National trends in psychotropic medication prescribing before and during the COVID-19 pandemic.

The early months of the COVID-19 pandemic saw a decline in psychotropic medication use; however, little is known about how this trend evolved as the pandemic progressed and how it varied across different payers in the United States. Using a national multi-payer pharmacy claims database and adopting a quasi-experimental research design, this study examines trends in psychotropic medication prescriptions dispensed from July 2018 - June 2022. The study finds that the number of patients with dispensed psychotropic medications and the number of psychotropic medications dispensed declined during the early months of the pandemic but experienced a statistically significant growth in later periods compared to the pre-pandemic rate. Average days supply of psychotropic medications dispensed increased significantly throughout the pandemic. Commercial insurance remained the primary payer for psychotropic medication during the pandemic, but there was a significant increase in the number of prescription fills covered under Medicaid. This implies that public insurance programs played an increasing role in financing psychotropic medication use during the COVID-19 pandemic.

Prescription of anxiolytics, sedatives, hypnotics and antidepressants in outpatient, universal care during the COVID-19 pandemic in Portugal: a nationwide, interrupted time-series approach.

BACKGROUND: The COVID-19 pandemic has had a significant impact on the population's mental health. However, its impact on the consumption of anxiolytics, sedatives, hypnotics and antidepressants remains to be evaluated. Hence, this article aims to assess the prescription trends of these drugs in Portugal, from January 2018 to March 2021, while critically examining whether the COVID-19 pandemic had an impact on these prescription trends or not. METHODS: A nationwide interrupted time-series analysis of the prescription data of anxiolytics, sedatives, hypnotics and antidepressants in outpatient setting of the public health sector was conducted. The data encompassed the defined daily dose per month, age range and sex and were analysed following a segmented regression approach. RESULTS: The pandemic preceded an immediate reduction in the prescription of anxiolytics, sedatives and hypnotics for children and adolescents. However, an increasing trend throughout the pandemic has been noted in the prescription of these drugs, especially among adults aged 65 years or above. A drop in antidepressant prescription was observed as an immediate effect of the pandemic among male and female adolescents and elderly women. From March 2020 to March 2021, a decreasing prescription trend has been noted among men. CONCLUSIONS: When analysing specific genders and age ranges, differences can be noted, in terms of both immediate impact and prescribing trends throughout 1 year of the COVID-19 pandemic. The impact of the pandemic on mental health and its association with the consumption trends of psychoactive drugs, and with the access to mental health treatments, should be further assessed.

Implementation of a telemedicine geriatric co-evaluation in the emergency department: a prospective pilot study.

  INTRODUCTION: Complex drug management is a common challenge in the treatment of geriatric patients. Pandemic scenarios, such as the current one (COVID-19), call for a reduction of face-to-face meetings, especially for elderly patients. Therefore, the aim of the present study was to compare the innovative concept of applying telemedical assessment to geriatric patients in the emergency department (ED) with ED standard treatment. The therapeutic recommendations regarding drug management from the two assessments were compared. A special focus was the use of potentially inadequate drugs (PIMs) for geriatric patients according to the “Fit for the Aged” (FORTA) classification. METHODS: 50 patients (40% female) aged ≥70 years and assessed with an Identification of Seniors at Risk Score (ISAR score) of ≥2 admitted to the ED were prospectively enrolled in this study between November 2017 and February 2018. In addition to the standard treatment in the ED, co-evaluation via video transmission was independently carried out by a board-certified geriatrician. Drug recommendations by ED physicians (A) and the geriatrician (B) were compared. RESULTS: There was a significantly higher frequency of recommendations regarding changes to preexisting medication (p <0.001, n = 50) via geriatric telemedicine in comparison with standard ED treatment. The geriatrician intervened significantly more often than the ED physicians: discontinuation of a drug, p <0.001; start of a new drug, p = 0.004; dose change of a drug, p = 0.001; n = 50). Based on the additional therapy recommendations of the geriatrician, the amount of medication taken by the patient was significantly reduced compared with standard ED treatment (ED assessment t(49) = 0.622 vs geriatrician’s assessment t(49) = 4.165; p <0.001; n = 50). Additionally, the number of PIMs was significantly reduced compared with standard medical treatment (p <0.001). The geriatrician changed 53.9% of the drugs (35/65) whereas the ED physicians changed only 12.3% (8/65). Recommendations for immediate drug therapy, however, were made more frequently by ED physicians (p <0.039, n = 50). DISCUSSION: An early assessment of elderly emergency patients by a geriatrician had a significant impact on the number of drug interventions in the ED. The number of PIMs could be significantly reduced. Whether this also has a positive effect on the further inpatient course needs to be investigated in further prospective studies. The study was retrospectively registered at ClinicalTrials.gov (NCT04148027).  .

Antibiotic Receipt During Outpatient Visits for COVID-19 in the US, From 2020 to 2022.

This cross-sectional study examines prescribed and filled antibiotics for outpatient COVID-19 treatment among children, adolescents, and adults with commercial insurance.

Prescription of antibiotics by general practitioners for patients with a diagnosis of SARS- CoV-2 infection: Analysis of an electronic French health record.

OBJECTIVE: To define the factors associated with overprescription of antibiotics by general practitioners (GPs) for patients diagnosed with COVID-19 during the first wave of the pandemic. METHODS: Anonymised electronic prescribing records of 1370 GPs were analysed. Diagnosis and prescriptions were retrieved. The initiation rate by GP for 2020 was compared with 2017-2019. Prescribing habits of GPs who initiated antibiotics for > 10% of COVID-19 patients were compared with those who did not. Regional differences in prescribing habits of GPs who had consulted at least one COVID-19 patient were also analysed. RESULTS: For the March-April 2020 period, GPs who initiated antibiotics for > 10% of COVID-19 patients had more consultations than those who did not. They also more frequently prescribed antibiotics for non-COVID-19 patients consulting with rhinitis and broad-spectrum antibiotics for treating cystitis. Finally, GPs in the Île-de-France region saw more COVID-19 patients and more frequently initiated antibiotics. General practitioners in southern France had a higher but non-significant ratio of azithromycin initiation rate over total antibiotic initiation rate. CONCLUSION: This study identified a subset of GPs with overprescribing profiles for COVID-19 and other viral infections; they also tended to prescribe broad-spectrum antibiotics for a long duration. There were also regional differences concerning antibiotic initiation rates and the ratio of azithromycin prescribed. It will be necessary to evaluate the evolution of prescribing practices during subsequent waves.

Opioid prescribing among aged care residents during the first year of the COVID-19 pandemic: an analysis using general practice health records in Australia.

BACKGROUND: Opioid use is common among adults 65 years and older, while long-term use of opioids remains controversial and poses risks of drug dependence and other adverse events. The acute disease caused by the SARS-CoV-2 (COVID-19) pandemic has created new challenges and barriers to healthcare access, particularly for long-term care residents. Australia had a relatively low incidence and deaths due to COVID-19 during the first year of the pandemic compared to most OECD countries. In this context, we examined opioid prescribing rates and their dosage in residential aged care facilities (RACFs) before (2019) and during the COVID-19 pandemic (2020) from March to December in Australia. METHODS: We conducted a retrospective cohort using general practice electronic health records. This includes 17,304 RACF residents aged 65 years and over from 361 general practices in New South Wales and Victoria. Number of opioid prescriptions and percentage of opioids over 50 mg/day of oral morphine equivalent (OME) were described. Multivariate generalized estimating equations were applied to estimate odds ratios [aORs (95% confidence intervals)] for 1) opioids prescribed per consultation and 2) prescription opioids over 50 mg/day OME. RESULTS: In 2020 among 11,154 residents, 22.8% of 90,897 total prescriptions were opioids, and of the opioids, 11.3% were over 50 mg/day OME. In 2019 among 10,506 residents, 18.8% of 71,829 total prescriptions were opioids, of which 10.3% were over 50 mg/day OME. Year [2020 vs. 2019: aOR (95% CI):1.50 (1.44, 1.56); 1.29 (1.15, 1.46)] and regionality [rural/regional vs. metropolitan: 1.37 (1.26, 1.49); 1.40 (1.14, 1.71)] were associated with higher odds of prescription opioids and OME > 50 mg/day, respectively. Similar results were found when limited to the same residents (n = 7,340) recorded in both years. CONCLUSIONS: Higher prescription rates of opioids were observed during the COVID-19 pandemic in 2020 than in 2019 in Australian RACFs. The higher odds of prescription opioids and higher dosing in rural/regional than metropolitan areas indicate a widening of the gap in the quality of pain management during the pandemic. Our findings contribute to the limited data that indicate increased opioid prescriptions in long-term care facilities, likely to continue while COVID-19 pandemic restrictions remain.

Comparison of Postpartum Opioid Prescriptions Before vs During the COVID-19 Pandemic.

Importance: The COVID-19 pandemic substantially disrupted routine health care and exacerbated existing barriers to health care access. Although postpartum women frequently experience pain that interferes with activities of daily living, which is often successfully treated with prescription opioid analgesics, they are also at high risk for opioid misuse. Objective: To compare postpartum opioid prescription fills after the onset of the COVID-19 pandemic in March 2020 with fills before the pandemic. Design, Setting, and Participants: In this cross-sectional study of 460 371 privately insured postpartum women who delivered a singleton live newborn between July 1, 2018, and December 31, 2020, postpartum opioid fills before March 1, 2020, were compared with fills after March 1, 2020. Statistical analysis was performed from December 1, 2021, to September 15, 2022. Exposure: COVID-19 pandemic onset in March 2020. Main Outcomes and Measures: The main outcome was postpartum opioid fills, defined as patient fills of opioid prescriptions during the 6 months after birth. Opioid prescriptions were explored in terms of 5 measures: mean number of fills per person, mean filled morphine milligram equivalents (MMEs) per day, mean days supplied, percentage of patients filling a prescription for a schedule II opioid, and percentage of patients filling a prescription for a schedule III or higher opioid. Results: Among 460 371 postpartum women (mean [SD] age at delivery, 29.0 [10.8] years), those who gave birth to a single, live newborn after March 2020 were 2.8 percentage points more likely to fill an opioid prescription than expected based on the preexisting trend (forecasted, 35.0% [95% CI, 34.0%-35.9%]; actual, 37.8% [95% CI, 36.8%-38.7%]). The COVID-19 period was also associated with an increase in MMEs per day (forecasted mean [SD], 34.1 [2.0] [95% CI, 33.6-34.7]; actual mean [SD], 35.8 [1.8] [95% CI, 35.3-36.3]), number of opioid fills per patient (forecasted, 0.49 [95% CI, 0.48-0.51]; actual, 0.54 [95% CI, 0.51-0.55]), and percentage of patients filling a schedule II opioid prescription (forecasted, 28.7% [95% CI, 27.9%-29.6%]; actual, 31.5% [95% CI, 30.6%-32.3%]). There was no significant association with days' suppy of opioids per prescription or percentage of patients filling a prescription for a schedule III or higher opioid. Results stratified by delivery modality showed that the observed increases were larger for patients who delivered by cesarean birth than those delivering vaginally. Conclusions and Relevance: This cross-sectional study suggests that the onset of the COVID-19 pandemic was associated with significant increases in postpartum opioid fills. Increases in opioid prescriptions may be associated with increased risk of opioid misuse, opioid use disorder, and opioid-related overdose among postpartum women.

Reduced burden of antibiotic prescription in an italian pediatric primary care clinic during the first wave of COVID-19 pandemic: a shot in the arm for antimicrobial resistance?

Rates of antibiotic-resistant bacteria have increased worldwide over recent years, but the Italian Institute of Health reported a disruption to this trend in 2021 compared with 2020. Children are often recipients of unnecessary antibiotic prescriptions, especially for respiratory tract infections (RTIs). During the initial phase of the COVID-19 pandemic, common RTIs substantially decreased, so it is conceivable that antibiotic prescriptions also reduced during this time. To test this hypothesis, we retrospectively collected data on all visits to a pediatric primary care clinic in Northern Italy from February 20, 2020 to June 2, 2020 and compared data with the same period in 2019. We evaluated the antibiotic prescription rate according to the diagnosis at discharge. While the total number of visits significantly decreased (1335 in 2020 vs. 4899 in 2019), there was only a slight reduction in the antibiotic prescription rate (1039 in 2019, 21.2%, vs. 272 in 2020, 20.4%). However, this corresponded to a 73.8% decrease in the total number of antibiotic prescriptions, with antibiotics for RTI accounting for 69% of the total reduction. It is possible that, at the larger scale, reduced antibiotic prescription in pediatrics during the COVID-19 pandemic resulted in a slight reduction in antimicrobial resistance.

SARS-CoV-2 caused a surge in antibiotic consumption causing a silent pandemic inside the pandemic. A retrospective analysis of Italian data in the first half of 2022.

BACKGROUND: The phenomenon of antibiotic resistance shows no sign of stopping, despite global policies to combat it that have been in place for several years. The risk of forms of pathogenic microorganisms that are increasingly resistant to common antibiotics has led health authorities around the world to pay greater attention to the phenomenon. The worrying situation, has led to further recommendations from the World Health Organization (WHO) and national recommendations in Italy through the new National Plan against Antibiotic Resistance 2022-2025 (PNCAR 2022-2025). AIM: This manuscript aims to raise the awareness of all health professionals to follow what is suggested by regulatory agencies and scientific societies. METHOD: We conducted a retrospective study of antibiotic pharmacoutilization in Italy, in the Campania region at the Azienda Sanitaria Locale (ASL) Napoli 3 Sud, on consumption in the first half of 2022 in a population of more than 1 million people. RESULT: The results indicate that consumption, based on defined daily doses (DDDs), is above the national average. Probably the COVID-19 pandemic has influenced this growth in prescriptions. CONCLUSIONS: Our study suggests an informed and appropriate use of antibiotics, so as to embark on a virtuous path in the fight against antibiotic resistance.

[Impact of COVID-19 lockdown on the prescription of benzodiazepines]. / Impacto del confinamiento por COVID-19 en la prescripción de benzodiacepinas.

OBJECTIVE: To evaluate the effect of COVID-19 lockdown on the prescription of benzodiazepines by gender, age and district health departments. DESIGN: Longitudinal observational study. LOCATION: Primary care. Asturias (Spain) health district V. PARTICIPANTS: People over 15 years of age with filled benzodiazepine prescriptions in between 2017 and 2020. MAIN MEASUREMENTS: Benzodiazepine DHD (defined daily dose per 1000 habitants) mean difference between the period defined as pre-lockdown and lockdown. Additionally, the difference was adjusted for gender, sex and district health department and also with the interaction among them. RESULTS: DHD mean pre-lockdown was 131.3 and 139.5 in the lockdown; this difference was significant in the global analysis (95% CI: 4.1-12.1). There was an increase in the DHD mean in the 60-74 age group (95% CI: 2.28-21.42), in the group over 90 years old (95% CI: 21.31-40.63) and in women (95% CI: 3.51-14.59). Finally, a decrease in the DHD mean of V11 (95% CI: -29 to -0.66) and V14 (95% CI: -54.28 to -25.04) district health departments was observed. CONCLUSIONS: Certain subgroups show a change in the pattern of benzodiazepine prescription without being able to relate this to the lockdown. We believe that there could be some inertia in the prescription of psychiatric medication according to the biopsychosocial characteristics of the patients; it is important to detect this in order to avoid the medicalization of psychological disorders.

Impact of COVID-19 on antibiotic prescriptions for Brazilian children.

The COVID-19 brought a new model of sanitary behavior (social distancing, etc.) that may have reduced the transmissibility of respiratory diseases, reflecting in the number of antibiotic prescriptions. This study evaluated antibiotic prescriptions for children throughout Brazil, between 2014 and 2021. An interrupted time series was conducted to assess variations in antibiotic consumption by the 1-12-year-old children. Joinpoint regression was used to assess the monthly variations. 86 million prescriptions were evaluated. On average, there was a 54% reduction in prescriptions during the pandemic. Amoxicillin showed a reduction of 65%. Joinpoint regression showed that the pandemic altered the prescription growth curve, changing the trend to a 22% drop per month. The new sanitary behavior showed us that it is possible, decreasing the use of antibiotics, to control the children's respiratory health.

Prevalence and characteristics of antibiotic prescription for acute COVID-19 patients in Japan.

COVID-19 is a viral infection and does not require antibiotics. The study aimed to elucidate a prescribing pattern of antibiotics for COVID-19. A nationwide cross-sectional study was conducted in Japan. The Diagnosis and Procedure Combinations (DPC) data was used to collect information, covering 25% of all acute care hospitals in the country. In 140,439 COVID-19 patients, 18,550 (13.21%) patients received antibiotics. Antibiotics were prescribed more often in inpatients (10,809 out of 66,912, 16.15%) than outpatients (7741 out of 73,527, 10.53%) (p < 0.001). Outpatient prescription was significantly associated with older patients (odds ratio [OR], 4.66; 95% confidence interval [CI] 4.41-4.93) and a greater Charlson index (OR with one-point index increase, 1.22; 95% CI 1.21-1.23). Inpatient prescription was significantly associated with older patients (OR 2.10; 95% CI 2.01-2.21), male gender (OR 1.12, 95% CI 1.07-1.18), a greater Charlson index (OR with one-point increase, 1.06; 95% CI 1.05-1.07), requirement of oxygen therapy (OR 3.44; 95% CI 3.28-3.60) and mechanical ventilation (OR 15.09; 95% CI 13.60-16.74). The most frequently prescribed antibiotic among outpatients was cefazolin, while that among inpatients was ceftriaxone. Antibiotic prescription is relatively low for acute COVID-19 in Japan. Antibiotic prescription was associated with older age, multi-morbidity, severe disease, and winter season.

Trends in incident diagnoses and drug prescriptions for anxiety and depression during the COVID-19 pandemic: an 18-month follow-up study based on the UK Biobank.

Serious concerns have been raised about the negative effects of the COVID-19 pandemic on population psychological well-being. However, limited data exist on the long-term effects of the pandemic on incident psychiatric morbidities among individuals with varying exposure to the pandemic. Leveraging prospective data from the community-based UK Biobank cohort, we included 308,400 participants free of diagnosis of anxiety or depression, as well as 213,757 participants free of anxiolytics or antidepressants prescriptions, to explore the trends in incident diagnoses and drug prescriptions for anxiety and depression from 16 March 2020 to 31 August 2021, compared to the pre-pandemic period (i.e., 1 January 2017 to 31 December 2019) and across populations with different exposure statuses (i.e., not tested for COVID-19, tested negative and tested positive). The age- and sex-standardized incidence ratios (SIRs) were calculated by month which indicated an increase in incident diagnoses of anxiety or depression among individuals who were tested for COVID-19 (tested negative: SIR 3.05 [95% confidence interval 2.88-3.22]; tested positive: 2.03 [1.76-2.34]), especially during the first six months of the pandemic (i.e., March-September 2020). Similar increases were also observed for incident prescriptions of anxiolytics or antidepressants (tested negative: 1.56 [1.47-1.67]; tested positive: 1.41 [1.22-1.62]). In contrast, individuals not tested for COVID-19 had consistently lower incidence rates of both diagnoses of anxiety or depression (0.70 [0.67-0.72]) and prescriptions of respective psychotropic medications (0.70 [0.68-0.72]) during the pandemic period. These data suggest a distinct rise in health care needs for anxiety and depression among individuals tested for COVID-19, regardless of the test result, in contrast to a reduction in health care consumption for these disorders among individuals not tested for and, presumably, not directly exposed to the disease.

Impact of the COVID-19 pandemic and multiplex polymerase chain reaction test on outpatient antibiotic prescriptions for pediatric respiratory infection.

This study aimed to evaluate the impact of the prolonged COVID-19 pandemic on outpatient antibiotic prescriptions for pediatric respiratory infections at an acute care hospital in Japan in order to direct future pediatric outpatient antibiotic stewardship. The impact of the COVID-19 pandemic and the FilmArray Respiratory Panel (RP) on outpatient antibiotic prescriptions was assessed from January 2019 to December 2021 using an interrupted time series analysis of children <20 years. The overall antimicrobial prescription rate decreased from 38.7% to 22.4% from the pre-pandemic period to the pandemic. The pandemic (relative risk [RR] level, 0.97 [0.58-1.61]; P = 0.90; RR slope, 1.05 [0.95-1.17] per month; P = 0.310) and FilmArray RP (RR level, 0.90 [0.46-1.75]; P = 0.75; RR slope, 0.95 [0.85-1.06] per month; P = 0.330) had no significant effect on the monthly antibiotic prescription rates. The COVID-19 pandemic was not significantly related to the antibiotic prescription rate, suggesting that it did not impact physicians' behavior toward antibiotic prescriptions. Replacing rapid antigen tests with the FilmArray RP introduced on December 1, 2020, did not affect the magnitude of the reduction in antibiotic prescription rate for pediatric respiratory infections.

Impact of the COVID-19 pandemic on prescription refills for immune-mediated inflammatory disorders: a time series analysis (January 2019 to January 2021) using the English Prescribing Dataset.

OBJECTIVE: To investigate monthly prescription refills for common immunosuppressive/immunomodulatory therapy (sulfasalazine, hydroxychloroquine, azathioprine, methotrexate, leflunomide) prescriptions in England during the complete first wave of the COVID-19 pandemic. Secondary analysis examined unit cost analysis and regional use. DESIGN AND SETTING: A national cohort of community-based, primary care patients who anonymously contribute data to the English Prescribing Dataset, dispensed in the community in England, were included. Descriptive statistics and interrupted time series analysis over 25 months (14 months before, 11 months after first lockdown) were evaluated (January 2019 to January 2021, with March 2020 as the cut-off point). OUTCOME MEASURES: Prescription reimbursement variance in period before the pandemic as compared with after the first lockdown. RESULTS: Fluctuation in monthly medicines use is noted in March 2020: a jump is observed for hydroxychloroquine (Mann-Whitney, SE 14.652, standardised test statistic 1.911, p value=0.059) over the study period. After the first lockdown, medicines use fluctuated, with wide confidence intervals. Unit-cost prices changed substantially: sulfasalazine 33% increase, hydroxychloroquine 98% increase, azathioprine 41% increase, methotrexate 41% increase, leflunomide 20% decrease. London showed the least quantity variance, suggesting more homogeneous prescribing and patient access compared with Midlands and East of England, suggesting that some patients may have received medication over/under requirement, representing potential resource misallocation and a proxy for adherence rates. Changepoint detection revealed four out of the five medicines' use patterns changed with a strong signal only for sulfasalazine in March/April 2020. CONCLUSIONS: Findings potentially present lower rates of adherence because of the pandemic, suggesting barriers to care access. Unit price increases are likely to have severe budget impacts in the UK and potentially globally. Timely prescription refills for patients taking immunosuppressive/immunomodulatory therapies are recommended. Healthcare professionals should identify patients on these medicines and assess their prescription-day coverage, with planned actions to flag and follow-up adherence concerns in patients.