scholarly journals Patient access to chronic medications during the Covid-19 pandemic: Evidence from a comprehensive dataset of US insurance claims

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249453
Author(s):  
Jeffrey Clement ◽  
Maura Jacobi ◽  
Brad N. Greenwood
Keyword(s):  
Linear Models ◽  
Ethinyl Estradiol ◽  
Hormonal Contraceptive ◽  
Patient Access ◽  
Care Providers ◽  
Significant Drop ◽  
Stimulant Treatment ◽  
Addiction Therapy ◽  
Chronic Medications ◽  
Contraceptive Discontinuation

Patient access and adherence to chronic medications is critical. In this work, we evaluate whether disruptions related to Covid-19 have affected new and existing patients’ access to pharmacological therapies without interruption. We do so by performing a retrospective analysis on a dataset of 9.4 billion US prescription drug claims from 252 million patients from May, 2019 through August, 2020 (about 93% of prescriptions dispensed within those months). Using fixed effect (conditional likelihood) linear models, we evaluate continuity of care, how many days of supply patients received, and the likelihood of discontinuing therapy for drugs from classes with significant population health impacts. Findings indicate that more prescriptions were filled in March 2020 than in any prior month, followed by a significant drop in monthly dispensing. Compared to the pre-Covid era, a patient’s likelihood of discontinuing some medications increased after the spread of Covid: norgestrel-ethinyl estradiol (hormonal contraceptive) discontinuation increased 0.62% (95% CI: 0.59% to 0.65%, p<0.001); dexmethylphenidate HCL (ADHD stimulant treatment) discontinuation increased 2.84% (95% CI: 2.79% to 2.89%, p<0.001); escitalopram oxalate (SSRI antidepressant) discontinuation increased 0.57% (95% CI: 0.561% to 0.578%, p<0.001); and haloperidol (antipsychotic) discontinuation increased 1.49% (95% CI: 1.41% to 1.57%, p<0.001). In contrast, the likelihood of discontinuing tacrolimus (immunosuppressant) decreased 0.15% (95% CI: 0.12% to 0.19%, p<0.001). The likelihood of discontinuing buprenorphine/naloxone (opioid addiction therapy) decreased 0.59% (95% CI: 0.55% to 0.62% decrease, p<0.001). We also observe a notable decline in new patients accessing these latter two therapies. Most US patients were able to access chronic medications during the early months of Covid-19, but still were more likely to discontinue their therapies than in previous months. Further, fewer than normal new patients started taking medications that may be vital to their care. Providers would do well to inquire about adherence and provide prompt, nonjudgmental, re-initiation of medications. From a policy perspective, opioid management programs seem to demonstrate a robust ability to manage existing patients in spite of disruption.

scholarly journals Physiologic Changes during Sponge Bathing in Premature Infants

2021 ◽  
Vol 18 (5) ◽  
pp. 2467
Author(s):  
Jongcheul Lee ◽  
Yaelim Lee
Keyword(s):  
Intensive Care Unit ◽  
Heart Rate ◽  
Body Temperature ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Measurement Point ◽  
Care Providers ◽  
Significant Drop ◽  
Transcutaneous Oxygen ◽  
Physiological Reactions

In this study, we observed physiological reactions of premature infants during sponge bathing in the neonatal intensive care unit (NICU). The infants’ body temperature, heart rate, and oxygen saturation were monitored to examine hypothermia risks during bathing. The participants of the study were 32 premature infants who were hospitalized right after their birth in the V hospital in Korea between December 2012 and August 2013. The informed consents of the study were received from the infants’ parents. The infants were randomly assigned into two-day and four-day bath cycle groups and their physiological reactions were monitored before bathing as well as 5 and 10 min after bathing. The collected data were analyzed using the SPSS statistical package through t-test. A significant drop in body temperature was noted in both groups; that is, 4-day bathing cycle and 2-day bathing cycle (p < 0.001). However, there were no significant changes in heart rate or transcutaneous oxygen levels. There was no significant change between groups at each measurement point. In order to minimize the physiological instability that may be caused during bathing, the care providers should try to complete bathing within the shortest possible time and to make bathing a pleasant and useful stimulus for infants.

Estetrol and the possibilities of its clinical use

2021 ◽  
Vol 86 (3) ◽  
pp. 217-221
Author(s):  
Petr Křepelka ◽  
Keyword(s):  
Ethinyl Estradiol ◽  
Fetal Liver ◽  
Hormonal Contraception ◽  
Hormonal Contraceptive ◽  
Cardiovascular Complications ◽  
Estradiol Valerate ◽  
Planned Parenthood ◽  
Menopausal Syndrome ◽  
Contraceptive Effectiveness ◽  
Combined Hormonal Contraception

Summary Combined hormonal contraceptive methods are one of the most commonly used methods of planned parenthood. They show high contraceptive effectiveness, reasonable cycle control and bring several non-contraceptive benefits. A limitation of the widespread use of combined hormonal contraception is the risk of cardiovascular complications in individuals with specific risk factors. The risk of cardiovascular complications is related to the used estrogen component. Currently, the most common use of estrogen in combined hormonal contraception is ethinyl estradiol and estradiol valerate. The good estrogenic part of combined oral contraceptives is estetrol, a hormone produced exclusively by the fetal liver. Estetrol exhibits a tissue-selective receptor activity. Unlike previously used estrogens, it does not negatively affect the production of liver proteins and blood clotting parameters. Estetrol is not a perspective for combined hormonal contraception only. It is also promising for treating and preventing osteoporosis, hormonal therapy of menopausal syndrome, and vulvovaginal atrophy syndrome.

scholarly journals Superior Mesenteric Vein Thrombosis Associated with Hormonal Contraceptive Use

2016 ◽  
Vol 10 (2) ◽  
pp. 264-268 ◽  
Author(s):  
Nobuatsu Koyama
Keyword(s):  
Superior Mesenteric Vein ◽  
Ethinyl Estradiol ◽  
Lower Abdominal Pain ◽  
Hormonal Contraceptive ◽  
Laboratory Evaluation ◽  
Mesenteric Vein Thrombosis ◽  
Mesenteric Vein ◽  
Vein Thrombosis ◽  
Superior Mesenteric Vein Thrombosis ◽  
History Of

A 44-year-old woman was admitted with a 7-day history of lower abdominal pain and nausea. Physical examination demonstrated tenderness in the lower abdomen without signs of peritonitis. There were no specific findings in the laboratory evaluation. She had a history of dysmenorrhea for 15 years and was taking a combined hormonal contraceptive containing 0.02 mg ethinyl estradiol and 3 mg drospirenone for 19 months. Contrast-enhanced computed tomography showed superior mesenteric vein thrombosis (SMVT). Systemic anticoagulant infusion was immediately administered and the symptoms disappeared within 2 days. The thrombus disappeared after 3 months. This case report suggests that early diagnosis of SMVT and immediate systemic anticoagulant therapy may reduce the rate of intestinal infarction.

Influence of hormonal contraceptives on peripheral vascular function and structure in premenopausal females: a review

2021 ◽  
Vol 320 (1) ◽  
pp. H77-H89
Author(s):  
Jennifer S. Williams ◽  
Maureen J. MacDonald
Keyword(s):  
Vascular Function ◽  
Contraceptive Use ◽  
Ethinyl Estradiol ◽  
Hormonal Contraceptive ◽  
Risk Indicators ◽  
Hormonal Contraceptives ◽  
Future Research ◽  
Vascular Structure ◽  
Peripheral Vascular ◽  
The Impact

Hormonal contraceptives are one of the most widely used prescriptions for premenopausal women worldwide. Although the risk of venous and arterial cardiovascular events (e.g., deep vein thrombosis, arterial clotting) with hormonal contraceptives, specifically oral contraceptive pills, has been established, the literature on early risk indicators, such as peripheral vascular structure and function has yet to be consolidated. The purpose of this review is to summarize literature examining the impact of different hormonal contraceptives on vascular function and structure, including consideration of phasic differences within a contraceptive cycle, and to propose future directions for research. It is evident that hormonal contraceptive use appears to impact both macrovascular and microvascular endothelial function, with phasic differences in some contraceptive types dependent on progestin type, the ratio of ethinyl estradiol-to-progestin, and route of administration. However, hormonal contraceptives do not appear to impact smooth muscle function in the macrovasculature or microvasculature, arterial stiffness, or vascular structure. Underlying mechanisms for observed impacts and areas of future research are discussed. This review provides timely consolidation of research examining hormonal contraceptives and peripheral vascular function and structure and provides guidance on considerations for hormonal contraceptive use in study design.

scholarly journals Vaginal hormonal ring: a modern method for prolonged contraception

2020 ◽  
pp. 61-66
Author(s):  
A. Z. Khashukoeva ◽  
S. A. Khlynova ◽  
S. B. Kerchelaeva ◽  
M. V. Burdenko
Keyword(s):  
Ethinyl Estradiol ◽  
Unwanted Pregnancy ◽  
Hormonal Contraception ◽  
Hormonal Contraceptive ◽  
Modern Method ◽  
Modern Medicine ◽  
Ease Of Use ◽  
Contraceptive Effect ◽  
Combined Hormonal Contraception ◽  
Indications For Use

Protection of women’s reproductive health and fertility is one of the priorities for the modern medicine. The prevention of an unintended pregnancy is critical for successful solving of this problem. Prevention of unwanted pregnancy and abortion, medical and social counselling are an integral part of the obstetrician-gynecologist activities. The effectiveness of preventing an unwanted pregnancy is a major factor in choosing a remedy, as well as the ease of use. The article presents information on the new modern contraception methods, including prolonged forms of combined hormonal contraception. A comparative analysis of oral and parenteral contraceptives is provided. The authors gave criteria of efficacy and principles for rational choice of contraceptives. The mechanism of action of a hormonal contraceptive drug containing etonogestrel and ethinyl estradiol is described. The article reviews the main advantages, indications for use and side effects of hormonal releasing systems, which contraceptive effect is provided by a combination of various factors. The suppression of ovulation is the most important of these factors. The researchers provided an analysis of the effect of the vaginal hormonal ring on the biocenosis of vagina and cervical mucosa, on the course of background cervix diseases and the possibility of preventing the development of pathogenic flora, as well as the benefits of its use in women with uncomplicated ectopia of the cervix: the effect on the epithelization of ectopia of columnar epithelium and the beneficial effect on endometrioid heterotopia. The article presents data on the frequency of adverse effects associated with the use of the contraceptive method, as well as risk factors that may become a contraindication to the use of the vaginal hormonal ring. Clear guidelines for postabortion contraception are provided.

scholarly journals New Contraception Update — Annovera, Phexxi, Slynd, and Twirla

2022 ◽  
Author(s):  
Courtney C. Baker ◽  
Melissa J. Chen
Keyword(s):  
Contraceptive Method ◽  
Infection Prevention ◽  
Ethinyl Estradiol ◽  
Safety Data ◽  
Pregnancy Prevention ◽  
Hormonal Contraceptive ◽  
Urogenital Infection ◽  
The Usa ◽  
One Year ◽  
Combined Hormonal Contraceptive

Abstract Purpose of Review In this review, we discuss the efficacy, safety, and benefits of four new contraceptive products available in the USA, specifically Annovera, Phexxi, Slynd, and Twirla. Recent Findings Annovera is a vaginal ring releasing ethinyl estradiol and segesterone acetate that can be used for up to one year (13 cycles), offering patients an effective, user-controlled option that may improve contraceptive access for those in low-resource settings or those with barriers to retrieving monthly prescriptions; however, given limited efficacy and safety data in people with body mass index (BMI) > 29 kg/m2, clinicians may consider whether Annovera is an appropriate contraceptive method for obese patients if there are other acceptable alternatives. Phexxi prescription-only vaginal gel is a user-controlled, non-hormonal, on-demand contraceptive method that represents a novel addition to the market with its additional uses as a personal lubricant and as a potential microbicide for urogenital infection prevention. Slynd, a drospirenone-only pill, provides more flexibility for delayed or missed pills while maintaining efficacy and a more favorable bleeding profile compared with previously available progestin-only pills. Lastly, Twirla is a transdermal patch releasing ethinyl estradiol and levonorgestrel that offers users an additional option for a user-controlled, combined hormonal contraceptive method without daily dosing; however, prescription is limited to patients with BMI < 30 kg/m2 due to decreased efficacy and VTE events in people with obesity. Summary The addition of these products expands the available options for pregnancy prevention to address unmet contraceptive needs.

scholarly journals Appointment Lead Time Policy Development to Improve Patient Access to Care

2016 ◽  
Vol 07 (04) ◽  
pp. 954-968 ◽  
Author(s):  
Sarah Bach ◽  
Yu-Li Huang
Keyword(s):  
Access To Care ◽  
Health Care Providers ◽  
Policy Development ◽  
Lead Time ◽  
Lead Times ◽  
Patient Access ◽  
Care Providers ◽  
Data Driven Approach ◽  
The Difference ◽  
Improve Patient

Summary Background Patient access to care has been a known and continuing struggle for many health care providers. In spite of appointment lead time policies set by government or clinics, the problem persists. Justification for how lead time policies are determined is lacking. Objectives This paper proposed a data-driven approach for how to best set feasible appointment target lead times given a clinic’s capacity and appointment requests. Methods The proposed approach reallocates patient visits to minimize the deviation between actual appointment lead time and a feasible target lead time. A step-by-step algorithm was presented and demonstrated for return visit (RV) and new patient (NP) types from a Pediatric clinic excluding planned visits such as well-child exam and the same day urgent appointments. The steps are: 1. Obtain appointment requests; 2. Initialize a target lead time; 3. Set up an initial schedule; 4. Check the feasibility based on appointment availability; 5. Adjust schedule backward to fill appointment slots earlier than the target; 6. Adjust schedule forward for appointments not able to be scheduled earlier or on target to the later slots; 7. Trial different target lead times until the difference between earlier and later lead time is minimized. Results The results indicated a 59% lead time reduction for RVs and a 45% reduction for NPs. The lead time variation was reduced by 75% for both patient types. Additionally, the opportunity for the participating clinic to achieve their organization’s goal of a two-week lead time for RVs and a twoday lead time for NPs is discussed by adjusting capacity to increase one slot for NP and reduce one slot for RV. Conclusions The proposed approach and study findings may help clinics identify feasible appointment lead times. Citation: Huang Y, Bach SM. Appointment lead time policy development to improve patient access to care.

scholarly journals Hormonal contraception alters vaginal microbiota and cytokines in South African adolescents in a randomized trial

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Christina Balle ◽  
Iyaloo N. Konstantinus ◽  
Shameem Z. Jaumdally ◽  
Enock Havyarimana ◽  
Katie Lennard ◽  
...  
Keyword(s):  
Microbial Diversity ◽  
T Cell Activation ◽  
Hiv Risk ◽  
Cell Activation ◽  
Ethinyl Estradiol ◽  
Hormonal Contraception ◽  
Hormonal Contraceptive ◽  
Sub Saharan Africa ◽  
Open Label ◽  
Unintended Pregnancies

Abstract Young women in sub-Saharan Africa are disproportionally affected by HIV infection and unintended pregnancies. However, hormonal contraceptive (HC) use may influence HIV risk through changes in genital tract microbiota and inflammatory cytokines. To investigate this, 130 HIV negative adolescent females aged 15–19 years were enrolled into a substudy of UChoose, an open-label randomized crossover study (NCT02404038), comparing acceptability and contraceptive product preference as a proxy for HIV prevention delivery methods. Participants were randomized to injectable norethisterone enanthate (Net-En), combined oral contraceptives (COC) or etonorgesterol/ethinyl estradiol combined contraceptive vaginal ring (CCVR) for 16 weeks, then crossed over to another HC for 16 weeks. Cervicovaginal samples were collected at baseline, crossover and exit for characterization of the microbiota and measurement of cytokine levels; primary endpoints were cervical T cell activation, vaginal microbial diversity and cytokine concentrations. Adolescents randomized to COCs had lower vaginal microbial diversity and relative abundance of HIV risk-associated taxa compared to Net-En or CCVR. Cervicovaginal inflammatory cytokine concentrations were significantly higher in adolescents randomized to CCVR compared to COC and Net-En. This suggests that COC use may induce an optimal vaginal ecosystem by decreasing bacterial diversity and inflammatory taxa, while CCVR use is associated with genital inflammation.

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