A retrospective cohort study of medication dispensing at pharmacies: Administration matters!

Hesse, Morten; Thylstrup, Birgitte; Seid, Abdu Kedir; Tjagvad, Christian; Clausen, Thomas

doi:10.1016/j.drugalcdep.2021.108792

Cited by 4 publications

(5 citation statements)

References 40 publications

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“…In Denmark, OMT medication can be administered at OMT clinics or dispensed at pharmacies where there is less supervision of intake. A recent Danish cohort study on dispensing of OMT medication at pharmacies highlighted the risks associated with such a practice in the Danish context ( 23 ). The study found that after having methadone or buprenorphine dispensed at a pharmacy, adverse outcomes, including all-cause mortality, increased.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings indicate that there is a potential for improvement in clinical practices by applying a systematic evaluation and monitoring of mortality risk, increased involvement of psychosocial services, and enhanced safety measures to manage overdoses and other health risks. The differences between the Czech and Danish clinical approaches are substantial; one approach focuses more on safety and restrictions while the other focuses more on inclusion and reduced control measures ( 9 , 22 , 23 ). It may be that many patients who relapse to harmful drug use are excluded from treatment in Czechia.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, these two countries represent distinct treatment settings. Denmark adopts a more liberal and inclusive approach, whereas Czechia employs a more stringent treatment framework ( 9 , 15 , 22 , 23 ). Examining mortality rates within and outside of OMT for each country individually can yield valuable insights for shaping clinical approaches.…”

Section: Introductionmentioning

confidence: 99%

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Large variations in all-cause and overdose mortality among >13,000 patients in and out of opioid maintenance treatment in different settings: a comparative registry linkage study

Gabrhelík,

Hesse,

Nechanská

et al. 2023

Front. Public Health

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BackgroundOpioid maintenance treatment (OMT) has the potential to reduce mortality rates substantially. We aimed to compare all-cause and overdose mortality among OMT patients while in or out of OMT in two different countries with different approaches to OMT.MethodsTwo nation-wide, registry-based cohorts were linked by using similar analytical strategies. These included 3,637 male and 1,580 female patients enrolled in OMT in Czechia (years 2000–2019), and 6,387 male and 2,078 female patients enrolled in OMT in Denmark (years 2007–2018). The direct standardization method using the European (EU-27 plus EFTA 2011–2030) Standard was employed to calculate age-standardized rate to weight for age. All-cause and overdose crude mortality rates (CMR) as number of deaths per 1,000 person years (PY) in and out of OMT were calculated for all patients. CMRs were stratified by sex and OMT medication modality (methadone, buprenorphine, and buprenorphine with naloxone).ResultsAge-standardized rate for OMT patients in Czechia and Denmark was 9.7/1,000 PY and 29.8/1,000 PY, respectively. In Czechia, the all-cause CMR was 4.3/1,000 PY in treatment and 10.8/1,000 PY out of treatment. The overdose CMR was 0.5/1,000 PY in treatment and 1.2/1,000 PY out of treatment. In Denmark, the all-cause CMR was 26.6/1,000 PY in treatment and 28.2/1,000 PY out of treatment and the overdose CMR was 7.3/1,000 PY in treatment and 7.0/1,000 PY out of treatment.ConclusionCountry-specific differences in mortality while in and out of OMT in Czechia and Denmark may be partly explained by different patient characteristics and treatment systems in the two countries. The findings contribute to the public health debate about OMT management and may be of interest to practitioners, policy and decision makers when balancing the safety and accessibility of OMT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Large variations in all-cause and overdose mortality among >13,000 patients in and out of opioid maintenance treatment in different settings: a comparative registry linkage study

Gabrhelík,

Hesse,

Nechanská

et al. 2023

Front. Public Health

Self Cite

View full text Add to dashboard Cite

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“…A third important area is to continue evaluating the impact that the changes in provisions of MAT have had on the service users’ health. Specific examples are examining the relation between changes in MAT delivery and hospital visits resulting from drug overdoses, as well as increased risk of all-cause mortality (Hesse et al, 2021). Lastly, a key area for policy will be devising protocols to smooth out transition periods of rapid reorganisation in SUD services, with particular attention to securing a continuous support for the users’ physical and mental health.…”

Section: Implications and Recommendations For Future Research And Policymentioning

confidence: 99%

The impact of the COVID-19 lockdown on services for substance use in Denmark: Implications for meeting users’ needs and recommendations for the future

Palacio-González

Thylstrup

Houborg

2022

Nordic Studies on Alcohol and Drugs

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Background: The aim of this study was to document employees’ experiences of changes in service provision for substance use disorders (SUDs) during the first COVID-19 lockdown in Denmark (spring 2020), as well as to examine their relation to challenges in meeting the service users’ needs. Methods: Employees ( N = 373) working in SUD treatment and harm reduction services completed an online survey soon after the first national lockdown. The survey included questions about changes in service provision during the lockdown, perceived concerns of the service users, and challenges in meeting the users’ emerging needs. Results: Employees reported some positive changes in service provisions, such as increased flexibility in appointments, administering medication-assisted treatment (MAT), and use of telehealth. Negative changes were related to reduced contact with practitioners and harm reduction facilities. Approximately one third of employees reported significant challenges in meeting the users’ emerging needs. This was particularly so when users’ concerns were about physical and mental well-being, and substance use. In regression models, negative changes in the access to practitioners and MAT administration (but not other changes) predicted difficulties meeting the users’ needs. Conclusion: Employees in SUD treatment and harm reduction services in Denmark experienced both positive and negative changes as a result of the first lockdown. However, not all the provision changes were linked to challenges in meeting the users’ needs. We discuss practical and research implications of our findings with a focus on the users’ physical and mental health, use of telehealth, MAT, and overall service reorganisation.

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“…This, however, constitutes a rather outdated approach to the measurement of in-hospital expenditure, as in recent years for a variety of reasons, hospitals in many countries have evolved to become a major channel for the distribution of innovative (and expensive) drugs 4 5. In this sense, a refocus on hospital pharmaceutical expenditure is imperative in order to assess the current situation, foresee future needs and, if necessary, establish appropriate financing and evaluation mechanisms under evidence-based pharmaceutical policies that ensure patients’ access to optimal treatment choices.…”

Section: Introductionmentioning

confidence: 99%

Hospital pharmaceutical expenditure: a need to focus on an ‘obscure’ and growing component of pharmaceutical spending

Athanasakis

Nomikos²,

Agorastos³

et al. 2022

Eur J Hosp Pharm

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A retrospective cohort study of medication dispensing at pharmacies: Administration matters!

Cited by 4 publications

References 40 publications

Large variations in all-cause and overdose mortality among >13,000 patients in and out of opioid maintenance treatment in different settings: a comparative registry linkage study

Large variations in all-cause and overdose mortality among >13,000 patients in and out of opioid maintenance treatment in different settings: a comparative registry linkage study

The impact of the COVID-19 lockdown on services for substance use in Denmark: Implications for meeting users’ needs and recommendations for the future

Hospital pharmaceutical expenditure: a need to focus on an ‘obscure’ and growing component of pharmaceutical spending

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