Evaluating the effect of COVID-19 on dispensing patterns: a national cohort analysis

Abstract

BackgroundMedication prescribing and dispensing often regarded as one of the most effective ways to manage and improve population health. Prescribed and dispensed medications can be monitored through data linkage for each patient. We hypothesised that changes in patient care resulting from COVID-19, changed the way patients access their prescribed medication.Objective To develop an efficient approach for evaluation of the impact of COVID-19 on drug dispensing patterns.MethodsRetrospective observational study using national patient-level dispensing records in Wales-UK. Total dispensed drug items between 01-Jan-2016 and 31-Dec-2019 (counterfactual pre-COVID-19) were compared to 2020 (COVID-19 year). We compared trends of dispensed items in three main British National Formulary (BNF) sections(Cardiovascular system, Central Nervous System, Immunological & Vaccine) using European Age-Standardized rates. We developed an online tool to enable monitoring of changes in dispensing as the pandemic evolves.ResultAmongst all BNF chapters, 52,357,639 items were dispensed in 2020 compared to 49,747,141 items in 2019 demonstrating a relative increase of 5.25% in 2020(95%CI[5.21,5.29]). Comparison of monthly patterns of 2020 and 2019 dispensed items showed a notable difference between the total number of dispensed drug items each month, with an average difference (D) of +290,055 and average Relative Change (RC) of +5.52%. The greatest RC was observed in a substantial March-2020 increase (D=+1,501,242 and RC=+28%), followed by second peak in June (D=+565,004, RC=+10.97%). May was characterised by lower dispensing (D=-399,244, RC=-5.9%). Cardiovascular categories were characterised, across all age groups, by dramatic March-2020 increases, at the epidemic peak, followed by months of lower than expected dispensing, and gradual recovery by September. The Central Nervous System category was similar, but with only a short decline in May, and quicker recovery. A stand-out grouping was Immunological and Vaccine, which dropped to very low levels across all age groups, and all months (including the March dispensing peak).ConclusionsAberration in clinical service delivery during COVID-19 led to substantial changes in community pharmacy drug dispensing. This change may contribute to a long-term burden of COVID-19, raising the importance of a comprehensive and timely monitoring of changes for evaluation of the potential impact on clinical care and outcomes

The adverse impact of COVID-19 pandemic on cardiovascular disease prevention and management in England, Scotland and Wales: A population-scale analysis of trends in medication data

“…Patients therefore accessed additional medications but continued to have medications prescribed at a similar level to pre-pandemic levels, suggestive of some stockpiling of medications. Welsh data using all community dispensing data found similar patterns for cardiovascular categories until September 2020 16 ; data which are also now incorporated into these analyses and updated until Summer 2021. As lockdown eased, a return of some services to near normal levels has been described but this did not include medication data 33 .…”

“…Secondly, dispensing data from all community pharmacies in Wales is available within the Welsh Dispensing Data Set (WDDS) 15 , which is updated on a monthly basis. Within SAIL upon each monthly release of WDDS, a research ready data asset (RRDA) is created and maintained 16 based on COVID-19 population e-cohort RRDA 12 , which enhances the dispensing data for research purposes with mapping to additional coding classifications and meta-data. Although primary care prescribing data is available for the population of Wales, a comprehensive mapping between Read and BNF codes is currenty not available.…”