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Trinh Z, Cogswell I, Causey K. Impacts of the COVID-19 pandemic on healthcare utilization among Home Care Aides in Washington, U.S. Home Health Care Serv Q 2024:1-26. [PMID: 38940018 DOI: 10.1080/01621424.2024.2369079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
This study assesses the impacts of the COVID-19 pandemic on healthcare access for Washington State Home Care Aides (HCAs). Analyzing 62 months of medical claims data from over 35,000 HCAs, the research reveals significant healthcare disruptions during the early pandemic, especially in outpatient settings. However, healthcare utilization rebounded swiftly, surpassing pre-COVID levels as new variants emerged. Furthermore, the analysis indicated significant decreases in healthcare utilization for respiratory conditions in later stages of the pandemic, suggesting that the implementation of non-pharmaceutical and pharmaceutical interventions played a crucial role in preventing the transmission of respiratory diseases. Notably, behavioral health-related utilization among HCAs increased significantly throughout most pandemic phases, underscoring the importance of enhancing behavioral health support during public health crises. This research represents the first comprehensive study unveiling the effects of the COVID-19 pandemic on HCAs' healthcare access and opening avenues for further research and policy development to support this essential workforce.
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Affiliation(s)
- Zhenhui Trinh
- Health Benefits Trust, SEIU 775 Benefits Group, Seattle, USA
| | - Ian Cogswell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Kate Causey
- Research, Insights & Innovation, SEIU 775 Benefits Group, Seattle, USA
- Department of Public Health, University of Washington
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2
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Vallée A. The impact of the COVID-19 pandemic on the socioeconomic gradient of hypertension. J Public Health Policy 2024:10.1057/s41271-024-00491-4. [PMID: 38831023 DOI: 10.1057/s41271-024-00491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/05/2024]
Abstract
The COVID-19 pandemic has brought into sharp focus the impact of socioeconomic factors on hypertension outcomes. This review examines the implications of the pandemic on the socioeconomic gradient of hypertension and explores the physiological and pathophysiological processes underlying this relationship. Changes in socioeconomic factors have disproportionately affected individuals with lower socioeconomic status, leading to adverse hypertension outcomes. The pandemic-related stressors, coupled with social isolation and disrupted daily routines, have contributed to elevated stress levels among individuals, particularly those with lower socioeconomic status. Equitable access to healthcare, enhancing health literacy and patient empowerment, and addressing social determinants of health are essential components of hypertension management strategies. By recognizing the specific challenges faced by individuals with lower socioeconomic status and implementing targeted interventions, public health efforts can help reduce the socioeconomic gradient of hypertension.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, 92150, Suresnes, France.
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3
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Steiner JF, Powers JD, Malone A, Lyons J, Olson K, Paolino AR, Steiner CA. Hypertension care during the COVID-19 pandemic in an integrated health care system. J Clin Hypertens (Greenwich) 2023; 25:315-325. [PMID: 36919191 PMCID: PMC10085815 DOI: 10.1111/jch.14641] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/06/2023] [Accepted: 01/24/2023] [Indexed: 03/16/2023]
Abstract
Retention in hypertension care, medication adherence, and blood pressure (BP) may have been affected by the COVID-19 pandemic. In a retrospective cohort study of 64 766 individuals with treated hypertension from an integrated health care system, we compared hypertension care during the year pre-COVID-19 (March 2019-February 2020) and the first year of COVID-19 (March 2020-February 2021). Retention in hypertension care was defined as receiving clinical BP measurements during COVID-19. Medication adherence was measured using prescription refills. Clinical care was assessed by in-person and virtual visits and changes in systolic and diastolic BP. The cohort had a mean age of 67.8 (12.2) years, 51.2% were women, and 73.5% were White. In 60 757 individuals with BP measurements pre-COVID-19, 16618 (27.4%) had no BP measurements during COVID-19. Medication adherence declined from 86.0% to 80.8% (p < .001). In-person primary care visits decreased from 2.7 (2.7) to 1.4 (1.9) per year, while virtual contacts increased from 9.5 (12.2) to 11.2 (14.2) per year (both p < .001). Among individuals with BP measurements, mean (SD) systolic BP was 126.5 mm Hg (11.8) pre-COVID-19 and 127.3 mm Hg (12.6) during COVID-19 (p = .14). Mean diastolic BP was 73.5 mm Hg (8.5) pre-COVID-19 and 73.5 mm Hg (8.7) during COVID-19 (p = .77). Even in this integrated health care system, many individuals did not receive clinical BP monitoring during COVID-19. Most individuals who remained in care maintained pre-COVID BP. Targeted outreach may be necessary to restore care continuity and hypertension control at the population level.
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Affiliation(s)
- John F Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA.,Colorado Permanente Medical Group, Denver, Colorado, USA
| | - J David Powers
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Allen Malone
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Jason Lyons
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Kari Olson
- Pharmacy Department, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Andrea R Paolino
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Claudia A Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA.,Colorado Permanente Medical Group, Denver, Colorado, USA
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4
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Cao N, Marcus A, Altarawneh L, Kwon S. Priority-based replenishment policy for robotic dispensing in central fill pharmacy systems: a simulation-based study. Health Care Manag Sci 2023:10.1007/s10729-023-09630-x. [PMID: 36906675 PMCID: PMC10008078 DOI: 10.1007/s10729-023-09630-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 01/05/2023] [Indexed: 03/13/2023]
Abstract
In recent years, companies that operate pharmacy store chains have adopted centralized and automated fulfillment systems, which are called Central Fill Pharmacy Systems (CFPS). The Robotic Dispensing System (RDS) plays a crucial role by automatically storing, counting, and dispensing various medication pills to enable CFPS to fulfill high-volume prescriptions safely and efficiently. Although the RDS is highly automated by robots and software, medication pills in the RDS should still be replenished by operators in a timely manner to prevent the shortage of medication pills that causes huge delays in prescription fulfillment. Because the complex dynamics of the CFPS and manned operations are closely associated with the RDS replenishment process, there is a need for systematic approaches to developing a proper replenishment control policy. This study proposes an improved priority-based replenishment policy, which is able to generate a real-time replenishment sequence for the RDS. In particular, the policy is based on a novel criticality function calculating the refilling urgency for a canister and corresponding dispenser, which takes the inventory level and consumption rates of medication pills into account. A 3D discrete-event simulation is developed to emulate the RDS operations in the CFPS to evaluate the proposed policy based on various measurements numerically. The numerical experiment shows that the proposed priority-based replenishment policy can be easily implemented to enhance the RDS replenishment process by preventing over 90% of machine inventory shortages and saving nearly 80% product fulfillment delays.
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Affiliation(s)
- Nieqing Cao
- Department of Systems Science and Industrial Engineering, Binghamton University, 4400 Vestal Parkway East, Binghamton, 13902, New York, USA
| | - Austin Marcus
- Department of Systems Science and Industrial Engineering, Binghamton University, 4400 Vestal Parkway East, Binghamton, 13902, New York, USA
| | - Lubna Altarawneh
- Department of Systems Science and Industrial Engineering, Binghamton University, 4400 Vestal Parkway East, Binghamton, 13902, New York, USA
| | - Soongeol Kwon
- Department of Industrial Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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5
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Development and Application of a Comprehensive Measure of Access to Health Services to Examine COVID-19 Health Disparities. Healthcare (Basel) 2023; 11:healthcare11030354. [PMID: 36766929 PMCID: PMC9914001 DOI: 10.3390/healthcare11030354] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
Research on access to health services during the COVID-19 pandemic is limited, and the conceptualization of access has not typically included access to community resources. We developed and tested an access-to-health-services measure and examined disparities in access among individuals in the U.S. during the pandemic. Data are from a U.S. sample of 1491 respondents who completed an online survey in August 2021. Linear regression models assessed the relationships between the access-to-health-services-measure components, including impact on access to medicine and medical equipment, impact on access to healthcare visits, and confidence in accessing community resources, and predictor variables, including sociodemographic- and health-related factors. Disparities in access to healthcare during the pandemic were associated with sociodemographic characteristics (i.e., race, gender, and age) and health-related characteristics (i.e., chronic illness, mental health condition, and disability). Factors such as race, gender, income, and age were associated with individuals' degree of confidence in accessing community services. Our study presents a new access-to-health-services measure, sheds light on which populations may be most vulnerable to experiencing reduced access to health services, and informs the development of programmatic interventions to address the salient needs of these populations.
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6
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Zhong B, Gao H, Ding L, Wang Y. A Blockchain-Based Life-Cycle Environmental Management Framework for Hospitals in the COVID-19 Context. ENGINEERING (BEIJING, CHINA) 2023; 20:208-221. [PMID: 36245898 PMCID: PMC9540700 DOI: 10.1016/j.eng.2022.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/13/2022] [Accepted: 06/16/2022] [Indexed: 06/16/2023]
Abstract
During the coronavirus disease 2019 (COVID-19) emergency, many hospitals were built or renovated around the world to meet the challenges posed by the rising number of infected cases. Environmental management in the hospital life cycle is vital in preventing nosocomial infection and includes many infection control procedures. In certain urgent situations, a hospital must be completed quickly, and work process approval and supervision must therefore be accelerated. Thus, many works cannot be checked in detail. This results in a lack of work liability control and increases the difficulty of ensuring the fulfillment of key infection prevention measures. This study investigates how blockchain technology can transform the work quality inspection workflow to assist in nosocomial infection control under a fast delivery requirement. A blockchain-based life-cycle environmental management framework is proposed to track the fulfillment of crucial infection control measures in the design, construction, and operation stages of hospitals. The proposed framework allows for work quality checking after the work is completed, when some work cannot be checked on time. Illustrative use cases are selected to demonstrate the capabilities of the developed solution. This study provides new insights into applying blockchain technology to address the challenge of environmental management brought by rapid delivery requirements.
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Affiliation(s)
- Botao Zhong
- National Center of Technology Innovation for Digital Construction, Huazhong University of Science and Technology, Wuhan 430074, China
- School of Civil and Hydraulic Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Han Gao
- National Center of Technology Innovation for Digital Construction, Huazhong University of Science and Technology, Wuhan 430074, China
- School of Civil and Hydraulic Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
- Department of Civil and Building Systems, Technische Universität Berlin, Berlin 13156, Germany
| | - Lieyun Ding
- National Center of Technology Innovation for Digital Construction, Huazhong University of Science and Technology, Wuhan 430074, China
- School of Civil and Hydraulic Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Yuhang Wang
- National Center of Technology Innovation for Digital Construction, Huazhong University of Science and Technology, Wuhan 430074, China
- School of Civil and Hydraulic Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
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7
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Lawry LL, Lugo-Robles R, McIver V. Overlooked sex and gender aspects of emerging infectious disease outbreaks: Lessons learned from COVID-19 to move towards health equity in pandemic response. Front Glob Womens Health 2023; 4:1141064. [PMID: 36891170 PMCID: PMC9986530 DOI: 10.3389/fgwh.2023.1141064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/01/2023] [Indexed: 02/22/2023] Open
Abstract
Sex and gender issues are especially important in emerging infectious diseases (EIDs) but are routinely overlooked despite data and practice. Each of these have an effect either directly, via the effects on vulnerability to infectious diseases, exposures to infectious pathogens, and responses to illness, and indirectly through effects on disease prevention and control programs. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the viral agent of coronavirus disease 2019 (COVID-19) has underscored the importance of understanding the sex and gender impacts on pandemics. This review takes a broader looks at how sex and gender impact vulnerability, exposure risk, and treatment and response that affect incidence, duration, severity, morbidity, mortality, and disability of EIDs. And although EID epidemic and pandemic plans need to be "pro-women", they need to be broader and include all sex and gender factors. Incorporation of these factors are a priority at the local, national, and global policy levels to fulfil the gaps in scientific research, public health intervention programs and pharmaceutical service strengthening to reduce emerging disease inequities in the population during pandemics and epidemics. A failure to do so creates acceptance of the inequities and infringes on fairness and human rights norms.
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Affiliation(s)
- Lynn Lieberman Lawry
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States
| | - Roberta Lugo-Robles
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States.,Department of Preventive Medicine and Biostatistics, Henry M. Jackson Foundation, Bethesda, MD, United States
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Egan BM, Sutherland SE, Macri CI, Deng Y, Gerelchuluun A, Rakotz MK, Campbell SV. Association of Baseline Adherence to Antihypertensive Medications With Adherence After Shelter-in-Place Guidance for COVID-19 Among US Adults. JAMA Netw Open 2022; 5:e2247787. [PMID: 36538326 PMCID: PMC9856530 DOI: 10.1001/jamanetworkopen.2022.47787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Adherence to selected antihypertensive medications (proportion of days covered [PDC]) declined after guidance to shelter in place for COVID-19. OBJECTIVES To determine whether PDC for all antihypertensive medications collectively fell from the 6 months before sheltering guidance (September 15, 2019, to March 14, 2020 [baseline]) compared with the first (March 15 to June 14, 2020) and second (June 15 to September 14, 2020) 3 months of sheltering and to assess the usefulness of baseline PDC for identifying individuals at risk for declining PDC during sheltering. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included a random sample of US adults obtained from EagleForce Health, a division of EagleForce Associates Inc. Approximately one-half of the adults were aged 40 to 64 years and one-half were aged 65 to 90 years, with prescription drug coverage, hypertension, and at least 1 antihypertensive medication prescription filled at a retail pharmacy during baseline. MAIN OUTCOMES AND MEASURES Prescription claims were used to assess (1) PDC at baseline and changes in PDC during the first and second 3 months of sheltering and (2) the association of good (PDC ≥ 80), fair (PDC 50-79), and poor (PDC < 50) baseline adherence with adherence during sheltering. RESULTS A total of 27 318 adults met inclusion criteria (mean [SD] age, 65.0 [11.7] years; 50.7% women). Mean PDC declined from baseline (65.6 [95% CI, 65.2-65.9]) during the first (63.4 [95% CI, 63.0-63.8]) and second (58.9 [95% CI, 58.5-59.3]) 3 months after sheltering in all adults combined (P < .001 for both comparisons) and both age groups separately. Good, fair, and poor baseline adherence was observed in 40.0%, 27.8%, and 32.2% of adults, respectively. During the last 3 months of sheltering, PDC declined more from baseline in those with good compared with fair baseline adherence (-13.1 [95% CI, -13.6 to -12.6] vs -8.3 [95% CI, -13.6 to -12.6]; P < .001), whereas mean (SD) PDC increased in those with poor baseline adherence (mean PDC, 31.6 [95% CI, 31.3-31.9] vs 34.4 [95% CI, 33.8-35.0]; P < .001). However, poor adherence during sheltering occurred in 1034 adults (9.5%) with good baseline adherence, 2395 (31.6%) with fair baseline adherence, and 6409 (72.9%) with poor baseline adherence. CONCLUSIONS AND RELEVANCE These findings suggest that individuals with poor baseline adherence are candidates for adherence-promoting interventions irrespective of sheltering guidance. Interventions to prevent poor adherence during sheltering may be more useful for individuals with fair vs good baseline adherence.
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Affiliation(s)
- Brent M. Egan
- Improving Health Outcomes, American Medical Association, Greenville, South Carolina
| | - Susan E. Sutherland
- Improving Health Outcomes, American Medical Association, Greenville, South Carolina
| | | | - Yi Deng
- EagleForce Health, Herndon, Virginia
| | | | - Michael K. Rakotz
- Improving Health Outcomes, American Medical Association, Chicago, Illinois
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9
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Machado-Duque ME, Gaviria-Mendoza A, Valladales-Restrepo LF, Albanés-Beltrán JP, Machado-Alba JE. Trends in the Use of Sedative-Hypnotics, Opioids, and Neuromuscular Blockers in Hospitalized Patients During the COVID-19 Pandemic: Observational Retrospective Study. Drugs Real World Outcomes 2022; 9:629-638. [PMID: 36329371 PMCID: PMC9633019 DOI: 10.1007/s40801-022-00337-z] [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] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has increased the use of drugs administered for mechanical ventilation, leading to shortages in some countries. Objective The aim was to identify trends in the consumption of sedatives, hypnotics, neuromuscular blockers, and opioids used for anesthetic induction and deep sedation in hospitals in Colombia. Method This was a descriptive, longitudinal, and retrospective study with monthly follow-up of sedative, hypnotic, opioid, and neuromuscular blocker dispensing in 20 clinics and hospitals from January to November 2020. The frequencies of use of each drug and variations in the institutions and intensive care units (ICUs) were identified. Results A total of 1,252,576 units of the analyzed drugs were delivered to 79,094 treated patients, 55.0% of whom were women (n = 43,521). The drugs with the greatest increase in consumption were rocuronium (1058% variation in March–November) and propofol (511%). The consumption of midazolam and vecuronium initially increased, but by the end of the study period, it decreased. Among drugs dispensed only in ICUs, 920,170 units were delivered (73.5% of the drugs dispensed during the study), and the most often dispensed drugs were fentanyl (n = 251,519; 27.3% of the drugs used in the ICU) and midazolam (5 mg/5 mL) solution (n = 188,568; 20.5%). Specifically in the ICU, the drugs with the greatest increase in use were rocuronium (19,709%), propofol (2622%), and ketamine (2591%). Conclusion Rapid changes in the use of drugs were evident, which demonstrates the need for closer cooperation among treating physicians, service providers, pharmaceutical managers, and state institutions to maintain a sufficient and timely supply of critical drugs in this type of contingency. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-022-00337-z.
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Affiliation(s)
- Manuel E. Machado-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A. Pereira, Calle 105 No. 14-140, Pereira, 660003 Risaralda, Colombia ,Grupo de Investigación Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | - Andrés Gaviria-Mendoza
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A. Pereira, Calle 105 No. 14-140, Pereira, 660003 Risaralda, Colombia ,Grupo de Investigación Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | - Luis Fernando Valladales-Restrepo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A. Pereira, Calle 105 No. 14-140, Pereira, 660003 Risaralda, Colombia ,Grupo de Investigación Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | - Juan Pablo Albanés-Beltrán
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A. Pereira, Calle 105 No. 14-140, Pereira, 660003 Risaralda, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A. Pereira, Calle 105 No. 14-140, Pereira, 660003 Risaralda, Colombia
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10
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Kavanagh ON, Courtenay A, Khan F, Lowry D. Providing pharmaceutical care remotely through medicines delivery services in community pharmacy. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 8:100187. [PMID: 36277308 PMCID: PMC9579036 DOI: 10.1016/j.rcsop.2022.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/05/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
Abstract
Background The delivery of pharmaceutical care - and what that means - has been at the centre of many transformations of the pharmacy profession in the last century. Today, the exponential growth of pharmacies which provide pharmaceutical care exclusively online has placed increased scrutiny on the quality of the care they provide. Aim As more patients are managed by remote pharmaceutical care (via medicines delivery services), we sought to critically evaluate this service to identify new research directions. Methods The COnsolidated criteria for REporting Qualitative research and Standards for reporting qualitative research guideline provided the methodological framework throughout this process. Results We reveal that although home delivery services ensure that many patients have access to their medicines, it may reduce time available to provide comprehensive pharmaceutical care, particularly in traditional brick-and-mortar pharmacies. Conclusion We highlight a critical need for research in this area and suggest a variety of research directions: is remote pharmaceutical care a matter of convenience? Does remote pharmaceutical care help patients adhere to their medicines? How do digital health innovations impact care across patient demographics? What does comprehensive pharmaceutical care mean for patients?
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Affiliation(s)
- Oisín N. Kavanagh
- School of Pharmacy, Newcastle University, United Kingdom.,Corresponding author.
| | - Aaron Courtenay
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Ireland.
| | - Fatimah Khan
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Ireland.
| | - Deborah Lowry
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Ireland.
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11
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Jalan M, Riehm K, Nekkanti M, Agarwal S, Gibson DG, Labrique A, Thrul J. Burden of mental distress in the United States is associated with delayed medical visits and missed prescription refills during the COVID-19 pandemic. Prev Med 2022; 163:107195. [PMID: 35964776 PMCID: PMC9371769 DOI: 10.1016/j.ypmed.2022.107195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/21/2022] [Accepted: 08/07/2022] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic has contributed to poor health due to a decrease in healthcare utilization and those with mental health problems may be impacted. For this analysis, data came from a cross-sectional, nationally representative December 2020 survey. Logistic regression analyses examined associations between (1) mental distress and delayed medical visits, (2) mental distress and missed prescription refills, controlling for sociodemographics, pre-existing chronic conditions, and access to health insurance. We found that, compared to those that exhibited normal levels of mental distress, those with mild (aOR = 2.83, 95% CI = 2.47-3.24), moderate (aOR = 3.43, 95% CI = 2.95-3.99), and severe (aOR = 4.96, 95% CI = 4.21-5.84) mental distress showed greater odds of delaying medical visits. Similarly, compared to those that exhibited normal levels of mental distress, those with mild (aOR =3.93, 95% CI = 3.04-5.09), moderate (aOR =6.52, 95% CI = 5.07-8.43), and severe (aOR =8.69, 95% CI = 6.71-11.32) mental distress showed greater odds of missing prescription refills. Our study shows that individuals who showed signs of mental distress had increased odds of delayed medical visits and missed prescription refills, compared to those that showed normal levels of mental distress.
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Affiliation(s)
- Madhu Jalan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Kira Riehm
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Manali Nekkanti
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Smisha Agarwal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States of America; Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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12
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Cocuzzo B, Wrench A, O’Malley C. Effects of COVID-19 on Older Adults: Physical, Mental, Emotional, Social, and Financial Problems Seen and Unseen. Cureus 2022; 14:e29493. [PMID: 36299954 PMCID: PMC9588279 DOI: 10.7759/cureus.29493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
Older adults are vulnerable to coronavirus disease 2019 (COVID-19) and efforts have been made to protect them. However, one protective mechanism, isolation of older adults, has resulted in unintended physical, mental, emotional, social, and financial consequences. We conducted a comprehensive literature review to understand the effects of COVID-19 and the new COVID-19 vaccine on older adults and the factors affecting vaccine acceptance. A review of the literature was conducted to understand the unique challenges COVID-19 creates for older adults. It was found that older adults are significantly impacted by the COVID-19 pandemic and resulting isolation. Physical health can be improved by increasing contact with healthcare providers and opportunities for physical activity. Mental and emotional health can be improved by addressing fear and uncertainty about the pandemic. Social health interventions should be targeted at ensuring older adults have contact with loved ones both in person and in the virtual format. To ameliorate financial concerns, interventions should be targeted at assistance with food and medications.
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Guadamuz JS, Shooshtari A, Qato DM. Global, regional and national trends in statin utilisation in high-income and low/middle-income countries, 2015-2020. BMJ Open 2022; 12:e061350. [PMID: 36691204 PMCID: PMC9462115 DOI: 10.1136/bmjopen-2022-061350] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/23/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Prior studies have reported inequitable global access to essential medicines for cardiovascular disease (CVD) prevention, especially statins. Here we examine recent trends and disparities in statin utilisation at the income group, regional and country levels. DESIGN Ecological study. Pharmaceutical sales data were used to examine statin utilisation in high-income counties (HICs) and low/middle-income countries (LMICs) from 2015 to 2020. Population estimates were obtained from the Global Burden of Disease. Fixed-effects panel regression analysis was used to examine associations between statin utilisation and country-level factors. SETTING Global, including 41 HICs and 50 LMICs. PARTICIPANTS Population older than 40 years of age. PRIMARY AND SECONDARY OUTCOME MEASURES Statin utilisation was measured using defined daily doses (DDDs) per 1000 population ≥40 years per day (TPD). RESULTS Globally, statin utilisation increased 24.7% from 54.7 DDDs/TPD in 2015 to 68.3 DDDs/TPD in 2020. However, regional and income group disparities persisted during this period. In 2020, statin utilisation was more than six times higher in HICs than LMICs (192.4 vs 28.4 DDDs/TPD, p<0.01). Substantial disparities were also observed between LMICs, ranging from 3.1 DDDs/TPD in West African nations to 225.0 DDDs/TPD in Lebanon in 2020. While statin utilisation increased in most LMICs between 2015 and 2020, several experienced declines in utilisation, most notably Venezuela (-85.1%, from 92.3 to 14.0 DDDs/TPD). In LMICs, every $100 increase in per capita health spending was associated with a 17% increase in statin utilisation, while every 10% increase in out-of-pocket health spending was associated with a 11% decline (both p<0.05). CONCLUSIONS Despite global increases in statin utilisation, there are substantial regional and country-level disparities between HICs and LMICs. To address global CVD disparities, policymakers should promote increased and equitable access to statins in LMICs.
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Affiliation(s)
- Jenny S Guadamuz
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California, USA
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Andrew Shooshtari
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California, USA
| | - Dima M Qato
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California, USA
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
- Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
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14
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Blankart KE, Felder S. Do Medicine Shortages Reduce Access and Increase Pharmaceutical Expenditure? A Retrospective Analysis of Switzerland 2015-2020. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1124-1132. [PMID: 35219600 DOI: 10.1016/j.jval.2021.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES We analyze how shortages led to changes in access to and expenditure for pharmaceutical care in the Swiss health system between 2015 and 2020. METHODS We combined cross-sectional and longitudinal data to study medicine shortages by incidence, duration, intensity, and pharmaceutical expenditure. We assessed 4119 markets defined by active ingredient, dosage form, and strength. We classified markets by essential medicine status and other characteristics. We differentiated shortages by the degree to which alternative options are still available. We investigated the first lockdown period of the pandemic, considering also the shortage of COVID-19-specific medicines. RESULTS A total of 1964 markets never reported shortages, and 1336 markets reported some shortages; 819 markets reported shortages lasting at least 14 days. Markets with a higher number of manufacturers, a lower co-payment share, and lower prices more frequently reported shortages. We did not find differences by essential medicine status. In 50% of instances, the average price of substitutes available was lower than the price of the product on shortage. The total pharmaceutical expenditure attributed to shortages increased by CHF 17.00 million (€15.63 million) in 2018. CONCLUSIONS Medicine shortages have substantially reduced access to pharmaceuticals. Switzerland has experienced shortages on a scale similar to that in other countries. Prices of substitutes available at the time of shortages can be higher or lower, indicating an unelastic demand for medicines.
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Affiliation(s)
- Katharina E Blankart
- Faculty of Business Administration and Economics/CINCH Health Economics Research Center, Universität Duisburg-Essen, Essen, Germany
| | - Stefan Felder
- Faculty of Business and Economics, University of Basel, Basel, Switzerland.
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15
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Liu M, Richard L, Campitelli MA, Nisenbaum R, Dhalla IA, Wadhera RK, Shariff SZ, Hwang SW. Hospitalizations During the COVID-19 Pandemic Among Recently Homeless Individuals: a Retrospective Population-Based Matched Cohort Study. J Gen Intern Med 2022; 37:2016-2025. [PMID: 35396658 PMCID: PMC8992790 DOI: 10.1007/s11606-022-07506-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospitalizations fell precipitously among the general population during the COVID-19 pandemic. It remains unclear whether individuals experiencing homelessness experienced similar reductions. OBJECTIVE To examine how overall and cause-specific hospitalizations changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control. DESIGN Population-based cohort study conducted in Ontario, Canada, between September 30, 2018, and September 26, 2020. PARTICIPANTS In total, 38,617 IRHH, 15,022,368 housed individuals, and 186,858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden. MAIN MEASURES Primary outcomes included medical-surgical, non-elective (overall and cause-specific), elective surgical, and psychiatric hospital admissions. KEY RESULTS Average rates of medical-surgical (rate ratio: 3.8, 95% CI: 3.7-3.8), non-elective (10.3, 95% CI: 10.1-10.4), and psychiatric admissions (128.1, 95% CI: 126.1-130.1) between January and September 2020 were substantially higher among IRHH compared to housed individuals. During the peak period (March 17 to June 16, 2020), rates of medical-surgical (0.47, 95% CI: 0.47-0.47), non-elective (0.80, 95% CI: 0.79-0.80), and psychiatric admissions (0.86, 95% CI: 0.84-0.88) were significantly lower among housed individuals relative to equivalent weeks in 2019. No significant changes were observed among IRHH. During the re-opening period (June 17-September 26, 2020), rates of non-elective hospitalizations for liver disease (1.41, 95% CI: 1.23-1.69), kidney disease (1.29, 95% CI: 1.14-1.47), and trauma (1.19, 95% CI: 1.07-1.32) increased substantially among IRHH but not housed individuals. Distinct hospitalization patterns were observed among IRHH even in comparison with more medically and socially vulnerable matched housed individuals. CONCLUSIONS Persistence in overall hospital admissions and increases in non-elective hospitalizations for liver disease, kidney disease, and trauma indicate that the COVID-19 pandemic presented unique challenges for recently homeless individuals. Health systems must better address the needs of this population during public health crises.
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Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, MA, USA. .,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. .,ICES Central, Toronto, Ontario, Canada.
| | | | | | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Irfan A Dhalla
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
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16
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Perception of community pharmacists about the work process of drug dispensing: a cross-sectional survey study. BMC Health Serv Res 2022; 22:161. [PMID: 35135535 PMCID: PMC8822789 DOI: 10.1186/s12913-022-07528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background Drug dispensing aims to promote rational medicine use. However, in many countries, the work processes are still not well defined. In this sense, the perception of pharmacists about dispensing practices presents an overview of how the service is being performed in the country and its main challenges. Thus, the purpose of this study was to determine the self-reported work process of Brazilian community pharmacists in relation to drug dispensing, challenges, and strategies for carrying out the service. Method A cross-sectional survey was conducted between May and July 2021, with community pharmacists from all regions of Brazil. Pharmacists were invited to answer a validated, self-administered questionnaire, implemented through Google Forms, containing 33 questions related to the steps of drug dispensing (questions and counseling) and the main challenges and strategies to perform the service. The data were exported to Microsoft Office Excel and SPSS®. Multiple linear regression analysis was used to assess the association between responses and demographic information, with a significance level of less than 5% (p < 0.05). This study was approved by the Research Ethics Committee (number: 4.295.171). Results A total of 625 community pharmacists responded to the survey. Most pharmacists reported always or frequently performing 17 (54%) of the 31 steps described in the instrument. The steps that pharmacists reported performing more frequently were forming the medication name (n = 569, 91.04%), verifying the completeness and adequacy of the prescription according to current legislation (n = 567, 90.72%) and providing counseling on dosage (n = 549, 87.84%). Documentation was the main step in which pharmacists reported never or rarely performing (n = 424, 67.84%). The results showed that there was a significant influence of the variables of public education institution, age, and postgraduate education on the frequency of dispensing steps (F(3, 621) = 14.884, p < 0.001; R2ajdusted = 0,063). Conclusion This study showed that most pharmacists reported always or frequently asking most of the questions and performing counseling contained in the instrument during drug dispensing. These results can contribute to an understanding of current dispensing practices and generate insights for developing strategies to qualify the service. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07528-y.
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17
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Alam MS, Sultana R, Haque MA. Vulnerabilities of older adults and mitigation measures to address COVID-19 outbreak in Bangladesh: A review. SOCIAL SCIENCES & HUMANITIES OPEN 2022; 6:100336. [PMID: 36124099 PMCID: PMC9474424 DOI: 10.1016/j.ssaho.2022.100336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/24/2022] [Accepted: 09/14/2022] [Indexed: 11/27/2022]
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18
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Yadav S, Goel A. Abbreviated health-care services for older persons during the COVID-19 pandemic – A wake-up call for a longer-term plan. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_341_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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19
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Ng WY, Tan TE, Movva PVH, Fang AHS, Yeo KK, Ho D, Foo FSS, Xiao Z, Sun K, Wong TY, Sia ATH, Ting DSW. Blockchain applications in health care for COVID-19 and beyond: a systematic review. Lancet Digit Health 2021; 3:e819-e829. [PMID: 34654686 PMCID: PMC8510632 DOI: 10.1016/s2589-7500(21)00210-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 01/04/2023]
Abstract
The COVID-19 pandemic has had a substantial and global impact on health care, and has greatly accelerated the adoption of digital technology. One of these emerging digital technologies, blockchain, has unique characteristics (eg, immutability, decentralisation, and transparency) that can be useful in multiple domains (eg, management of electronic medical records and access rights, and mobile health). We conducted a systematic review of COVID-19-related and non-COVID-19-related applications of blockchain in health care. We identified relevant reports published in MEDLINE, SpringerLink, Institute of Electrical and Electronics Engineers Xplore, ScienceDirect, arXiv, and Google Scholar up to July 29, 2021. Articles that included both clinical and technical designs, with or without prototype development, were included. A total of 85 375 articles were evaluated, with 415 full length reports (37 related to COVID-19 and 378 not related to COVID-19) eventually included in the final analysis. The main COVID-19-related applications reported were pandemic control and surveillance, immunity or vaccine passport monitoring, and contact tracing. The top three non-COVID-19-related applications were management of electronic medical records, internet of things (eg, remote monitoring or mobile health), and supply chain monitoring. Most reports detailed technical performance of the blockchain prototype platforms (277 [66·7%] of 415), whereas nine (2·2%) studies showed real-world clinical application and adoption. The remaining studies (129 [31·1%] of 415) were themselves of a technical design only. The most common platforms used were Ethereum and Hyperledger. Blockchain technology has numerous potential COVID-19-related and non-COVID-19-related applications in health care. However, much of the current research remains at the technical stage, with few providing actual clinical applications, highlighting the need to translate foundational blockchain technology into clinical use.
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Affiliation(s)
- Wei Yan Ng
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien-En Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore
| | - Prasanth V H Movva
- Certis Commercial and Industrial Security Corporation Security, Singapore
| | - Andrew Hao Sen Fang
- Duke-NUS Medical School, National University of Singapore, Singapore,SingHealth Polyclinics, Singapore
| | - Khung-Keong Yeo
- Duke-NUS Medical School, National University of Singapore, Singapore,National Heart Centre Singapore, Singapore
| | - Dean Ho
- Institute for Digital Medicine and Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,N.1 Institute for Health, National University of Singapore, Singapore,Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Fuji Shyy San Foo
- Certis Commercial and Industrial Security Corporation Security, Singapore
| | - Zhe Xiao
- Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore
| | - Kai Sun
- Data Science Institute, Imperial College London, London, UK
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore
| | - Alex Tiong-Heng Sia
- Duke-NUS Medical School, National University of Singapore, Singapore,KK Women's and Children's Hospital, Singapore
| | - Daniel Shu Wei Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore,Correspondence to: Dr Daniel Ting, Duke-NUS Medical School, National University of Singapore, Singapore 168751
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20
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Manmadhan A, Kozloff SJ, Heffron SP. Demographic predictors of nonHDL-C increase during COVID-19 pandemic stay-at-home period. Am J Prev Cardiol 2021; 8:100282. [PMID: 34661184 PMCID: PMC8503967 DOI: 10.1016/j.ajpc.2021.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/22/2021] [Accepted: 10/09/2021] [Indexed: 11/26/2022] Open
Abstract
The onset of the coronavirus 2019 (COVID-19) pandemic prompted unique public health measures including stay-at-home (SAH) orders that provoked altered dietary and exercise patterns and may have affected medication access and use. Although these impacts have the potential to influence lipid levels, little is known of the consequences of COVID-19 SAH on objective atherosclerotic cardiovascular disease (ASCVD) risk factors. We performed a patient-level analysis of the primary measure of atherogenic lipid-associated risk, nonHDL-C during the 2020 SAH period and the same time period in 2019, in patients within a large health system in New York City. We found that women and racial and ethnic minority group members were more likely to exhibit substantial worsening of atherogenic lipid profile (≥38 mg/dL increase in nonHDL-C) during this period. Our results suggest that the pandemic and subsequent public health measures may have produced unintended negative consequences on already at-risk groups.
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Affiliation(s)
| | | | - Sean P. Heffron
- Leon H. Charney Division of Cardiology
- NYU Center for the Prevention of Cardiovascular Disease
- Cardiovascular Research Center, New York, NY, United States
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21
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Bolarinwa OA. Factors associated with access to condoms and sources of condoms during the COVID-19 pandemic in South Africa. ACTA ACUST UNITED AC 2021; 79:186. [PMID: 34702340 PMCID: PMC8548264 DOI: 10.1186/s13690-021-00701-5] [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: 04/14/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Evidence has shown that the prescribed lockdown and physical distancing due to the novel coronavirus disease 2019 (COVID-19) have made accessing essential health care services much more difficult in low-and middle-income countries. Access to contraception is an essential service and should not be denied, even in a global crisis, because of its associated health benefits. Therefore, it is important to maintain timely access to contraception without unnecessary barriers. Hence, this study examines the factors contributing to limited access to condoms and sources of condoms during the COVID-19 pandemic in South Africa. METHODS This study used the National Income Dynamics Study-Coronavirus Rapid Mobile Survey (NIDS-CRAM) wave 1 survey dataset. The NIDS-CRAM is a nationally representative survey of the National Income Dynamics Survey (NIDS) conducted via telephone interview during COVID-19 in the year 2020. This is the first secondary dataset on COVID-19 conducted by NIDS during pandemic. A total of 5304 respondents were included in the study. Data were analysed using frequencies distribution percentages, chi-square test and multivariable logistic regression analysis. RESULTS Almost one-quarter (22.40%) of South Africans could not access condoms, and every 7 in 10 South Africans preferred public source of condoms during the COVID-19 pandemic. Those who were from other population groups [AOR = 0.37; 95% CI = 0.19-0.74] and those who were in the third wealth quintile [AOR = 0.60; 95% CI = 0.38-0.93] had lower odds of having access to condoms while those respondents who were aged 25-34 [AOR = 0.48; 95% CI = 0.27-0.83] and those with a secondary level of education and above [AOR = 0.24; 95% CI = 0.08-0.71] were less likely to prefer public source of condom. CONCLUSIONS This study concludes that there was limited access to condoms during the COVID-19 pandemic and that the preferred source of condoms was very skewed to public sources in South Africa. Strategic interventions such as community distribution of free condoms to avert obstruction of condom access during the COVID-19 pandemic or any future pandemics should be adopted.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. .,Obaxlove Consult, Lagos, 100009, Nigeria. .,Department of Global Public Health, School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, CT1 1QU, UK.
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22
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The Impact of the Coronavirus Disease 2019 Pandemic on Adherence to Ocular Hypotensive Medication in Patients with Primary Open-Angle Glaucoma. Ophthalmology 2021; 129:258-266. [PMID: 34673098 PMCID: PMC8523310 DOI: 10.1016/j.ophtha.2021.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 10/03/2021] [Accepted: 10/06/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose Emerging evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic is disrupting health behaviors such as medication adherence. The objective of this study was to determine whether adherence to ocular hypotensive medication was affected by the pandemic and to identify factors associated with this change. Design In this cohort study, we used a controlled interrupted time series design in which the interruption was the declaration of the COVID-19 pandemic in the United States on March 13, 2020. The 300-day monitoring period, which evenly bracketed this declaration, started on October 16, 2019, and ended on August 10, 2020. Participants Patients with primary open-angle glaucoma enrolled in an ongoing longitudinal National Institutes of Health-funded study initiated before the onset of the pandemic were selected if they were prescribed ocular hypotensive medication and had adherence data spanning the 300-day period. Methods We applied segmented regression analysis using a “slope change following a lag” impact model to obtain the adherence slopes in the periods before and after the segmentation. We compared the 2 slopes using the Davies test. Main Outcome Measures The main outcome measure was daily adherence to ocular hypotensive medication, defined as the number of doses taken divided by the number of doses prescribed, expressed in percent. Adherence was measured objectively using Medication Event Monitoring System caps. We assessed the associations between change in adherence and demographic, clinical, and psychosocial factors. Results The sample included 79 patients (mean age, 71 years [standard deviation, 8 years]). Segmented regression identified a breakpoint at day 28 after the declaration of the pandemic. The slope in the period after the breakpoint (–0.04%/day) was significantly different from zero (P < 0.001) and from the slope in the period before the breakpoint (0.006%/day; P < 0.001). Mean adherence in the period before the segmentation breakpoint was significantly worse in Black patients (median, IQR: 80.6%, 36.2%) compared with White patients (median, IQR: 97.2%, 8.7%; chi-square, 15.4; P = 0.0004). A significant positive association was observed between the Connor-Davidson resilience score and the change in slope between the periods before and after the breakpoint (P = 0.002). Conclusions Adherence to ocular hypotensive medication worsened during the COVID-19 pandemic and seems to be related to patient resilience. This collateral consequence of the pandemic may translate into vision loss that may manifest beyond its containment.
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Freed B, Hillman S, Shantikumar S, Bick D, Dale J, Gauly J. The impact of disasters on contraception in OECD member countries: a scoping review. EUR J CONTRACEP REPR 2021; 26:429-438. [PMID: 34126834 DOI: 10.1080/13625187.2021.1934440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Review evidence is lacking about how contraception is affected by severe social disruption, such as that caused by the COVID-19 pandemic. The purpose of this scoping review was to explore the impact of natural and man-made disasters on contraception in OECD member countries. METHODS Manual searches and systematic searches in six electronic databases were conducted with no language restrictions. All articles were screened by at least two researchers. The data were analysed thematically. RESULTS 108 articles were included. Most focussed on the Zika virus outbreak (n = 50) and the COVID-19 pandemic (n = 28). Four key themes were identified: importance of contraception during disasters, impact of disasters on contraceptive behaviour, barriers to contraception during disasters and ways of improving use of contraception during disasters. Despite efforts to increase access to contraception including by transforming ways of delivery, barriers to use meant that unmet need persisted. CONCLUSIONS To prevent adverse health outcomes and reduce health costs as a result of failure to have access to contraception during disasters, there is a need to intensify efforts to remove barriers to use. This should include increasing access and information on methods of contraception and their side effects (e.g., menstrual suppression) and making contraception freely available.
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Affiliation(s)
- Benjamin Freed
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Sarah Hillman
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Debra Bick
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Julia Gauly
- Warwick Medical School, University of Warwick, Coventry, UK
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24
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Abdoli S, Silveira MSVM, Doosti-Irani M, Fanti P, Miller-Bains K, Pavin EJ, Cardoso EB, Vardanjani LR, Noorjan K, Hessler D. Cross-national comparison of psychosocial well-being and diabetes outcomes in adults with type 1 diabetes during the COVID-19 pandemic in US, Brazil, and Iran. Diabetol Metab Syndr 2021; 13:63. [PMID: 34116721 PMCID: PMC8193175 DOI: 10.1186/s13098-021-00681-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/28/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic is a global public health emergency, which presents wide-ranging negative impacts on individuals with diabetes. To examine psychosocial well-being and diabetes outcomes in individuals with type 1 diabetes during the COVID-19 pandemic, and investigate how these factors vary in different countries. METHODS Between April and June 2020 we employed a cross national comparative research study in the United States (US), Brazil, and Iran to collect data from 1788 adults with type 1 diabetes using web-based survey. Study participants answered questions relevant to diabetes distress, diabetes burnout, depressive symptoms, COVID-19 related changes, and socio-demographic characteristics. They also reported their last Hemoglobin A1c (HbA1c) and daily Time-in-Range (TiR) blood glucose. We analyzed data using comparative tests (Chi-square, Kruskal-Wallis and McNemar test), logistic and linear regression adjusted for fixed effects. RESULTS There were significant changes prior and during the pandemic regarding access to diabetes care, diabetes supplies and medications, healthy food and safe places to exercise in all countries (p < 0.05). Participants in Iran experienced higher levels of diabetes distress (57.1%), diabetes burnout (50%), and depressive symptoms (60.9%), followed by Brazil and US (p < 0.0001). US participants reported better glycemic control (HbA1c = 6.97%, T1R = 69.64%) compared to Brazil (HbA1c = 7.94%, T1R = 51.95%) and Iran (HbA1c = 7.47%, T1R = 51.53%) (p < 0.0001). There were also significant relationships between psychosocial well-being, diabetes outcomes, socio-demographic data, and COVID-19 related challenges in overall sample (p < 0.05). CONCLUSIONS Regardless of differences among US, Brazil, and Iran, our findings revealed that different countries may experience similar challenges related to the COVID-19 pandemic which can impact negatively diabetes outcomes and psychosocial well-being in individuals with type 1 diabetes. Countries need to consider modifiable variables associated with poor diabetes outcomes and sub optimal psychosocial well-being and target vulnerable population using significant socio-demographic variables.
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Affiliation(s)
- Samereh Abdoli
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd Rm 155, Knoxville, TN 37996 USA
| | - Monica S. V. M. Silveira
- Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887 Brazil
| | - Mehri Doosti-Irani
- School of Nursing and Midwifery, Shahrekourd University of Medical Sciences, Shahrekord, Iran
| | - Paulo Fanti
- Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887 Brazil
| | | | - Elizabeth João Pavin
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887 Brazil
| | - Edimariz Buin Cardoso
- Clinical Psychologist, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887 Brazil
| | - Leila Rafiee Vardanjani
- Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, San Francisco, CA 94117 USA
| | - Kobra Noorjan
- School of Nursing and Midwifery, Shahrekourd University of Medical Sciences, Shahrekord, Iran
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, San Francisco, CA 94117 USA
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Abbott J, Ferraro K, Johnson D, Statland B, Massone J, Fowler C, Budai P, Cantrill SV. Colorado Palliative Care and Hospice Crisis Standards: Moving Beyond Critical Care Planning. J Pain Symptom Manage 2021; 61:1287-1296. [PMID: 33348027 DOI: 10.1016/j.jpainsymman.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022]
Abstract
Palliative care (PC) and hospice services have experienced shortages before 2020, and during the initial phases of the current pandemic, more critical gaps are expected with future surges, much as scarcity in intensive care unit services may recur during the COVID-19 pandemic. Although ethical allocation of ventilators and intensive care unit care is the subject of important discussions during this pandemic, caring for those at the end of life and those not desiring or qualifying for critical interventions must not be neglected, as critical care and comfort-focused care are intertwined. We review state and regional gaps already recognized in planning for scarcity in PC and hospice services during this pandemic and describe the planning initiatives Colorado has developed to address potential scarcities for this vulnerable and diverse group of people. We hope to encourage other state and regional groups to anticipate needs in the coming surges of this pandemic or in public health crises to come. Such planning is key to avoid the degradation of care that may result if it is necessary to invoke crisis standards of care and ration these essential services to our communities.
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Affiliation(s)
- Jean Abbott
- Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.
| | - Kelly Ferraro
- Palliative Medicine Physician, Denver Health & Hospital Authority, Denver, Colorado, USA
| | - Daniel Johnson
- Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Barbara Statland
- Hospitalist and Co Chair Ethics Committee, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - John Massone
- Medical Director, Palliative Care and Hospice, TRU Community Care, Lafayette, Colorado, USA
| | - Carol Fowler
- SCL Health-St. Mary's Hospital Palliative Medicine & Medical Director, HopeWest, Grand Junction, Colorado, USA
| | - Peggy Budai
- Poudre Valley Hospital and Medical Center of the Rockies, Older Adult and Palliative Care Programs, Fort Collins, Colorado, USA
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Bartlett L, Brady JJR, Farrow M, Kim S, Bindoff A, Fair H, Vickers JC, Sinclair D. Change in modifiable dementia risk factors during COVID-19 lockdown: The experience of over 50s in Tasmania, Australia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12169. [PMID: 34027023 PMCID: PMC8116867 DOI: 10.1002/trc2.12169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/14/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Containment measures implemented to minimize the spread of coronavirus disease 2019 (COVID-19) are reported to be negatively affecting mental health, diet, and alcohol consumption. These factors, as well as poor cardiometabolic health and insufficient physical and cognitive activity, are known to increase the risk of developing dementia. COVID-19 "lockdown" measures may have exacerbated these dementia risk factors among people in mid-to-later life. METHODS We compared longitudinal data from before (October 2019) and during (April-June 2020) the first COVID-19 lockdown period in Tasmania, Australia. Participants (n = 1671) were 50+ years of age and engaged in a public health program targeting dementia risk reduction, with one-third participating in the Preventing Dementia Massive Open Online Course (PD-MOOC). Regression models were used to assess changes in smoking, alcohol use, body mass index (BMI), diet, physical exercise, cognitive and social activity, anxiety and depression, and management of cholesterol, diabetes, and blood pressure. Where significant changes were noted, the moderating influence of being in current employment, living with others, and completing the PD-MOOC was tested. RESULTS Although friend networks contracted marginally during lockdown, no detrimental effects on modifiable dementia risk factors were noted. Anxiety levels and alcohol consumption decreased, there was no change in depression scores, and small but significant improvements were observed in cognitive and physical activity, smoking, diet, and BMI. Stronger improvements in cognitive activity were observed among people who were cohabiting (not living alone) and both cognitive activity and adherence to the MIND diet (Mediterranean-DASH diet Intervention for Neurological Delay) improved more for people who participated in the PD-MOOC. DISCUSSION Longitudinal data did not show widespread negative effects of COVID-19 lockdown on modifiable dementia risk factors in this sample. The results counter the dominant narratives of universal pandemic-related distress and suggest that engaging at-risk populations in proactive health promotion and education campaigns during lockdown events could be a protective public health strategy.
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Affiliation(s)
- Larissa Bartlett
- Wicking Dementia Research and Education CentreUniversity of TasmaniaTasmaniaAustralia
| | - James J. R. Brady
- Wicking Dementia Research and Education CentreUniversity of TasmaniaTasmaniaAustralia
| | - Maree Farrow
- Wicking Dementia Research and Education CentreUniversity of TasmaniaTasmaniaAustralia
| | - Sarang Kim
- Wicking Dementia Research and Education CentreUniversity of TasmaniaTasmaniaAustralia
| | - Aidan Bindoff
- Wicking Dementia Research and Education CentreUniversity of TasmaniaTasmaniaAustralia
| | - Hannah Fair
- Wicking Dementia Research and Education CentreUniversity of TasmaniaTasmaniaAustralia
| | - James C. Vickers
- Wicking Dementia Research and Education CentreUniversity of TasmaniaTasmaniaAustralia
| | - Duncan Sinclair
- Wicking Dementia Research and Education CentreUniversity of TasmaniaTasmaniaAustralia
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Chan AHY, Horne R. Preventing a Post-Pandemic Double Burden of Disease in the COVID-19 Pandemic. Glob Adv Health Med 2021; 10:21649561211010137. [PMID: 34104575 PMCID: PMC8172331 DOI: 10.1177/21649561211010137] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 02/15/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
As the world focuses on containing the spread of the coronavirus disease 2019 (COVID-19) and limiting the effects of the pandemic on the global population, care must be taken not to lose sight of existing individual health issues. There is a real risk of creating a 'post-pandemic double burden of disease'- where the pressures of having to manage acute COVID-19-related impacts on the health system are added to the existing burden of chronic non-communicable diseases or long-term conditions in developed countries. This could create a post-pandemic health crisis by devoting less attention to existing health conditions. A growing evidence base from other epidemics and health emergencies highlight the potential negative impact of short-term health crises on long-term public health. The significant disruptions to the usual healthcare systems and society can lead to increased morbidity and mortality in the long-term if not managed appropriately. This viewpoint provides an overview of the evidence to support the management of long-term conditions during, and after, health emergencies, to limit the impact of COVID-19 on public health in the short- and long-term.
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Affiliation(s)
- Amy Hai Yan Chan
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rob Horne
- Centre of Behavioural Medicine, University College London, London, UK
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Yang LY, Lyons JG, Erickson SR, Wu CH. Trends and Characteristics of the US Adult Population's Behavioral Patterns in Web-Based Prescription Filling: National Survey Study. J Med Internet Res 2021; 23:e23662. [PMID: 33724193 PMCID: PMC8074868 DOI: 10.2196/23662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/01/2020] [Accepted: 02/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background Filling a prescription on the web has become an alternative to in-person pharmacies for individuals to access their medications. However, the adoption of web-based filling has been gradual, and the use patterns remain to be unclear. Objective This study aims to estimate the trend and prevalence of web-based prescription-filling behavior and identify associated factors among adults in the United States. Methods We used data from the US National Health Interview Survey (NHIS) from 2009 to 2018. Adult respondents (aged ≥18 years and over) self-reported their behavior of web-based prescription filling, which was defined as having filled a prescription using the internet in the past 12 months during the survey year. We reported trends using weighted percentages adjusted by the NHIS complex sampling design. We used descriptive statistics and multivariable logistic regression models to examine trends and identify factors associated with web-based prescription-filling behavior. Results The estimated number of adults reporting web-based prescription-filling behavior significantly increased from 13,319,877 (13,319,877/225,217,942, 5.91%) in 2009 to 28,308,262 (28,308,262/246,611,125, 11.48%) in 2018 (P<.001). Those who were more likely to report filling a prescription on the web were aged between 35 and 74 years, female, White, and frequent users of the computer or internet; these adults also reported higher education, higher income, insurance coverage, and poorer health status. Conclusions Web-based prescription-filling behavior among US adults has increased significantly from 2009 to 2018. Health care providers should be aware of the upward trend in the use of web-based pharmacies and ensure the clinical safety of web-based prescriptions.
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Affiliation(s)
- Lin-Ya Yang
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Jennifer G Lyons
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Steven R Erickson
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Chung-Hsuen Wu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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Barbato D, Bryie L, Carlisle CM, Doroodchi P, Dowbiggin P, Huber LB. Chronically unprepared: emergency preparedness status among US medically vulnerable populations. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2021; 30:1775-1783. [PMID: 33688460 PMCID: PMC7932905 DOI: 10.1007/s10389-021-01487-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
Background The prevalence of large-scale natural and biological disasters has increased in recent years and can have detrimental impacts on health. Some populations are more susceptible to these impacts, including medically vulnerable populations. The purpose of this study was to evaluate the association between medically vulnerable populations and perceived emergency preparedness status. Methods This study used 2010 and 2012 Behavioral Risk Factor Surveillance System data (n = 33,852). Participants were classified into four exposure groups related to medical vulnerability for each of three chronic diseases. The outcome was based on responses to a question that asked how prepared the individual’s household was to handle a large-scale disaster or emergency. Logistic regression was used to assess the medical vulnerability-preparedness association. Results In adjusted analyses, individuals who were considered medically vulnerable had approximately 40% decreased odds of feeling prepared (OR range 0.61–0.64) compared to individuals without chronic diseases and disabilities. Conclusions Public health professionals should direct their efforts toward medically vulnerable individuals and their preparedness statuses. This study further solidifies the need for community partnerships between medical, emergency, and public health professionals to help individuals prepare for future emergencies.
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Affiliation(s)
- David Barbato
- Department of Public Health Sciences, UNC Charlotte, Charlotte, NC 28223 USA
| | - Lindsey Bryie
- Department of Public Health Sciences, UNC Charlotte, Charlotte, NC 28223 USA
| | | | - Padydeh Doroodchi
- Department of Public Health Sciences, UNC Charlotte, Charlotte, NC 28223 USA
| | - Patricia Dowbiggin
- Department of Public Health Sciences, UNC Charlotte, Charlotte, NC 28223 USA
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Mechanical-Ventilation Supply and Options for the COVID-19 Pandemic. Leveraging All Available Resources for a Limited Resource in a Crisis. Ann Am Thorac Soc 2021; 18:408-416. [PMID: 33202144 PMCID: PMC7919160 DOI: 10.1513/annalsats.202004-317cme] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus disease (COVID-19) has exposed critical supply shortages both in the United States and worldwide, including those in intensive care unit (ICU) and hospital bed supply, hospital staff, and mechanical ventilators. Many of those who are critically ill have required days to weeks of supportive invasive mechanical ventilation (IMV) as part of their treatment. Previous estimates set the U.S. availability of mechanical ventilators at approximately 62,000 full-featured ventilators, with 98,000 non–full-featured devices (including noninvasive devices). Given the limited availability of this resource both in the United States and in low- and middle-income countries, we provide a framework to approach the shortage of IMV resources. Here we discuss evidence and possibilities to reduce overall IMV needs, discuss strategies to maximize the availability of IMV devices designed for invasive ventilation, discuss the underlying methods in the literature to create and fashion new sources of potential ventilation that are available to hospitals and front-line providers, and discuss the staffing needs necessary to support IMV efforts. The pandemic has already pushed cities like New York and Boston well beyond previous ICU capacity in its first wave. As hot spots continue to develop around the country and the globe, it is evident that issues may arise ahead regarding the efficient and equitable use of resources. This unique challenge may continue to stretch resources and require care beyond previously set capacities and boundaries. The approaches presented here provide a review of the known evidence and strategies for those at the front line who are facing this challenge.
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Guadamuz JS, McCormick CD, Choi S, Urick B, Alexander GC, Qato DM. Telepharmacy and medication adherence in urban areas. J Am Pharm Assoc (2003) 2021; 61:e100-e113. [DOI: 10.1016/j.japh.2020.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 01/16/2023]
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Warr D, Storey E, Denys M, Brown S, Rose C. Providing pharmacy services in a basketball arena: Reflections on building a pharmacy in a COVID-19 surge facility. Am J Health Syst Pharm 2021; 78:416-425. [PMID: 33386406 PMCID: PMC7799192 DOI: 10.1093/ajhp/zxaa418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE As Coronavirus disease 19 (COVID-19) has spread globally, hospital systems have seen an increasing strain on their ability to accommodate the growing caseload. This demand has led countries to adopt varying surge-facility or alternate care site (ACS) models to manage patient overflow. This report describes the experience of setting up pharmacy services at a city-run surge facility in Philadelphia. SUMMARY The COVID-19 Surge Facility at the Liacouras Center (CSF-L) was initially developed to serve as a site for patients convalescing from acute inpatient stays in order to free up healthcare resources in surrounding hospitals. The CSF-L site required a distinct set of services to provide the desired level of care. This report details the preparations and challenges faced by the CSF-L pharmacy team in this endeavor, including identifying a pharmacy location that met regulatory requirements, obtaining proper licenses, coordinating drug procurement, filling staffing requirements, developing a formulary, defining the pharmacy and medication management workflow, and ensuring safety protocols were followed. This report explains the rational for developing certain processes and suggests alternative options and ideal plans for developing future pharmacy services in an ACS. CONCLUSION Identifying a pharmacy leadership team early in the ACS planning process can lead to more efficient plans for pharmacy services. This report details the important steps taken, decisions made, and challenges faced in setting up pharmaceutical services at a COVID-19 field hospital.
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Affiliation(s)
- Dillon Warr
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Eileen Storey
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Mark Denys
- Student and Employee Health Services, Temple University, Philadelphia, PA
| | - Suzanne Brown
- Department of Pharmacy, Pennsylvania Hospital, Penn Medicine, Philadelphia, PA
| | - Christina Rose
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA
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Fragala MS, Goldberg ZN, Goldberg SE. Return to Work: Managing Employee Population Health During the COVID-19 Pandemic. Popul Health Manag 2021; 24:S3-S15. [PMID: 33347795 PMCID: PMC7875125 DOI: 10.1089/pop.2020.0261] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has abruptly transformed the outlook of employer health benefits plans for 2020 and 2021. Containing the spread of the virus and facilitating care of those infected have quickly emerged as immediate priorities. Employers have adjusted health benefits coverage to make COVID-19 testing and treatment accessible and remove barriers to care in order to facilitate the containment of the disease. Employers also are introducing strategies focused on testing, surveillance, workplace modifications, and hygiene to keep workforces healthy and workplaces safe. This paper is intended to provide evidence-based perspectives for self-insured employers for managing population health during the COVID-19 pandemic. Such considerations include (1) return to work practices focused on mitigating the spread of COVID-19 through safety practices, testing and surveillance; and (2) anticipating the impact of COVID-19 on health benefits and costs (including adaptations in delivery of care, social and behavioral health needs, and managing interrupted care for chronic conditions).
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Abstract
In health care, the year 2020 is marked by the ongoing coronavirus (COVID-19) pandemic, with much research published to clarify infection risk, treatment approaches, and proposed interventions to reduce spread and combat complications. Although much work focused on COVID-19, medication safety remains a priority, and studies on adverse drug reactions, high-risk medications, and approaches to mitigate risk associated with chronic medication use, such as inappropriate dosing in hospital settings, were published. A continued commitment to patient-centered care, such as the approach put forth by the Age-Friendly Health Systems initiative and telehealth initiatives, ensures that even as health care practice strives to meet the challenge of an unprecedented global pandemic, safe medication use informed by patient needs continues to guide best practices through lessons learned. [Journal of Gerontological Nursing, 47(1), 7-11.].
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Moss JD, Schwenk HT, Chen M, Gaskari S. Drug Shortage and Critical Medication Inventory Management at a Children's Hospital During the COVID-19 Pandemic. J Pediatr Pharmacol Ther 2021; 26:21-25. [PMID: 33424496 DOI: 10.5863/1551-6776-26.1.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/14/2020] [Indexed: 11/11/2022]
Abstract
Drug shortages have significantly affected the ability to provide care at pediatric institutions, particularly in the inpatient and critical care settings. The coronavirus disease 2019 (COVID-19) pandemic highlighted additional challenges with drug supply chains. A working group consisting of pharmacy management, clinical pharmacists, and pharmacy buyers met regularly at the beginning of the COVID-19 pandemic. In collaboration with medical staff leadership and the Pharmacy and Therapeutics Committee, we developed a pediatric critical drug list to track essential medications for targeted monitoring. We created an inventory model with easily modifiable input variables related to patient and hospital data. This model was aligned across affiliate health care systems to increase transparency of our hospital's surge capacity for managing patients with COVID-19. Here, we share our framework for modeling drug inventory management at a freestanding children's hospital during a global pandemic.
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Livingston AN, Mattingly TJ. Drug and medical device product failures and the stability of the pharmaceutical supply chain. J Am Pharm Assoc (2003) 2021; 61:e119-e122. [PMID: 32753251 PMCID: PMC7395820 DOI: 10.1016/j.japh.2020.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/29/2020] [Accepted: 07/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Our objective was to review recent drug and medical device recalls, categorize recall types based on the free text descriptions posted within the recall announcements, and conduct exploratory analyses for researchers interested in pharmaceutical supply chain challenges. METHODS A cross-sectional study of all current recalls, market withdrawals, and safety alerts published by the United States Food and Drug Administration pertaining to drugs was conducted. A manual review of all the recalls was also conducted to extract additional information including company details, recall type (labeling or quality), and location of failure in the pharmaceutical supply chain (manufacturing or distribution). Descriptive statistics and exploratory bivariate analyses were conducted to test any potential differences between drug and device recalls. RESULTS Most recalls issued between January 2017 and September 2019 were pharmaceutical drug recalls (85.2%), while 34 (14.8%) medical device recalls were issued for the same period. For drug recalls, 85.1% (166/195) were because of quality, while 14.9% (29/195) were because of labeling issues. Of the quality issues for drug recalls, lack of sterility was the most frequent issue (139/166, 83.7%). There was no difference between drug or device recalls based on recall type (P = 0.16), top 20 pharmaceutical company (P = 0.62), or location of the supply chain failure (P = 0.20). CONCLUSIONS This study provides a process to categorize and evaluate drug and device recalls by recall type and location of the supply chain. By categorizing the free text provided in public recall data it would be easier to monitor trends over time.
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Liljenquist D, Bai G, Sarpatwari A, Anderson GF. A Non-Profit Approach to Address Foreign Dependence of Generic Drugs. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:30-33. [PMID: 33966649 DOI: 10.1017/jme.2021.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has revealed the vulnerability of the US generic drug supply chain to foreign production. Many policies have been proposed to mitigate this vulnerability. In this article, we argue that nonprofit drug manufacturers have the potential to make important contributions.
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Englund TR, Kinlaw AC, Sheikh SZ. Rise and Fall: Hydroxychloroquine and COVID-19 Global Trends: Interest, Political Influence, and Potential Implications. ACR Open Rheumatol 2020; 2:760-766. [PMID: 33263947 PMCID: PMC7738805 DOI: 10.1002/acr2.11207] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/06/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has led to rapid research and reporting on potential preventatives and treatments for the disease, including the drug hydroxychloroquine (HCQ). Despite a lack of robust evidence to support the use of HCQ for treatment of COVID-19, it was publicly endorsed and received widespread media coverage and public interest. The purpose of this report is to describe and contextualize the surges in public interest, demand, and adoption of HCQ for treatment of COVID-19 and outline implications for future public health policy and practice. METHODS Using national and global events and Google Trends data as a measure of public interest, we describe the timeline and trends in the emergence of, interest in, and adoption of HCQ as a treatment of COVID-19. We additionally review reports on public demand for HCQ for treatment of COVID-19 and impacts on medication access among patients with indicated uses. RESULTS Public interest and demand for HCQ surged in the United States and globally following endorsements from public officials and enaction of policies to facilitate off-label use of HCQ for treatment of COVID-19. Surges in demand for HCQ led to multiple documented shortages and barriers to accessing HCQ treatment for patients with indicated uses for HCQ. Although there have been reversals in policies to support HCQ use for treatment of COVID-19 in some regions, others have continued or expanded recommended uses. CONCLUSION Insights from the global response to HCQ and COVID-19 can be used to inform prudent decision-making in the future to prevent premature action and promote informed and equitable responses to promote public health.
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Reducing the dose of neuromuscular blocking agents with adjuncts: a systematic review and meta-analysis. Br J Anaesth 2020; 126:608-621. [PMID: 33218672 DOI: 10.1016/j.bja.2020.09.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Acute global shortages of neuromuscular blocking agents (NMBA) threaten to impact adversely on perioperative and critical care. The use of pharmacological adjuncts may reduce NMBA dose. However, the magnitude of any putative effects remains unclear. METHODS We conducted a systematic review and meta-analysis of RCTs. We searched Medline, Embase, Web of Science, and Cochrane Database (1970-2020) for RCTs comparing use of pharmacological adjuncts for NMBAs. We excluded RCTs not reporting perioperative NMBA dose. The primary outcome was total NMBA dose used to achieve a clinically acceptable depth of neuromuscular block. We assessed the quality of evidence using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) criteria. Data are presented as the standardised mean difference (SMD); I2 indicates percentage of variance attributable to heterogeneity. RESULTS From 3082 records, the full texts of 159 trials were retrieved. Thirty-one perioperative RCTs met the inclusion criteria for meta-analysis (n=1962). No studies were conducted in critically ill patients. Reduction in NMBA dose was associated with use of magnesium (SMD: -1.10 [-1.44 to -0.76], P<0.001; I2=85%; GRADE=moderate), dexmedetomidine (SMD: -0.89 [-1.55 to -0.22]; P=0.009; I2=87%; GRADE=low), and clonidine (SMD: -0.67 [-1.13 to -0.22]; P=0.004; I2=0%; GRADE=low) but not lidocaine (SMD: -0.46 [-1.01 to -0.09]; P=0.10; I2=68%; GRADE=moderate). Meta-analyses for nicardipine, diltiazem, and dexamethasone were not possible owing to the low numbers of studies. We estimated that 30-50 mg kg-1 magnesium preoperatively (8-15 mg kg h-1 intraoperatively) reduces rocuronium dose by 25.5% (inter-quartile range, 14.7-31). CONCLUSIONS Magnesium, dexmedetomidine, and clonidine may confer a clinically relevant sparing effect on the required dose of neuromuscular block ing drugs in the perioperative setting. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42020183969.
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Brown JD, Vouri SM, Manini TM. Survey-reported medication changes among older adults during the SARS-CoV-2 (COVID-19) pandemic. Res Social Adm Pharm 2020; 17:1478-1482. [PMID: 33221267 PMCID: PMC7659512 DOI: 10.1016/j.sapharm.2020.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 01/26/2023]
Abstract
Background Speculation on benefits and harms of prescription, over-the-counter and complementary medications has been widespread during the SARS-CoV-2 (or COVID-19) pandemic. This community-based survey assessed self-reported changes in medications including those stopped, started, or if access had been impacted. Methods A survey was collected via Research Electronic Data Capture (REDCap). The survey was advertised in the community through social media, email lists, websites, and post-cards. Survey responses were collected between 5/21/2020 and 6/24/2020. Variables included demographic characteristics such as age, sex, race, marital status, education, employment, income, and community type. Questions related to medication changes included: “Have you started any medication due to COVID-19?”, “Have you stopped any medication due to COVID-19?” and “Have you had issues getting your prescription medications?”. Respondents aged 50 years or older were included. Results There were N = 1397 responses of which 1169 were older adults ≥50 years-old. Of these, 1141 responded to the medication changes survey questions and 28 had missing responses and were excluded from the survey sample for this analysis. Among these, 31 (2.7%) reported a medication change included 5 (0.4%) reported stopping a medication, 18 (1.6%) reported starting a medication, and 8 (0.7%) reported trouble obtaining medications. Medications started included mostly vitamins or other supplements including zinc (n = 9), vitamin C (6), and other supplements (3). Among prescription medications, antidepressants and anti-anxiety medications (4) were reported as well as aspirin (1), losartan (1), and low dose naltrexone (1). One respondent reported unidentified homeopathy. There were no significant differences between those with medication changes and those with none. Conclusions In this community-based survey sample of over one thousand older adults, only a small percentage (2.7%; n = 31) reported any changes to medications during the pandemic. As essential workers during this crisis, pharmacists have played a critical role in providing medication information and continued access.
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Affiliation(s)
- Joshua D Brown
- Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL, USA.
| | - Scott M Vouri
- Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Todd M Manini
- Institute on Aging, Division of Epidemiology and Data Science in Gerontology, Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL, USA.
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41
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Farmer BM, Cole JB, Olives TD, Farrell NM, Rao R, Nelson LS, Mazer-Amirshahi M, Stolbach AI. ACMT Position Statement: Medication Administration and Safety During the Response to COVID-19 Pandemic. J Med Toxicol 2020; 16:481-483. [PMID: 32617893 PMCID: PMC7332309 DOI: 10.1007/s13181-020-00794-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Brenna M Farmer
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jon B Cole
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, USA
| | - Travis D Olives
- Minnesota Poison Control System, Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Natalija M Farrell
- Department of Pharmacy, Boston Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Rama Rao
- Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | | | - Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC, USA
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Kuo S, Ou HT, Wang CJ. Managing medication supply chains: Lessons learned from Taiwan during the COVID-19 pandemic and preparedness planning for the future. J Am Pharm Assoc (2003) 2020; 61:e12-e15. [PMID: 32919923 PMCID: PMC7439991 DOI: 10.1016/j.japh.2020.08.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 11/18/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has posed unprecedented challenges for nations worldwide, among which medication shortages can cause a devastatingly negative impact on global health. Using Taiwan as an example, this report describes the sources of potential medication shortages, discusses the preparedness and contingency strategies to address medication shortages, and outlines the evidence-based recommendations on ensuring a stable medication supply and improving the quality and security of medicines. Many drug shortages have focused on shortfalls of overseas manufacturing, but the effect of the COVID-19 crisis on misallocation of medications within the nation's internal supply chains is also a great concern. A wide range of stakeholders are involved in pharmaceutical supply chains, including government regulators, health care insurers, pharmaceutical companies, frontline physicians and pharmacists, patients and families, professional and patient associations or unions, and even individuals who acquire medications from abroad. Collaborative inputs and efforts from all these interdependent stakeholders are critical for establishing transparent preparedness and contingency plans to address drug shortages affected by disruptions of overseas manufacturing or stockouts in pharmacies owing to medication misallocation. Strategies have been documented and recommended in Taiwan and the United States to mitigate drug shortages and ensure the long-term quality and security of medicines. Barriers to accessing medicines are nothing new, but the COVID-19 pandemic poses urgent and even novel challenges to the stability and integrity of medication supply, which urges for a need to reconsider and reinforce effective management strategies for pharmaceuticals. Active management, transparent information, and timely communications are essential to ensure a stable supply of key therapeutic medications, especially during a pandemic.
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43
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Strand MA, Bratberg J, Eukel H, Hardy M, Williams C. Community Pharmacists' Contributions to Disease Management During the COVID-19 Pandemic. Prev Chronic Dis 2020; 17:E69. [PMID: 32701431 PMCID: PMC7380294 DOI: 10.5888/pcd17.200317] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Community pharmacists assist patients to manage disease and prevent complications. Despite the enormous challenge the coronavirus disease 2019 (COVID-19) pandemic has dealt to the health care system, community pharmacists have maintained the delivery of critical health services to communities, including those most at risk for COVID-19. Community pharmacists are in a key position to deliver priority pandemic responses including point-of-care testing for chronic disease management, vaccinations, and COVID-19 testing.
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Affiliation(s)
- Mark A Strand
- Professor, School of Pharmacy and Department of Public Health, North Dakota State University, Fargo, North Dakota.,Pharmacy Practice, Master of Public Health Program, College of Health Professions, North Dakota State University, 118K Sudro Hall, Fargo, ND 58101.
| | - Jeffrey Bratberg
- Clinical Professor, College of Pharmacy, The University of Rhode Island, Kingston, Rhode Island
| | - Heidi Eukel
- Professor, School of Pharmacy and Department of Public Health, North Dakota State University, Fargo, North Dakota
| | - Mark Hardy
- Executive Director, North Dakota State Board of Pharmacy, Bismarck, North Dakota
| | - Christopher Williams
- Associate Professor of Pharmacology, Division of Pharmaceutical Sciences, Xavier University of Louisiana, New Orleans, Louisiana
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Molina MF, Chary AN, Baugh JJ, Ludy S, Ginart P, Dadabhoy FZ, Samuels-Kalow ME, Slutzman JE, Raja AS, Hayes BD. To-go medications as a means to treat discharged emergency department patients during COVID-19. Am J Emerg Med 2020; 41:239-240. [PMID: 32505470 PMCID: PMC7836693 DOI: 10.1016/j.ajem.2020.05.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Melanie F Molina
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America.
| | - Anita N Chary
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Joshua J Baugh
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Stephanie Ludy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Paul Ginart
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Farah Z Dadabhoy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Jonathan E Slutzman
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Ali S Raja
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Bryan D Hayes
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States of America; Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
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45
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Lim W, Liang C, Assantachai P, Auyeung TW, Kang L, Lee W, Lim J, Sugimoto K, Akishita M, Chia S, Chou M, Ding Y, Iijima K, Jang HC, Kawashima S, Kim M, Kojima T, Kuzuya M, Lee J, Lee SY, Lee Y, Peng L, Wang NY, Wang Y, Won CW, Woo J, Chen L, Arai H. COVID-19 and older people in Asia: Asian Working Group for Sarcopenia calls to actions. Geriatr Gerontol Int 2020; 20:547-558. [PMID: 32365259 PMCID: PMC7267164 DOI: 10.1111/ggi.13939] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 01/10/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has casted a huge impact on global public health and the economy. In this challenging situation, older people are vulnerable to the infection and the secondary effects of the pandemic and need special attention. To evaluate the impacts of COVID-19 on older people, it is important to balance the successful pandemic control and active management of secondary consequences. These considerations are particularly salient in the Asian context, with its diversity among countries in terms of sociocultural heritage, healthcare setup and availability of resources. Thus, the Asian Working Group for Sarcopenia summarized the considerations of Asian countries focusing on responses and difficulties in each country, impacts of health inequity related to the COVID-19 pandemic and proposed recommendations for older people, which are germane to the Asian context. More innovative services should be developed to address the increasing demands for new approaches to deliver healthcare in these difficult times and to establish resilient healthcare systems for older people. Geriatr Gerontol Int 2020; 9999: n/a-n/a.
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Affiliation(s)
- Wee‐Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active AgingTan Tock Seng HospitalSingapore
| | - Chih‐Kuang Liang
- Center for Geriatrics and GerontologyKaohsiung Veterans General HospitalKaohsiungTaiwan
| | - Prasert Assantachai
- Division of Geriatric Medicine, Department of Preventive and Social MedicineFaculty of Medicine Siriraj Hospital, Mahidol UniversityBangkokThailand
| | - Tung W Auyeung
- Jockey Club Institute of AgeingThe Chinese University of Hong KongHong KongChina
| | - Lin Kang
- Department of GeriatricsPeking Union Medical College HospitalBeijingChina
| | - Wei‐Ju Lee
- Aging and Health Research CenterNational Yang Ming UniversityTaipeiTaiwan
- Department of Family MedicineTaipei Veterans General Hospital Yuanshan BranchYilanTaiwan
| | - Jae‐Young Lim
- Department of Rehabilitation MedicineSeoul National University College of Medicine, Seoul National University Bundang HospitalSeongnamSouth Korea
| | - Ken Sugimoto
- Department of Geriatric and General MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Shu‐Lih Chia
- Health Promotion AdministrationMinistry of Health and WelfareTaipeiTaiwan
| | - Ming‐Yueh Chou
- Center for Geriatrics and GerontologyKaohsiung Veterans General HospitalKaohsiungTaiwan
| | - Yew‐Yoong Ding
- Department of Geriatric Medicine, Institute of Geriatrics and Active AgingTan Tock Seng HospitalSingapore
| | - Katsuya Iijima
- Institute of GerontologyThe University of TokyoTokyoJapan
| | - Hak C Jang
- Department of Internal MedicineSeoul National University College of Medicine, Seoul National University Bundang HospitalSeongnamSouth Korea
| | | | - Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East‐West Medical Research InstituteKyung Hee UniversitySeoulSouth Korea
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Masafumi Kuzuya
- Department of Community Healthcare and GeriatricsNagoya University Graduate School of MedicineNagoyaJapan
| | - Jenny Lee
- Jockey Club Institute of AgeingThe Chinese University of Hong KongHong KongChina
| | - Sang Y Lee
- Department of Rehabilitation MedicineSeoul National University Boramae Medical CenterSeoulSouth Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public HealthAjou University School of MedicineSuwonSouth Korea
| | - Li‐Ning Peng
- Aging and Health Research CenterNational Yang Ming UniversityTaipeiTaiwan
- Center for Geriatrics and GerontologyTaipei Veterans General HospitalTaipeiTaiwan
| | | | - Yin‐Wei Wang
- Health Promotion AdministrationMinistry of Health and WelfareTaipeiTaiwan
| | - Chang W Won
- Department of Family Medicine, College of MedicineKyung Hee UniversitySeoulSouth Korea
| | - Jean Woo
- Department of Medicine & Therapeutics, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Liang‐Kung Chen
- Aging and Health Research CenterNational Yang Ming UniversityTaipeiTaiwan
- Center for Geriatrics and GerontologyTaipei Veterans General HospitalTaipeiTaiwan
| | - Hidenori Arai
- National Center for Geriatrics and GerontologyObuJapan
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Marchandot B, Sattler L, Jesel L, Matsushita K, Schini-Kerth V, Grunebaum L, Morel O. COVID-19 Related Coagulopathy: A Distinct Entity? J Clin Med 2020; 9:E1651. [PMID: 32486469 PMCID: PMC7356260 DOI: 10.3390/jcm9061651] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has impacted healthcare communities across the globe on an unprecedented scale. Patients have had diverse clinical outcomes, but those developing COVID-19-related coagulopathy have shown a disproportionately worse outcome. This narrative review summarizes current evidence regarding the epidemiology, clinical features, known and presumed pathophysiology-based models, and treatment guidance regarding COVID-19 coagulopathy.
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Affiliation(s)
- Benjamin Marchandot
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France; (B.M.); (L.J.); (K.M.)
| | - Laurent Sattler
- Université de Strasbourg, Pôle de Biologie, Département d’Hémostase, Centre Hospitalier Universitaire, 67000 Strasbourg, France; (L.S.); (L.G.)
| | - Laurence Jesel
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France; (B.M.); (L.J.); (K.M.)
- UMR INSERM 1260, Regenerative Nanomedicine, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France;
| | - Kensuke Matsushita
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France; (B.M.); (L.J.); (K.M.)
- UMR INSERM 1260, Regenerative Nanomedicine, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France;
| | - Valerie Schini-Kerth
- UMR INSERM 1260, Regenerative Nanomedicine, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France;
| | - Lelia Grunebaum
- Université de Strasbourg, Pôle de Biologie, Département d’Hémostase, Centre Hospitalier Universitaire, 67000 Strasbourg, France; (L.S.); (L.G.)
| | - Olivier Morel
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France; (B.M.); (L.J.); (K.M.)
- UMR INSERM 1260, Regenerative Nanomedicine, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France;
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47
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Wong AH, Roppolo LP, Chang BP, Yonkers KA, Wilson MP, Powsner S, Rozel JS. Management of Agitation During the COVID-19 Pandemic. West J Emerg Med 2020; 21:795-800. [PMID: 32726244 PMCID: PMC7390577 DOI: 10.5811/westjem.2020.5.47789] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/02/2020] [Accepted: 05/10/2020] [Indexed: 01/10/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the coronavirus SARS-CoV-2 has radically altered delivery of care in emergency settings. Unprecedented hardship due to ongoing fears of exposure and threats to personal safety, along with societal measures enacted to curb disease transmission, have had broad psychosocial impact on patients and healthcare workers alike. These changes can significantly affect diagnosing and managing behavioral emergencies such as agitation in the emergency department. On behalf of the American Association for Emergency Psychiatry, we highlight unique considerations for patients with severe behavioral symptoms and staff members managing symptoms of agitation during COVID-19. Early detection and treatment of agitation, precautions to minimize staff hazards, coordination with security personnel and psychiatric services, and avoidance of coercive strategies that cause respiratory depression will help mitigate heightened risks to safety caused by this outbreak.
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Affiliation(s)
- Ambrose H. Wong
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Lynn P. Roppolo
- University of Texas Southwestern, Department of Emergency Medicine, Dallas, Texas
| | - Bernard P. Chang
- Columbia University, Irving Medical Center, Department of Emergency Medicine, New York, New York
| | - Kimberly A. Yonkers
- Yale School of Medicine, Department of Psychiatry, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, Connecticut
| | - Michael P. Wilson
- University of Arkansas for Medical Sciences, Department of Emergency Medicine, Department of Psychiatry, Little Rock, Arkansas
| | - Seth Powsner
- Yale School of Medicine, Department of Psychiatry, Department of Emergency Medicine New Haven, Connecticut
| | - John S. Rozel
- University of Pittsburgh School of Law and School of Medicine, Department of Psychiatry, Pittsburgh, Pennsylvania
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48
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Chan AHY, Rutter V, Ashiru-Oredope D, Tuck C, Babar ZUD. Together we unite: the role of the Commonwealth in achieving universal health coverage through pharmaceutical care amidst the COVID-19 pandemic. J Pharm Policy Pract 2020; 13:13. [PMID: 32426144 PMCID: PMC7218554 DOI: 10.1186/s40545-020-00214-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The world currently faces unprecedented health challenges as COVID-19 poses a huge threat to health systems, economies and societies as we know it. The events of the current COVID-19 pandemic have further emphasised existing issues within our health systems. There is no better time than now to come together in global solidarity to tackle these evolving threats of COVID-19 pandemic. The Commonwealth is an ideally placed network to tackle these global health challenges, with its wide-reaching networks of governmental, non-governmental and civil society organisations across all continents. Although the biennial Commonwealth Heads of Government Meeting (CHOGM) originally scheduled to take place in Kigali in Rwanda 22-27 June 2020 has been postponed in view of COVID-19, Commonwealth country discussions are continuing, centred on the CHOGM key theme of 'Delivering a Common Future: Connecting, Innovating, Transforming', and five subthemes of Information and Communications Technology (ICT) and Innovation; Trade; Environment; Governance and the Rule of Law; and Youth. The planned CHOGM and Commonwealth itself provides all members a timely platform to consider innovative ways to connect, innovate and transform healthcare to meet the needs of their populations. This commentary considers these five CHOGM subthemes and how member nations can be supported to achieve universal health coverage through optimising medicines use and outcomes, in the midst of a global pandemic in line with the global health agenda.
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Affiliation(s)
- Amy Hai Yan Chan
- Commonwealth Pharmacists Association, London, UK
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 505, 85 Pard Road, Grafton, Auckland, 1023 New Zealand
| | - Victoria Rutter
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 505, 85 Pard Road, Grafton, Auckland, 1023 New Zealand
| | - Diane Ashiru-Oredope
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 505, 85 Pard Road, Grafton, Auckland, 1023 New Zealand
| | - Chloe Tuck
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 505, 85 Pard Road, Grafton, Auckland, 1023 New Zealand
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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49
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Khera A, Baum SJ, Gluckman TJ, Gulati M, Martin SS, Michos ED, Navar AM, Taub PR, Toth PP, Virani SS, Wong ND, Shapiro MD. Continuity of care and outpatient management for patients with and at high risk for cardiovascular disease during the COVID-19 pandemic: A scientific statement from the American Society for Preventive Cardiology. Am J Prev Cardiol 2020; 1:100009. [PMID: 32835347 PMCID: PMC7194073 DOI: 10.1016/j.ajpc.2020.100009] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has consumed our healthcare system, with immediate resource focus on the management of high numbers of critically ill patients. Those that fare poorly with COVID-19 infection more commonly have cardiovascular disease (CVD), hypertension and diabetes. There are also several other conditions that raise concern for the welfare of patients with and at high risk for CVD during this pandemic. Traditional ambulatory care is disrupted and many patients are delaying or deferring necessary care, including preventive care. New impediments to medication access and adherence have arisen. Social distancing measures can increase social isolation and alter physical activity and nutrition patterns. Virtually all facility based cardiac rehabilitation programs have temporarily closed. If not promptly addressed, these changes may result in delayed waves of vulnerable patients presenting for urgent and preventable CVD events. Here, we provide several recommendations to mitigate the adverse effects of these disruptions in outpatient care. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers should be continued in patients already taking these medications. Where possible, it is strongly preferred to continue visits via telehealth, and patients should be counselled about promptly reporting new symptoms. Barriers to medication access should be reviewed with patients at every contact, with implementation of strategies to ensure ongoing provision of medications. Team-based care should be leveraged to enhance the continuity of care and adherence to lifestyle recommendations. Patient encounters should include discussion of safe physical activity options and access to healthy food choices. Implementation of adaptive strategies for cardiac rehabilitation is recommended, including home based cardiac rehab, to ensure continuity of this essential service. While the practical implementation of these strategies will vary by local situation, there are a broad range of strategies available to ensure ongoing continuity of care and health preservation for those at higher risk of CVD during the COVID-19 pandemic.
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Affiliation(s)
- Amit Khera
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Seth J. Baum
- Florida Atlantic University, Department of Integrated Medical Sciences, Boca Raton, FL, USA
| | - Ty J. Gluckman
- Center for Cardiovascular Analytics, Research, and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, OR, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine- Phoenix, Phoenix, AZ, USA
| | - Seth S. Martin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ann Marie Navar
- Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Pam R. Taub
- Division of Cardiovascular Medicine, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Peter P. Toth
- CGH Medical Center, Sterling, IL, Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Salim S. Virani
- Division of Cardiology, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Nathan D. Wong
- Division of Cardiology, UC Irvine School of Medicine, Irvine, CA, USA
| | - Michael D. Shapiro
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
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