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加拿大安大略省 COVID-19 对智力和发育障碍者精神活性药物使用的影响:一项重复横断面研究。

Impact of COVID-19 on psychoactive medication use among individuals with intellectual and developmental disabilities in Ontario, Canada: A repeated cross-sectional study.

机构信息

Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. 4th floor, Toronto, Ontario, M5T 3M6, Canada; ICES, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St., Toronto, Ontario, M5B 1T8, Canada.

ICES, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St., Toronto, Ontario, M5B 1T8, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, Ontario, M5S 3M2, Canada.

出版信息

Disabil Health J. 2024 Oct;17(4):101649. doi: 10.1016/j.dhjo.2024.101649. Epub 2024 Jun 12.

Abstract

BACKGROUND

Evidence for worsening mental health among individuals with intellectual and developmental disabilities (IDD) during COVID-19 sparked concerns for increased use of psychoactive medications.

OBJECTIVE

To examine the impact of COVID-19 on psychoactive medication use and clinical monitoring among individuals with IDD in Ontario, Canada.

METHODS

We conducted a repeated cross-sectional study among individuals with IDD and examined weekly trends for psychoactive medication dispensing and outpatient physician visits among those prescribed psychoactive medications between April 7, 2019, and March 25, 2023. We used interventional autoregressive integrated moving average models to determine the impact of the declaration of emergency for COVID-19 (March 17, 2020) on the aforementioned trends.

RESULTS

The declaration of emergency for COVID-19 did not significantly impact psychoactive medication use among individuals with IDD. Provision of clinical monitoring remained relatively stable, apart from a short-term decline in the weekly rate of outpatient physician visits following the declaration of emergency for COVID-19 (step estimate: 21.26 per 1000 individuals [p < 0.01]; ramp estimate: 0.88 per 1000 individuals [p = 0.01]). When stratified by mode of delivery, there was a significant shift towards virtual care (step estimate: 78.80 per 1000 individuals; p < 0.01). The weekly rate of in-person physician visits gradually increased, returning to rates observed prior to the COVID-19 pandemic in January 2023.

CONCLUSION

Although access to clinical care remained relatively stable, the shift towards virtual care may have negatively impacted those who encounter challenges communicating via virtual mediums. Future research is required to identify the support systems necessary for individuals with IDD during virtual health care interactions.

摘要

背景

COVID-19 期间,智障和发育障碍者(IDD)的心理健康状况恶化,这引发了人们对精神活性药物使用增加的担忧。

目的

研究 COVID-19 对加拿大安大略省 IDD 患者精神活性药物使用和临床监测的影响。

方法

我们对 IDD 患者进行了一项重复横断面研究,并在 2019 年 4 月 7 日至 2023 年 3 月 25 日期间为精神活性药物开处方的患者中,每周观察精神活性药物配药和门诊医生就诊的趋势。我们使用干预自回归综合移动平均模型来确定 COVID-19 紧急状态(2020 年 3 月 17 日)对上述趋势的影响。

结果

COVID-19 紧急状态的宣布并没有显著影响 IDD 患者的精神活性药物使用。临床监测的提供基本保持稳定,除了 COVID-19 紧急状态宣布后门诊医生就诊的每周率短暂下降(阶跃估计值:每 1000 人 21.26 [p<0.01];斜坡估计值:每 1000 人 0.88 [p=0.01])。按交付模式分层时,虚拟护理的使用有显著增加(阶跃估计值:每 1000 人 78.80;p<0.01)。现场医生就诊的每周率逐渐增加,在 2023 年 1 月恢复到 COVID-19 大流行前的水平。

结论

尽管临床护理的获取相对稳定,但向虚拟护理的转变可能对那些通过虚拟媒介交流有困难的人产生负面影响。需要进行未来的研究,以确定虚拟医疗保健互动中 IDD 患者所需的支持系统。

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