Background The Coronavirus disease of 2019 (COVID-19) pandemic and the corresponding mitigation measures have had a discernible impact on drug utilization among outpatients. However, limited research exists on the prescription trends in the elderly population during the pandemic period in Viet Nam. Objectives This study aims to analyze the effects of COVID-19 on outpatient drug utilization patterns at a national geriatric hospital in Ho Chi Minh City before and after the early onset of the pandemic. Methods Data was collected from the prescriptions and administration claims, encompassing the period from January 2016 to December 2022. The dataset was divided into two periods: Period 1: January 2016 to December 2020 and Period 2: January 2021 to December 2022. The drug utilization was measured using DDD/1000P (defined daily doses–DDD per 1000 prescriptions) on a monthly basis. The analysis employed interrupted time series using Autoregressive Integrated Moving Average (ARIMA) to detect changes in drug use levels and rates. Results A total of 1,060,507 and 644,944 outpatient prescriptions from Thong Nhat Hospital were included in Period 1 and Period 2, respectively. The median age of the patients were 58 in Period 1 and 67 years old in Period 2. The most common comorbidities were dyslipidemia, hypertension, and diabetes mellitus. In terms of medication utilization, cardiovascular drugs were the most frequently prescribed, followed by drugs active on the digestive and hormonal systems. The study observed significant surges in the number of prescriptions and the average number of drugs per prescription. However, there were no significant changes in the overall consumption of all drugs. Among the drug groups related to the cardiovascular system, three subgroups experienced a sudden and significant increase: cardiac therapy, beta-blocking agents, and antihypertensives, with increasing consumption levels of 1,177.73 [CI 95%: 79.29; 2,276.16], 73.32 [CI 95%: 28.18; 118.46], and 36.70 [CI 95%: 6.74; 66.66] DDD/1000P, respectively. On the other hand, there was a significant monthly decrease of -31.36 [CI 95%: -57.02; -5.70] DDD/1000P in the consumption of anti-inflammatory and antirheumatic products. Interestingly, there was a significant increase of 74.62 [CI 95%: -0.36; 149.60] DDD/1000P in the use of antigout preparations. Conclusion COVID-19 resulted in a sudden, non-significant increase in overall drug consumption levels among outpatients. Notably, our findings highlight significant increases in the utilization of three drug groups related to the cardiovascular system, specifically cardiac therapy, beta-blocking agents, and antihypertensives. Intriguingly, there was a statistically significant increase in the consumption of antigout preparations, despite a decline in the monthly consumption rate of non-steroidal anti-flammatory drugs (NSAIDs). Further studies in the following years are necessary to provide a more comprehensive understanding of the impact of COVID-19 on outpatient drug utilization patterns.

Impact of COVID-19 on patterns of drug utilization: A case study at national hospital

Objective: The whole world stopped turning, for most countries, due to shutdowns during coronavirus pandemics, with the exception of chronic pain patients. More than 40 years of unprecedented service changes in the pain clinic, under the COVID-19 era, could cause major impacts on patients living with chronic pain. We conducted this in-depth interview to evaluate how COVID-19 affected pain in patients with chronic pain.Material and Methods: Face-to-face, in-depth interviews with tape recordings were used to explore the informants’ perspective, so as to capture their own words, thoughts, perceptions, feelings and experiences under the COVID-19 prevention and control measures. Field-notes and detailed memos were also recorded during the interview. The key informants consisted of 17 chronic pain patients, who came for follow-up visits at the pain clinic during the third and fourth waves of the COVID-19 pandemic. The qualitative content analysis method was employed to analyze the verbatim transcription of the interview recordings to identify themes and patterns.Results: The findings revealed the key informants viewed COVID-19 as being closely tied with the perception of to what extent it impacted on maintaining their usual pain treatment and care as accessed. The key informants’ feelings of fear and worry were not generated from the effects of COVID-19 on their physical health, but were from the healthcare services changes and restrictions they faced. The ‘new normal’; as such social distancing, was viewed as similar and congruence with their long-lasting normal lifestyles. Talking about COVID-19 is a lot less interesting without talking about pain. The key informants preferred taking the risk of catching COVID-19, rather than coming back for untreated pain. The door-to-door pain medication delivery service provided a sense of uncertainty and could not replace the therapeutic feelings of a sense of heartwarming, care and safety generated while having face-to-face meetings with a doctor as well as acts of kindness and compassion from the pain clinic staff.Three themes emerged from the findings: 1) the COVID-19 pandemic poses a threat to perceived stability on pain control; 2) embracing the ‘new normal’ in the world of chronic pain patients; and 3) a silver lining in the midst of the COVID-19 pandemic.Conclusion: The way patients experienced the COVID-19 pandemic well reflects individual differences in the subjective experience of pain and individual needs of chronic pain patients. Changing of healthcare services utiliza­tion at pain clinics during the COVID-19 pandemic should be therefore concerned not only with the continuum of pain treatments, but also congruent to the care needs of chronic pain patients.  

/pdf/lived-experiences-of-chronic-pain-patients-attending-follow-17apr601.pdf

Lived Experiences of Chronic Pain Patients Attending Follow-up Visits at a Pain Clinic During the COVID-19 Pandemic in Thailand

Abstract Background: Coronavirus disease 2019 (COVID-19) has various sequelae, one of which might be hypertension. We aimed to evaluate COVID-19’s impact on blood pressure (BP) in non-hospitalized patients at one-year follow-up. Method: A total of 7,950 consecutive COVID-19 patients regularly visiting our cardiology clinic were retrospectively screened. Patients' electronic medical records including demographics, comorbidities, vital signs, treatments, and outcomes, were reviewed by two physicians. Individuals with at least one BP measurement in the three months preceding COVID-19 and one measurement in 12 months or more following recovery were included. BP levels before and after COVID-19 were compared using the paired t-test. Results : 5,355 confirmed COVID-19 patients (mean age 55.51 ± 15.38 years) were included. Hypertension (56.9%) and diabetes mellitus (34%) were the predominant comorbidities, and 44.3% had prior major adverse cardiovascular events. Both systolic (126.90 ± 20.91 vs. 139.99 ± 23.94 mmHg, P&lt;0.001) and diastolic BP (80.54 ± 13.94 vs. 86.49 ± 14.40 mmHg, P&lt;0.001) were significantly higher post-COVID-19 vs. pre-COVID-19. Notably, 456 (14%) hypertensive patients experienced exacerbated hypertension, while 408 (17%) patients developed new-onset hypertension, overall 864 (16%) of patients had exacerbation or new hypertension. Linear regression analysis revealed that advanced age, smoking, previous cardiovascular events, hypertension, and diabetes mellitus predict increased BP following COVID-19 (P &lt;0.001). Conclusion: COVID-19 raised systolic and diastolic BP in the long term in non-hospitalized patients, with over one-sixth developing new-onset or exacerbated hypertension. All patients should be evaluated regarding BP, following COVID-19 recovery, particularly those with the mentioned predictive factors. (clinicaltrial.gov: NCT05798208) 

Evaluation of blood pressure variation in recovered COVID-19 patients at one-year follow-up: a retrospective cohort study

Coronavirus disease 2019 (COVID-19) has various sequelae, one of which might be hypertension. We aimed to evaluate COVID-19's impact on blood pressure (BP) in non-hospitalized patients at one-year follow-up. 

INTRODUCTION
We evaluated the impact of the lockdown policy during the COVID-19 pandemic on cardiovascular outpatients of a cardiology clinic in Vietnam from April to June 2020. We estimated the occurrence of different cardiovascular problems in general and the stability of blood pressure.


METHODOLOGY
During the Covid-19 outbreak in Vietnam, we conducted a cross-sectional study to evaluate its impact on blood pressure stability of hypertensive patients treated as outpatients at the clinic of the University Medical Center (UMC), Ho Chi Minh City.


RESULTS
The mean age of the recruited 493 patients was 62.2 ± 10.2 years. The stable blood pressure group consisted of 87% patients, while the unstable blood pressure group consisted of 13% patients. We found that 68% of the study population attended their follow-up appointments as scheduled: 87% with stable blood pressure versus only 13% with unstable blood pressure. Significant differences were noticed in body weight changes and cardiovascular problems between the two groups: body weight increase (22.6% vs. 10.2%), body weight decrease (3.2% vs. 6.7%), worsening of cardiovascular problems (35.5% vs. 17.9%) in the unstable and stable blood pressure groups, respectively. Multivariable regression analysis reflected the impact of the increase in body weight and occurrence of cardiovascular problems on the patients with unstable blood pressure.


CONCLUSIONS
Our study provided concrete proof of the impact of the lockdown on chronic patients, which should warrant further surveys, and evaluation of the lockdown policy.

https://www.jidc.org/index.php/journal/article/download/15002/2747

The effects of the COVID-19 lockdown on patients with chronic cardiovascular disease in Vietnam.

/pdf/novel-approach-to-quality-improvement-and-patient-safety-34x7qpd0.pdf

Novel Approach to Quality Improvement and Patient Safety Education for Emergency Medicine Residents

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The effects of the COVID-19 lockdown on patients with chronic cardiovascular disease in Vietnam.

Novel Approach to Quality Improvement and Patient Safety Education for Emergency Medicine Residents