Changes in dispensing of medicines proposed for re-purposing in the first year of the COVID-19 pandemic in Australia

AbstractPurposeWe quantified changes in dispensing of common medicines proposed for “re-purposing” due to their perceived benefits as therapeutic or preventive treatments for COVID-19 in Australia, a country with relatively low COVID-19 incidence in 2020.MethodsWe performed an interrupted time series analysis and cross-sectional study using nationwide dispensing claims data (January 2017-November 2020). We focused on six subsidised medicines proposed for re-purposing: hydroxychloroquine, azithromycin, ivermectin, colchicine, corticosteroids, and calcitriol (Vitamin D analogue). We quantified changes in monthly dispensing and initiation trends during COVID-19 (March-November 2020) using autoregressive integrated moving average models (ARIMA) and compared characteristics of initiators in 2020 and 2019.ResultIn March 2020, we observed a 99% (95%CI 96%-103%) increase in hydroxychloroquine dispensing (of which approximately 30% attributable to new use), and a 201% increase (95%CI 186%-215%) in initiation, with a shift towards prescribing by general practitioners (42% in 2020 vs 25% in 2019) rather than specialists. These increases subsidised following regulatory restrictions on prescribing to relevant specialties. There was also a small but sustained increase in ivermectin dispensing over multiple months, with a 80% (95%CI 42%-119%) increase in initiation in May 2020 following its first identification as potentially disease-modifying in April 2020. Other than increases in March related to stockpiling among existing users, we observed no increases in initiation of calcitriol or colchicine during COVID-19. Dispensing of corticosteroids and azithromycin remained low after March 2020.ConclusionsMost increases in dispensing observed early on during COVID-19 were temporary and appear to be related to stockpiling among existing users. However, we observed increases in initiation of hydroxychloroquine and ivermectin and a shift in prescribing patterns, indicating that a small proportion may be COVID-19 related. A quick response by regulators can help limit inappropriate repurposing to lessen the impact on medicine supply and patient harms.Key pointsIn Australia, a country with low incidence of COVID-19 in 2020, most increases in dispensing of medicines proposed for re-purposing for treatment or prevention of COVID-19 were temporary and appeared to be related to stockpiling among existing usersWe observed a dramatic increase in new users of hydroxychloroquine in March and April 2020, with a shift toward prescribing by general practitioners instead of rheumatologists which subsided after the introduction of restrictions on its prescribing by non-specialistsDispensing of ivermectin also increased during COVID-19, but occurred later and was spread out over several monthsWhen such situations arise, a quick response by regulators can help limit inappropriate repurposing to reduce the potential for medicine supply shortages and patient harms

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General practitioners’ predictions of their own patients’ health literacy: a cross-sectional study in Belgium

BMJ Open ◽

10.1136/bmjopen-2019-029357 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029357

Author(s):

Hannelore Storms ◽

Bert Aertgeerts ◽

Frank Vandenabeele ◽

Neree Claes

Keyword(s):

Health Literacy ◽

General Practitioners ◽

Cross Sectional Study ◽

Kappa Statistics ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Adequate Health Literacy ◽

General Practices ◽

Patient Relationships ◽

The Impact

ObjectivesTo support patients in their disease management, providing information that is adjusted to patients’ knowledge and ability to process health information (ie, health literacy) is crucial. To ensure effective health communication, general practitioners (GPs) should be able to identify people with limited health literacy. To this end, (dis)agreement between patients’ health literacy and GPs’ estimations thereof was examined. Also, characteristics impacting health literacy (dis)agreement were studied.DesignCross-sectional survey of general practice patients and GPs undertaken in 2016–17.SettingForty-one general practices in two Dutch-speaking provinces in Belgium.ParticipantsPatients (18 years of age and older) visiting general practices. Patients were excluded when having severe impairments (physical, mental, sensory).Main outcome measuresPatients’ health literacy was assessed with 16-item European Health Literacy Survey Questionnaire. GPs indicated estimations on patients’ health literacy using a simple scale (inadequate; problematic; adequate). (Dis)agreement between patients’ health literacy and GPs’ estimations thereof (GPs’ estimations being equal to/higher/lower than patients’ health literacy) was measured using Kappa statistics. The impact of patient and GP characteristics, including duration of GP–patient relationships, on this (dis)agreement was examined using generalised linear logit model.ResultsHealth literacy of patients (n=1375) was inadequate (n=201; 14.6%), problematic (n=299; 21.7%), adequate (n=875; 63.6%). GPs overestimated the proportion patients with adequate health literacy: adequate (n=1241; 90.3%), problematic (n=130; 9.5%) and inadequate (n=4; 0.3%). Overall, GPs’ correct; over-/underestimations of health literacy occurred for, respectively, 60.9%; 34.2%; 4.9% patients, resulting in a slight agreement (κ=0.033). The likelihood for GPs to over-/underestimate patients’ health literacy increases with decreasing educational level of patients; and decreasing number of years patients have been consulting with their GP.ConclusionsIntuitively assessing health literacy is difficult. Patients’ education, the duration of GP–patient relationships and GPs’ gender impact GPs’ perceptions of patients’ health literacy.

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Impact of the national protocol for malaria treatment on prescribing patterns in Gezira state, Sudan

Eastern Mediterranean Health Journal ◽

10.26719/2004.10.4-5.566 ◽

2004 ◽

Vol 10 (4-5) ◽

pp. 566-572

Author(s):

M. E. Ahmed ◽

M. A. Yousif

Keyword(s):

Cross Sectional Study ◽

Malaria Treatment ◽

Prescribing Patterns ◽

Cross Sectional ◽

Negative Attitudes ◽

Medical Assistants ◽

Supervision Training ◽

Central Sudan ◽

The Impact

A cross-sectional study to assess the impact of the national protocol for malaria treatment was conducted in a town in Gezira state, central Sudan, in 2001. Most of the 165 doctors and medical assistants interviewed [80.0%] had not been trained in the protocol and many [57.5%] were still using their own protocols. Analysis of 410 prescriptions showed chloroquine was the most common antimalarial drug used [69.5% of prescriptions]. Compared with a study before implementation of the protocol, more prescriptions met the protocol st and ards for correct chloroquine dose, whereas regimens for administration of intravenous quinine were still inadequate. The study showed a lack of continuous supervision, training and follow-up in the protocol guidelines and negative attitudes of hospital specialists towards the protocol

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Evaluating the early impacts of delisting high-strength opioids on patterns of prescribing in Ontario

Health Promotion and Chronic Disease Prevention in Canada ◽

10.24095/hpcdp.38.6.07 ◽

2018 ◽

Vol 38 (6) ◽

pp. 256-262 ◽

Cited By ~ 6

Author(s):

Qi Guan ◽

Wayne Khuu ◽

Diana Martins ◽

Mina Tadrous ◽

Maria Chiu ◽

...

Keyword(s):

Palliative Care ◽

Moving Average ◽

High Strength ◽

Population Based ◽

Cross Sectional Study ◽

Prescribing Patterns ◽

Cross Sectional ◽

The Public ◽

Long Acting ◽

Public Drug

Introduction Ontario delisted high-strength fentanyl, hydromorphone and morphine from the public drug formulary for non-palliative care prescribers on 31 January, 2017. Our aim is to assess the early impact of this policy on prescribing patterns and to examine whether this impact varied by prescriber type, opioid type and opioid strength. Methods We conducted a population-based, cross-sectional study on palliative and non-palliative care patients dispensed fentanyl, hydromorphone or morphine through the Ontario public drug program between 1 January, 2014, and 31 July, 2017. For each month during the study period, we reported the total number of high-strength opioid recipients stratified by prescriber type, and the total volume of each drug dispensed, stratified by strength. We used interventional autoregressive integrated moving average (ARIMA) models to assess the policy’s impact on prescribing patterns. Results We observed a 98% decrease in the total number of publicly funded recipients of high-strength opioids between December 2016 and July 2017 (5930 to 133 recipients) for all prescribers. The policy led to a significant decline in the total volume of all three opioids dispensed: hydromorphone from 20 374 621 to 16 952 097 mg (p $lt; .01); morphine from 40 644 190 to 33 555 480 mg (p $lt; .03); and fentanyl from 9 604 913 to 5 842 405 mcg/h (p $lt; .01). For both fentanyl and hydromorphone, this reduction generally corresponded to an increase in the number of low-strength opioids dispensed. Conclusion Delisting high-strength opioids substantially reduced the number of highstrength opioid recipients and reduced the overall volume of long-acting opioids dispensed in Ontario through the public drug program. Future studies should examine its impact on patient outcomes.

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Multidisciplinary team decision is rare and decreasing in percutaneous vascular interventions despite positive impact on in-hospital outcomes

VASA ◽

10.1024/0301-1526/a000771 ◽

2019 ◽

Vol 48 (3) ◽

pp. 262-269 ◽

Cited By ~ 3

Author(s):

Christian-Alexander Behrendt ◽

Tilo Kölbel ◽

Thea Schwaneberg ◽

Holger Diener ◽

Ralf Hohnhold ◽

...

Keyword(s):

Multidisciplinary Team ◽

Positive Impact ◽

Cross Sectional Study ◽

Invasive Treatment ◽

Cross Sectional ◽

Hospital Outcomes ◽

Vascular Intervention ◽

Medical Specialties ◽

Team Decision ◽

The Impact

Abstract. Background: Worldwide prevalence of peripheral artery disease (PAD) is increasing and peripheral vascular intervention (PVI) has become the primary invasive treatment. There is evidence that multidisciplinary team decision-making (MTD) has an impact on in-hospital outcomes. This study aims to depict practice patterns and time changes regarding MTD of different medical specialties. Methods: This is a retrospective cross-sectional study design. 20,748 invasive, percutaneous PVI of PAD conducted in the metropolitan area of Hamburg (Germany) were consecutively collected between January 2004 and December 2014. Results: MTD prior to PVI was associated with lower odds of early unsuccessful termination of the procedures (Odds Ratio 0.662, p < 0.001). The proportion of MTD decreased over the study period (30.9 % until 2009 vs. 16.6 % from 2010, p < 0.001) while rates of critical limb-threatening ischemia (34.5 % vs. 42.1 %), patients´ age (70 vs. 72 years), PVI below-the-knee (BTK) (13.2 % vs. 22.4 %), and rates of severe TASC C/D lesions BTK (43.2 % vs. 54.2 %) increased (all p < 0.001). Utilization of MTD was different between medical specialties with lowest frequency in procedures performed by internists when compared to other medical specialties (7.1 % vs. 25.7 %, p < 0.001). Conclusions: MTD prior to PVI is associated with technical success of the procedure. Nonetheless, rates of MTD prior to PVI are decreasing during the study period. Future studies should address the impact of multidisciplinary vascular teams on long-term outcomes.

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The impact of the use of a footrest on the quality of chest compressions. A prospective, randomized, cross-sectional study

Postępy Nauk Medycznych ◽

10.25121/pnm.2018.31.3.133 ◽

2018 ◽

Vol 31 (3) ◽

Author(s):

Jolanta Majer ◽

Sandra Pyda ◽

Jerzy Robert Ladny ◽

Antonio Rodriguez-Nunez ◽

Lukasz Szarpak

Keyword(s):

Cross Sectional Study ◽

Sectional Study ◽

Chest Compressions ◽

Cross Sectional ◽

The Impact

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Correlation of Altmetric Attention Scores with Citations in Major Pharmacy Journals (Preprint)

10.2196/preprints.13129 ◽

2018 ◽

Author(s):

Dave L Dixon ◽

William L Baker

Keyword(s):

Citation Count ◽

Cross Sectional Study ◽

Scientific Output ◽

Cross Sectional ◽

Promotion And Tenure ◽

Article Type ◽

Key Factor ◽

Number Of Citations ◽

The Impact

BACKGROUND The impact and quality of a faculty members publications is a key factor in promotion and tenure decisions and career advancement. Traditional measures, including citation counts and journal impact factor, have notable limitations. Since 2010, alternative metrics have been proposed as another means of assessing the impact and quality of scholarly work. The Altmetric Attention Score is an objective score frequently used to determine the immediate reach of a published work across the web, including news outlets, blogs, social media, and more. Several studies evaluating the correlation between the Altmetric Attention Score and number of citations have found mixed results and may be discipline-specific. OBJECTIVE To determine the correlation between higher Altmetric Attention Scores and citation count for journal articles published in major pharmacy journals. METHODS This cross-sectional study evaluated articles from major pharmacy journals ranked in the top 10% according to the Altmetric Attention Score. Sources of attention that determined the Altmetric Attention Score were obtained, as well each articles open access status, article type, study design, and topic. Correlation between journal characteristics, including the Altmetric Attention Score and number of citations, was assessed using the Spearman’s correlation test. A Kruskal-Wallis 1-way analysis of variance (ANOVA) was used to compare the Altmetric Attention Scores between journals. RESULTS Six major pharmacy journals were identified. A total of 1,376 articles were published in 2017 and 137 of these represented the top 10% with the highest Altmetric Attention Scores. The median Altmetric Attention Score was 19 (IQR 15-28). Twitter and Mendeley were the most common sources of attention. Over half (56.2%) of the articles were original investigations and 49.8% were either cross-sectional, qualitative, or cohort studies. No significant correlation was found between the Altmetric Attention Score and citation count (rs=0.07, P = 0.485). Mendeley was the only attention source that correlated with the number of citations (rs=0.486, P<0.001). The median Altmetric Attention Score varied widely between each journal (P<0.001). CONCLUSIONS The overall median Altmetric Attention score of 19 suggests articles published in major pharmacy journals are near the top 5% of all scientific output. However, we found no correlation between the Altmetric Attention Score and number of citations for articles published in major pharmacy journals in the year 2017.

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Impact of Community-Led Total Sanitation and Hygiene on Prevalence of Diarrheal Disease and Associated Factors among Under-Five Children: A Comparative Cross-Sectional Study in Selected Woredas of Gamo Gofa Zone, Southern Ethiopia

Advances in Public Health ◽

10.1155/2020/8237101 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Agune Ashole Alto ◽

Wanzahun Godana ◽

Genet Gedamu

Keyword(s):

Drinking Water ◽

Diarrheal Disease ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Under Five ◽

Under Five Children ◽

Sanitation And Hygiene ◽

The Impact ◽

Gamo Gofa

Background. Diarrheal diseases are still one of the major causes of morbidity in under-five children in sub-Saharan Africa. In Ethiopia, diarrhea is responsible for 9% of all deaths and is the major cause of under-five mortality. Objective. To assess the impact of community-led total sanitation and hygiene on the prevalence of diarrheal disease and factors associated among under-five children in Gamo Gofa Zone. Methods. Community-based comparative cross-sectional study design was used to compare the impact of community-led total sanitation and hygiene intervention on under-five diarrheal disease. Multistage sampling method was employed. The data were collected by using pretested structured questionnaires. Data quality was ensured by daily supervision completeness and consistency. The data were coded, entered, and cleaned by using Epi Info version 7 and were analyzed by using SPSS version 20. Bivariate and multivariable analyses were carried out by using binary logistic regression. Significance was declared by using p value of <0.05 and AOR with 95% confidence intervals. Results. The response rate of this study was 93.3%. The overall diarrhea prevalence was 27.5% (CI = (24.06, 30.97)) which was 18.9% (CI = (14.94, 23.2)) in implemented and 36.2%. (CI = (30.41, 41.59)) in nonimplemented woredas. Children whose age was between 12 and 23 months (AOR = 1.6) and greater than 24 months (AOR = 5), availability of handwashing facilities (AOR = 4), disposal of waste in open field (AOR = 9.7), unimproved source of drinking water (AOR = 6.5), using only water for handwashing (AOR = 6), children who started complementary feeding less than 6 months (AOR = 5.6) and greater than 6 months (AOR = 5.2), and utensils used to feed children such as bottle (AOR = 3.9) were the factors positively associated with diarrhea. Conclusion. The overall prevalence of under-five diarrhea was 27.5%. The prevalence was low in CLTSH woredas as compared with non-CLTSH woredas. The study showed that handwashing facility, using only water for handwashing, open refuse disposal, and unimproved source of drinking water among under-five had a statistically significant association with diarrhea occurrence in CLTSH nonimplemented areas. Integrated efforts are needed from the Ministry of Health together with the WASH Project in improving drinking water, handwashing facilities, and solid waste disposal practices.

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The impact of health literacy on health outcomes in individuals with chronic pain: a cross-sectional study

Physiotherapy ◽

10.1016/j.physio.2018.11.006 ◽

2019 ◽

Vol 105 (3) ◽

pp. 346-353

Author(s):

Laura M. Mackey ◽

Catherine Blake ◽

Maire-Brid Casey ◽

Camillus K. Power ◽

Ray Victory ◽

...

Keyword(s):

Chronic Pain ◽

Health Literacy ◽

Health Outcomes ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

The Impact

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Green Work-Life Balance and Greenwashing the Construct of Work-Life Balance: Myth and Reality

Energies ◽

10.3390/en14154556 ◽

2021 ◽

Vol 14 (15) ◽

pp. 4556

Author(s):

Anuradha Iddagoda ◽

Eglantina Hysa ◽

Helena Bulińska-Stangrecka ◽

Otilia Manta

Keyword(s):

Job Performance ◽

Employee Engagement ◽

Cross Sectional Study ◽

Work Life ◽

Work Life Balance ◽

Cross Sectional ◽

Life Balance ◽

Theoretical Contribution ◽

Green Human Resource Management ◽

The Impact

Some of the frequently used buzz words in the corporate sector include green leadership, green human resource management, green employee engagement and green work-life balance. The intention of this article is to identify and examine the logical reasons that govern “green work-life balance” or, in simple terms, “greenwashing” work-life balance. The paper also aims at providing a comprehensive conceptualization of work-life balance, while thoroughly examining the components of measuring the construct. Based on a cross-sectional study in the banking industry with a sample of 170 managerial employees, this study analyzes the impact of work-life balance on employee job performance mediated by employee engagement. Results support the assumed relationship between work-life balance and employee job performance embedded in employee engagement. The theoretical contribution of this study concerns the application of role behavior theory to describe the mechanisms shaping the relationship between work-life balance and job performance through employee engagement. The practical implications of the paper include recommendations for improving job performance by enhancing the work-life balance and strengthening employee engagement.

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The impact of COVID-19 pandemic on training and mental health of residents: a cross-sectional study

BMC Medical Education ◽

10.1186/s12909-021-02655-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Eman Alshdaifat ◽

Amer Sindiani ◽

Wasim Khasawneh ◽

Omar Abu-Azzam ◽

Aref Qarqash ◽

...

Keyword(s):

Mental Health ◽

Residency Training ◽

Training Programs ◽

Cross Sectional Study ◽

Protective Equipment ◽

Sectional Study ◽

Cross Sectional ◽

Surgical Residents ◽

Tertiary Center ◽

The Impact

Abstract Background Residency programs have been impacted by the Coronavirus disease 2019 (COVID-19) pandemic. In this study we aim to investigate and evaluate the impact of the pandemic on residents as well as residency training programs. Methods This was a cross-sectional study including a survey of 43 questions prepared on Google forms and electronically distributed among a convenience sample of residents training at a tertiary center in North Jordan during the COVID-19 pandemic. Data were collected in the period between October 30th and November 8th of 2020. The survey included questions that addressed the impact of the pandemic on residents’ health as well as training programs. The study participants included residents in training at KAUH in 2020 and were stratified according to the type of residency program (surgical residents (SRs) and non-surgical residents (NSRs)). Statistical methods included descriptive analysis, Chi-square or Fisher’s exact test, Mann Whitney U test, and Cramer’s V and r statistics as measures of effect sizes. Results Of all 430 residents, 255 (59%) responded to the survey. A total of 17 (7%) of residents reported being infected with COVID-19 and a significant difference was reported between SRs and NSRs (10% vs 4%, V = .124 “small effect” (95% CI; .017–.229), p = 0.048). Approximately, 106 (42%) reported a decrease in the number of staff working at the clinic and 164 (64%) reported limited access to personal protective equipment during the pandemic. On a 4-point Likert scale for the feeling of anxiety, the median was 2 (2–3 IQR) in the NSRs group, vs 2 (1–2 IQR) in the SRs groups, with the NSRs being more likely to feel anxious (r = 0.13 “small effect” (95% CI; 0.007–0.249), p = .044). Similarly, the proportion of residents who reported feeling anxious about an inadequacy of protective equipment in the work area was significantly greater in the NSRs group (90.3% vs 75.2%; V = .201 “small effect” (95% CI; .078–.313), p = .001), as well as the proportion of residents who reported feeling increased stress and anxiety between colleagues being also significantly higher in the NSRs group (88.1% vs 76%; V = .158 “small effect” (95% CI; .032–.279), p = .012). Conclusion The burden of the ongoing pandemic on the mental health status of residents is very alarming and so providing residents with psychological counseling and support is needed. Also, critical implications on the flow of residency training programs have been noticed. This necessitates adapting and adopting smart educational techniques to compensate for such limitations.

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