Disruptions in Primary Care among People with Schizophrenia in Ontario, Canada, During the COVID-19 Pandemic

Abstract

Objective To investigate how primary care access, intensity and quality of care changed among patients living with schizophrenia before and after the onset of the COVID-19 pandemic in Ontario, Canada. Methods This cohort study was performed using primary care electronic medical record data from the University of Toronto Practice-Based Research Network (UTOPIAN), a network of > 500 family physicians in Ontario, Canada. Data were collected during primary care visits from 2643 patients living with schizophrenia. Rates of primary care health service use (in-person and virtual visits with family physicians) and key preventive health indices indicated in antipsychotic monitoring (blood pressure readings, hemoglobin A1c, cholesterol and complete blood cell count [CBC] tests) were measured and compared in the 12 months before and after onset of the COVID-19 pandemic. Results Access to in-person care dropped with the onset of the COVID-19 pandemic. During the first year of the pandemic only 39.5% of patients with schizophrenia had at least one in-person visit compared to 81.0% the year prior. There was a corresponding increase in virtual visits such that 78.0% of patients had a primary care appointment virtually during the pandemic period. Patients prescribed injectable antipsychotics were more likely to continue having more frequent in-person appointments during the pandemic than patients prescribed only oral or no antipsychotic medications. The proportion of patients who did not have recommended tests increased from 41.0% to 72.4% for blood pressure readings, from 48.9% to 60.2% for hemoglobin A1c, from 57.0% to 67.8% for LDL cholesterol and 45.0% to 56.0% for CBC tests during the pandemic. Conclusions There were substantial decreases in preventive care after the onset of the pandemic, although primary care access was largely maintained through virtual care. Addressing these deficiencies will be essential to promoting health equity and reducing the risk of poor health outcomes.

Evaluation of antipsychotic monitoring in a community health center during the COVID‐19 pandemic

“…One study from Canada compared monitoring rates of LDL and hemoglobin A1C (among other measures) and found a 10% decrease in monitoring rates for both items from pre-to postpandemic care. 8 Pre-pandemic rates of these measures were between 43% and 51%, which were considerably less than the phase 1 rates of over 60% seen in this study. A pre-pandemic study conducted in New Zealand measured primary care monitoring rates similar to phase 1, observing rates of weight (82%), lipids (66%), and A1C (70%) in their sample.…”

“…Published studies in the medical literature do provide some insight regarding metabolic monitoring of antipsychotics in primary care settings, both pre‐pandemic and after it began. One study from Canada compared monitoring rates of LDL and hemoglobin A1C (among other measures) and found a 10% decrease in monitoring rates for both items from pre‐ to post‐pandemic care 8 . Pre‐pandemic rates of these measures were between 43% and 51%, which were considerably less than the phase 1 rates of over 60% seen in this study.…”

Adult Psychiatric Hospitalizations in Ontario, Canada Before and During the COVID-19 Pandemic

“…The continued elevated volumes of hospitalizations for psychotic disorders even as overall volumes returned to prepandemic levels may suggest that individuals living with these disorders face new challenges stemming from the pandemic. Though evidence from Ontario has found that primary care visits for these conditions in the first year of the pandemic were largely maintained virtually, 23 those unable to make the shift to virtual care may have had their continuity of care disrupted, 3 which has been found to be a predictor of future relapses. 24 Additionally, the possibility that those living with severe psychotic conditions would face challenges due to new norms requiring extended periods of isolation has been previously raised, given the known role of community social support in supporting care outside of the hospital.…”

The impact of the COVID-19 pandemic on the provision of physical health interventions to mental health consumers within Sydney Local Health District

“…Furthermore, a study from Ontario, Canada found that people living with a diagnosis of schizophrenia experienced significant reductions in completion rates of blood pressure, haemoglobin A1C, LDL cholesterol and full blood counts in primary care settings during the pandemic, despite access to GPs being largely maintained through virtual appointments (Stephenson et al. , 2023).…”