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Sauvage A, Laurent E, Gaborit C, Guillon A, Grammatico-Guillon L. Herpes simplex encephalitis in France: incidence, 6-month rehospitalizations and mortality. Infection 2024:10.1007/s15010-024-02272-3. [PMID: 38678152 DOI: 10.1007/s15010-024-02272-3] [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: 02/25/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Herpes simplex encephalitis (HSE) is a disease with unfavorable vital and functional prognoses. There are no recent epidemiological data on HSE at a national level using real-life databases, especially in France. This study aimed to report the incidence, the clinical characteristics and outcomes of the patients with HSE. METHODS We conducted a comprehensive retrospective cohort study on all patients hospitalized for HSE in France between 2015 and 2022 using national hospital discharge databases. Incidence, socio-demographic and clinical characteristics (including comorbidities, seizure, stays' features, intensive care supports) were described. The short- (first stay) and long-term (6-month) outcomes were reported, in terms of mortality and rehospitalizations. RESULTS 1425 HSE patients were included (median age 67 [54-77] years old, M/F sex ratio 1.07), giving a mean yearly hospital incidence of 2.3 [2.1-2.5] per 1,000,000 inhabitants. 51.2% of the patients were admitted in ICU (n = 730), of whom 59.0% were mechanically ventilated. The overall mortality during the first stay was 14.3% (n = 204), up to 17.9% for ICU patients. Within 6 months, among the survivors, 10.1% had at least one rehospitalization related to HSE. At 6 months, 16.5% of all patients had died (n = 235), 20.8% for ICU patients. CONCLUSION In France, the incidence of hospitalizations for HSE was 2.3 per 1,000,000 inhabitants with more than half of the patients admitted in ICU and a 6-month in-hospital mortality about 16.5%. This real-life update on the characteristics and severe outcomes of the disease raises awareness among care practitioners, of the serious nature of the disease, and thus can lead to higher vigilance.
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Affiliation(s)
- Ambre Sauvage
- Clinical Data Epidemiology Unit in Centre-Val de Loire (EpiDcliC), Tours University Hospital, Tours, France
- University of Tours, Tours, France
| | - Emeline Laurent
- Clinical Data Epidemiology Unit in Centre-Val de Loire (EpiDcliC), Tours University Hospital, Tours, France
- Research Team EA 7505 "Education, Ethics, Health", University of Tours, Tours, France
| | - Christophe Gaborit
- Clinical Data Epidemiology Unit in Centre-Val de Loire (EpiDcliC), Tours University Hospital, Tours, France
| | - Antoine Guillon
- Intensive Care Unit, Tours University Hospital, Tours, France
- Research Center for Respiratory Diseases, INSERM U1100, Tours, France
| | - Leslie Grammatico-Guillon
- Clinical Data Epidemiology Unit in Centre-Val de Loire (EpiDcliC), Tours University Hospital, Tours, France.
- University of Tours, Tours, France.
- MAVIVH, INSERM U1259, Tours, France.
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2
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Ibsen TL, Strand BH, Bergh S, Livingston G, Lurås H, Mamelund SE, Voshaar RO, Rokstad AMM, Thingstad P, Gerritsen D, Selbæk G. A longitudinal cohort study on the use of health and care services by older adults living at home with/without dementia before and during the COVID-19 pandemic: the HUNT study. BMC Health Serv Res 2024; 24:485. [PMID: 38641570 PMCID: PMC11027287 DOI: 10.1186/s12913-024-10846-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/11/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Older adults and people with dementia were anticipated to be particularly unable to use health and care services during the lockdown period following the COVID-19 pandemic. To better prepare for future pandemics, we aimed to investigate whether the use of health and care services changed during the pandemic and whether those at older ages and/or dementia experienced a higher degree of change than that observed by their counterparts. METHODS Data from the Norwegian Trøndelag Health Study (HUNT4 70 + , 2017-2019) were linked to two national health registries that have individual-level data on the use of primary and specialist health and care services. A multilevel mixed-effects linear regression model was used to calculate changes in the use of services from 18 months before the lockdown, (12 March 2020) to 18 months after the lockdown. RESULTS The study sample included 10,607 participants, 54% were women and 11% had dementia. The mean age was 76 years (SD: 5.7, range: 68-102 years). A decrease in primary health and care service use, except for contact with general practitioners (GPs), was observed during the lockdown period for people with dementia (p < 0.001) and those aged ≥ 80 years without dementia (p = 0.006), compared to the 6-month period before the lockdown. The use of specialist health services decreased during the lockdown period for all groups (p ≤ 0.011), except for those aged < 80 years with dementia. Service use reached levels comparable to pre-pandemic data within one year after the lockdown. CONCLUSION Older adults experienced an immediate reduction in the use of health and care services, other than GP contacts, during the first wave of the COVID-19 pandemic. Within primary care services, people with dementia demonstrated a more pronounced reduction than that observed in people without dementia; otherwise, the variations related to age and dementia status were small. Both groups returned to services levels similar to those during the pre-pandemic period within one year after the lockdown. The increase in GP contacts may indicate a need to reallocate resources to primary health services during future pandemics. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov, with the identification number NCT04792086.
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Affiliation(s)
- Tanja Louise Ibsen
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway.
| | - Bjørn Heine Strand
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Sverre Bergh
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-Related Functional Decline and Disease (AFS), Innlandet Hospital Trust, Ottestad, Norway
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Hilde Lurås
- Health Services Research Unit, Akershus University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Svenn-Erik Mamelund
- Centre for Research On Pandemics & Society (PANSOC), at Oslo Metropolitan University, Oslo, Norway
| | - Richard Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne Marie Mork Rokstad
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health and Social Services, Trondheim Municipality, Trondheim, Norway
| | - Debby Gerritsen
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, Netherlands
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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3
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Hursman A, Vang C, Thooft T, Stone K. The Role of Telepharmacy in the Delivery of Clinical Pharmacy Services Following the COVID-19 Pandemic: A Descriptive Report. J Pharm Technol 2024; 40:66-71. [PMID: 38525089 PMCID: PMC10959079 DOI: 10.1177/87551225231222426] [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: 03/26/2024] Open
Abstract
Background: Telepharmacy, which utilizes telecommunication technology to provide pharmaceutical care remotely, has gained significance in expanding access to pharmacists, particularly in areas with limited health care facility access. The COVID-19 pandemic, with its restrictions on in-person interactions, underscored the importance of telepharmacy in ensuring continuity of care. Objectives: The objective of this study was to determine the impact of telepharmacy on the delivery of clinical pharmacy services before and after the COVID-19 pandemic. Methods: This study explores the use of telepharmacy in delivering medication therapy management (MTM), chronic disease management (CDM), chronic opioid analgesic therapy (COAT), and transitions of care (TCM) visits. Data from electronic health records (EHRs) was collected to analyze the number referrals, number and type of visits, mode of visits, and locations served using correlations and descriptive statistics. Results: The findings indicate an increase in the number of referrals and visits following the pandemic, with a shift toward telepharmacy visits. The study highlights the convenience and accessibility provided by telepharmacy, resulting in improved patient access to clinical pharmacy services at 1 Midwest health system following the COVID-19 pandemic. Conclusions: The continued use of telepharmacy is important to ensure that patients, especially those in rural locations, have access to health care services and can be a positive factor in growing clinical pharmacy services.
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Affiliation(s)
| | - Chapleur Vang
- School of Pharmacy, North Dakota State University, Fargo, ND, USA
| | - Taylor Thooft
- Ambulatory Pharmacy, Essentia Health, Detroit Lakes, MN, USA
| | - Kirsten Stone
- Ambulatory Pharmacy, Essentia Health, Superior, WI, USA
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Rakusa M, Moro E, Akhvlediani T, Bereczki D, Bodini B, Cavallieri F, Fanciulli A, Filipović SR, Guekht A, Helbok R, Hochmeister S, Martinelli Boneschi F, Özturk S, Priori A, Romoli M, Willekens B, Zedde M, Sellner J. The COVID-19 pandemic and neurology: A survey on previous and continued restrictions for clinical practice, curricular training, and health economics. Eur J Neurol 2024; 31:e16168. [PMID: 38038262 PMCID: PMC11235678 DOI: 10.1111/ene.16168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND AND PURPOSE The COVID-19 pandemic has significantly impacted health systems worldwide. Here, we assessed the pandemic's impact on clinical service, curricular training, and financial burden from a neurological viewpoint during the enforced lockdown periods and the assumed recovery by 2023. METHODS An online 18-item survey was conducted by the European Academy of Neurology (EAN) NeuroCOVID-19 Task Force among the EAN community. The survey was online between February and March 2023. Questions related to general, demographic, clinical, work, education, and economic aspects. RESULTS We collected 430 responses from 79 countries. Most health care professionals were aged 35-44 years, with >15 years of work experience. The key findings of their observations were as follows. (i) Clinical services were cut back in all neurological subspecialties during the most restrictive COVID-19 lockdown period. The most affected neurological subspecialties were services for patients with dementia, and neuromuscular and movement disorders. The levels of reduction and the pace of recovery were distinct for acute emergencies and in- and outpatient care. Recovery was slow for sleep medicine, autonomic nervous system disorders, neurorehabilitation, and dementia care. (ii) Student and residency rotations and grand rounds were reorganized, and congresses were converted into a virtual format. Conferences are partly maintained in a hybrid format. (iii) Affordability of neurological care and medication shortage are emerging issues. CONCLUSIONS Recovery of neurological services up to spring 2023 has been incomplete following substantial disruption of neurological care, medical education, and health economics in the wake of the COVID-19 pandemic. The continued limitations for the delivery of neurological care threaten brain health and call for action on a global scale.
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Affiliation(s)
- Martin Rakusa
- Division of NeurologyUniversity Medical Centre MariborMariborSlovenia
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences, INSERM U1216Grenoble Alpes UniversityGrenobleFrance
| | | | | | - Benedetta Bodini
- Neurology DepartmentSt. Antoine Hospital, APHPParisFrance
- Paris Brain Institute, ICM, CNRS, INSERMSorbonne UniversitéParisFrance
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation DepartmentAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
| | | | | | - Alla Guekht
- Research and Clinical Center for NeuropsychiatryMoscowRussian Federation
- Pirogov Russian National Research Medical UniversityMoscowRussian Federation
| | - Raimund Helbok
- Department of NeurologyJohannes Kepler UniversityLinzAustria
| | | | | | - Serefnur Özturk
- Department of Neurology, Faculty of MedicineSelcuk UniversityKonyaTurkey
| | - Alberto Priori
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health SciencesUniversity of MilanMilanItaly
- Clinical Neurology Unit, Azienda Socio‐Sanitaria Territoriale Santi Paolo e Carlo and Department of Health SciencesUniversity of MilanMilanItaly
| | - Michele Romoli
- Neurology and Stroke Unit, Department of NeuroscienceBufalini HospitalCesenaItaly
| | - Barbara Willekens
- Department of NeurologyAntwerp University HospitalEdegemBelgium
- Translational Neurosciences Research GroupUniversity of AntwerpWilrijkBelgium
| | - Marialuisa Zedde
- Neurology Unit, Stroke UnitAzienda Unità Sanitaria Locale, IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Johann Sellner
- Department of NeurologyLandesklinkum Mistelbach‐GänserndorfMistelbachAustria
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Rerkasem A, Thaichana P, Bunsermvicha N, Nopparatkailas R, Arwon S, Orrapin S, Reanpang T, Apichartpiyakul P, Orrapin S, Siribumrungwong B, Lumjuan N, Rerkasem K, Derraik JGB. A COVID-19 Silver Lining-Decline in Antibiotic Resistance in Ischemic Leg Ulcers during the Pandemic: A 6-Year Retrospective Study from a Regional Tertiary Hospital (2017-2022). Antibiotics (Basel) 2023; 13:35. [PMID: 38247594 PMCID: PMC10812686 DOI: 10.3390/antibiotics13010035] [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: 10/28/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Antibiotic resistance (AR) associated with chronic limb-threatening ischemia (CLTI) poses additional challenges for the management of ischemic leg ulcers, increasing the likelihood of severe outcomes. This study assessed AR prevalence in bacteria isolated from CLTI-associated leg ulcers before (1 January 2017-10 March 2020; n = 69) and during (11 March 2020-31 December 2022; n = 59) the COVID-19 pandemic from patients admitted with positive wound cultures to a regional hospital in Chiang Mai (Thailand). There was a marked reduction in AR rates from 78% pre-pandemic to 42% during the pandemic (p < 0.0001), with rates of polymicrobial infections 22 percentage points lower (from 61% to 39%, respectively; p = 0.014). There were reduced AR rates to amoxicillin/clavulanate (from 42% to 4%; p < 0.0001) and ampicillin (from 16% to 2%; p = 0.017), as well as multidrug resistance (19% to 8%; p = 0.026). Factors associated with increased AR odds were polymicrobial infections (adjusted odds ratio (aOR) 5.6 (95% CI 2.1, 15.0); p = 0.001), gram-negative bacteria (aOR 7.0 (95% CI 2.4, 20.5); p < 0.001), and prior use of antibiotics (aOR 11.9 (95% CI 1.1, 128.2); p = 0.041). Improvements in infection control measures and hygiene practices in the community during the pandemic were likely key factors contributing to lower AR rates. Thus, strategic public health interventions, including community education on hygiene and the informed use of antibiotics, may be crucial in mitigating the challenges posed by AR in CLTI. Further, advocating for more judicious use of empirical antibiotics in clinical settings can balance effective treatment against AR development, thereby improving patient outcomes.
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Affiliation(s)
- Amaraporn Rerkasem
- Environmental-Occupational Health Sciences and Non-Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (A.R.); (P.T.)
- Research Center for Infectious Disease and Substance Use, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Pak Thaichana
- Environmental-Occupational Health Sciences and Non-Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (A.R.); (P.T.)
| | - Nuttida Bunsermvicha
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (N.B.); (S.A.); (S.O.); (T.R.); (P.A.)
| | - Rawee Nopparatkailas
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Supapong Arwon
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (N.B.); (S.A.); (S.O.); (T.R.); (P.A.)
| | - Saranat Orrapin
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (N.B.); (S.A.); (S.O.); (T.R.); (P.A.)
| | - Termpong Reanpang
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (N.B.); (S.A.); (S.O.); (T.R.); (P.A.)
| | - Poon Apichartpiyakul
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (N.B.); (S.A.); (S.O.); (T.R.); (P.A.)
| | - Saritphat Orrapin
- Department of Surgery, Faculty of Medicine, Thammasat University, Rangsit Campus, Pathum Thani 12120, Thailand; (S.O.); (B.S.)
| | - Boonying Siribumrungwong
- Department of Surgery, Faculty of Medicine, Thammasat University, Rangsit Campus, Pathum Thani 12120, Thailand; (S.O.); (B.S.)
| | - Nongkran Lumjuan
- Research Center for Molecular and Cell Biology, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Kittipan Rerkasem
- Environmental-Occupational Health Sciences and Non-Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (A.R.); (P.T.)
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (N.B.); (S.A.); (S.O.); (T.R.); (P.A.)
| | - José G. B. Derraik
- Environmental-Occupational Health Sciences and Non-Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (A.R.); (P.T.)
- Department of Women’s and Children’s Health, Uppsala University, 75185 Uppsala, Sweden
- Department of Pediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand
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Fortuna D, Caselli L, Berti E, Moro ML. Mortality and healthcare assessment among patients with chronic disease over 2 years of COVID-19: a population-based study in a large hard-hit Italian region. BMJ Open 2023; 13:e073477. [PMID: 38149421 PMCID: PMC10711920 DOI: 10.1136/bmjopen-2023-073477] [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: 03/08/2023] [Accepted: 11/07/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVES We aimed to provide a region-wide comprehensive account of the indirect effects of COVID-19 on patients with chronic disease, in terms of non-COVID-19 mortality, and access to both inpatient and outpatient health services over a 2-year pandemic period. DESIGN Population-based retrospective study. SETTING Adult patients, affected by at least 1 of 32 prevalent chronic conditions, residing in the Emilia-Romagna Region in Italy, during the years 2020 (N=1 791 189, 47.7% of the overall adult regional population) and 2021 (N=1 801 071, 47.8%). RESULTS Overall, non-COVID-19 mortality among patients with chronic disease during the pandemic (2.7%) did not differ substantially from the expected mortality (2.5%), based on a 3 years prepandemic period (2017-2019) and adjusting for the demographic and clinical characteristics of the population under study. Indeed, while the first pandemic wave was characterised by a significant non-COVID-19 excess mortality (March: +35%), the subsequent phases did not show such disruptive variations in non-COVID-19 deaths, which remained around or even below the excess mortality threshold. End-of-life care of patients with chronic disease, especially for non-COVID-19 cases, significantly shifted from hospitalisations (-19%), to homecare (ADI: +7%; w/o ADI: +9%). Overall, healthcare of patients without COVID-19 chronic disease decreased, with similar negative trends in hospitalisations (-15.5%), major procedures (-19.6%) and ER accesses (-23.7%). Homecare was the least affected by the pandemic, with an overall reduction of -9.8%. COVID-19 outbreak also impacted on different types of outpatient care. Rehabilitation therapies, specialist visits, diagnostic and lab tests were considerably reduced during the first pandemic wave and consequent lockdown, with access rates of patients without COVID-19 chronic disease below -60%. CONCLUSIONS This work thoroughly describes how a large and well-defined population of patients without COVID-19 chronic disease has been affected by the changes and reorganisation in the healthcare system during 2 years of the pandemic, highlighting health priorities and challenges in chronic disease management under conditions of limited resources.
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Affiliation(s)
- Daniela Fortuna
- Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Emilia-Romagna, Italy
| | - Luana Caselli
- Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Emilia-Romagna, Italy
| | - Elena Berti
- Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Emilia-Romagna, Italy
| | - Maria Luisa Moro
- Regional Agency for Health and Social Care, Emilia-Romagna Region, Bologna, Emilia-Romagna, Italy
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7
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Russell A, Filec S, Serper M, Opsasnick L, Batio S, O'Conor RM, Curtis L, Kwasny M, Benavente JY, Wismer G, Bonham M, Zheng P, Lovett R, Arvanitis M, Ladner DP, McCaffery K, Linder JA, Bailey SC, Wolf MS. Impact of COVID-19 on the capacity to self-manage health and chronic conditions. PEC INNOVATION 2023; 2:100163. [PMID: 37197693 PMCID: PMC10167781 DOI: 10.1016/j.pecinn.2023.100163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 05/07/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
Objective To investigate well-being, lifestyle behaviors, self-management capacity and healthcare utilization among adults with chronic conditions at the outbreak of the COVID-19 pandemic. Methods Data was collected from two interviewer-administered telephone surveys conducted between March 27 - May 22, 2020. Participants were patients at Chicago-area clinics. Self-report and validated measures were used for study-related outcomes. Results A total of 553 participants (age range 23-88) completed data collection at both timepoints. One in five (20.7%) participants experienced stress due to the coronavirus most or all the time and rates of negative well-being were high (WHO-5 Index mean = 58.7%). Almost a quarter (22.3%) engaged in hazardous drinking and 79.7% reported insufficient physical activity. Nearly one in four participants (23.7%) avoided seeking medical care due to worry about COVID-19. In multivariable analyses, greater COVID-19 related stress was associated with less physical activity, lower self-efficacy, greater difficulty managing health and medications, and delays in seeking medical care due to the coronavirus. Conclusions Mental well-being, lifestyle behaviors, self-management capacity, and healthcare utilization were impacted in the months following the COVID outbreak. Innovation These findings suggest health systems should implement proactive measures for detecting and treating emotional and behavioral COVID-related concerns.
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Affiliation(s)
- Andrea Russell
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Sarah Filec
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Marina Serper
- Hospital of the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Lauren Opsasnick
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Stephanie Batio
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Rachel M. O'Conor
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Laura Curtis
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Mary Kwasny
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Julia Yoshino Benavente
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Guisselle Wismer
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Morgan Bonham
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Pauline Zheng
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Rebecca Lovett
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Marina Arvanitis
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Daniela P. Ladner
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | | | - Jeffrey A. Linder
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Stacy Cooper Bailey
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Michael S. Wolf
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
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8
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Johnston EE, Meng Q, Hageman L, Wu J, Ross E, Lim S, Balas N, Bosworth A, Te HS, Francisco L, Bhatia R, Forman SJ, Wong FL, Armenian SH, Weisdorf DJ, Landier W, Bhatia S. Risk of COVID-19 infection in long-term survivors of blood or marrow transplantation: a BMTSS report. Blood Adv 2023; 7:2843-2854. [PMID: 36724527 PMCID: PMC9906674 DOI: 10.1182/bloodadvances.2022009550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 02/03/2023] Open
Abstract
There is limited information regarding COVID-19 in long-term blood or marrow transplant (BMT) survivors. We leveraged the BMT Survivor Study (BMTSS) to address this gap. BMTSS included patients who underwent BMT at 1 of 3 sites in the United States between 1974 and 2014 and survived ≥2 years after BMT. A sibling cohort serves as a non-BMT comparison group. Participants (2430 BMT survivors; 780 non-BMT participants) completed the BMTSS survey between October 2020 and November 2021 about COVID-19 testing, risk mitigation behaviors, morbidity, and health care use. Median age at BMT was 46 years (range, 0-78 years) and median follow-up since BMT was 14 years (6-46 years); 76% were non-Hispanic White, 54% had received allogeneic BMT. The risk of COVID-19 infection was comparable for BMT survivors vs non-BMT participants (15-month cumulative incidence, 6.5% vs 8.1%; adjusted odd ratio [aOR] = 0.93; 95% confidence interval [CI], 0.65-1.33; P = .68). Among survivors, being unemployed (aOR 1.90; 95% CI, 1.12-3.23; P = .02; reference: retired) increased the odds of infection; always wearing a mask in public was protective (aOR = 0.49; 95% CI, 0.31-0.77; P = .002; reference: not always masking). When compared with COVID-positive non-BMT participants, COVID-positive BMT survivors had higher odds of hospitalization (aOR = 2.23; 95% CI, 0.99-5.05; P = .05); however, the odds of emergency department visits were comparable (aOR = 1.60; 95% CI = 0.71-3.58; P = .25). COVID-19 infection status did not increase the odds of hospitalization among BMT survivors (aOR = 1.32; 95% CI = 0.89-1.95; P = .17) but did increase the odds of emergency department visits (aOR = 2.63; 95% CI, 1.74-3.98; P <.0001). These findings inform health care providers about the management of care for long-term BMT survivors during the ongoing pandemic.
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Affiliation(s)
- Emily E. Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Qingrui Meng
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Lindsey Hageman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Jessica Wu
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth Ross
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Shawn Lim
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Nora Balas
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | | | - Hok Sreng Te
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Ravi Bhatia
- Division of Hematology, Oncology and Bone Marrow Transplantation, University of Alabama at Birmingham, Birmingham, AL
| | - Stephen J. Forman
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - F. Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, CA
| | | | - Daniel J. Weisdorf
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
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9
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Cao YJ, Chen D, Smith M. Use telehealth as needed: telehealth substitutes in-person primary care and associates with the changes in unplanned events and follow-up visits. BMC Health Serv Res 2023; 23:426. [PMID: 37138327 PMCID: PMC10154749 DOI: 10.1186/s12913-023-09445-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 04/24/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Telehealth rapidly expanded since the outbreak of the COVID-19 pandemic. This study aims to understand how telehealth can substitute in-person services by 1) estimating the changes in non-COVID emergency department (ED) visits, hospitalizations, and care costs among US Medicare beneficiaries by visit modality (telehealth vs. in-person) during the COVID-19 pandemic relative to the previous year; 2) comparing the follow-up time and patterns between telehealth and in-person care. METHODS A retrospective and longitudinal study design using US Medicare patients 65 years or older from an Accountable Care Organization (ACO). The study period was April-December 2020, and the baseline period was March 2019 - February 2020. The sample included 16,222 patients, 338,872 patient-month records and 134,375 outpatient encounters. Patients were categorized as non-users, telehealth only, in-person care only and users of both types. Outcomes included the number of unplanned events and costs per month at the patient level; number of days until the next visit and whether the next visit happened within 3-, 7-, 14- and 30-days at the encounter level. All analyses were adjusted for patient characteristics and seasonal trends. RESULTS Beneficiaries who used only telehealth or in-person care had comparable baseline health conditions but were healthier than those who used both types of services. During the study period, the telehealth only group had significantly fewer ED visits/hospitalizations and lower Medicare payments than the baseline (ED 13.2, 95% CI [11.6, 14.7] vs. 24.6 per 1,000 patients per month and hospitalization 8.1 [6.7, 9.4] vs. 12.7); the in-person only group had significantly fewer ED visits (21.9 [20.3, 23.5] vs. 26.1) and lower Medicare payments, but not hospitalizations; the both-types group had significantly more hospitalizations (23.0 [21.4, 24.6] vs. 17.8). Telehealth was not significantly different from in-person encounters in number of days until the next visit (33.4 vs. 31.2 days) or the probabilities of 3- and 7-day follow-up visits (9.2 vs. 9.3% and 21.8 vs.23.5%). CONCLUSIONS Patients and providers treated telehealth and in-person visits as substitutes and used either depending on medical needs and availability. Telehealth did not lead to sooner or more follow-up visits than in-person services.
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Affiliation(s)
- Ying Jessica Cao
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut St., 760B WARF Office Building, Madison, WI, 53726, USA.
| | - Dandi Chen
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut St., 760B WARF Office Building, Madison, WI, 53726, USA
| | - Maureen Smith
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut St., 760B WARF Office Building, Madison, WI, 53726, USA
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, 610 N Whitney Way, Ste 200, Madison, WI, 53705, USA
- Health Innovation Program, University of Wisconsin-Madison, 800 University Bay, Madison, WI, 53726, USA
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10
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Adinkrah EK, Cobb S, Bazargan M. Delayed Medical Care of Underserved Middle-Aged and Older African Americans with Chronic Disease during COVID-19 Pandemic. Healthcare (Basel) 2023; 11:595. [PMID: 36833128 PMCID: PMC9956154 DOI: 10.3390/healthcare11040595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Background: While African American middle-aged and older adults with chronic disease are particularly vulnerable during the COVID-19 pandemic, it is unknown which subgroups of this population may delay seeking care. The aim of this study was to examine demographic, socioeconomic, COVID-19-related, and health-related factors that correlate with delayed care in African American middle-aged and older adults with chronic disease. Methods: In this cross-sectional study, 150 African American middle-aged and older adults who had at least one chronic disease were recruited from faith-based organizations. We measured the following exploratory variables: demographic factors (age and gender), socioeconomic status (education), marital status, number of chronic diseases, depressive symptoms, financial strain, health literacy, COVID-19 vaccination history, COVID-19 diagnosis history, COVID-19 knowledge, and COVID-19 perceived threat. The outcome was delay in chronic disease care. Results: According to the Poisson log-linear regression, higher level of education, higher number of chronic diseases, and depressive symptoms were associated with a higher level of delayed care. Age, gender, COVID-19 vaccination history, COVID-19 diagnosis history, COVID-19 perceived threat, COVID-19 knowledge, financial strain, marital status, and health literacy were not correlated with delayed care. Discussion: Given that higher healthcare needs in terms of multiple chronic medical diseases and depressive symptomatology but not COVID-19-related constructs (i.e., vaccination history, diagnosis history, and perceived threat) were associated with delayed care, there is a need for programs and interventions that assist African American middle-aged and older adults with chronic disease to seek the care that they need. More research is needed to understand why educational attainment is associated with more delayed care of chronic disease in African American middle-aged and older adults with chronic illness.
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Affiliation(s)
- Edward K. Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), 1731 E. 120th St., Los Angeles, CA 90059, USA
| | - Sharon Cobb
- Mervyn M. Dymally School of Nursing (MMDSON), CDU, Los Angeles, CA 90059, USA
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), 1731 E. 120th St., Los Angeles, CA 90059, USA
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90059, USA
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11
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Obikane E, Nishi D, Ozaki A, Shinozaki T, Kawakami N, Tabuchi T. Association between Poverty and Refraining from Seeking Medical Care during the COVID-19 Pandemic in Japan: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2682. [PMID: 36768046 PMCID: PMC9915459 DOI: 10.3390/ijerph20032682] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
This limited study examined how low household income affected avoidant behaviors to seek medical care during the pandemic. We investigated an association between household income below the relative poverty line and refraining from seeking medical care (RSMC) in a longitudinal study during the COVID-19 pandemic. We conducted an analysis of a population-based internet cohort in Japan. Individuals aged 20 to 79 years old living in Japan participated in the internet surveys between 2020 and 2021. The primary outcome was the RSMC of regular visits and new symptoms in 2021. A total of 19,672 individuals were included in the analysis. Household income below the relative poverty line in 2020 was significantly associated with refraining from seeking regular medical visits for men and women (for men, odds ratio: 1.28; confidence interval: 1.19, 1.83; for women, odds ratio: 1.42; confidence interval: 1.14, 1.82) in 2021, after accounting for RSMC in 2020. Relative poverty in 2020 was also associated with the RSMC of new symptoms among men (for males, odds ratio: 1.32; confidence interval: 1.05, 1.66) in 2021 after adjusting for covariates. The study suggested the need to alleviate the financial burden of vulnerable people seeking medical care and advocate for making necessary medical visits, even in a pandemic.
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Affiliation(s)
- Erika Obikane
- Department of Social Medicine, National Center for Child Health and Development, Tokyo 157-0074, Japan
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
| | - Akihiko Ozaki
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo 162-8601, Japan
| | - Norito Kawakami
- Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Takahiro Tabuchi
- Department of Cancer Control Center, Osaka International Cancer Institute, Osaka 541-8567, Japan
- The Tokyo Foundation for Policy Research, Tokyo 106-6234, Japan
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