scholarly journals Cannabis in the Emergency Department: The impact of cannabis legalization on cannabis and opioid-related presentations

2019 ◽  
Vol 2 (3) ◽  
pp. 6
Author(s):  
Matthew Yeung ◽  
Kevin Janz ◽  
Colin Weaver ◽  
Rebecca Saah-Haines ◽  
Eddy Lang
Keyword(s):  
Information Service ◽  
State Level ◽  
Interrupted Time Series ◽  
The United States ◽  
Poison Control ◽  
Medical Cannabis ◽  
Interrupted Time Series Analysis ◽  
Developed Country ◽  
Short Period ◽  
The Impact

Background: On October 17th, 2018, non-medical cannabis became legal to adults for the first time in Canada. This has created a previously unseen opportunity to investigate the effects of recreational cannabis legalization in a developed country, particularly on strained Emergency Departments (EDs). Secondly, reports within the United States have suggested state-level legalization of cannabis, both recreationally and medically, has resulted in a decrease of opiate-related presentations. Given the pressure of the opiate crisis on healthcare resources, we sought to examine if this trend was present in Alberta. Objectives: The current study aims to identify if presentation patterns in adult and pediatric populations have changed when comparing pre- and post-legalization periods, and if rural-urban disparities exist. We also aim to identify if the legalization of cannabis is correlated with a reduction in opiate-related ED presentations. Lastly, we aimed to address the aforementioned objectives in the context of telehealth by examining calls to poison control and HealthLink within Alberta. Methods: Retrospective data was collected from the National Ambulatory Care Reporting System, HealthLink, and Poison and Drug Information Service. Extraction is currently in progress, and we expect to include 20 000 records and 12 000 calls. An interrupted time-series analysis will be completed, allowing for a comparison of trends pre- and post-legalization. Participants have been identified based on International Disease Classifications for cannabis and opiate-related injury. Commonly reported injuries will be clustered to identify changes in injury patterns. Data was collected from October 1st 2013 up to May 31st, 2019 for all EDs within Alberta. Results: Preliminary results suggest the legalization of cannabis initially led to a dramatic increase in ED presentations, followed by a return to pre-legalization volume. HealthLink data suggests a different trend, with steadily increasing calls in the months prior to legalization, followed by stabilization. Cannabis legalization is also correlated with a decrease in post-legalization opiate-related calls (r=-0.51, p=0.01). Conclusion: Overall, national legalization of cannabis appears to be responsible for a short period of increased ED usage, but does not appear to have long-lasting effects on healthcare resource utilization. Differences are apparent between telehealth service and ED use.

scholarly journals Global Utilization Trends of Direct Acting Antivirals (DAAs) during the COVID-19 Pandemic: A Time Series Analysis

Viruses ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1314
Author(s):  
Ahmad Shakeri ◽  
Natalia Konstantelos ◽  
Cherry Chu ◽  
Tony Antoniou ◽  
Jordan Feld ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
The United States ◽  
Interrupted Time Series Analysis ◽  
Cross Sectional ◽  
Series Analysis ◽  
Hcv Prevalence ◽  
Direct Acting ◽  
The Impact

The 2019 novel coronavirus (COVID-19) pandemic has placed a significant strain on hepatitis programs and interventions (screening, diagnosis, and treatment) at a critical moment in the context of hepatitis C virus (HCV) elimination. We sought to quantify changes in Direct Acting Antiviral (DAA) utilization among different countries during the pandemic. We conducted a cross-sectional time series analysis between 1 September 2018 and 31 August 2020, using the IQVIA MIDAS database, which contains DAA purchase data for 54 countries. We examined the percent change in DAA units dispensed (e.g., pills and capsules) from March to August 2019 to the same period of time in 2020 across the 54 countries. Interrupted time-series analysis was used to examine the impact of COVID-19 on monthly rates of DAA utilization across each of the major developed economies (G7 nations). Overall, 46 of 54 (85%) jurisdictions experienced a decline in DAA utilization during the pandemic, with an average of −43% (range: −1% in Finland to −93% in Brazil). All high HCV prevalence (HCV prevalence > 2%) countries in the database experienced a decline in utilization, average −49% (range: −17% in Kazakhstan to −90% in Egypt). Across the G7 nations, we also observed a decreased trend in DAA utilization during the early months of the pandemic, with significant declines (p < 0.01) for Canada, Germany, the United Kingdom, and the United States of America. The global response to COVID-19 led to a large decrease in DAA utilization globally. Deliberate efforts to counteract the impact of COVID-19 on treatment delivery are needed to support the goal of HCV elimination.

scholarly journals Outpatient Fluoroquinolone Prescription Fills in the United States, 2014-2020: Assessing the Impact of Food and Drug Administration Safety Warnings

2021 ◽  
Author(s):  
Deanna J. Buehrle ◽  
Marilyn M. Wagener ◽  
Cornelius J. Clancy
Keyword(s):  
United States ◽  
Drug Administration ◽  
Nurse Practitioners ◽  
Food And Drug Administration ◽  
Interrupted Time Series ◽  
The United States ◽  
Baseline Period ◽  
Interrupted Time Series Analysis ◽  
Prescription Audit ◽  
The Impact

Background: The impact of United States (US) Food and Drug Administration (FDA) safety warnings on outpatient fluoroquinolone use is unclear. Methods: Annual changes in outpatient ciprofloxacin, levofloxacin and moxifloxacin prescription fills (IQVIA National Prescription Audit databases) were assessed using a regression model. Monthly fills during baseline (August 2014–April 2016), first (May 2016–June 2018), and second FDA warning periods (July 2018–February 2020) were compared by interrupted time series analysis. Results: From 2015 through 2019, total fluoroquinolone fills decreased from 35,616,786 (111.1/1000 persons) to 21,100,050 (64.3/1000 persons) annually (10.8% annually (P=0.001)). Ciprofloxacin, levofloxacin, and moxifloxacin fills decreased annually by 10.4% (P=0.001), 11.2% (P<0.001), and 17.7% (P=0.008), respectively. During the baseline period, there was no significant change in monthly fluoroquinolone fills. In May 2016 and during the first warning period, monthly fluoroquinolone fills decreased significantly (P-values<0.001); the trend of decreased fills was significantly greater than that of the baseline period (P=0.02). There was no change in fluoroquinolone fills in July 2018. Monthly fills decreased significantly throughout the second warning period (P<0.001), but the trend did not differ from that of the first warning period. Trends for ciprofloxacin, the most commonly prescribed fluoroquinolone, were similar to those for the class. Fills of prescriptions by infectious diseases specialists (P<0.005) and nurse practitioners (P=0.04) significantly increased during the study. Conclusions: US outpatient fluoroquinolone prescription fills significantly decreased from August 2014-February 2020, most strongly in association with May 2016 FDA warnings. FDA safety warnings are useful tools for leveraging outpatient antimicrobial stewardship.

scholarly journals Did the Great Recession increase suicides in the USA? Evidence from an Interrupted Time Series analysis

2019 ◽  
Author(s):  
Sam Harper
Keyword(s):  
Great Recession ◽  
Interrupted Time Series ◽  
The United States ◽  
Interrupted Time Series Analysis ◽  
Men And Women ◽  
The Great Recession ◽  
Suicide Rates ◽  
The Usa ◽  
And Gender ◽  
The Impact

PurposeResearch suggests that the Great Recession of 2007–2009 led to nearly 5000 excess suicides in the United States. However, prior work has not accounted for seasonal patterning and unique suicide trends by age and gender.MethodsWe calculated monthly suicide rates from 1999 to 2013 for men and women aged 15 and above. Suicide rates before the Great Recession were used to predict the rate during and after the Great Recession. Death rates for each age-gender group were modeled using Poisson regression with robust variance, accounting for seasonal and nonlinear suicide trajectories.ResultsThere were 56,658 suicide deaths during the Great Recession. Age- and gender-specific suicide trends before the recession demonstrated clear seasonal and nonlinear trajectories. Our models predicted 57,140 expected suicide deaths, leading to 482 fewer observed than expected suicides (95% confidence interval −2079, 943).ConclusionsWe found little evidence to suggest that the Great Recession interrupted existing trajectories of suicide rates. Suicide rates were already increasing before the Great Recession for middle-aged men and women. Future studies estimating the impact of recessions on suicide should account for the diverse and unique suicide trajectories of different social groups.

scholarly journals Clearing the air: A study of cannabis-related presentations to urban Alberta emergency departments following legalization

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 776-783
Author(s):  
Matthew E. M. Yeung ◽  
Colin G. Weaver ◽  
Kevin Janz ◽  
Rebecca Haines-Saah ◽  
Eddy Lang
Keyword(s):  
Emergency Departments ◽  
Interrupted Time Series ◽  
Poison Control ◽  
Medical Cannabis ◽  
Interrupted Time Series Analysis ◽  
Absolute Level ◽  
Level Change ◽  
Control Centre ◽  
Ed Visits ◽  
Pre Treatment

ABSTRACTObjectivesNon-medical cannabis recently became legal for adults in Canada. Legalization provides opportunity to investigate the public health effects of national cannabis legalization on presentations to emergency departments (EDs). Our study aimed to explore association between cannabis-related ED presentations, poison control and telemedicine calls, and cannabis legalization.MethodsData were collected from the National Ambulatory Care Reporting System from October 1, 2013, to July 31, 2019, for 14 urban Alberta EDs, from Alberta poison control, and from HealthLink, a public telehealth service covering all of Alberta. Visitation data were obtained to compare pre- and post-legalization periods. An interrupted time-series analysis accounting for existing trends was completed, in addition to the incidence rate ratio (IRR) and relative risk calculation (to evaluate changes in co-diagnoses).ResultsAlthough only 3 of every 1,000 ED visits within the time period were attributed to cannabis, the number of cannabis-related ED presentations increased post-legalization by 3.1 (range -11.5 to 12.6) visits per ED per month (IRR 1.45, 95% confidence interval [CI]; 1.39, 1.51; absolute level change: 43.5 visits per month, 95% CI; 26.5, 60.4). Cannabis-related calls to poison control also increased (IRR 1.87, 95% CI; 1.55, 2.37; absolute level change: 4.0 calls per month, 95% CI; 0.1, 7.9). Lastly, we observed increases in cannabis-related hyperemesis, unintentional ingestion, and individuals leaving the ED pre-treatment. We also observed a decrease in co-ingestant use.ConclusionOverall, Canadian cannabis legalization was associated with small increases in urban Alberta cannabis-related ED visits and calls to a poison control centre.

scholarly journals COVID-19 and Antibiotic Prescribing in Pediatric Primary Care

PEDIATRICS ◽  
2022 ◽  
Author(s):  
Lauren Dutcher ◽  
Yun Li ◽  
Giyoung Lee ◽  
Robert Grundmeier ◽  
Keith W. Hamilton ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
The United States ◽  
Pediatric Primary Care ◽  
Antibiotic Prescribing ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
The Impact

BACKGROUND AND OBJECTIVES: With the onset of the coronavirus disease 2019 (COVID-19) pandemic, pediatric ambulatory encounter volume and antibiotic prescribing both decreased; however, the durability of these reductions in pediatric primary care in the United States has not been assessed. METHODS: We conducted a retrospective observational study to assess the impact of the COVID-19 pandemic and associated public health measures on antibiotic prescribing in 27 pediatric primary care practices. Encounters from January 1, 2018, through June 30, 2021, were included. The primary outcome was monthly antibiotic prescriptions per 1000 patients. Interrupted time series analysis was performed. RESULTS: There were 69 327 total antibiotic prescriptions from April through December in 2019 and 18 935 antibiotic prescriptions during the same months in 2020, a 72.7% reduction. The reduction in prescriptions at visits for respiratory tract infection (RTI) accounted for 87.3% of this decrease. Using interrupted time series analysis, overall antibiotic prescriptions decreased from 31.6 to 6.4 prescriptions per 1000 patients in April 2020 (difference of −25.2 prescriptions per 1000 patients; 95% CI: −32.9 to −17.5). This was followed by a nonsignificant monthly increase in antibiotic prescriptions, with prescribing beginning to rebound from April to June 2021. Encounter volume also immediately decreased, and while overall encounter volume quickly started to recover, RTI encounter volume returned more slowly. CONCLUSIONS: Reductions in antibiotic prescribing in pediatric primary care during the COVID-19 pandemic were sustained, only beginning to rise in 2021, primarily driven by reductions in RTI encounters. Reductions in viral RTI transmission likely played a substantial role in reduced RTI visits and antibiotic prescriptions.

scholarly journals Does admission prevalence change after reconfiguration of inpatient services? An interrupted time series analysis of the impact of reconfiguration in five centres

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joanne Martin ◽  
Edwin Amalraj Raja ◽  
Steve Turner
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Emergency Admission ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Emergency Admissions ◽  
Series Analysis ◽  
Inpatient Services ◽  
The Impact ◽  
Admission Prevalence

Abstract Background Service reconfiguration of inpatient services in a hospital includes complete and partial closure of all emergency inpatient facilities. The “natural experiment” of service reconfiguration may give insight into drivers for emergency admissions to hospital. This study addressed the question does the prevalence of emergency admission to hospital for children change after reconfiguration of inpatient services? Methods There were five service reconfigurations in Scottish hospitals between 2004 and 2018 where emergency admissions to one “reconfigured” hospital were halted (permanently or temporarily) and directed to a second “adjacent” hospital. The number of emergency admissions (standardised to /1000 children in the regional population) per month to the “reconfigured” and “adjacent” hospitals was obtained for five years prior to reconfiguration and up to five years afterwards. An interrupted time series analysis considered the association between reconfiguration and admissions across pairs comprised of “reconfigured” and “adjacent” hospitals, with adjustment for seasonality and an overall rising trend in admissions. Results Of the five episodes of reconfiguration, two were immediate closure, two involved closure only to overnight admissions and one with overnight closure for a period and then closure. In “reconfigured” hospitals there was an average fall of 117 admissions/month [95% CI 78, 156] in the year after reconfiguration compared to the year before, and in “adjacent” hospitals admissions rose by 82/month [32, 131]. Across paired reconfigured and adjacent hospitals, in the months post reconfiguration, the overall number of admissions to one hospital pair slowed, in another pair admissions accelerated, and admission prevalence was unchanged in three pairs. After reconfiguration in one hospital, there was a rise in admissions to a third hospital which was closer than the named “adjacent” hospital. Conclusions There are diverse outcomes for the number of emergency admissions post reconfiguration of inpatient facilities. Factors including resources placed in the community after local reconfiguration, distance to the “adjacent” hospital and local deprivation may be important drivers for admission pathways after reconfiguration. Policy makers considering reconfiguration might consider a number of factors which may be important determinants of admissions post reconfiguration.

Recession and risk of suicide in Denmark during the 2009 global financial crisis: an ecological register-based study

2021 ◽  
pp. 140349482110132
Author(s):  
Agnieszka Konieczna ◽  
Sarah Grube Jakobsen ◽  
Christina Petrea Larsen ◽  
Erik Christiansen
Keyword(s):  
Time Series ◽  
Financial Crisis ◽  
Time Series Analysis ◽  
Suicide Rate ◽  
Global Financial Crisis ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Prevention Programmes ◽  
The Impact

Aim: The aim of this study is to analyse the potential impact from the financial crisis (onset in 2009) on suicide rates in Denmark. The hypothesis is that the global financial crisis raised unemployment which leads to raising the suicide rate in Denmark and that the impact is most prominent in men. Method: This study used an ecological study design, including register data from 2001 until 2016 on unemployment, suicide, gender and calendar time which was analysed using Poisson regression models and interrupted time series analysis. Results: The correlation between unemployment and suicide rates was positive in the period and statistically significant for all, but at a moderate level. A dichotomised version of time (calendar year) showed a significant reduction in the suicide rate for women (incidence rate ratio 0.87, P=0.002). Interrupted time series analysis showed a significant decreasing trend for the overall suicide rate and for men in the pre-recession period, which in both cases stagnated after the onset of recession in 2009. The difference between the genders’ suicide rate changed significantly at the onset of recession, as the rate for men increased and the rate for women decreased. Discussion: The Danish social welfare model might have prevented social disintegration and suicide among unemployed, and suicide prevention programmes might have prevented deaths among unemployed and mentally ill individuals. Conclusions: We found some indications for gender-specific differences from the impact of the financial crises on the suicide rate. We recommend that men should be specifically targeted for appropriate prevention programmes during periods of economic downturn.

scholarly journals Shooting from the ‘Scrip: Scope of Practice Laws and Access to Immunizations in the Pharmacy Setting

Vaccines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 444
Author(s):  
Charles Stoecker
Keyword(s):  
Positive Impact ◽  
National Level ◽  
State Level ◽  
The United States ◽  
Scope Of Practice ◽  
Patient Specific ◽  
Behavioral Risk ◽  
Influenza Immunization ◽  
Immunization Rates ◽  
The Impact

In the past two decades, most states in the United States have added authorization for pharmacists to administer some vaccinations. Expansions of this authority have also come with prescription requirements or other regulatory burdens. The objective of this study was to evaluate the impact of these expansions on influenza immunization rates in adults age 65 and over. A panel data, differences-in-differences regression framework to control for state-level unobserved confounders and shocks at the national level was used on a combination of a dataset of state-level statute and regulatory changes and influenza immunization data from the Behavioral Risk Factor Surveillance System. Giving pharmacists permission to vaccinate had a positive impact on adult influenza immunization rates of 1.4 percentage points for adults age 65 and over. This effect was diminished by the presence of laws requiring pharmacists to obtain patient-specific prescriptions. There was no evidence that allowing pharmacists to administer vaccinations led patients to have fewer annual check-ups with physicians or not have a usual source of health care. Expanding pharmacists’ scope of practice laws to include administering the influenza vaccine had a positive impact on influenza shot uptake. This may have implications for relaxing restrictions on other forms of care that could be provided by pharmacists.

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