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International Journal of Pharmacy Practice ; 30(SUPPL 1):i12-i13, 2022.
Article in English | EMBASE | ID: covidwho-1816114


Introduction: The emergence of the COVID-19 pandemic presented unprecedented challenges for healthcare systems, including patients with chronic pain. The COVID-19 lockdown has resulted in limited access to most of the conventional chronic pain management services. Subsequently, changes in opioid utilisation could be expected (1). Aim: To assess the impact of the first COVID-19 lockdown on opioid utilisation using aggregated-level, community dispensing dataset covering the whole English population. Methods: This repeated cross-sectional study applied a segmented-linear regression analysis to monthly dispensed opioid prescriptions using the Prescription Cost Analysis database (PCA), from March 2019-March 2021. Opioid utilisation was measured using number of items dispensed/1000 inhabitants and Defined Daily Dose (DDD)/1000 inhabitants/day during 12-months pre and post the COVID-19 lockdown introduced in England in March 2020, stratified by strong and weak opioids. Results: There were insignificant changes in the number of items dispensed/1000 inhabitants trend pre-COVID-19 lockdown for total, strong, and weak opioids (β1=-0.064, β1=-0.055, β1=0.009, p>0.05, respectively). Immediately post-lockdown, there were small increases in the level of total, strong, and weak opioids (β2=0.494, β2=0.448, β2=0.045) albeit non-significant. There was a non-significant decline in the trend post-lockdown for all opioids' classes. Similarly, a non-significant reduction in the DDD/1000 inhabitants/day baseline trend was observed pre-lockdown for total, strong, and weak opioids (β1=-0.028, β1=-0.027, β1=-0.001, p>0.05, respectively). There were immediate increases in the level post-lockdown (β2=0.386, β2=0.360, β2=0.026, p>0.05) for total, strong, and weak opioids respectively. Subsequently, a decline in the trend post-lockdown for all opioids' classes was observed. Discussion/conclusion: Unexpectedly, the study's findings showed an overall stable trend in the utilisation of opioids pre and post COVID-19 in England. The stable trends observed in our study could be due to multiple factors. Firstly, patient level data and information about the specific indication were unavailable in the PCA dataset. This is a limitation as we were unable to examine the trend between the existing and new (incident) patients to obtain more accurate data for opioid utilisation. Moreover, the guidelines and strategies that have been implemented with regard to opioid prescription in the UK (2), to help regulate and minimize the harm from their use in chronic pain management may have had an impact. To our knowledge, this is the first study to estimate and quantify the impact of the COVID-19 pandemic on opioid utilisation using a segmented regression analysis. This was facilitated by the study focusing on opioid prescription over a 25-month period, i.e. 12 months either side of the pandemic, to predict a trend line for opioid prescription. This duration was beneficial as it gave us adequate time to investigate if COVID-19 had affected prescribing volumes. The limitations include lacking patient level data and specific indications for prescribing opioids. Also, over-the-counter codeine products were not included in the study as the datasets we used included only prescription medicines in ambulatory care Our findings support the further monitoring and investigation of patient level data to explore the impact of the pandemic on opioid prescription and to continue promoting the safe and effective use of opioids.

Value in Health ; 25(1):S99, 2022.
Article in English | EMBASE | ID: covidwho-1650289


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.

Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617066


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.