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Cyclones are expected to increase in frequency and intensity, significantly impacting communities and healthcare services. During these times, those with chronic diseases such as opioid dependence are at an increased risk of disease exacerbation due to treatment regimen interruptions. Disruptions to the continuity of the opioid replacement therapy (ORT) service can be detrimental to both clients and the community which can potentially lead to relapse, withdrawal, and risky behaviors.
To explore the impacts of cyclones on opioid treatment programs within community and hospital pharmacies in Queensland.
Qualitative research methods were used in this study with two methods of data analysis employed: the text analytics software, Leximancer®, and manual coding. Interviews were conducted with five hospital and five community pharmacists and four Queensland opioid treatment program (QOTP) employees. Participants worked in Mackay, Rockhampton, Townsville, and Yeppoon in a community impacted by a cyclone and involved with ORT supply.
The themes developed in the manual coding were “impact on essential services,” “human experience,” “healthcare infrastructure,” “preparedness,” and “interprofessional networks.” These themes were aligned with those identified in the Leximancer® analysis. The community pharmacists focused on client stability, whereas, the hospital pharmacists and QOTP employees focused on the need for disaster plans to be implemented.
The greatest concern for participants was maintaining the stability of their clients. Communication amongst the dosing sites and ORT stakeholders was most concerning. This led to a lack of dosing information in a timely manner with pharmacists being hesitant to provide doses and takeaways due to legislative restrictions. A review of coordinated efforts and the legislative constraints is recommended to ensure continuity of ORT supply during cyclones.
No studies to date have investigated cumulative anticholinergic exposure
and its effects in adults with intellectual disabilities.
To determine the cumulative exposure to anticholinergics and the factors
associated with high exposure.
A modified Anticholinergic Cognitive Burden (ACB) scale score was
calculated for a representative cohort of 736 people over 40 years old
with intellectual disabilities, and associations with demographic and
clinical factors assessed.
Age over 65 years was associated with higher exposure (ACB 1–4 odds ratio
(OR) = 3.28, 95% CI 1.49–7.28, ACB 5+ OR = 3.08, 95% CI 1.20–7.63), as
was a mental health condition (ACB 1–4 OR = 9.79, 95% CI 5.63–17.02, ACB
5+ OR = 23.74, 95% CI 12.29–45.83). Daytime drowsiness was associated
with higher ACB (P<0.001) and chronic constipation
reported more frequently (26.6% ACB 5+ v. 7.5% ACB 0,
Older people with intellectual disabilities and with mental health
conditions were exposed to high anticholinergic burden. This was
associated with daytime dozing and constipation.
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