Impact of COVID-19 pandemic on community medication dispensing: a national cohort analysis in Wales, UK

Torabi, Fatemeh; Akbari, Ashley; Bedston, Stuart; Davies, Gareth; Abbasizanjani, Hoda; Gravenor, Mike B.; Griffiths, Rowena; Harris, Daniel; Jenkins, Neil; Lyons, Jane; Morris, Andrew D.; North, Laura; Halcox, Julian; Lyons, Ronan A

doi:10.23889/ijpds.v5i4.1715

Cited by 4 publications

(2 citation statements)

References 15 publications

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“…This appears to be an isolated effect, coinciding with the start of UK pandemic measures. Similar spikes in non-cancer patients have been recorded in Wales for non-analgesic community prescriptions [ 34 ], and in England for both analgesic and non-analgesic community prescriptions [ 35 ], and the hypothesis is that this represents a form of stockpiling in anticipation of reduced availability. These spikes may be the result of either patient-initiated prescription requests, a more systematic primary care initiative, or a combination of the two.…”

Section: Discussionmentioning

confidence: 66%

The impact of the COVID-19 pandemic on community prescription of opioid and antineuropathic analgesics for cancer patients in Wales, UK

Han,

Rolles,

Torabi

et al. 2023

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Purpose Public health measures instituted at the onset of the COVID-19 pandemic in the UK in 2020 had profound effects on the cancer patient pathway. We hypothesise that this may have affected analgesic prescriptions for cancer patients in primary care. Methods A whole-nation retrospective, observational study of opioid and antineuropathic analgesics prescribed in primary care for two cohorts of cancer patients in Wales, using linked anonymised data to evaluate the impact of the pandemic and variation between different demographic backgrounds. Results We found a significant increase in strong opioid prescriptions during the pandemic for patients within their first 12 months of diagnosis with a common cancer (incidence rate ratio (IRR) 1.15, 95% CI: 1.12–1.18, p < 0.001 for strong opioids) and significant increases in strong opioid and antineuropathic prescriptions for patients in the last 3 months prior to a cancer-related death (IRR = 1.06, 95% CI: 1.04–1.07, p < 0.001 for strong opioids; IRR = 1.11, 95% CI: 1.08–1.14, p < 0.001 for antineuropathics). A spike in opioid prescriptions for patients diagnosed in Q2 2020 and those who died in Q2 2020 was observed and interpreted as stockpiling. More analgesics were prescribed in more deprived quintiles. This differential was less pronounced in patients towards the end of life, which we attribute to closer professional supervision. Conclusions We demonstrate significant changes to community analgesic prescriptions for cancer patients related to the UK pandemic and illustrate prescription patterns linked to patients’ demographic background.

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Section: Discussionmentioning

confidence: 66%

The impact of the COVID-19 pandemic on community prescription of opioid and antineuropathic analgesics for cancer patients in Wales, UK

Han,

Rolles,

Torabi

et al. 2023

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“…Data for each intervention were well populated from June 2014 onwards. We curtailed data until the end of February 2020 to avoid the COVID-19 pandemic, after which data were likely to be atypical [27]. Therefore, the study period looked at the complete years 2015 to 2019 inclusive.…”

Section: Study Periodmentioning

confidence: 99%

Cardiac interventions in Wales: A comparison of benefits between NHS Wales specialties

Davies,

Akbari,

Bailey

et al. 2024

PLoS ONE

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Objectives The study aimed to assess if specialised healthcare service interventions in Wales benefit the population equitably in work commissioned by the Welsh Health Specialised Services Committee (WHSSC). Approach The study utilised anonymised individual-level, population-scale, routinely collected electronic health record (EHR) data held in the Secure Anonymised Information Linkage (SAIL) Databank to identify patients resident in Wales receiving specialist cardiac interventions. Measurement was undertaken of associated patient outcomes 2-years before and after the intervention (minus a 6-month clearance period on either side) by measuring events in primary care, hospital attendance, outpatient and emergency department. The analysis controlled for comorbidity (Charlson) and deprivation (Welsh Index of Multiple Deprivation), stratified by admission type (elective or emergency) and membership of top 5% post-intervention costs. Costs were estimated by multiplying events by mean person cost estimates. Results We identified 5,999 percutaneous coronary interventions (PCI) and 1,640 coronary artery bypass graft (CABG) between 2014-06-01 to 2020-02-29. The ratio of emergency to elective interventions was 2.85 for PCI and 1.04 for CABG. In multivariate analysis significant associations were identified for comorbidity (OR = 1.52, CI = (1.01–2.27)), deprivation (OR = 1.34, CI = (1.03–1.76)) and rurality (OR = 0.81, CI = (0.70–0.95)) for PCI interventions, and comorbidity (OR = 1.47, CI = (1.10–1.98)) for CABG. Higher costs post-intervention were associated with increased comorbidity for PCI and CABG in the top 5% cost groups, but for PCI this was not seen outside the top 5%. For PCI, moderate cost increase was associated with increased deprivation, but the picture was more mixed following CABG interventions. For both interventions, lower costs post intervention were seen in rural locations. Conclusion We identified and compared health outcomes for selected specialist cardiac interventions amongst patients resident in Wales, with these methods and analyses, providing a template for comparing other cardiac interventions.

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The impact of the COVID-19 pandemic on cardiovascular disease prevention and management

Dale,

Takhar,

Carragher

et al. 2023

Nat Med

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How the Coronavirus Disease 2019 (COVID-19) pandemic has affected prevention and management of cardiovascular disease (CVD) is not fully understood. In this study, we used medication data as a proxy for CVD management using routinely collected, de-identified, individual-level data comprising 1.32 billion records of community-dispensed CVD medications from England, Scotland and Wales between April 2018 and July 2021. Here we describe monthly counts of prevalent and incident medications dispensed, as well as percentage changes compared to the previous year, for several CVD-related indications, focusing on hypertension, hypercholesterolemia and diabetes. We observed a decline in the dispensing of antihypertensive medications between March 2020 and July 2021, with 491,306 fewer individuals initiating treatment than expected. This decline was predicted to result in 13,662 additional CVD events, including 2,281 cases of myocardial infarction and 3,474 cases of stroke, should individuals remain untreated over their lifecourse. Incident use of lipid-lowering medications decreased by 16,744 patients per month during the first half of 2021 as compared to 2019. By contrast, incident use of medications to treat type 2 diabetes mellitus, other than insulin, increased by approximately 623 patients per month for the same time period. In light of these results, methods to identify and treat individuals who have missed treatment for CVD risk factors and remain undiagnosed are urgently required to avoid large numbers of excess future CVD events, an indirect impact of the COVID-19 pandemic.Cardiovascular disease (CVD) remains the commonest cause of mortality and morbidity worldwide; it is, therefore, vital to understand the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on CVD and its risk factors. In the UK, strategies for CVD prevention include screening for health conditions and risk factors that can be modified through medication, including type 2 diabetes mellitus (T2DM), hypertension, hypercholesterolemia and atrial fibrillation (AF). When adequately controlled, such measures reduce the level of CVD in the population.The COVID-19 pandemic has disrupted healthcare in multiple ways, putting additional pressure on both primary and secondary care services [1][2][3][4] . How these have impacted on screening and treatment of common risk factors, including CVD risk factors, and the downstream impact of missed detection of risk factors in terms of CVD outcomes, including myocardial infarction (MI) and stroke, remains understudied at a national level 5 .Examining the change in prescribed and dispensed medications used to treat CVD risk factors over the course of the COVID-19 pandemic can be used to assess the impact on future CVD events of not treating these risk factors. This approach is complementary to studying reduction in the level of disease diagnoses and risk factor control. The latter

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Impact of COVID-19 pandemic on community medication dispensing: a national cohort analysis in Wales, UK

Cited by 4 publications

References 15 publications

The impact of the COVID-19 pandemic on community prescription of opioid and antineuropathic analgesics for cancer patients in Wales, UK

The impact of the COVID-19 pandemic on community prescription of opioid and antineuropathic analgesics for cancer patients in Wales, UK

Cardiac interventions in Wales: A comparison of benefits between NHS Wales specialties

The impact of the COVID-19 pandemic on cardiovascular disease prevention and management

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