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Article ; Online: Analysis of primary care prescription trends in England during the COVID-19 pandemic compared against a predictive model.

Frazer, John Scott / Frazer, Glenn Ross

2021 Volume 9, Issue 3

Abstract: Objectives: The COVID-19 pandemic has had an unprecedented impact across primary care. Primary care services have seen an upheaval, and more and more patients are engaging in telephone consultations in order to maintain social distancing. In the present ...

Abstract	Objectives: The COVID-19 pandemic has had an unprecedented impact across primary care. Primary care services have seen an upheaval, and more and more patients are engaging in telephone consultations in order to maintain social distancing. In the present study, we seek to quantify the effect of the pandemic on primary care prescribing. Design: We conducted a retrospective analysis of the English Prescribing Dataset from January 2014 to November 2020, totalling 7 542 293 921 prescriptions. Data were separated into prepandemic and pandemic sets. A Holt-Winters predictive model was used to forecast individual drug prescribing based on historic trends. Observed data were compared with the forecast quantitatively and qualitatively. Setting: All prescriptions signed in England and dispensed during the years 2014-2020. Participants: All residents of England who received a prescription from primary care facilities during 2014-2020. Results: Prescribing of numerous health-critical medications was above predicted in March 2020, including salbutamol (53.0% (99% CI (41.2% to 66.9%))), insulin aspart (26.9% (99% CI (18.5% to 36.6%))) and tacrolimus (18.6% (99% CI (8.3% to 31.1%))). Medications for end-of-life symptom control increased in April, including levomepromazine hydrochloride (94.7% (99% CI (54.6% to 163.0%))). Medications requiring face-to-face visits decreased, including the local anaesthetic bupivacaine hydrochloride (86.6% (99% CI (89.3% to 82.0%))). There was no observed change in medications relating to type 2 diabetes, hypertension or mental health conditions. Conclusions: Significantly increased prescribing of several medications was observed, especially among those critical for health. A dramatic spike in end-of-life prescribing highlights the adversity faced by community practitioners during 2020. Medications involving face-to-face consultations declined, as did contraceptives, travel-related vaccines and drugs used in dementia and Parkinson's disease. Drugs relating to type 2 diabetes, hypertension and mental health were unchanged.
MeSH term(s)	COVID-19/drug therapy ; Drug Prescriptions ; England ; Forecasting ; Humans ; Pandemics ; Practice Patterns, Physicians' ; Primary Health Care ; Retrospective Studies ; SARS-CoV-2
Language	English
Publishing date	2021-08-03
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	2986753-8
ISSN	2009-8774 ; 2305-6983
ISSN (online)	2009-8774
ISSN	2305-6983
DOI	10.1136/fmch-2021-001143
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Changes in arterial pH do not explain the reductions in ionised calcium observed during COVID-19 infection.

Frazer, John Scott / Lucas-Evans, Robin / Dayala, Asghar / Mlangeni, Dennis A

Advances in medical sciences

2024 Volume 69, Issue 1, Page(s) 51–55

Abstract: Background: Hypocalcaemia predicts coronavirus disease 2019 (COVID-19) severity and mortality. We hypothesized an association between respiratory alkalosis secondary to hypoxia and low ionised calcium (iCa) concentration in patients with COVID-19.: ... ...

Abstract	Background: Hypocalcaemia predicts coronavirus disease 2019 (COVID-19) severity and mortality. We hypothesized an association between respiratory alkalosis secondary to hypoxia and low ionised calcium (iCa) concentration in patients with COVID-19. Methods: Arterial blood gas samples taken from January 2019 to March 2021 were retrospectively matched with infection status. Principal components regression was undertaken to determine the correlation between pH, partial pressure arterial oxygen (PaO Results: We included 4056 patients (300 COVID-19 detected, 19 influenza detected), corresponding to 5960 arterial blood samples. The COVID-19 detected group had a statistically significantly lower iCa, PaO Conclusion: Reduction in iCa concentration in patients with COVID-19 is not associated with pH derangement. Influenza infection was associated with a minor reduction in iCa in our small sample, a hitherto unreported finding, although statistical significance was not demonstrated.
MeSH term(s)	Humans ; COVID-19/blood ; COVID-19/complications ; Hydrogen-Ion Concentration ; Female ; Male ; Middle Aged ; Retrospective Studies ; Calcium/blood ; Calcium/metabolism ; Blood Gas Analysis ; SARS-CoV-2/isolation & purification ; Aged ; Oxygen/blood ; Oxygen/metabolism ; Hypocalcemia/blood ; Carbon Dioxide/blood ; Adult
Chemical Substances	Calcium (SY7Q814VUP) ; Oxygen (S88TT14065) ; Carbon Dioxide (142M471B3J)
Language	English
Publishing date	2024-02-15
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2273668-2
ISSN	1898-4002 ; 1896-1126
ISSN (online)	1898-4002
ISSN	1896-1126
DOI	10.1016/j.advms.2024.02.001
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Article ; Online: GP prescribing in Northern Ireland by deprivation index: retrospective analysis.

Frazer, John Scott / Frazer, Glenn Ross

Family medicine and community health

2020 Volume 8, Issue 3

Abstract: Objective: In the present study, we sought to explore the relationship between socioeconomic status and prescribing magnitude and cost in primary care throughout Northern Ireland.: Design: We performed a retrospective data analysis of general ... ...

Abstract	Objective: In the present study, we sought to explore the relationship between socioeconomic status and prescribing magnitude and cost in primary care throughout Northern Ireland. Design: We performed a retrospective data analysis of general practitioner (GP) prescribing using open-source databases with data collected from May to October 2019 to determine the number of prescriptions and cost of drugs and drug classes by area, ranking these by deprivation index. We used Kendall's tau to quantify the relationship between prescribing and deprivation. Setting: We analysed open-source data collected from 325 GP practices in Northern Ireland during the period from May to October 2019. Participants: We analysed a total of 2 764 303 prescriptions signed during our study period. Results: Our study indicates a clear trend of increased overall spending per patient (r=-0.1232, p=0.02) and number of prescriptions per patient (r=-0.3440, p<0.001) in areas of higher deprivation. The mean cost per item was higher in less deprived areas (r=0.3809, p<0.001). Overall, £13.79 more was spent and 3.5 more items were prescribed per patient in the most compared with the least deprived decile, although more expensive items tended to be prescribed in areas with lower socioeconomic deprivation (£11.27 per item vs £9.20 per item). We found a statistically significant correlation of prescribing of key drug classes, such as bronchodilators, antidepressants and drugs used to treat diabetes, among others, with greater deprivation. Prescribing of vaccines and drugs used in the treatment of glaucoma was correlated with lower deprivation. Conclusion: We provide an exploration of the correlation of prescribing with deprivation by analysing all prescriptions signed within a 6-month period in Northern Ireland. Our study broadly agrees with published literature, although a few notable exceptions are highlighted. We provide evidence of discrepancies in medication cost between areas of differing deprivation and suggest possible explanations for these trends. This information will be valuable for future investigation of disease prevalence, as well as targeting of patient education and future funding.
MeSH term(s)	Databases, Factual ; Drug Prescriptions/economics ; General Practitioners ; Humans ; Northern Ireland ; Poverty Areas ; Practice Patterns, Physicians' ; Qualitative Research ; Retrospective Studies ; Social Class
Language	English
Publishing date	2020-05-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2986753-8
ISSN	2009-8774 ; 2305-6983
ISSN (online)	2009-8774
ISSN	2305-6983
DOI	10.1136/fmch-2020-000376
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Article ; Online: Trends in medication use at the onset of and during the COVID-19 pandemic in the Republic of Ireland: An interrupted time series study.

Mattsson, Molly / Hong, Jung Ah / Frazer, John Scott / Frazer, Glenn Ross / Moriarty, Frank

Basic & clinical pharmacology & toxicology

2023 Volume 134, Issue 2, Page(s) 231–240

Abstract: The COVID-19 pandemic had a substantial impact on healthcare delivery, particularly in general practice. This study aimed to evaluate how dispensing of medications in primary care in Ireland changed following the COVID-19 pandemic's onset compared to ... ...

Abstract	The COVID-19 pandemic had a substantial impact on healthcare delivery, particularly in general practice. This study aimed to evaluate how dispensing of medications in primary care in Ireland changed following the COVID-19 pandemic's onset compared to expected trends. This interrupted time series study used data on medications prescribed in general practice 2016-2022 to patient eligible for state health cover, approximately one third of the population. Dispensing volumes for all therapeutic subgroups (ATC2 codes) and commonly dispensed medications were summarized. Pre-pandemic data were used to forecast expected trends (with 99% prediction intervals) using the Holt-Winters method, and these were compared to observed dispensing from March 2020 onwards. Many (31/77) therapeutic subgroups had dispensing significantly different from forecast in March 2020. Drugs for obstructive airway disease had the largest difference, with dispensing 26.2% (99%CI 19.5%-33.6%) higher than forecasted. Only two subgroups were significantly lower than forecasted, other gynaecologicals (17.7% lower, 99%CI 6.3%-26.6%) and dressings (11.6%, 99%CI 9.4%-41.6%). Dispensing of amoxicillin products and oral prednisolone were lower than forecasted in the months following the pandemic's onset, particularly during winter 2020/2021. There was a spike in dispensing for many long-term medications in March 2020, while pandemic restrictions likely contributed to reductions for other medications.
MeSH term(s)	Humans ; Pandemics ; Ireland/epidemiology ; Interrupted Time Series Analysis ; COVID-19/epidemiology ; Pharmaceutical Preparations
Chemical Substances	Pharmaceutical Preparations
Language	English
Publishing date	2023-11-27
Publishing country	England
Document type	Journal Article
ZDB-ID	2134679-3
ISSN	1742-7843 ; 1742-7835
ISSN (online)	1742-7843
ISSN	1742-7835
DOI	10.1111/bcpt.13958
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Article ; Online: Analysis of primary care prescription trends in England during the COVID-19 pandemic compared against a predictive model

John Scott Frazer / Glenn Ross Frazer

Family Medicine and Community Health, Vol 9, Iss

2021 Volume 3

Abstract: Objectives The COVID-19 pandemic has had an unprecedented impact across primary care. Primary care services have seen an upheaval, and more and more patients are engaging in telephone consultations in order to maintain social distancing. In the present ... ...

Abstract	Objectives The COVID-19 pandemic has had an unprecedented impact across primary care. Primary care services have seen an upheaval, and more and more patients are engaging in telephone consultations in order to maintain social distancing. In the present study, we seek to quantify the effect of the pandemic on primary care prescribing.Design We conducted a retrospective analysis of the English Prescribing Dataset from January 2014 to November 2020, totalling 7 542 293 921 prescriptions. Data were separated into prepandemic and pandemic sets. A Holt-Winters predictive model was used to forecast individual drug prescribing based on historic trends. Observed data were compared with the forecast quantitatively and qualitatively.Setting All prescriptions signed in England and dispensed during the years 2014–2020.Participants All residents of England who received a prescription from primary care facilities during 2014–2020.Results Prescribing of numerous health-critical medications was above predicted in March 2020, including salbutamol (53.0% (99% CI (41.2% to 66.9%))), insulin aspart (26.9% (99% CI (18.5% to 36.6%))) and tacrolimus (18.6% (99% CI (8.3% to 31.1%))). Medications for end-of-life symptom control increased in April, including levomepromazine hydrochloride (94.7% (99% CI (54.6% to 163.0%))). Medications requiring face-to-face visits decreased, including the local anaesthetic bupivacaine hydrochloride (86.6% (99% CI (89.3% to 82.0%))). There was no observed change in medications relating to type 2 diabetes, hypertension or mental health conditions.Conclusions Significantly increased prescribing of several medications was observed, especially among those critical for health. A dramatic spike in end-of-life prescribing highlights the adversity faced by community practitioners during 2020. Medications involving face-to-face consultations declined, as did contraceptives, travel-related vaccines and drugs used in dementia and Parkinson’s disease. Drugs relating to type 2 diabetes, hypertension and mental health ...
Keywords	Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2021-08-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Trends in medication use after the onset of the COVID-19 pandemic in the Republic of Ireland: an interrupted time series study

Mattsson, Molly / Hong, Jung Ah / Frazer, John Scott / Frazer, Glenn Ross / Moriarty, Frank

medRxiv

Abstract	The COVID-19 pandemic had a substantial impact on healthcare delivery, particularly in general practice. This study aimed to evaluate how dispensing of medications in primary care in Ireland changed following the COVID-19 pandemic9s onset compared to expected trends. This interrupted time series study used data on medications prescribed in general practice 2016-2022 to patient eligible for state health cover, approximately one third of the population. Dispensing volumes for all therapeutic subgroups (ATC2 codes) and commonly dispensed medications were summarised. Pre-pandemic data was used to forecast expected trends (with 99% prediction intervals) using the Holt-Winters method, and these were compared to observed dispensing from March 2020 onwards. Most (31/77) therapeutic subgroups had dispensing significantly different from forecast in March 2020. Drugs for obstructive airway disease had the largest difference, with dispensing 26.2% (99%CI 19.5%-33.6%) higher than forecasted. Only two subgroups were significantly lower than forecasted, other gynaecologicals (17.7% lower, 99%CI 6.3%-26.6%) and dressings (11.6%, 99%CI 9.4%-41.6%). Dispensing of amoxicillin products and oral prednisolone were lower than forecasted in the months following the pandemic9s onset, particularly during winter 2020/2021. There was a spike in dispensing for many long-term medications in March 2020, while pandemic restrictions likely contributed to reductions for other medications.
Keywords	covid19
Language	English
Publishing date	2023-06-12
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2023.06.09.23291202
Database	COVID19

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Article ; Online: GP prescribing in Northern Ireland by deprivation index

John Scott Frazer / Glenn Ross Frazer

Family Medicine and Community Health, Vol 8, Iss

retrospective analysis

2020 Volume 3

Abstract: Objective In the present study, we sought to explore the relationship between socioeconomic status and prescribing magnitude and cost in primary care throughout Northern Ireland.Design We performed a retrospective data analysis of general practitioner ( ... ...

Abstract	Objective In the present study, we sought to explore the relationship between socioeconomic status and prescribing magnitude and cost in primary care throughout Northern Ireland.Design We performed a retrospective data analysis of general practitioner (GP) prescribing using open-source databases with data collected from May to October 2019 to determine the number of prescriptions and cost of drugs and drug classes by area, ranking these by deprivation index. We used Kendall’s tau to quantify the relationship between prescribing and deprivation.Setting We analysed open-source data collected from 325 GP practices in Northern Ireland during the period from May to October 2019.Participants We analysed a total of 2 764 303 prescriptions signed during our study period.Results Our study indicates a clear trend of increased overall spending per patient (r=−0.1232, p=0.02) and number of prescriptions per patient (r=−0.3440, p<0.001) in areas of higher deprivation. The mean cost per item was higher in less deprived areas (r=0.3809, p<0.001). Overall, £13.79 more was spent and 3.5 more items were prescribed per patient in the most compared with the least deprived decile, although more expensive items tended to be prescribed in areas with lower socioeconomic deprivation (£11.27 per item vs £9.20 per item). We found a statistically significant correlation of prescribing of key drug classes, such as bronchodilators, antidepressants and drugs used to treat diabetes, among others, with greater deprivation. Prescribing of vaccines and drugs used in the treatment of glaucoma was correlated with lower deprivation.Conclusion We provide an exploration of the correlation of prescribing with deprivation by analysing all prescriptions signed within a 6-month period in Northern Ireland. Our study broadly agrees with published literature, although a few notable exceptions are highlighted. We provide evidence of discrepancies in medication cost between areas of differing deprivation and suggest possible explanations for these trends. This information will be valuable for future investigation of disease prevalence, as well as targeting of patient education and future funding.
Keywords	Medicine (General) ; R5-920
Language	English
Publishing date	2020-09-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Involvement of the open-source community in combating the worldwide COVID-19 pandemic: a review.

Frazer, John Scott / Shard, Amelia / Herdman, James

Journal of medical engineering & technology

2020 Volume 44, Issue 4, Page(s) 169–176

Abstract: The ongoing COVID-19 pandemic is unprecedented in the modern age both due to its scale and its disruption to daily life throughout the world. Widespread social isolation and restrictions in the age of modern communicative technology, coupled with some ... ...

Abstract	The ongoing COVID-19 pandemic is unprecedented in the modern age both due to its scale and its disruption to daily life throughout the world. Widespread social isolation and restrictions in the age of modern communicative technology, coupled with some early successes for makers, have united the open-source community towards a common goal in a way not previously seen. Local hospitals and care facilities are turning to makers to print essential consumable parts, such as simple visors, while in the hardest hit areas, critical pieces of medical technology are being fabricated. While important and effective innovations are appearing almost daily, there are also some worrying trends towards hobbyists attempting manufacture of complex medical devices with little understanding of the clinical or scientific rationale behind their design. The nature of the open-source community, an area of intensive innovation, fluidity, and experimentation, jars with the exacting standards of medical device regulation. Here, we review the involvement of rapid prototyping and the open-source community in the key areas of personal protective equipment (PPE), diagnostics, critical care technology, and information acquisition and sharing, highlighting where makers and hackers have clashed with medical device regulations, and areas where the system has worked well to facilitate change.
MeSH term(s)	COVID-19 ; Coronavirus Infections/diagnosis ; Coronavirus Infections/prevention & control ; Critical Care/methods ; Humans ; Pandemics/prevention & control ; Personal Protective Equipment ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/prevention & control ; Printing, Three-Dimensional
Keywords	covid19
Language	English
Publishing date	2020-05-13
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	243092-7
ISSN	1464-522X ; 0309-1902
ISSN (online)	1464-522X
ISSN	0309-1902
DOI	10.1080/03091902.2020.1757772
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Article ; Online: Emerging patterns of hypercoagulability associated with critical COVID-19: A review.

Frazer, John Scott / Tyrynis Everden, Angharad Joanna

Trends in anaesthesia & critical care

2020 Volume 34, Page(s) 4–13

Abstract: While the COVID-19 pandemic sweeps the world, much evidence is being gathered regarding its novel pathological mechanisms. It is the authors' clinical experience that patients in the intensive care unit suffering from COVID-19 are extremely pro- ... ...

Abstract	While the COVID-19 pandemic sweeps the world, much evidence is being gathered regarding its novel pathological mechanisms. It is the authors' clinical experience that patients in the intensive care unit suffering from COVID-19 are extremely pro-coagulable, with venous and arterial thromboembolism frequently observed, and losses of vascular access lines and filtration circuits to thrombosis now commonplace. Here, we explore the evidence for hypercoagulability in this group, presenting evidence of both a localised pulmonary hypercoagulability, and a systemic hypercoagulability resulting in thrombosis distant to the pulmonary vasculature. Furthermore, we discuss the possible risk factors exacerbated by, or selected for in COVID-19. We review the available evidence for use of plasma D-dimer as a prognostic marker, exploring the possibility that it acts as a marker of a COVID-19-associated hypercoagulability. We review the evidence for a pro-coagulant subtype of disseminated intravascular coagulation, discussing its clinical significance. Finally, we discuss the current evidence surrounding treatment of COVID-19 hypercoagulability, including prophylactic and treatment-dose heparin, thrombolytic agents, antiplatelet agents, and direct thrombin inhibitors, among others. We suggest areas in which further investigation is urgently needed to reduce the startling incidence of thrombosis in this group, a complication no doubt contributing to morbidity and mortality.
Language	English
Publishing date	2020-07-09
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2210-8467
ISSN (online)	2210-8467
DOI	10.1016/j.tacc.2020.07.004
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Article ; Online: Involvement of the open-source community in combating the worldwide COVID-19 pandemic

Frazer, John Scott / Shard, Amelia / Herdman, James

Journal of Medical Engineering & Technology

a review

2020 Volume 44, Issue 4, Page(s) 169–176

Keywords	Biomedical Engineering ; General Medicine ; covid19
Language	English
Publisher	Informa UK Limited
Publishing country	uk
Document type	Article ; Online
ZDB-ID	243092-7
ISSN	1464-522X ; 0309-1902
ISSN (online)	1464-522X
ISSN	0309-1902
DOI	10.1080/03091902.2020.1757772
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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