Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Graduate Department of Pharmaceutical Sciences, University of Toronto, Toronto, Canada.
J Am Med Dir Assoc. 2023 Aug;24(8):1120-1126.e1. doi: 10.1016/j.jamda.2023.05.013. Epub 2023 May 25.
Little is known about how COVID-19 treatment patterns have evolved over time in nursing homes (NHs) despite the devastating effects of COVID-19 in this setting. The aim was to describe changes in COVID-19-related medication use over time among NH residents in the United States.
Retrospective cohort study.
This study used electronic health records (EHR) from 11 different US NH corporations between January 1, 2018, and March 31, 2022.
The use of medications approved for COVID-19-related conditions or known to be used off-label for COVID-19 during the study period is identified. We described trends in the use of each drug and combined use per 1000 NH residents over calendar time [quarters (Q)].
A total of 59,022 unique residents with the use of an eligible medication were identified. Hydroxychloroquine use sharply increased from 9.8 in 2020Q1 to 30.2 orders per 1000 individuals in 2020Q2. Dexamethasone use increased sharply from 14.8 in 2020Q2 to a peak of 121.9 orders per 1000 individuals in 2020Q4. Azithromycin use increased from 44.1 in 2019Q3 to a peak of 99.9 orders per 1000 individuals in 2020Q4, with a drop in 2020Q3 of 51.3 per 1000 individuals in 2020Q3. Concurrent use of azithromycin and hydroxychloroquine increased sharply from 0.3 in 2020Q1 to 10.6 orders per 1000 residents in 2020Q2 and then drastically decreased to 0.6 per 1000 residents in 2020Q3. Concurrent use of dexamethasone and azithromycin rose considerably from 0.7 in 2020Q2 to 28.2 orders per 1000 residents in 2020Q4.
As in other settings, COVID-19-related medication use in NHs appears to have changed in response to the shifting evidence base and availability of medications during the pandemic. Providers should continue to diligently modify their prescribing as new evidence accrues.
尽管 COVID-19 在护理院（NH）中造成了毁灭性的影响，但对于 COVID-19 治疗模式随时间如何演变的了解甚少。本研究旨在描述美国 NH 居民 COVID-19 相关药物使用随时间的变化。
回顾性队列研究。
本研究使用了 2018 年 1 月 1 日至 2022 年 3 月 31 日期间来自 11 家不同美国 NH 公司的电子健康记录（EHR）。
确定了在研究期间用于 COVID-19 相关疾病的药物或已知用于 COVID-19 的药物的使用情况。我们描述了每种药物的使用趋势，并按日历时间（季度[Q]）计算每 1000 名 NH 居民的联合用药情况。
共确定了 59022 名使用合格药物的独特居民。羟氯喹的使用量从 2020 年 Q1 的 9.8 个处方急剧增加到 2020 年 Q2 的 30.2 个处方/每 1000 人。地塞米松的使用量从 2020 年 Q2 的 14.8 个处方急剧增加到 2020 年 Q4 的 121.9 个处方/每 1000 人，达到峰值。阿奇霉素的使用量从 2019 年 Q3 的 44.1 个处方增加到 2020 年 Q4 的 99.9 个处方/每 1000 人，2020 年 Q3 下降了 51.3 个处方/每 1000 人。阿奇霉素和羟氯喹的联合使用量从 2020 年 Q1 的 0.3 个处方急剧增加到 2020 年 Q2 的 10.6 个处方/每 1000 人，然后在 2020 年 Q3 急剧下降至 0.6 个处方/每 1000 人。地塞米松和阿奇霉素的联合使用量从 2020 年 Q2 的 0.7 个处方增加到 2020 年 Q4 的 28.2 个处方/每 1000 人。
与其他环境一样，NH 中 COVID-19 相关药物的使用似乎也随着大流行期间证据基础和药物供应的变化而发生了变化。随着新证据的积累，提供者应继续认真修改他们的处方。
