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New plan for reducing NHS reliance on single-use

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The post New plan for reducing NHS reliance on single-use appeared first on Nursing Times.

The government has launched a new plan to phase out single-use medical items in the UK’s health services by 2045.
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Consultation launched on revisions to senior nursing job profiles

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The post Consultation launched on revisions to senior nursing job profiles appeared first on Nursing Times.

A consultation has been launched on draft changes to the national NHS job profiles for senior nursing and midwifery roles.
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Implementing a remote self-screening programme for atrial fibrillation using digital health technology among community-dwellers aged 75 years and older: a qualitative evaluation

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Objective

To examine the feasibility of implementing remote atrial fibrillation (AF) self-screening among older people supported by a remote central monitoring system.

Design

Process evaluation of the Mass AF randomised clinical trial (ACTRN12621000184875) with one-to-one semistructured interviews using interview guides underpinned by the Critical Realism approach and coded using the UK Medical Research Council Guidance of Process Evaluation Framework.

Setting and participants

Community-dwelling people aged ≥75 years from both genders (ratio 1:1) and urban/rural (ratio 2:1) in Australia.

Interventions

Participants were provided handheld single-lead electrocardiogram (ECG) devices and trained to self-record ECGs once daily on weekdays for at least 6 months. A remote central team notified participants and general practitioners (GPs) of AF.

Primary feasibility outcomes

The strengths, weaknesses, opportunities and threats (SWOT) analysis examined enablers (ie, strengths and opportunities) and barriers (ie, weaknesses and threats).

Results

Overall, 200 participants; 98.5% completed the 6-month programme, 96% reported being satisfied with screening and 48 were interviewed: mean age 79 years, 54% male and 71% urban. 11 GPs were interviewed: 55% female and 64% urban. Programme participants trusted the remote monitoring system that supported the screening programme and provided follow-up pathways where required. GPs saw opportunities to introduce this self-screening programme to at-risk patients and improve patients’ risk profiles. Programme participants reported that after being trained to use the device, they felt empowered to do self-screening and found it convenient. GPs saw empowerment could enhance the doctor–patient relationship. Participants and GPs valued screening in diagnosing AF that would otherwise be missed in usual care, but the uncertainty of effective screening duration could be a barrier.

Conclusions

This screening programme was feasible with the reinforcement of the underpinning enablers. Several implementation strategies were identified using SWOT analysis, including leveraging the opportunity for GPs to introduce this screening programme to at-risk patients.

Trial registration number

ACTRN12621000184875.

Objective
To examine the feasibility of implementing remote atrial fibrillation (AF) self-screening among older people supported by a remote central monitoring system.

Design
Process evaluation of the Mass AF randomised clinical trial (ACTRN12621000184875) with one-to-one semistructured interviews using interview guides underpinned by the Critical Realism approach and coded using the UK Medical Research Council Guidance of Process Evaluation Framework.

Setting and participants
Community-dwelling people aged ≥75 years from both genders (ratio 1:1) and urban/rural (ratio 2:1) in Australia.

Interventions
Participants were provided handheld single-lead electrocardiogram (ECG) devices and trained to self-record ECGs once daily on weekdays for at least 6 months. A remote central team notified participants and general practitioners (GPs) of AF.

Primary feasibility outcomes
The strengths, weaknesses, opportunities and threats (SWOT) analysis examined enablers (ie, strengths and opportunities) and barriers (ie, weaknesses and threats).

Results
Overall, 200 participants; 98.5% completed the 6-month programme, 96% reported being satisfied with screening and 48 were interviewed: mean age 79 years, 54% male and 71% urban. 11 GPs were interviewed: 55% female and 64% urban. Programme participants trusted the remote monitoring system that supported the screening programme and provided follow-up pathways where required. GPs saw opportunities to introduce this self-screening programme to at-risk patients and improve patients’ risk profiles. Programme participants reported that after being trained to use the device, they felt empowered to do self-screening and found it convenient. GPs saw empowerment could enhance the doctor–patient relationship. Participants and GPs valued screening in diagnosing AF that would otherwise be missed in usual care, but the uncertainty of effective screening duration could be a barrier.

Conclusions
This screening programme was feasible with the reinforcement of the underpinning enablers. Several implementation strategies were identified using SWOT analysis, including leveraging the opportunity for GPs to introduce this screening programme to at-risk patients.

Trial registration number
ACTRN12621000184875.

Do Swedish rock-climbers exhibit more eating disorder and body dissatisfaction symptoms than non-climbers? A cross-sectional study

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Objectives

The inclusion of rock-climbing in the Olympic Games has increased participation in the sport and attention to athletes’ health. In sports where the importance of low body weight is considerate, there is an increased risk of developing eating disorders (EDs). There is sparse research on EDs among rock-climbers. The primary aim was to map ED symptoms among rock-climbers compared with controls. The secondary aim was to analyze differences in body dissatisfaction. Comparisons between rock-climbing levels and sexes were performed.

Design

This is a cross-sectional study in a larger prospective longitudinal study series, CLIMB: Climber’s Longitudinal attitudes towards Injury, Mental health and Body image, using baseline data.

Participants

Swedish rock-climbers, at an advanced and elite level according to the International Rock Climbing Research Association, participated. Participants were at least 13 years old. 183 rock-climbers partook with a mean age of 29.5 (SD=9.1) with two participants under 15 years old. 180 controls partook with a mean age of 29.0 (SD=8.9). There were no control participants under 15 years of age.

Primary and secondary outcome measures

Data was gathered through a self-report questionnaire collecting the primary outcome measure, ED symptoms (Eating Disorders Examination Questionnaire (EDE-Q) V.6.0) and the secondary outcome measure, body dissatisfaction (Body Shape Questionnaire-8C).

Results

There were no differences between rock-climbers and controls regarding ED symptoms. Symptoms were higher among female rock-climbers (26%) than male (5.8%). Regarding body dissatisfaction, the control group reported higher levels compared with rock-climbers. At least a mild concern was observed in 13.3% of male rock-climbers, compared with 47.4% of females.

Conclusions

Although there was no difference in the EDE-Q V.6.0 between rock-climbers and controls, females reported significantly more symptoms than men. Regarding body dissatisfaction, female rock-climbers exhibited higher levels of dissatisfaction than males. Further, higher levels of dissatisfaction were reported in controls, especially in men, where symptoms were three times higher than rock-climbers.

Trial registration number

NCT05587270.

Objectives
The inclusion of rock-climbing in the Olympic Games has increased participation in the sport and attention to athletes’ health. In sports where the importance of low body weight is considerate, there is an increased risk of developing eating disorders (EDs). There is sparse research on EDs among rock-climbers. The primary aim was to map ED symptoms among rock-climbers compared with controls. The secondary aim was to analyze differences in body dissatisfaction. Comparisons between rock-climbing levels and sexes were performed.

Design
This is a cross-sectional study in a larger prospective longitudinal study series, CLIMB: Climber’s Longitudinal attitudes towards Injury, Mental health and Body image, using baseline data.

Participants
Swedish rock-climbers, at an advanced and elite level according to the International Rock Climbing Research Association, participated. Participants were at least 13 years old. 183 rock-climbers partook with a mean age of 29.5 (SD=9.1) with two participants under 15 years old. 180 controls partook with a mean age of 29.0 (SD=8.9). There were no control participants under 15 years of age.

Primary and secondary outcome measures
Data was gathered through a self-report questionnaire collecting the primary outcome measure, ED symptoms (Eating Disorders Examination Questionnaire (EDE-Q) V.6.0) and the secondary outcome measure, body dissatisfaction (Body Shape Questionnaire-8C).

Results
There were no differences between rock-climbers and controls regarding ED symptoms. Symptoms were higher among female rock-climbers (26%) than male (5.8%). Regarding body dissatisfaction, the control group reported higher levels compared with rock-climbers. At least a mild concern was observed in 13.3% of male rock-climbers, compared with 47.4% of females.

Conclusions
Although there was no difference in the EDE-Q V.6.0 between rock-climbers and controls, females reported significantly more symptoms than men. Regarding body dissatisfaction, female rock-climbers exhibited higher levels of dissatisfaction than males. Further, higher levels of dissatisfaction were reported in controls, especially in men, where symptoms were three times higher than rock-climbers.

Trial registration number
NCT05587270.

Protocol for a scoping review of older informal carers and digital health service use

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Introduction

The ageing population and increasing demands for healthcare pose challenges for national health services, which are increasingly looking to digital health services (DHS) as a potential solution. However, older informal carers, who provide unpaid care, often lack the digital skills necessary to access and use DHS, placing them at risk of social exclusion. This scoping review aims to systematically map and explore the existing literature on this topic, with the goal of identifying and addressing gaps in the research.

Methods and analysis

This scoping review follows Arksey and O’Malley’s methodological framework. A systematic search will be conducted across seven databases: AgeLine, PubMed, ScienceDirect, Scopus, Social Sciences Abstracts, SocINDEX and Web of Science, focusing on studies published in English from 2010 onwards. The research team will collectively work on all stages of the review, ensuring consistency and collaboration throughout. Data extraction will capture key information on study topics, participant demographics, types of DHS and study design. The findings will be analysed using descriptive statistics.

Ethics and dissemination

Ethical approval is not required for this scoping review as it will rely solely on previously published data. The findings will be disseminated through peer-reviewed publications, conference presentations and engagements with non-academic stakeholders through seminars and workshops to maximise societal impact.

Introduction
The ageing population and increasing demands for healthcare pose challenges for national health services, which are increasingly looking to digital health services (DHS) as a potential solution. However, older informal carers, who provide unpaid care, often lack the digital skills necessary to access and use DHS, placing them at risk of social exclusion. This scoping review aims to systematically map and explore the existing literature on this topic, with the goal of identifying and addressing gaps in the research.

Methods and analysis
This scoping review follows Arksey and O’Malley’s methodological framework. A systematic search will be conducted across seven databases: AgeLine, PubMed, ScienceDirect, Scopus, Social Sciences Abstracts, SocINDEX and Web of Science, focusing on studies published in English from 2010 onwards. The research team will collectively work on all stages of the review, ensuring consistency and collaboration throughout. Data extraction will capture key information on study topics, participant demographics, types of DHS and study design. The findings will be analysed using descriptive statistics.

Ethics and dissemination
Ethical approval is not required for this scoping review as it will rely solely on previously published data. The findings will be disseminated through peer-reviewed publications, conference presentations and engagements with non-academic stakeholders through seminars and workshops to maximise societal impact.

Cross-sectional exploratory survey among health researchers in Europe on the awareness of and barriers affecting the use of an evidence-based research approach

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Objectives

This exploratory study was conducted to find out how well the concept of evidence-based research (EBR) is known among European health researchers with substantial clinical research experience, and which barriers affect the use of an EBR approach. The concept of EBR implies that researchers use evidence synthesis to justify new studies and to inform their design.

Design

A cross-sectional exploratory survey study.

Setting and participants

The survey was conducted among European health researchers. Respondents included 205 health researchers (physicians, nurses, dentists, allied health researchers and members of other professions involved in health research) with a doctoral degree or at least 5 years of research experience.

Primary and secondary outcome measures

The primary outcome measures were the level of awareness of the concept of EBR and the presence of barriers affecting the use of an EBR approach. Secondary outcome measures include correlations between sociodemographic characteristics (eg, profession) and awareness of EBR.

Results

We discovered that 84.4% of the respondents initially indicated their awareness of the concept of EBR. Nevertheless, 22.5% of them concluded that, on reading the definition, they either do not know or do not fully comprehend the concept of EBR. The main barriers affecting the use of an EBR approach were related to organisational issues, such as not being attributed resources (30.5% of the respondents), time (24.8%) or access to implement it (14.9%).

Conclusions

Despite the limitations, this study clearly shows that ongoing initiatives are necessary to raise awareness about the importance of implementing the EBR approach in health research. This paper contributes to a discussion of the issues that obstruct the implementation of the EBR approach and potential solutions to overcome these issues, such as improving the knowledge and skills necessary to practice the EBR approach.

Objectives
This exploratory study was conducted to find out how well the concept of evidence-based research (EBR) is known among European health researchers with substantial clinical research experience, and which barriers affect the use of an EBR approach. The concept of EBR implies that researchers use evidence synthesis to justify new studies and to inform their design.

Design
A cross-sectional exploratory survey study.

Setting and participants
The survey was conducted among European health researchers. Respondents included 205 health researchers (physicians, nurses, dentists, allied health researchers and members of other professions involved in health research) with a doctoral degree or at least 5 years of research experience.

Primary and secondary outcome measures
The primary outcome measures were the level of awareness of the concept of EBR and the presence of barriers affecting the use of an EBR approach. Secondary outcome measures include correlations between sociodemographic characteristics (eg, profession) and awareness of EBR.

Results
We discovered that 84.4% of the respondents initially indicated their awareness of the concept of EBR. Nevertheless, 22.5% of them concluded that, on reading the definition, they either do not know or do not fully comprehend the concept of EBR. The main barriers affecting the use of an EBR approach were related to organisational issues, such as not being attributed resources (30.5% of the respondents), time (24.8%) or access to implement it (14.9%).

Conclusions
Despite the limitations, this study clearly shows that ongoing initiatives are necessary to raise awareness about the importance of implementing the EBR approach in health research. This paper contributes to a discussion of the issues that obstruct the implementation of the EBR approach and potential solutions to overcome these issues, such as improving the knowledge and skills necessary to practice the EBR approach.

A Self-led Self-management Intervention Supporting Teens with IBD (ASSIST-IBD): protocol for a feasibility study of a novel digital treatment adherence intervention

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Introduction

Treatment non-adherence is common in young people with inflammatory bowel disease (IBD), yet support is lacking. A self-led self-management intervention supporting teens with IBD (ASSIST-IBD) is a new theory-based digital treatment adherence intervention, co-developed by young people living with IBD. ASSIST-IBD includes 10 short modules supporting adolescents to feel confident to follow their treatment plan, develop skills to overcome adherence obstacles, feel confident when talking to others about IBD and feel positive about the future. This research aims to determine the feasibility of implementing and measuring the effectiveness of ASSIST-IBD, using a single-arm mixed-methods feasibility trial.

Methods and analysis

24 young people (aged 13–17) with IBD identified as being ≤80% adherent, and their parents, will use ASSIST-IBD for 6–12 weeks. For the primary endpoint of progression to randomised controlled trial, qualitative and quantitative data will be collected on; number of eligible members of the target population; number of recruited participants; reasons for non-participation and ineligibility; retention and follow-up rates; reasons for early withdrawal; completeness and utility of outcome measures; as well as further data on intervention acceptability, user experiences and user engagement. Secondary outcomes of preliminary effectiveness will include pre-intervention and post-intervention measures of treatment adherence (MARS-5), quality-of-life (IMPACT-III) and well-being (WEMWBS), and self-reported behaviour change success. Quantitative data will be analysed using descriptive statistics; qualitative data will be analysed thematically. An active patient and public involvement and engagement group will advise on the research throughout, including the development of the protocol.

Ethics and dissemination

The study has been granted ethical approval by Aston University’s Health and Life Sciences Research Ethics Committee (ref:#HLS2112) and NHS Research Ethics Committee, Nottingham 1 Board (IRAS:#344918). Findings will be disseminated via peer-reviewed publications and lay summaries.

Registration details

This protocol is registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/KC649).

Introduction
Treatment non-adherence is common in young people with inflammatory bowel disease (IBD), yet support is lacking. A self-led self-management intervention supporting teens with IBD (ASSIST-IBD) is a new theory-based digital treatment adherence intervention, co-developed by young people living with IBD. ASSIST-IBD includes 10 short modules supporting adolescents to feel confident to follow their treatment plan, develop skills to overcome adherence obstacles, feel confident when talking to others about IBD and feel positive about the future. This research aims to determine the feasibility of implementing and measuring the effectiveness of ASSIST-IBD, using a single-arm mixed-methods feasibility trial.

Methods and analysis
24 young people (aged 13–17) with IBD identified as being ≤80% adherent, and their parents, will use ASSIST-IBD for 6–12 weeks. For the primary endpoint of progression to randomised controlled trial, qualitative and quantitative data will be collected on; number of eligible members of the target population; number of recruited participants; reasons for non-participation and ineligibility; retention and follow-up rates; reasons for early withdrawal; completeness and utility of outcome measures; as well as further data on intervention acceptability, user experiences and user engagement. Secondary outcomes of preliminary effectiveness will include pre-intervention and post-intervention measures of treatment adherence (MARS-5), quality-of-life (IMPACT-III) and well-being (WEMWBS), and self-reported behaviour change success. Quantitative data will be analysed using descriptive statistics; qualitative data will be analysed thematically. An active patient and public involvement and engagement group will advise on the research throughout, including the development of the protocol.

Ethics and dissemination
The study has been granted ethical approval by Aston University’s Health and Life Sciences Research Ethics Committee (ref:#HLS2112) and NHS Research Ethics Committee, Nottingham 1 Board (IRAS:#344918). Findings will be disseminated via peer-reviewed publications and lay summaries.

Registration details
This protocol is registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/KC649).

Effectiveness of resistance training of masticatory muscles for patients with temporomandibular disorders: protocol for a systematic review

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Introduction

Temporomandibular disorders (TMDs) are musculoskeletal disorders characterised by jaw pain and typically temporomandibular joint limitations. Resistance training (RT) has been shown to be effective at reducing pain and improving function for different musculoskeletal conditions (eg, neck pain, low back pain); however, the effectiveness of RT for patients with TMDs remains unclear. This systematic review will evaluate the effectiveness of RT on pain and temporomandibular joint range of motion in people with TMDs.

Methods and analysis

The report of this protocol aligns with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. The search strategy will be conducted from 1 March 2024 to 31 March 2024 via the following electronic databases: MEDLINE (OVID interface), EMBASE (OVID interface), SCOPUS, Web of Science, PubMed and Cochrane Central Register of Controlled Trials. Any randomised controlled trials or non-randomised studies of interventions in adults with TMD that examine RT targeting the masticatory muscles, compared to other interventions not including RT, will be included. Primary outcomes will be jaw pain intensity and maximal mouth opening. Secondary outcomes will include measures of neuromuscular performance and pressure pain thresholds. Two independent reviewers will conduct the screening of articles for inclusion, data extraction, risk-of-bias assessment using the revised Cochrane risk-of-bias tool for included studies and will evaluate the overall quality of evidence following the Grading of Recommendations Assessment, Development and Evaluation framework. A meta-analysis will be performed where applicable. Alternately, a narrative synthesis will be performed by adhering to the synthesis without meta-analysis guidelines. Data will be summarised according to the outcome measures or, when this is not possible, according to other pertinent variables such as TMD type (ie, temporomandibular joint disorders, masticatory muscle disorders and mixed disorders).

Ethics and dissemination

Ethical approval is not necessary, since this study does not involve the collection of primary data. The results will be disseminated through presentations at scientific conferences and publication in a peer-reviewed journal.

PROSPERO registration number

CRD42023476269.

Introduction
Temporomandibular disorders (TMDs) are musculoskeletal disorders characterised by jaw pain and typically temporomandibular joint limitations. Resistance training (RT) has been shown to be effective at reducing pain and improving function for different musculoskeletal conditions (eg, neck pain, low back pain); however, the effectiveness of RT for patients with TMDs remains unclear. This systematic review will evaluate the effectiveness of RT on pain and temporomandibular joint range of motion in people with TMDs.

Methods and analysis
The report of this protocol aligns with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. The search strategy will be conducted from 1 March 2024 to 31 March 2024 via the following electronic databases: MEDLINE (OVID interface), EMBASE (OVID interface), SCOPUS, Web of Science, PubMed and Cochrane Central Register of Controlled Trials. Any randomised controlled trials or non-randomised studies of interventions in adults with TMD that examine RT targeting the masticatory muscles, compared to other interventions not including RT, will be included. Primary outcomes will be jaw pain intensity and maximal mouth opening. Secondary outcomes will include measures of neuromuscular performance and pressure pain thresholds. Two independent reviewers will conduct the screening of articles for inclusion, data extraction, risk-of-bias assessment using the revised Cochrane risk-of-bias tool for included studies and will evaluate the overall quality of evidence following the Grading of Recommendations Assessment, Development and Evaluation framework. A meta-analysis will be performed where applicable. Alternately, a narrative synthesis will be performed by adhering to the synthesis without meta-analysis guidelines. Data will be summarised according to the outcome measures or, when this is not possible, according to other pertinent variables such as TMD type (ie, temporomandibular joint disorders, masticatory muscle disorders and mixed disorders).

Ethics and dissemination
Ethical approval is not necessary, since this study does not involve the collection of primary data. The results will be disseminated through presentations at scientific conferences and publication in a peer-reviewed journal.

PROSPERO registration number
CRD42023476269.

Co-creation and implementation of a healthy lunch at Dutch primary schools in disadvantaged neighbourhoods: design of a cluster randomised cross-over effectiveness study

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Introduction

The majority of children fails to have a healthy diet. Providing a healthy lunch at school is a way to target all children, regardless of ethnic and socioeconomic background. This study aims to investigate the effectivity and feasibility of a co-created healthy school lunch in disadvantaged neighbourhoods of the city of Rotterdam, the Netherlands.

Methods and analysis

This is a cluster randomised cross-over trial with five participating primary schools. Schools will be randomised to have an 18 week healthy school lunch the first or second half of the academic year. The other half of the academic year, children will bring their own lunch from home. A tailored lunch concept for each school will be co-created with school staff, parents, children and key-stakeholders.

Primary outcome is the dietary content of children’s lunches, assessed by observations for all children. Secondary outcomes include healthy lunch-related parameters, like general dietary behaviour, perceived health, taste preferences, concentration in class, and some feasibility outcomes, like satisfaction, implementation at school and affordability for parents. Secondary outcomes will be assessed by questionnaires for children (grades 5–8), parents and teachers. The observations and questionnaires for children and parents will be completed at baseline (September 2023), half way the academic year (January–February 2024) and at the end of the academic year (June–July 2024). Teachers will complete a monthly questionnaire starting in September 2023.

Ethics and dissemination

This study obtained ethical approval from the Institutional research Review Board Erasmus MC of Rotterdam, the Netherlands. Informed consent will be collected from all participants (parents, teachers and children 12 years or older) and/or their parents (for children under the age of 16). The findings will be disseminated by conference presentations and publications in scientific peer-reviewed journals.

Trial registration number

NCT06058325.

Introduction
The majority of children fails to have a healthy diet. Providing a healthy lunch at school is a way to target all children, regardless of ethnic and socioeconomic background. This study aims to investigate the effectivity and feasibility of a co-created healthy school lunch in disadvantaged neighbourhoods of the city of Rotterdam, the Netherlands.

Methods and analysis
This is a cluster randomised cross-over trial with five participating primary schools. Schools will be randomised to have an 18 week healthy school lunch the first or second half of the academic year. The other half of the academic year, children will bring their own lunch from home. A tailored lunch concept for each school will be co-created with school staff, parents, children and key-stakeholders.
Primary outcome is the dietary content of children’s lunches, assessed by observations for all children. Secondary outcomes include healthy lunch-related parameters, like general dietary behaviour, perceived health, taste preferences, concentration in class, and some feasibility outcomes, like satisfaction, implementation at school and affordability for parents. Secondary outcomes will be assessed by questionnaires for children (grades 5–8), parents and teachers. The observations and questionnaires for children and parents will be completed at baseline (September 2023), half way the academic year (January–February 2024) and at the end of the academic year (June–July 2024). Teachers will complete a monthly questionnaire starting in September 2023.

Ethics and dissemination
This study obtained ethical approval from the Institutional research Review Board Erasmus MC of Rotterdam, the Netherlands. Informed consent will be collected from all participants (parents, teachers and children 12 years or older) and/or their parents (for children under the age of 16). The findings will be disseminated by conference presentations and publications in scientific peer-reviewed journals.

Trial registration number
NCT06058325.

Impact of the COVID-19 pandemic on initiation of antihypertensive drugs in Sweden: an interrupted time series study

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Objectives

Antihypertensives reduce the risk of myocardial infarction and stroke. Restrictions during the COVID-19 pandemic limited access to healthcare, which may have had a negative impact on drug prescribing. This study aimed to assess the effect of the COVID-19 pandemic on the initiation of antihypertensive drugs.

Design

Interrupted time series study using a segmented linear regression model.

Setting

Swedish population assessed through linked national healthcare registers.

Participants

720 300 new users of antihypertensives.

Intervention

March 2020, COVID-19 pandemic onset.

Main outcomes measures

The change in the initiation of antihypertensives expressed as monthly cumulative incidence, stratified by age and sex. Data on dispensed prescriptions of diuretics, beta-blockers, calcium channel blockers, ACE inhibitors (ACEi) and angiotensin receptor blockers were extracted from the Swedish Prescribed Drug Register, from March 2018 to November 2021. Initiation (new use) was defined as having no previous dispensations before March 2019. Monthly cumulative incidence in March 2019–November 2021 was calculated as the number of patients initiating each drug class in each month divided by the population.

Results

The start of the pandemic was associated with an immediate drop in the initiation of any antihypertensive, but no sustained effects were observed, as the incidence continued to increase in the postinterruption period by +0.02% each month in both sexes. The immediate drop was statistically significant for ACEi in both sexes and all antihypertensive classes except diuretics in patients >65 years. A significant postintervention trend change was observed for initiation of diuretics (+0.013% overall), driven mainly by a significant increase in patients >65 years. Similar findings were also observed for diuretics in females (+0.02%) and ACEi (+0.03%) in patients >65 years.

Conclusions

The pandemic had an immediate negative short-term effect, but we found no major long-term negative influence of the COVID-19 pandemic on initiation of any type of antihypertensive drugs.

Objectives
Antihypertensives reduce the risk of myocardial infarction and stroke. Restrictions during the COVID-19 pandemic limited access to healthcare, which may have had a negative impact on drug prescribing. This study aimed to assess the effect of the COVID-19 pandemic on the initiation of antihypertensive drugs.

Design
Interrupted time series study using a segmented linear regression model.

Setting
Swedish population assessed through linked national healthcare registers.

Participants
720 300 new users of antihypertensives.

Intervention
March 2020, COVID-19 pandemic onset.

Main outcomes measures
The change in the initiation of antihypertensives expressed as monthly cumulative incidence, stratified by age and sex. Data on dispensed prescriptions of diuretics, beta-blockers, calcium channel blockers, ACE inhibitors (ACEi) and angiotensin receptor blockers were extracted from the Swedish Prescribed Drug Register, from March 2018 to November 2021. Initiation (new use) was defined as having no previous dispensations before March 2019. Monthly cumulative incidence in March 2019–November 2021 was calculated as the number of patients initiating each drug class in each month divided by the population.

Results
The start of the pandemic was associated with an immediate drop in the initiation of any antihypertensive, but no sustained effects were observed, as the incidence continued to increase in the postinterruption period by +0.02% each month in both sexes. The immediate drop was statistically significant for ACEi in both sexes and all antihypertensive classes except diuretics in patients >65 years. A significant postintervention trend change was observed for initiation of diuretics (+0.013% overall), driven mainly by a significant increase in patients >65 years. Similar findings were also observed for diuretics in females (+0.02%) and ACEi (+0.03%) in patients >65 years.

Conclusions
The pandemic had an immediate negative short-term effect, but we found no major long-term negative influence of the COVID-19 pandemic on initiation of any type of antihypertensive drugs.

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