A scoping review of non-professional medication practices and medication safety outcomes during public health emergencies.

OBJECTIVES: Public health emergencies (PHE) can disrupt personal medication practices and increase the risk of medication-related harm and other negative medication-related outcomes. Our aim was to examine the extent and nature of published research on this topic to guide future research and practice. STUDY DESIGN: Scoping review. METHODS: Standard electronic databases were searched. PRISMA-ScR guidelines were followed. Extracted data were organised in response to review questions and narrative accounts developed. RESULTS: A total of 129 studies were included, conducted across 32 countries, mostly in the USA (n = 42). Sixty-eight (53%) reported on infectious events, 49 (39%) climatological or ecological events and the remainder a mixture of terrorism, war or other disasters. The studies described several medication safety outcomes (medication-related harm, adherence, supply) and adaptive medication practices (self-altering prescribed medications, sharing medications and changing healthcare providers). Challenges to maintaining routine medication practices during a PHE included transport, finance, quarantine and knowledge-related issues. Twenty-eight studies (22%) examined health inequalities pertaining to adverse medication-related outcomes, with findings suggesting that gender, age, ethnicity, educational and socio-economic status may be related to inequalities. Research gaps identified included carers', children's and minority communities' experiences and intervention studies. CONCLUSIONS: There is considerable evidence of disruptions to routine personal medication practices during PHEs and of medication-related harm and other negative outcomes. Maintaining medication supply for the management of chronic conditions is a universal problem across all emergency types. Research is needed to address these disruptions, particularly amongst people who experience health inequalities who may need additional support.

Access to general practice during the COVID-19 pandemic - a cross-sectional view of the opinions of adults who use social media.

INTRODUCTION: The COVID-19 pandemic has had a significant impact on the health and wellbeing of people worldwide. General practices were forced to adapt to constantly changing circumstances, leading to predominance of virtual consultations. The aim of this study was to examine the impact the pandemic had on the ability of patients to access general practice. Other focuses included determining the nature of changes to appointment cancellations or delays and the level of disruption to long-term medication regimes during this period. METHODS: A 25-question online survey was administered using Qualtrics®. Adult patients of Irish general practices were recruited via social media between October 2020 and February 2021. The data were examined for associations between participant groupings and key findings using chi-squared tests. RESULTS: 670 persons participated. Half of all doctor-patient consultations during that time were completed virtually, predominantly via telephone. Overall, 497 (78%) participants accessed their healthcare teams as scheduled, and without disruption. 18% of participants (n=104) reported difficulty in accessing their long-term medications; those who were younger, and those who typically attend general practice on a quarterly or more basis, were associated most with this disruption (p<0.05; p<0.05). DISCUSSION: Despite the COVID-19 pandemic, Irish general practice has maintained its schedule for appointments in greater than three quarters of cases. There was a clear shift away from face-to-face consultations to telephone appointments. Maintaining the prescription of long-term medications for patients remains a challenge. Further work needs to be done to ensure the continuation of care and undisrupted medication schedules during any future pandemics.

Access to general practice during COVID-19: a cross-sectional view of the opinions of adults who use social media.

Background/Aim: Since the onset of the COVID-19 pandemic, virtual consultations have become commonplace, and access to healthcare more complex. The study was designed to examine the impact COVID-19 has had on access to general practice care in Ireland. Methods: A 25-question online survey was designed in Qualtrics®. Adult patients of Irish general practices were recruited via social media between October 2020 and February 2021 and volunteered their opinions. Results: 670 persons participated. Half of all doctor-patient consultations were now completed virtually-predominantly via telephone. Overall, 497 (78%) participants accessed their healthcare teams as scheduled, and without disruption. 18% of participants (n=104) reported difficulty in accessing their long-term medications; those who are younger, and those who typically attend general practice quarterly or more, were associated most with this disruption (p<0.05). Fifty-nine instances where a new health concern was subject to an appointment cancellation or rescheduling were reported. Conclusions: Despite the COVID-19 pandemic, Irish general practice has maintained its schedule for appointments in 78% of cases despite the challenges of the pandemic. Half of consultations were provided virtually; teleconsultation use was very infrequent. Maintaining the supply chain for long-term medications for patients remains a challenge during a pandemic. Authors accept that study participants were confined to those who use social media. A protocol may need to be designed by each practice to optimize the continuation of care and of medication schedules during any future pandemics.

Antidepressant medication prescribing patterns in Irish general practice from 2016 to 2020 to assess for long-term use.

BACKGROUND/AIMS: The aim of this study was to identify the trends in antidepressant (AD) medication use in two Irish general practices over a 5-year period, 2016 to 2020. The rationale for this study is attributed to the growing prevalence of depression amongst the Irish general public as well as concerns surrounding long-term AD medication use. METHODS: The research was undertaken in 2021 examining AD prescription rates from 2016 to 2020. The medications of interest were selective serotonin and norepinephrine reuptake inhibitors (SSRI and SNRIs): sertraline, escitalopram, fluoxetine and venlafaxine. The number of medical card holders (MCH) and prescription dispensing rates were analysed for observable trends. RESULTS: AD medication use is rising amongst the Irish MCH population. The number of MCH prescribed AD grew from 9.42 to 12.3 per 100 MCH between the years 2016 and 2020, respectively. The year 2020 represented the largest proportion of MCH prescriptions, 6.32 AD prescriptions per 1000 MCH prescriptions. The years 2019 to 2020 represented the largest annual increase in prescription dispensing with a growth of 0.45 per 1000 MCH prescriptions. Annual figures show a continual increase in AD dispensing refill rates from 4.14 to 5.67 per 1000 MCH prescriptions in 2016 and 2020, respectively. CONCLUSION: This study illustrates a steady rise in AD medication within the general practice setting, with an observed rise in prescription dispensing rates. The high proportion of refill prescriptions demonstrates the long-term use of AD medications. This may be indicative of chronic depression or may highlight a lack of appropriate medication cessation strategies.