ABSTRACT
Background: People living with HIV (PLWH) are at increased risk of severe COVID-19. The UK recommends vaccination against COVID-19 for PLWH with two primary doses, a booster dose, then seasonal boosters (i.e. four doses by Autumn 2022). Vaccination uptake in the UK has been lower among non-white minority ethnic groups than in the white British population, despite these groups having a higher risk of severe COVID-19. Method(s): We evaluated vaccine uptake by PLWH attending treatment services at two NHS Trusts in North East England. To ensure representation of minorities, alternating PLWH from white and ethnic minorities (excluding white minorities) were purposively selected for review from the HIV and AIDS Reporting System;vaccination data were obtained from regional integrated care records. Result(s): 200 PLWH were included. 103 (51.5%) were from ethnic minority groups, of whom 78 (75.7%) were of black African ethnicity. Vaccination rates in the total population and among ethnic groups are shown in the table below. Similar proportions of white and minority ethnic background PLWH had received up to two vaccinations. These proportions among white PLWH were similar to those reported in the general English population, while fewer Black African PLWH were unvaccinated than in the general population (14.1% vs. 26%, data not shown). Vaccine uptake among PLWH diverged beyond 3 doses, with white people being almost three times as likely to have received four doses (OR 2.92;95% CI 1.63 to 5.19;pvalue for difference in distribution across all doses=0.005). Conclusion(s): Although ethnic minority PLWH were less likely to be fully vaccinated than white ethnicity PLWH, the proportion of unvaccinated black African PLWH was lower than that reported from the general population. This could infer that regular contact with healthcare professionals coupled with consistent promotion of vaccination by HIV clinicians can improve uptake. (Table Presented).
ABSTRACT
Background/Aims The impact of the pandemic on the incidence and management of inflammatory arthritis (IA) is not understood. Routinely-captured data in secure platforms, such as OpenSAFELY, offer unique opportunities to understand how IA was impacted upon by the pandemic. Our objective was to use OpenSAFELY to assess the effects of the pandemic on diagnostic incidence and care delivery for IA in England, and replicate key metrics from the National Early Inflammatory Arthritis Audit. Methods With the approval of NHS England, we used primary care and hospital data for 17 million adults registered with general practices using TPP health record software, to explore the following outcomes between 1 April 2019 and 31 March 2022: 1) incidence of IA diagnoses (rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, undifferentiated IA) recorded in primary care;2) time to first rheumatology assessment;3) time to first prescription of a conventional synthetic DMARD (csDMARD) in primary care, and choice of first csDMARD. Results From 17,683,500 adults (representing 40% of the English population), there were 31,280 incident IA diagnoses recorded between April 2019 and March 2022. New IA diagnoses decreased by 39.7% in the early months of the pandemic. Overall, a 20.3% decrease in IA diagnoses was seen in the year commencing April 2020, relative to the preceding year (5.1 vs. 6.4 diagnoses per 10,000 adults, respectively). Further decreases coincided with rising COVID-19 numbers, before returning to pre-pandemic levels by the end of the study period. No rebound increase in IA incidence was observed as of April 2022. The median time from referral to first rheumatology assessment was shorter during the pandemic (18 days;IQR 8-35 days) than before (21 days;9-41 days). The proportion of patients prescribed csDMARDs in primary care was comparable to before the pandemic;however, fewer people were prescribed methotrexate or leflunomide, and more were prescribed sulfasalazine or hydroxychloroquine. Conclusion IA diagnoses decreased markedly during the early phase of the pandemic;however, the impact on rheumatology assessment times and DMARD prescribing was less marked than might have been anticipated. This study demonstrates the feasibility of using routinelycaptured, near real-time data in the secure OpenSAFELY platform to benchmark care quality on a national scale, without the need for manual data collection.
ABSTRACT
Background: Digital health solutions (DHS) allow for enhanced remote communication between patients and clinical staff and the COVID-19 pandemic has brought these tools to the forefront of care delivery. Once adopted, barriers to adequate utilization still exist. Given the important need to decrease digital divides, and the diversity of patients and care settings across our clinic's 220 sites of service, we sought to understand how utilization of oncology DHS may be limited among certain populations. Methods: We investigated utilization among cancer patients who enrolled and engaged with a portfolio of DHS between March 1, 2019 and January 15, 2022. This portfolio includes three tools: (1) an electronic patient-reported outcomes (ePRO) remote monitoring program for tracking symptoms and oral adherence, (2) a patient portal (PP) for securely accessing patient health records, and (3) digital education (DE) for patients regarding disease and treatments. ePRO completion rate, average number of PP logins, and DE read rate were used as measures of utilization for each tool, respectively, and compared among patients with different age (< 65 and ≥65 years), language preference [English (EL) or Spanish (SL)], and distance from clinic (non-rural: < 20 miles OR rural: ≥20 miles). Mann-Whitney U and Chi-Square tests were used to compare continuous and categorical variables, respectively. Results: This study included a total of 77,347 unique patients representing 651,004 digital encounters. 9,938 patients engaged in ePRO, 49,771 patients in PP, and 12,044 patients in DE. Engagement across all DHS was high in patients of age group < 65 (ePRO: 72.7%, PP: 79.67% and PE 54.7%) as compared to ≥65 years, but the ePRO completion rate is high in ≥65 age group (59.0% vs 55.6%), whereas no significant difference was observed in the PP login activity and DE read rate. EL patients were significantly (p-value < 0.01) more engaged (ePRO 68% vs. 54%, PP: 80% vs. 62%, DE: 57% vs. 37%) and had higher digital utilization (ePRO completion rate: 57.31% vs 53.23%, average PP logins: 7.48 vs 7.14 and DE read rate: 96.2% vs 90.8%) than SL patients across the DHS. Patients living in rural areas comprised roughly 25% of the population and participated across tools similarly as patients living in non-rural areas (ePRO 67% vs. 69%, PP: 79% vs. 79%, DE: 56.9% vs. 56.8%). Utilization of the portfolio was variable based on rural vs non-rural status (ePRO completion rate: 56.3% vs. 57.4%, average PP logins: 7.9 vs. 7.3, DE read rate: 96.02.7% vs 96.3%). Conclusions: Despite variable engagement based on age, language, and rural status across the portfolio, patients within these populations continue to utilize the DHS. How we understand and explore enhancements to DHS remain under investigation for tool optimization for patient-specific barriers to care.
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Objectives: COVID-19 has demanded innovation in critical care and shone a light on ready-to-administer formulations for intravenous administration. This analysis quantifies the human resource released when moving away from traditional mixing of drug concentrate at the bedside. Methods: A model was constructed to simulate noradrenaline delivery for people experiencing critical hypotension requiring vasopressor support in the intensive care setting. It simulated resource consumption over 24 hours taking account of noradrenaline dose and flow rate, product size, ampoule pooling for dilution, preparation volume, sterility changes, pumping methods, and drug wastage. The duration, location and skill requirement of human-resourced tasks were also included and costed. Outcomes were applied to a hypothetical English population over one year (2019). Results: Based on 4,123 critical care beds giving 231,011 days of vasopressor support annually, and a move from syringe-based double pumping to volumetric pumping in 80% of units (20% estimated to deliver volumetrically already), a comprehensive switch to the ready-to-administer formulation released 33,927 days (167.1 WTEs) of nursing time from non-patient facing activity. A resource equivalent to £11.0m at 50/50 band 5/6. There were fewer episodes of preparation needed, no ampoule cracking or pooling for dilution, and no injection into infusion bags and changing with ensuing sterility risk. The cost of moving to the ready-to-administer product was £2.2m in acquisition (Sinora®). When monetised throughout, there was a net saving of £8.7m. Conclusions: The human resource of the NHS is its highest value component as made evident by the COVID-19 pandemic. This modelling supports the recommendations of the Lord Carter review, the Royal Pharmaceutical Society, and the NHS Specialist Pharmacy Service in their encouragement of ready-to-administer formulations in this context of care. Resource-effective approaches will help skilled healthcare professionals divert their time from therapy preparation to patient-facing care.
ABSTRACT
Background and Objectives: In March 2020, approximately 57 million children were affected by massive school closures in the wake of the SARS-CoV-2 pandemic. Many child advocates expressed concerns about the impact of physical school closures and transition to virtual learning on school-aged children's mental health and well-being, particularly those who utilized resources, such as counselling or special education, within the school system. This systematic review was done to identify a) the effect and impact of school closures on the mental health of children in grades K-12, if any, and b) to guide future research on the topic. Methods: A systematic review focused on published articles addressing the effect that COVID-19 related school closures and transition to virtual learning had on school-aged children's and adolescents' mental health. Inclusion criteria included: human studies, scholarly papers, school-aged children, SARS-CoV-2 research, mental health impacts, an article written in English, and research-based in the United States. Exclusion criteria included: not human studies, studies not available in English, individuals over 18 years old, and SARS-CoV or MERS-CoV research. The search was conducted between March 20, 2021, and April 18, 2021. Articles were further screened utilizing the PRISMA flow diagram. Once screened, included articles were reviewed by one member of the research team and a PICO-style analysis was used for each article. After the initial review, a total of 11 articles were included in this systematic review. Learning Points Discussion: We identified several areas of a child's life that school closures limited access to, such as reduced-cost meals, mental health services, and special education. Since the school closures and subsequent transition to online schooling, these resources became unavailable or limited by virtual technology. Children from lower socioeconomic backgrounds and marginalized communities were particularly vulnerable to negative mental health changes due to school closures and decreased access to school-based resources. These individuals belonging to a lower socioeconomic class are more likely to have inadequate computers to utilize in-home learning, have more unstable internet connections, and are less likely to have a caregiver that can stay home to help with their distanced learning. This research will be vital in understanding any adverse effects on children and shaping the future development of school-based programs and their funding.