Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.
Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Intern Med J. 2022 Feb;52(2):214-222. doi: 10.1111/imj.15510.
The COVID-19 pandemic has generated significant debate about how emerging infections can be treated in the absence of evidence-based therapies to combat disease. In particular, the use of off-label therapies outside of a clinical trial setting has been controversial.
To longitudinally study policies and prescribing practices pertaining to therapies for COVID-19 in Australian health services during 2020.
Prospective data were collected from participating Australian health services who may care for patients with COVID-19 via an electronic portal. A single informant from each health service was emailed a survey link at regular intervals. Information was sought regarding changes to COVID-19 policy at their service and use of therapies for COVID-19.
Overall, 78 hospitals were represented from 39 respondents with longitudinal data collection from May to December 2020. All Australian states/territories were represented with the majority (34/39; 87%) of respondents located in a major city. Just over half (20/39) of respondents had a written policy for COVID-19 therapy use at their health service at survey enrolment and policies changed frequently throughout the pandemic. Therapy use outside of a clinical trial was reported in 54% of health services, most frequently in Victoria, correlating with higher numbers of COVID-19 cases. At study commencement, hydroxychloroquine was most frequently used, with corticosteroids and remdesivir use increasingly throughout the study period.
Our results reflect the reactive nature of prescribing of therapies for COVID-19 and highlight the importance of evidence-based guidelines to assist prescribers.
COVID-19 大流行引发了关于在缺乏针对疾病的循证疗法的情况下如何治疗新出现的感染的激烈争论。特别是，在临床试验之外使用标签外疗法一直存在争议。
在 2020 年期间，纵向研究澳大利亚卫生服务机构针对 COVID-19 的治疗方法的政策和处方实践。
通过电子门户，从可能通过电子门户照顾 COVID-19 患者的参与澳大利亚卫生服务机构中收集前瞻性数据。每个卫生服务机构的一名单一信息提供者定期通过电子邮件向他们发送调查链接。调查中寻求有关服务中 COVID-19 政策的变化以及 COVID-19 治疗方法的使用情况。
共有 39 名受访者代表 78 家医院进行了纵向数据收集，从 2020 年 5 月至 12 月进行了收集。所有澳大利亚州/地区都有代表，大多数（34/39；87%）受访者来自主要城市。在调查登记时，只有一半（20/39）的受访者在其服务机构中有针对 COVID-19 治疗使用的书面政策，而且整个大流行期间政策经常发生变化。54%的卫生服务机构报告了标签外治疗的使用，在维多利亚州最常见，这与 COVID-19 病例较多有关。在研究开始时，羟氯喹的使用最为频繁，而皮质类固醇和瑞德西韦的使用在整个研究期间逐渐增加。
我们的结果反映了针对 COVID-19 治疗方法的处方的反应性质，并强调了循证指南对协助处方者的重要性。
