METHODS We used Poisson regression to measure the relationship between the number of RT-PCR confirmed COVID-19 outbreaks in care homes, and as a measure of community COVID-19 prevalence, the Office for National Statistics COVID-19 Infection Survey estimated the number of people testing positive for COVID-19 in NI. We estimated the change in this relationship and estimated the expected number of care home outbreaks in the absence of the vaccination programme. A Cox proportional hazards model estimated the hazard ratio of a confirmed COVID-19 care home outbreak closure. RESULTS Care home outbreaks reduced by two-thirds compared to expected following the introduction of the vaccination programme, from a projected 1625 COVID-19 outbreaks (95% prediction interval 1553-1694) between 7 December 2020 and 28 October 2021 to an observed 501. We estimated an adjusted hazard ratio of 2.53 of the outbreak closure assuming a 21-day lag for immunity. CONCLUSIONS These findings describe the association of the vaccination with a reduction in outbreak frequency and duration across NI care homes. This indicates probable reduced harm and disruption from COVID-19 in social care settings following vaccination. Future research using individual level data from care home residents will be needed to investigate the effectiveness of the vaccines and the duration of their effects.
Collapse
Affiliation(s)
- D T Bradley
- Public Health Agency, Belfast, UK; Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - S Murphy
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | | | - S Arnold
- Public Health Agency, Belfast, UK
| | - S Lavery
- Public Health Agency, Belfast, UK
| | - J Murphy
- Public Health Agency, Belfast, UK
| | - S de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R Hobbs
- Nuffield Department of Health Care Sciences, University of Oxford, Oxford, UK
| | - R S M Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - A Akbari
- Population Data Science and Health Data Research UK, Swansea University, Swansea, UK
| | - F Torabi
- Population Data Science, Swansea University Medical School, UK
| | - J Beggs
- BREATHE- The Health Data Research Hub For Respiratory Health, UK
| | - A Chuter
- BREATHE- The Health Data Research Hub For Respiratory Health, UK
| | - T Shi
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E Vasileiou
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - C Robertson
- Public Health Scotland, UK; University of Strathclyde, Glasgow, UK
| | - A Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK; BREATHE- The Health Data Research Hub For Respiratory Health, UK
| | - H Reid
- Public Health Agency, Belfast, UK
| | - D O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| |
Collapse
|
3
|
Simpson CR, Shi T, Vasileiou E, Katikireddi SV, Kerr S, Moore E, McCowan C, Agrawal U, Shah SA, Ritchie LD, Murray J, Pan J, Bradley DT, Stock SJ, Wood R, Chuter A, Beggs J, Stagg HR, Joy M, Tsang RSM, de Lusignan S, Hobbs R, Lyons RA, Torabi F, Bedston S, O’Leary M, Akbari A, McMenamin J, Robertson C, Sheikh A. First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland. Nat Med 2021; 27:1290-1297. [PMID: 34108714 PMCID: PMC8282499 DOI: 10.1038/s41591-021-01408-4] [Citation(s) in RCA: 171] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
Reports of ChAdOx1 vaccine-associated thrombocytopenia and vascular adverse events have led to some countries restricting its use. Using a national prospective cohort, we estimated associations between exposure to first-dose ChAdOx1 or BNT162b2 vaccination and hematological and vascular adverse events using a nested incident-matched case-control study and a confirmatory self-controlled case series (SCCS) analysis. An association was found between ChAdOx1 vaccination and idiopathic thrombocytopenic purpura (ITP) (0-27 d after vaccination; adjusted rate ratio (aRR) = 5.77, 95% confidence interval (CI), 2.41-13.83), with an estimated incidence of 1.13 (0.62-1.63) cases per 100,000 doses. An SCCS analysis confirmed that this was unlikely due to bias (RR = 1.98 (1.29-3.02)). There was also an increased risk for arterial thromboembolic events (aRR = 1.22, 1.12-1.34) 0-27 d after vaccination, with an SCCS RR of 0.97 (0.93-1.02). For hemorrhagic events 0-27 d after vaccination, the aRR was 1.48 (1.12-1.96), with an SCCS RR of 0.95 (0.82-1.11). A first dose of ChAdOx1 was found to be associated with small increased risks of ITP, with suggestive evidence of an increased risk of arterial thromboembolic and hemorrhagic events. The attenuation of effect found in the SCCS analysis means that there is the potential for overestimation of the reported results, which might indicate the presence of some residual confounding or confounding by indication. Public health authorities should inform their jurisdictions of these relatively small increased risks associated with ChAdOx1. No positive associations were seen between BNT162b2 and thrombocytopenic, thromboembolic and hemorrhagic events.
Collapse
Affiliation(s)
- C. R. Simpson
- grid.267827.e0000 0001 2292 3111School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand ,grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - T. Shi
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E. Vasileiou
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - S. V. Katikireddi
- grid.8756.c0000 0001 2193 314XMRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S. Kerr
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E. Moore
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - C. McCowan
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St. Andrews, St. Andrews, UK
| | - U. Agrawal
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St. Andrews, St. Andrews, UK
| | - S. A. Shah
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - L. D. Ritchie
- grid.7107.10000 0004 1936 7291Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - J. Murray
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - J. Pan
- grid.11984.350000000121138138Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - D. T. Bradley
- grid.4777.30000 0004 0374 7521Queen’s University Belfast, Belfast, UK ,grid.454053.30000 0004 0494 5490Public Health Agency, Belfast, Northern Ireland
| | - S. J. Stock
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - R. Wood
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK ,grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - A. Chuter
- grid.507332.0Health Data Research UK, BREATHE Hub, Edinburgh, UK
| | - J. Beggs
- grid.507332.0Health Data Research UK, BREATHE Hub, Edinburgh, UK
| | - H. R. Stagg
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - M. Joy
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R. S. M. Tsang
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - S. de Lusignan
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R. Hobbs
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R. A. Lyons
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - F. Torabi
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - S. Bedston
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - M. O’Leary
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - A. Akbari
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - J. McMenamin
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - C. Robertson
- grid.508718.3Public Health Scotland, Glasgow, Scotland ,grid.11984.350000000121138138Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - A. Sheikh
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK ,grid.507332.0Health Data Research UK, BREATHE Hub, Edinburgh, UK
| |
Collapse
|