Brown Andrew D, Fisher Louis, Curtis Helen J, Wiedemann Milan, Hulme William J, Speed Victoria, Hopcroft Lisa E M, Cunningham Christine, Costello Ruth E, Galloway James B, Russell Mark D, Bechman Katie, Kurt Zeyneb, Croker Richard, Wood Chris, Walker Alex J, Schaffer Andrea L, Bacon Seb C J, Mehrkar Amir, Hickman George, Bates Chris, Cockburn Jonathan, Parry John, Hester Frank, Harper Sam, Goldacre Ben, MacKenna Brian
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
London School of Hygiene and Tropical Medicine, London, UK.
Br J Clin Pharmacol. 2024 Apr 8. doi: 10.1111/bcp.16062.
The COVID-19 pandemic created unprecedented pressure on healthcare services. This study investigates whether disease-modifying antirheumatic drug (DMARD) safety monitoring was affected during the COVID-19 pandemic.
A population-based cohort study was conducted using the OpenSAFELY platform to access electronic health record data from 24.2 million patients registered at general practices using TPP's SystmOne software. Patients were included for further analysis if prescribed azathioprine, leflunomide or methotrexate between November 2019 and July 2022. Outcomes were assessed as monthly trends and variation between various sociodemographic and clinical groups for adherence with standard safety monitoring recommendations.
An acute increase in the rate of missed monitoring occurred across the study population (+12.4 percentage points) when lockdown measures were implemented in March 2020. This increase was more pronounced for some patient groups (70-79 year-olds: +13.7 percentage points; females: +12.8 percentage points), regions (North West: +17.0 percentage points), medications (leflunomide: +20.7 percentage points) and monitoring tests (blood pressure: +24.5 percentage points). Missed monitoring rates decreased substantially for all groups by July 2022. Consistent differences were observed in overall missed monitoring rates between several groups throughout the study.
DMARD monitoring rates temporarily deteriorated during the COVID-19 pandemic. Deterioration coincided with the onset of lockdown measures, with monitoring rates recovering rapidly as lockdown measures were eased. Differences observed in monitoring rates between medications, tests, regions and patient groups highlight opportunities to tackle potential inequalities in the provision or uptake of monitoring services. Further research should evaluate the causes of the differences identified between groups.
新冠疫情给医疗服务带来了前所未有的压力。本研究调查了在新冠疫情期间，改善病情抗风湿药（DMARD）的安全监测是否受到影响。
利用OpenSAFELY平台开展了一项基于人群的队列研究，以获取使用TPP公司SystmOne软件在全科诊所注册的2420万患者的电子健康记录数据。在2019年11月至2022年7月期间，如果患者被处方使用硫唑嘌呤、来氟米特或甲氨蝶呤，则纳入进一步分析。评估结果为每月的趋势以及不同社会人口学和临床组之间在遵循标准安全监测建议方面的差异。
2020年3月实施封锁措施时，研究人群中错过监测的比例急剧上升（上升12.4个百分点）。这种上升在一些患者群体（70 - 79岁：上升13.7个百分点；女性：上升12.8个百分点）、地区（西北部：上升17.0个百分点）、药物（来氟米特：上升20.7个百分点）和监测检查（血压：上升24.5个百分点）中更为明显。到2022年7月，所有组的错过监测比例都大幅下降。在整个研究过程中，几个组之间的总体错过监测比例存在持续差异。
在新冠疫情期间，DMARD的监测比例暂时恶化。恶化与封锁措施的开始同时发生，随着封锁措施的放松，监测比例迅速恢复。在药物、检查、地区和患者群体之间观察到的监测比例差异凸显了解决监测服务提供或使用方面潜在不平等问题的机会。进一步的研究应评估组间差异的原因。
