key: cord-0884460-olfqwal2
authors: Shao, Shih-Chieh; Lai, Edward Chia-Cheng; Chen, Yi-Hua; Chan, Yuk-Ying; Chen, Hui-Yu
title: Management of Irrational Self-Purchase of Hydroxychloroquine During the COVID-19 Pandemic: Experiences From the Largest Healthcare System in Taiwan
date: 2020-10-19
journal: J Patient Saf
DOI: 10.1097/pts.0000000000000795
sha: da180ae005fa0549e0a7fe8e8a9837dcfaefc842
doc_id: 884460
cord_uid: olfqwal2

nan

H ydroxychloroquine (HCQ) received global attention as a potential therapy for COVID-19 after a positive report from a small clinical trial was mentioned with supportive claims during a U.S. White House news conference on March 19, 2020. 1 This news was rapidly disseminated by mass media, leading the public to search for HCQ-related products. 2 However, the effectiveness of HCQ for COVID-19 is not proven, and it may be associated with life-threating adverse reactions. 3 Therefore, clinical management to reduce irrational drug use is critical, especially during the pandemic. In this cross-sectional study, we investigate trends in self-purchased HCQ during the COVID-19 pandemic within the largest multi-institutional healthcare system in Taiwan. Notably, we share our experiences of adopting a prescription control process led by pharmacists using computerized provider order entry (CPOE) to manage irrational self-purchase of HCQ.

We retrospectively analyzed electronic medical records data from the largest multiinstitutional healthcare system covering approximately 1.3 million individuals (approximately 6% of Taiwan's population) in Taiwan from January 1 to March 31, 2020. 4 We calculated daily prescription rates of self-purchased HCQ among all outpatient prescriptions. Specifically, on March 23, we implemented a prescribing control process for self-purchased HCQ using a CPOE system, whereby any prescription with self-purchased HCQ required additional review by pharmacists to ensure appropriate HCQ use. Our analysis of daily self-purchased prescription rates of HCQ compares the baseline period (from January 1 to March 19), the period of global attention on HCQ (March 20-22), and the period after implementing clinical management to reduce irrational self-purchased HCQ prescriptions (March 23-31). We used SAS Enterprise Guide, Version 7.13 (SAS, Inc, Chicago, IL) for all analyses.

We found that the average daily prescription rates of self-purchased HCQ were 1.41 per 10,000 prescriptions in the baseline period and 8.41 per 10,000 prescriptions during the period of global attention on HCQ. After implementation of clinical management to reduce irrational self-purchased HCQ prescriptions, the average daily prescription rates of self-purchased HCQ were restored to levels similar to the baseline period (1.43 per 10,000 prescriptions). We present the trends in prescription rates of self-purchased HCQ in Figure 1 .

Mass media play a critical role in public dissemination of valuable information about disease and treatment. 5 However, it may influence people's medical behavior in seeking treatment even when treatment effectiveness has not been well established. Our results indicate rapidly increasing rates (approximately 6-fold within 2 days) of self-purchased prescriptions of HCQ starting from the first news release about HCQ for COVID-19. Even if Taiwan, with only 322 COVID-19 cases confirmed nationwide to March 31, has experienced a more moderate effect of the COVID-19 pandemic than many other countries, public fears relating to the COVID-19 pandemic have led to a search for nonevidence-based therapies, which could be similar to other countries. 2 In response to the rapid increase in selfpurchased HCQ, we formed a multidisciplinary working team to conduct timely review of relevant evidence and undertook to restrict self-purchased HCQ using the CPOE system. Pharmacists are especially important team members in maintaining the rational use of drugs, balancing the trade-off between routine clinical use and exponentially increased demand for drugs. After the pharmacists' review process on self-purchased prescriptions was intensified, the rate of self-purchased HCQ was restored to baseline levels. In conclusion, because the impact of mass media on medical behaviors with unproven therapies may be large and sometimes unavoidable, multidisciplinary teamwork in the development of strategies for timely detection and prevention of irrational medical behaviors is necessary in the future.

Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial

Internet searches for unproven COVID-19 therapies in the United States

Pharmacologic treatments for coronavirus disease 2019 (COVID-19): a review

The Chang gung research database-a multi-institutional electronic medical records database for real-world epidemiological studies in Taiwan

Use of mass media campaigns to change health behaviour

The authors disclose no conflict of interest. This study received a grant from Chang Gung Medical Foundation (ID:

CMRPG3H1552), which had no role in design, analysis, interpretation, reporting of results, or the decision to develop this manuscript.