Opioid agonist treatment and patient outcomes during the COVID-19 pandemic in south east Sydney, Australia.

INTRODUCTION: In early 2020, many services modified their delivery of opioid treatment in response to the COVID-19 pandemic, to limit viral spread and maintain treatment continuity. We describe the changes to treatment and preliminary analysis of the association with patients' substance use and well-being. METHODS: A pre-post comparison of treatment conditions and patient self-reported outcomes using data extracted from electronic medical records in the 5 months before (December 2019-April 2020) and after (May 2020-September 2020) changes were implemented in three public treatment services in South Eastern Sydney Local Health District. RESULTS: Data are available for 429/460 (93%) patients. Few (21, 5%) dropped out of treatment. In the 'post' period there was significantly more use of depot buprenorphine (12-24%), access to any take-away doses (TAD; 24-69%), access to ≥6 TAD per week (7-31%), pharmacy dosing (24-52%) and telehealth services. There were significant reductions in average opioid and benzodiazepine use, increases in cannabis use, with limited group changes in social conditions, or quality of life, psychological and physical health. At an individual level, 22% of patients reported increases in their use of either alcohol, opioids, benzodiazepines or stimulants of ≥4 days in the past 4 weeks. Regression analysis indicates increases in substance use were associated with higher levels of supervised dosing. DISCUSSION AND CONCLUSIONS: These preliminary findings suggest that the modified model of care continued to provide safe and effective treatment, during the pandemic. Notably, there was no association between more TAD and significant increases in substance use. Limitations are discussed and further evaluation is needed.

Implementation of NICE technology guidance on venous leg ulcers and diabetic foot ulcers: a conference report.

Implementation of evidence-based care is central to achieving good results. In the UK, this involves implementing guidance from the National Institute for Health and Care Excellence (NICE). Here, Tracy Cowan, JWC consultant editor, reports on a conference that outlined recently published NICE guidance on UrgoStart for treating leg ulcers and diabetic foot ulcers, and described how to incorporate this into everyday practice to drive significant cost savings and improve patient outcomes.

Strategies for improving outcomes in venous leg ulcer care.

In May 2018, BSN Medical hosted a symposium, 'The management of venous leg ulcers: the value of high-quality care', at the European Wound Management Association (EWMA) conference in Poland. It focused on the impact of excessive exudate on venous leg ulcer outcomes, how to address it, and concluded with a stepwise strategy for improving the quality of care.

Realistic outcomes.

Patient-centred care is one of the new mantras of nursing and medicine. However, I wonder if this is a concept we are starting to take for granted, and if our understanding of it is based more on assumptions than we'd like to admit. I've often interpreted it as the need to involve patients in decision-making and ensure they are happy with the care they receive. In short, we want their involvement and, ultimately, stamp of approval.

A high court of wound care?

I have just arrived back from two very enjoyable (albeit rainy) days in Galway, attending the Wound Management Association of Ireland's biennial conference. The title of one of the sessions, 'The great debate: technology versus dressings in wound management - is there a difference in outcomes?', caught my eye. Interestingly, while listening to the proceedings, it became apparent that there was more consensus than debate among the delegates, with most agreeing that the key to success is simply the ability to identify which option is most suited to the needs of the patient and wound. Ironically, given that we were talking about new technology, the old phrase 'back to basics' was used repeatedly, referring in this instance to the need for thorough and holistic assessment. Plus ça change, plus c'est la même chose!

Industry, teach us about research!

At the time of writing, it is barely a week since the European Wound Management Association conference in Brussels. For me, one of the highlights of these events is the opportunity to meet so many readers and get feedback on the journal. It was also great to see EWMA and other wound-care associations, industry representatives and practitioners all working together to achieve the shared goal of disseminating information on best practice. A perfect example of tripartite working.

A business approach will reap dividends.

The new UK coalition government is making one of the most radical changes to the NHS since it was set up over 60 years ago. From 2013, GP consortia will take over the commissioning of health-care services from primary care trusts. They will be tasked with choosing service providers that offer best value clinical outcomes, with a strong emphasis on patient choice. In essence, this means that service providers will be competing with each other for business. Of course, the rationale behind this, which some consider to be ideologically driven, is that competition is needed to provide the necessary impetus to improve standards and avoid inefficiency. It goes back to the old debate of whether competition or collaboration between providers is the best way forward for the public sector. We shall see...

Making clinically informed R&D a reality.

Many exciting new initiatives are described in this month's international organisations' update (see pages 600-604). One that caught my eye is the first EPUAP focus meeting on 'Technological Innovations in Pressure Ulcer Diagnosis, Prevention and Treatment', which takes place in Tel Aviv, Israel, on 16-17 April 2012. In case you're wondering how relevant a focus group on technological innovation is to you, especially in this current climate of cuts and cost savings, then please note this is an opportunity for clinicians to influence, in part, the scientific agenda of both researchers and industry.