Knowledge and attitudes of German and Swiss community pharmacists towards biologicals and biosimilars – a prospective survey before and after the COVID-19 pandemic

Abstract Background Knowledge, attitudes and substitution laws of biosimilars are not consistent across countries. Biosimilar acceptance among patients and healthcare professionals may be suffering from gaps in knowledge and understanding about biosimilars and their regulatory approval process. Pharmacists' roles and responsibilities changed considerably during the COVID-19 pandemic. Thus, they might have gained new skills and self-confidence in counseling and substitution of biosimilars. Aims To examine and compare the knowledge, perceptions and information needs of German and Swiss pharmacists regarding original biologicals and biosimilars in 2020 and 2022. Methods We conducted an online survey among Swiss and German community pharmacies in February 2020 (before) and August 2022 (after the COVID-19 pandemic). Descriptive statistics were calculated and the Chi-Square test was used for comparisons among categorical variables. Results A total of 764 pharmacists took part in the survey (390 in 2020 and 374 in 2022) with comparable demographics. The frequency of dispensing biologicals remained similar between German and Swiss pharmacists in 2020 and 2022, but the Swiss dispensation of biosimilars increased significantly in 2022 compared to 2020. Concerning the understanding of the term biosimilars, knowledge remained moderate in both countries in both years. Participants were equally familiar with the term and most felt sufficiently informed. In both countries, substitution with a biosimilar showed the least confidence of all attitudes. A third of the participants indicated correct substitution rules in their country. In both years, around 85% of the participants were highly interested in additional training on this topic. Discussion/Conclusion The results indicate that similarities and differences between Germany and Switzerland regarding knowledge and attitudes towards biologicals and biosimilars remained unchanged before and after the COVID-19 pandemic. An influence of the pandemic is unlikely. There is still a clear lack of knowledge among community pharmacists on biosimilars, especially regarding the substitution rules. Due to a rising market with many benefits but also big challenges to overcome, the topic of biosimilars should receive more attention in the future. This requires additional training for pharmacists

Determinants of handbike use in persons with spinal cord injury: results of a community survey in Switzerland

PURPOSE To examine the prevalence and determinants of handbike use in persons living with spinal cord injury in Switzerland. METHOD A population-based cross-sectional survey in Switzerland. RESULTS The crude prevalence of handbike use among the 1549 participants was 22.6%, varying between 25.3% in men and 17.7% in women. Prevalence was higher in complete than in incomplete spinal cord injury (SCI) (41.5% versus 11.9% in paraplegia, 25.6% versus 11.1% in tetraplegia). Multivariable analysis of handbike use confirmed differences with lesion characteristics and gender and showed a decline with age, lowest rates in the low-income group, variation with language, but no association with level of education or cause of spinal cord injury. In total, 45.8% of users reported to engage in handcycling at least once a week. Frequent contextual reasons for refraining from handcycling were: no interest (26%); inability due to disability (20%); unfamiliarity with the handbike (19%) and financial constraints (14%). CONCLUSIONS Conditional on the major determinants that include demographic factors and lesion characteristics, main barriers involve contextual factors that can principally be overcome. Our findings thus suggest scope for promoting handcycling as a means towards a healthy and more physically active lifestyle in persons living with SCI. IMPLICATIONS FOR REHABILITATION Handcycling is an effective means of improving health and quality of life of persons with a spinal cord injury. Persons with the following traits are most likely to use the handbike: persons younger than 62 years, with a complete paraplegia, who are German-speaking (vs. French/Italian) and having a middle or high net income. Indicated reasons for not using a handbike varied by SCI characteristics and included disinterest, inability related to the level of impairment, unfamiliarity and financial costs. Barriers that involve the above mentioned contextual factors can principally be overcome by targeted policy or information campaigns

Chronic pain, depression and quality of life in individuals with spinal cord injury: Mediating role of participation

To test the hypotheses that: (i) pain is associated with depressive symptoms and quality of life; and (ii) participation restriction, satisfaction, and frequency mediate these relationships.; Population-based, cross-sectional study.; Community-dwelling individuals with spinal cord injury (n = 1,549).; Hypotheses were tested in individuals with at least moderate chronic pain on the spinal cord injury - Secondary Conditions Scale (n = 834), applying structural equation modelling to data for spinal cord injury subgroups related to lesion severity (paraplegia, tetraplegia, complete, incomplete) and time since injury (≤ 10 vs ≥ 10 years). Model parameters included pain intensity (numerical rating scale), participation frequency, restriction, satisfaction (Utrecht Scale of Evaluation of Rehabilitation-Participation; USER-Participation), depressive symptoms (5-item Mental Health Index of the Short Form Health Survey; MHI-5), and 5 selected quality of life items (World Health Organization Quality of Life Scale; WHOQoL-BREF).; Structural equation models confirmed associations of pain with depressive symptoms and quality of life, as well as the mediating role of participation restriction and low satisfaction with participation. These findings were apparent in individuals with tetraplegia or complete lesion and in those ≤ 10 years since paraplegia or incomplete injury.; Unrestricted or satisfactory participation was found to be a crucial resource for individuals living less than 10 years with a more severe spinal cord injury, since it represents buffering potential for the negative effects of chronic pain on mental health and quality of life

Prevalence and associated factors of pain in the Swiss spinal cord injury population

Population-based, cross-sectional.; To determine pain prevalence and identify factors associated with chronic pain in individuals with spinal cord injury (SCI) living in Switzerland.; Swiss SCI Cohort Study (SwiSCI).; Pain characteristics were assessed using an adapted version of the International SCI Pain Basic Data Set, adding one item of the SCI Secondary Conditions Scale to address chronic pain. Pain prevalence was calculated using stratification over demographic, SCI-related and socioeconomic characteristics; odds ratios (adjusted for non-response) for determinants of severity of chronic pain were calculated using stereotype logistic regressions.; Pain (in the past week) was reported by 68.9% and chronic pain by 73.5% (significant 36.9%) of all participants (N=1549; 28% female). Most frequently reported pain type was musculoskeletal (71.1%). Back/spine was the most frequently reported pain location (54.6%). Contrasting the 'significant' to the 'none/mild' category of chronic pain, adjusted odds ratios were 1.54 (95% CI: 1.18-2.01; P<0.01) for women (vs men); 6.64 (95% CI: 3.37-11.67; P<0.001) for the oldest age group 61+ (vs youngest (16-30)); 3.41 (95% CI: 2.07-5.62; P<0.001) in individuals reporting severe financial hardship (vs no financial hardship). Individuals reporting specific SCI-related health conditions were 1.41-2.92 (P<0.05) times more likely to report chronic pain as 'significant' rather than 'none/mild' compared with those without the respective condition.; Pain is highly prevalent in individuals with SCI living in Switzerland. Considered at risk for chronic pain are women, older individuals and individuals with financial hardship and specific secondary health conditions. Longitudinal studies are necessary to identify predictors for the development of pain and its chronification.Spinal Cord advance online publication, 15 November 2016; doi:10.1038/sc.2016.157

Shoulder pain in the Swiss spinal cord injury community: prevalence and associated factors

To determine the prevalence of shoulder pain and to identify factors associated with shoulder pain in a nationwide survey of individuals living with spinal cord injury (SCI) in Switzerland.; Data was collected through the 2012 community survey of the Swiss SCI Cohort Study (SwiSCI) (N = 1549; age 52.3 ± 14.8; 29% female). Sociodemographic and socioeconomic circumstances, SCI characteristics, health conditions as well as mobility independence and sporting activities were evaluated as predictor variables. Analyses were adjusted for item non-response (using multiple imputation) and unit-nonresponse (using inverse probability weighting).; The adjusted prevalence of shoulder pain was 35.8% (95% CI: 33.4-38.3). Multivariable regression analysis revealed higher odds of shoulder pain in females as compared to males (odds ratio: 1.89; 95% CI: 1.44-2.47), and when spasticity (1.36; 1.00-1.85) and contractures (2.47; 1.91-3.19) were apparent. Individuals with complete paraplegia (1.62; 1.13-2.32) or any tetraplegia (complete: 1.63; 1.01-2.62; incomplete: 1.82; 1.30-2.56) showed higher odds of shoulder pain compared to those with incomplete paraplegia.; This survey revealed a high prevalence of shoulder pain. Sex, SCI severity, and specific health conditions were associated with having shoulder pain. Implications for rehabilitation Individuals with spinal cord injury have a high prevalence of shoulder pain. Females, individuals with complete paraplegia or any tetraplegia and individuals with contractures and spasticity should receive considerable attention in rehabilitation programmes due to their increased odds of having shoulder pain

Age-related variation in mobility independence among wheelchair users with spinal cord injury: A cross-sectional study

<p><b>Objective</b>: To evaluate age-related variation in mobility independence among community-living wheelchair users with spinal cord injury (SCI).</p> <p><b>Design</b>: Community Survey (2011–2013) as part of the Swiss Spinal Cord Injury Cohort Study.</p> <p><b>Setting</b>: Community.</p> <p><b>Participants</b>: Individuals aged 16 years or older with traumatic or non-traumatic SCI permanently residing in Switzerland and using a wheelchair for moving around moderate distances (10–100 m).</p> <p><b>Interventions</b>: Not applicable.</p> <p><b>Outcome Measures</b>: Mobility-related items of the Spinal Cord Independence Measure-Self Report were matched to the three principal domains “changing basic body position,” “transferring oneself” and “moving around.” Binary outcomes (“independence” vs. “no independence”) were created for every domain and analyzed using multivariable logistic regression (adjusted for sex, socioeconomic factors, SCI characteristics, and health conditions).</p> <p><b>Results</b>: Regression analyses (<i>N</i> = 949; 27% women; median age 51, interquartile range 41–61) showed a decline in the odds of independence (odds ratio; 95% confidence interval) with increasing age for “changing basic body position” (age 16–30 (reference), 31–45 (0.99; 0.53–1.83), 46–60 (0.64; 0.33–1.21), 61–75 (0.45; 0.22–0.92), 76+ (0.18; 0.07–0.44); P < 0.001), “transferring oneself” (age 16–30 (reference), 31–45 (0.77; 0.37–1.61), 46–60 (0.39; 0.18–0.84), 61+ (0.05; 0.02–0.14); P < 0.001), and “moving around” (age 16–30 (reference), 31–45 (0.79; 0.42–1.48), 46–60 (0.49; 0.26–0.94), 61–75 (0.49; 0.24–1.01), 75+ (0.11; 0.04–0.30); P < 0.001).</p> <p><b>Conclusions</b>: Mobility independence was negatively associated with age in wheelchair users with SCI. Future longitudinal analyses are required to gain further insights into the causal factors for the age-related decline.</p

Estimating time-varying drug adherence using electronic records: extending the proportion of days covered (PDC) method

Purpose Accurate measurement of drug adherence is essential for valid risk-benefit assessments of pharmacologic interventions. To date, measures of drug adherence have almost exclusively been applied for a fixed-time interval and without considering changes over time. However, patients with irregular dosing behaviour commonly have a different prognosis than patients with stable dosing behaviour. Methods We propose a method, based on the proportion of days covered (PDC) method, to measure time-varying drug adherence and drug dosage using electronic records. We compare a time-fixed PDC method with the time-varying PDC method through detailed examples and through summary statistics of 100 randomly selected patients on statin therapy. Results We demonstrate that time-varying PDC method better distinguishes an irregularly dosing patient from a stably dosing patient and demonstrate how the time-fixed method can result in a biassed estimate of drug adherence. Furthermore, the time-varying PDC method may be better used to reduce certain types of confounding and misclassification of exposure. Conclusions The time-varying PDC method may improve longitudinal and time-to-event studies that associate adherence with a clinical outcome or (intervention) studies that seek to describe changes in adherence over time