scholarly journals Assessing the impact of SIGN 136 on opioid prescribing rates in Scotland: An interrupted time series analysis

2021 ◽  
Author(s):  
Harry L. Hébert ◽  
Daniel R. Morales ◽  
Nicola Torrance ◽  
Blair H. Smith ◽  
Lesley A. Colvin
Keyword(s):  
Chronic Pain ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Relative Reduction ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Opioid Prescribing ◽  
Prescribing Trends ◽  
The Impact

AbstractBackgroundOpioids are used to treat patients with chronic pain, but their long-term use is associated with harms. In December 2013, SIGN 136 was published, providing a comprehensive evidence-based guideline for the assessment and management of chronic pain in ScotlandAimsThis study aimed to examine the impact of SIGN 136 on opioid prescribing trends and costs across the whole of Scotland.MethodsOpioid prescribing data and average cost per item were obtained from Public Health Scotland. An interrupted time series analysis examined the effects of SIGN 136 publication on the number of items prescribed per 1,000 population per quarter for 29 opioids (or opioid-containing combinations) from 2005 to 2019 inclusive. Exploratory analysis was conducted in NHS Tayside and NHS Fife combined and then up-scaled to all 14 NHS Scotland health boards. A similar approach was also used to assess the effect of SIGN 136 on estimated gross ingredient costs per quarter.ResultsAt six years post-intervention there was a relative reduction in opioid prescribing of 18.8% (95% CI: 16.0-21.7) across Scotland. There was also a relative reduction of 22.8% (95%: 14.9-30.1) in gross ingredient cost nationally. Opioid prescribing increased significantly pre-intervention across all 14 NHS Scotland health boards (2.19 items per 1000 population per quarter), followed by a non-significant change in level and a significant negative change in trend post-intervention (−2.69 items per 1000 population per quarter). Similar findings were observed locally in NHS Tayside and NHS Fife.ConclusionsThe publication of SIGN 136 coincided with a statistically significant reduction in opioid prescribing rates in Scotland and suggests that changes in clinical policy are having a positive effect on prescribing practices in primary care. These prescribing trends appear to be in contrast to the UK as a whole.

scholarly journals The impact of COVID-19 on outpatient antibiotic prescriptions in Ontario, Canada; An interrupted time series analysis

2021 ◽  
Author(s):  
Taito Kitano ◽  
Kevin A Brown ◽  
Nick Daneman ◽  
Derek R MacFadden ◽  
Bradley J Langford ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Respiratory Infections ◽  
Population Level ◽  
Interrupted Time Series ◽  
Relative Reduction ◽  
Antibiotic Prescribing ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
The Impact

Abstract Background The 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’s specialty, patient demographics and conditions. Results In the evaluated COVID-19 period (March-December 2020), there was a 31.2% [95% CI: 27.0%–35.1%] relative reduction in total antibiotic prescriptions. Total outpatient antibiotic prescriptions decreased during the COVID-19 period by 37.1% [32.5%–41.3%] among family physicians, 30.7% [25.8%–35.2%] among sub-specialist physicians, 12.1% [4.4%–19.2%] among dentists and 25.7% [21.4%–29.8%] among other prescribers. Antibiotics indicated for respiratory infections decreased by 43.7% [38.4–48.6%]. Total patient visits and visits for respiratory infections decreased by 10.7% [5.4%–15.6%] and 49.9% [43.1%%–55.9%]). Total antibiotic prescriptions/1,000 visits decreased by 27.5% [21.5%–33.0%], while antibiotics indicated for respiratory infections/1,000 visits with respiratory infections only decreased by 6.8% [2.7%–10.8%]. Conclusion 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.

scholarly journals The impact of stringent prescription-only antimicrobial sale regulation (Schedule H1) in India: an interrupted time series analysis, 2008–18

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Habib Hasan Farooqui ◽  
Sakthivel Selvaraj ◽  
Aashna Mehta ◽  
Manu Raj Mathur
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Private Sector ◽  
Positive Impact ◽  
Interrupted Time Series ◽  
Control Group ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Series Analysis ◽  
The Impact

Abstract Objectives To assess the impact of Schedule H1 regulation notified and implemented in 2014 under the amended rules of the Drugs and Cosmetics Act (DCA), 1940 on the sale of antimicrobials in the private sector in India. Methods The dataset was obtained from the Indian pharmaceutical sales database, PharmaTrac. The outcome measure was the sales volume of antimicrobials in standard units (SUs). A quasi-experimental research design—interrupted time series analysis—was used to detect the impact of the intervention. Results We observed a substantial rise in antimicrobial consumption during 2008–18 in the private sector in India, both for antimicrobials regulated under Schedule H1 as well as outside the regulation. Key results suggested that post-intervention there was an immediate reduction (level change) in use of Schedule H1 antimicrobials by 10% (P = 0.007), followed by a sustained decline (trend change) in utilization by 9% (P > 0.000) compared with the pre-intervention trend. Segregated analysis on different antimicrobial classes suggests a sharp drop (level changes) and sustained decline (trend changes) in utilization post-intervention compared with the pre-intervention trend. Our findings remained robust on carrying out sensitivity analysis with the oral anti-diabetics market as a control. Post-intervention, the average monthly difference between antimicrobials under Schedule H1 and the control group witnessed an immediate increase of 16.3% (P = 0.10) followed by a sustained reduction of 0.5% (P = 0.13) compared with the pre-intervention scenario. Conclusions Though the regulation had a positive impact in terms of reducing sales of antimicrobials notified under the regulation, optimizing the effectiveness of such stand-alone policies will be limited unless accompanied by a broader set of interventions.

Eradication of Staphylococcus aureus post-sternotomy mediastinitis following the implementation of universal pre-operative nasal decontamination with mupirocin: an interrupted time-series analysis

2021 ◽  
Author(s):  
Rafael San-Juan ◽  
Consuelo Alejandra Gotor-Pérez ◽  
Francisco López-Medrano ◽  
Mario Fernández-Ruiz ◽  
David Lora ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Relative Reduction ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Series Analysis

Abstract Background Although pre-surgical nasal decontamination with mupirocin (NDM) has been advocated as a measure for preventing post-surgical mediastinitis (PSM) due to Staphylococcus aureus, this strategy is not universally recommended due to the lack of robust supporting evidence. We aimed to evaluate the role of pre-operative NDM in the annual incidence of S. aureus PSM at our institution. Methods An interrupted time-series analysis, with autoregressive error model, was applied to our single-center cohort by comparing pre-intervention (1990-2003) and post-intervention period (2005 to 2018). Logistic regression was performed to analyze risk factors for S. aureus PSM. Findings 12,236 sternotomy procedures were analyzed (6,370 [52.1%] and 5,866 [47.9%] in the pre-intervention and post-intervention periods, respectively). The mean annual percentage adherence to NDM estimated over the post-interventional period was 90.2%. Only four out of 127 total cases of S. aureus PSM occurred during the 14-years post-intervention period (0.68/1,000 sternotomies vs. 19.31/1,000 in pre-interventional period [p<0.0001]). Interrupted time-series analysis demonstrated a statistically significant annual reduction of S. aureus PSM trend of –9.85 cases per 1,000 sternotomies (-13.17 to -6.5, P-value< 0·0001) in 2005, with a decreasing trend maintained over the following five years with an estimated relative reduction of 84.8% (95% CI: 89·25 to 74·09). Chronic obstructive pulmonary disease was the single independent risk factor for S. aureus PSM (odds ratio: 3.7; 95% CI: 1.72-7.93) and was equally distributed in patients undergoing sternotomy during pre or post-intervention periods. Interpretation Our experience suggests that the implementation of pre-operative NDM reduces significantly the incidence of S. aureus PSM.

scholarly journals Does admission prevalence change after reconfiguration of inpatient services? An interrupted time series analysis of the impact of reconfiguration in five centres

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joanne Martin ◽  
Edwin Amalraj Raja ◽  
Steve Turner
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Emergency Admission ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Emergency Admissions ◽  
Series Analysis ◽  
Inpatient Services ◽  
The Impact ◽  
Admission Prevalence

Abstract Background Service reconfiguration of inpatient services in a hospital includes complete and partial closure of all emergency inpatient facilities. The “natural experiment” of service reconfiguration may give insight into drivers for emergency admissions to hospital. This study addressed the question does the prevalence of emergency admission to hospital for children change after reconfiguration of inpatient services? Methods There were five service reconfigurations in Scottish hospitals between 2004 and 2018 where emergency admissions to one “reconfigured” hospital were halted (permanently or temporarily) and directed to a second “adjacent” hospital. The number of emergency admissions (standardised to /1000 children in the regional population) per month to the “reconfigured” and “adjacent” hospitals was obtained for five years prior to reconfiguration and up to five years afterwards. An interrupted time series analysis considered the association between reconfiguration and admissions across pairs comprised of “reconfigured” and “adjacent” hospitals, with adjustment for seasonality and an overall rising trend in admissions. Results Of the five episodes of reconfiguration, two were immediate closure, two involved closure only to overnight admissions and one with overnight closure for a period and then closure. In “reconfigured” hospitals there was an average fall of 117 admissions/month [95% CI 78, 156] in the year after reconfiguration compared to the year before, and in “adjacent” hospitals admissions rose by 82/month [32, 131]. Across paired reconfigured and adjacent hospitals, in the months post reconfiguration, the overall number of admissions to one hospital pair slowed, in another pair admissions accelerated, and admission prevalence was unchanged in three pairs. After reconfiguration in one hospital, there was a rise in admissions to a third hospital which was closer than the named “adjacent” hospital. Conclusions There are diverse outcomes for the number of emergency admissions post reconfiguration of inpatient facilities. Factors including resources placed in the community after local reconfiguration, distance to the “adjacent” hospital and local deprivation may be important drivers for admission pathways after reconfiguration. Policy makers considering reconfiguration might consider a number of factors which may be important determinants of admissions post reconfiguration.

Recession and risk of suicide in Denmark during the 2009 global financial crisis: an ecological register-based study

2021 ◽  
pp. 140349482110132
Author(s):  
Agnieszka Konieczna ◽  
Sarah Grube Jakobsen ◽  
Christina Petrea Larsen ◽  
Erik Christiansen
Keyword(s):  
Time Series ◽  
Financial Crisis ◽  
Time Series Analysis ◽  
Suicide Rate ◽  
Global Financial Crisis ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Prevention Programmes ◽  
The Impact

Aim: The aim of this study is to analyse the potential impact from the financial crisis (onset in 2009) on suicide rates in Denmark. The hypothesis is that the global financial crisis raised unemployment which leads to raising the suicide rate in Denmark and that the impact is most prominent in men. Method: This study used an ecological study design, including register data from 2001 until 2016 on unemployment, suicide, gender and calendar time which was analysed using Poisson regression models and interrupted time series analysis. Results: The correlation between unemployment and suicide rates was positive in the period and statistically significant for all, but at a moderate level. A dichotomised version of time (calendar year) showed a significant reduction in the suicide rate for women (incidence rate ratio 0.87, P=0.002). Interrupted time series analysis showed a significant decreasing trend for the overall suicide rate and for men in the pre-recession period, which in both cases stagnated after the onset of recession in 2009. The difference between the genders’ suicide rate changed significantly at the onset of recession, as the rate for men increased and the rate for women decreased. Discussion: The Danish social welfare model might have prevented social disintegration and suicide among unemployed, and suicide prevention programmes might have prevented deaths among unemployed and mentally ill individuals. Conclusions: We found some indications for gender-specific differences from the impact of the financial crises on the suicide rate. We recommend that men should be specifically targeted for appropriate prevention programmes during periods of economic downturn.

scholarly journals Interrupted time series analysis of the impact of a bundle on surgical site infections after colon surgery

2021 ◽  
Author(s):  
Costanza Vicentini ◽  
Alessandro Scacchi ◽  
Alessio Corradi ◽  
Noemi Marengo ◽  
Maria Francesca Furmenti ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Surgical Site Infections ◽  
Interrupted Time Series ◽  
Colon Surgery ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
The Impact

scholarly journals Impact of Removal of Automatic 7-Day Stop Orders for Inpatient Antimicrobials

2020 ◽  
Vol 41 (S1) ◽  
pp. s264-s265
Author(s):  
Afia Adu-Gyamfi ◽  
Keith Hamilton ◽  
Leigh Cressman ◽  
Ebbing Lautenbach ◽  
Lauren Dutcher
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Treatment Interruptions ◽  
Days Of Therapy ◽  
Quasi Experimental ◽  
The Impact

Background: Automatic discontinuation of antimicrobial orders after a prespecified duration of therapy has been adopted as a strategy for reducing excess days of therapy (DOT) as part of antimicrobial stewardship efforts. Automatic stop orders have been shown to decrease antimicrobial DOT. However, inadvertent treatment interruptions may occur as a result, potentially contributing to adverse patient outcomes. To evaluate the effects of this practice, we examined the impact of the removal of an electronic 7-day ASO program on hospitalized patients. Methods: We performed a quasi-experimental study on inpatients in 3 acute-care academic hospitals. In the preintervention period (automatic stop orders present; January 1, 2016, to February 28, 2017), we had an electronic dashboard to identify and intervene on unintentionally missed doses. In the postintervention period (April 1, 2017, to March 31, 2018), the automatic stop orders were removed. We compared the primary outcome, DOT per 1,000 patient days (PD) per month, for patients in the automatic stop orders present and absent periods. The Wilcoxon rank-sum test was used to compare median monthly DOT/1,000 PD. Interrupted time series analysis (Prais-Winsten model) was used to compared trends in antibiotic DOT/1,000 PD and the immediate impact of the automatic stop order removal. Manual chart review on a subset of 300 patients, equally divided between the 2 periods, was performed to assess for unintentionally missed doses. Results: In the automatic stop order period, a monthly median of 644.5 antibiotic DOT/1,000 PD were administered, compared to 686.2 DOT/1,000 PD in the period without automatic stop orders (P < .001) (Fig. 1). Using interrupted time series analysis, there was a nonsignificant increase by 46.7 DOT/1,000 PD (95% CI, 40.8 to 134.3) in the month immediately following removal of automatic stop orders (P = .28) (Fig. 2). Even though the slope representing monthly change in DOT/1,000 PD increased in the period without automatic stop orders compared to the period with automatic stop orders, it was not statistically significant (P = .41). Manual chart abstraction revealed that in the period with automatic stop orders, 9 of 150 patients had 17 unintentionally missed days of therapy, whereas none (of 150 patients) in the period without automatic stop orders did. Conclusions: Following removal of the automatic stop orders, there was an overall increase in antibiotic use, although the change in monthly trend of antibiotic use was not significantly different. Even with a dashboard to identify missed doses, there was still a risk of unintentionally missed doses in the period with automatic stop orders. Therefore, this risk should be weighed against the modest difference in antibiotic utilization garnered from automatic stop orders.Funding: NoneDisclosures: None

Sign in / Sign up

Export Citation Format

Share Document