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      Comparison of Medication Prescribing Before and After the COVID-19 Pandemic Among Nursing Home Residents in Ontario, Canada

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          Abstract

          Key Points Question How are COVID-19 and related disruptions in care associated with changes in the dispensation of medications commonly used among nursing home residents? Findings In this population-based cohort study with an interrupted time-series analysis of all nursing home residents from the 630 facilities in Ontario, Canada, the emergence of the COVID-19 pandemic was associated with significant increases in the use of antipsychotics, benzodiazepines, antidepressants, anticonvulsants, and opioids and no meaningful changes in the use of antibiotics or selected cardiovascular medications. Meaning The finding of increased use of medications with the potential for adverse effects among nursing home residents during the initial wave of the pandemic warrants ongoing monitoring for prescribing appropriateness and related resident outcomes.

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          Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

          Safiya Richardson, Jamie Hirsch, Mangala Narasimhan … (2020)
          There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).
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            Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples

            Peter C Austin (2009)
            The propensity score is a subject's probability of treatment, conditional on observed baseline covariates. Conditional on the true propensity score, treated and untreated subjects have similar distributions of observed baseline covariates. Propensity-score matching is a popular method of using the propensity score in the medical literature. Using this approach, matched sets of treated and untreated subjects with similar values of the propensity score are formed. Inferences about treatment effect made using propensity-score matching are valid only if, in the matched sample, treated and untreated subjects have similar distributions of measured baseline covariates. In this paper we discuss the following methods for assessing whether the propensity score model has been correctly specified: comparing means and prevalences of baseline characteristics using standardized differences; ratios comparing the variance of continuous covariates between treated and untreated subjects; comparison of higher order moments and interactions; five-number summaries; and graphical methods such as quantile–quantile plots, side-by-side boxplots, and non-parametric density plots for comparing the distribution of baseline covariates between treatment groups. We describe methods to determine the sampling distribution of the standardized difference when the true standardized difference is equal to zero, thereby allowing one to determine the range of standardized differences that are plausible with the propensity score model having been correctly specified. We highlight the limitations of some previously used methods for assessing the adequacy of the specification of the propensity-score model. In particular, methods based on comparing the distribution of the estimated propensity score between treated and untreated subjects are uninformative. Copyright © 2009 John Wiley & Sons, Ltd.
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              Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

              Melissa M. Arons, Kelly Hatfield, Sujan Reddy … (2020)
              Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can spread rapidly within skilled nursing facilities. After identification of a case of Covid-19 in a skilled nursing facility, we assessed transmission and evaluated the adequacy of symptom-based screening to identify infections in residents. Methods We conducted two serial point-prevalence surveys, 1 week apart, in which assenting residents of the facility underwent nasopharyngeal and oropharyngeal testing for SARS-CoV-2, including real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), viral culture, and sequencing. Symptoms that had been present during the preceding 14 days were recorded. Asymptomatic residents who tested positive were reassessed 7 days later. Residents with SARS-CoV-2 infection were categorized as symptomatic with typical symptoms (fever, cough, or shortness of breath), symptomatic with only atypical symptoms, presymptomatic, or asymptomatic. Results Twenty-three days after the first positive test result in a resident at this skilled nursing facility, 57 of 89 residents (64%) tested positive for SARS-CoV-2. Among 76 residents who participated in point-prevalence surveys, 48 (63%) tested positive. Of these 48 residents, 27 (56%) were asymptomatic at the time of testing; 24 subsequently developed symptoms (median time to onset, 4 days). Samples from these 24 presymptomatic residents had a median rRT-PCR cycle threshold value of 23.1, and viable virus was recovered from 17 residents. As of April 3, of the 57 residents with SARS-CoV-2 infection, 11 had been hospitalized (3 in the intensive care unit) and 15 had died (mortality, 26%). Of the 34 residents whose specimens were sequenced, 27 (79%) had sequences that fit into two clusters with a difference of one nucleotide. Conclusions Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility.
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                Author and article information

                Journal
                Title: JAMA Network Open
                Abbreviated Title: JAMA Netw Open
                Publisher: American Medical Association (AMA)
                ISSN (Electronic): 2574-3805
                Publication date Created: August 02 2021
                Publication date (Electronic): August 02 2021
                Volume: 4
                Issue: 8
                Page: e2118441
                Affiliations
                [1 ]ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
                [2 ]Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
                [3 ]Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
                [4 ]Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
                [5 ]Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
                [6 ]Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
                [7 ]Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
                [8 ]Department of Family Medicine, University of Alberta, Edmonton, Canada
                [9 ]Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
                [10 ]School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
                [11 ]Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
                Article
                DOI: 10.1001/jamanetworkopen.2021.18441
                SO-VID: a2d2015e-8a29-4346-ab22-4f96d78167ee
                Copyright © © 2021
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