Physician visits and medication prescriptions for major chronic diseases during the COVID-19 pandemic in Japan: retrospective cohort study

Osawa, Itsuki; Goto, Tadahiro; Asami, Yuko; Itoh, Noriharu; Kaga, Yasuyuki; Yamamoto, Yuji; Tsugawa, Yusuke

doi:10.1136/bmjopen-2021-050938

Cited by 25 publications

(26 citation statements)

References 14 publications

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“…The number of prescriptions for drugs used in patients with chronic conditions, such as diabetes and hypertension, also decreased in May 2020, following prolongation of the length of prescription coverage in April (figure 5B). This correlates with a report based on a claims database in Japan that showed a temporary decline in physician visits by patients with chronic conditions, although the proportion of days covered by prescribed medication was unchanged 35…”

Section: Discussionsupporting

confidence: 88%

Impact of COVID-19 pandemic on healthcare service use for non-COVID-19 patients in Japan: retrospective cohort study

Yamaguchi

Okada

Sunaga³

et al. 2022

BMJ Open

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ObjectivesWe aimed to investigate the impact of the first and second waves of the COVID-19 pandemic on healthcare service use by non-COVID-19 patients.DesignRetrospective cohort study.SettingHospital-based claims database from anonymised hospitals in Japan.ParticipantsPatients (n=785 495) who visited and/or were hospitalised in 26 anonymised hospitals in Japan between January 2017 and November 2020.Outcome measuresWe compared changes in the monthly number of hospitalisations (overall or by diagnosis), outpatient visits, endoscopic fibrescopies (EFs), rehabilitations, outpatient chemotherapy treatments, maintenance haemodialysis treatments and outpatient prescriptions between pre-COVID-19 years and the same period in 2020.ResultsThe overall number of hospitalisations and outpatient visits decreased by 27% and 22%, respectively, in May 2020, of which the most substantial decrease was observed in the paediatrics department (65% and 51%, respectively). The number of hospitalisations for respiratory diseases, circulatory diseases, malignant neoplasms and digestive diseases decreased by a maximum of 55%, 32%, 10% and 26%, respectively, in 2020. The number of hospitalisations for non-COVID-19 pneumonia in patients aged <16 years, patients aged ≥16 years and patients with asthma decreased by 93%, 43% and 80%, respectively, in May 2020. EFs and outpatient rehabilitations decreased by >30%. In contrast, outpatient chemotherapy and maintenance haemodialysis treatments decreased by <10%, if at all. Outpatient prescriptions decreased by a maximum of 20% in 2020, with the largest decrease observed in drugs for obstructive airway diseases and cough and cold preparations.ConclusionsThe use of healthcare services by non-COVID-19 patients was most affected during the first wave of the COVID-19 pandemic in May 2020. The number of hospitalisations for respiratory diseases, particularly non-COVID-19 pneumonia and asthma, drastically decreased, while the number of hospitalisations and outpatient chemotherapies for malignant neoplasms or maintenance haemodialysis was less affected.

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Section: Discussionsupporting

confidence: 88%

Impact of COVID-19 pandemic on healthcare service use for non-COVID-19 patients in Japan: retrospective cohort study

Yamaguchi

Okada

Sunaga³

et al. 2022

BMJ Open

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“…Although chronic medication prescriptions remained stable during the Covid-19 waves and lockdowns, acute medication prescriptions diminished during the Covid-19 waves and lockdowns, which was in line with the decline in the registration of acute diseases, excluding Covid-19. After the first lockdown the different care metrics returned to pre-pandemic levels indicating at least a partial compensation for the reduced primary healthcare use, which corresponds with previous research [ 33 ].…”

Section: Discussionsupporting

confidence: 87%

“…Despite the overall increase in care provision during the first Covid-19 year, our findings indicated on a more detailed level that all of these metrics were reduced during the first wave of Covid-19, except for chronic medication prescriptions and physical therapy referrals. These observations showed a decrease in the use of primary healthcare in Flanders (Belgium) during the lockdowns as was also the case in other countries [ 2 , 7 , 9 , 33 ]. The exceptions concerning prescription renewals for chronic medications and physical therapy referrals could be explained by the increased use of teleconsultations in Belgium, which appeared to be an accessible way for patients to consult their primary healthcare provider to some extent [ 34 , 35 ].…”

Section: Discussionsupporting

confidence: 65%

The impact of the Covid-19 pandemic on the incidence of diseases and the provision of primary care: A registry-based study

et al. 2022

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Introduction The Covid-19 pandemic had a tremendous impact on healthcare but uncertainty remains about the extent to which primary care provision was affected. Therefore, this paper aims to assess the impact on primary care provision and the evolution of the incidence of disease during the first year of the Covid-19 pandemic in Flanders (Belgium). Methods Care provision was defined as the number of new entries added to a patient’s medical history. Pre-pandemic care provision (February 1, 2018–January 31, 2020) was compared with care provision during the pandemic (February 1, 2020-January 31, 2021). A large morbidity registry (Intego) was used. Regression models compared the effect of demographic characteristics on care provision and on acute and chronic diagnoses incidence both prior and during the pandemic. Results During the first year of the Covid-19 pandemic, overall care provision increased with 9.1% (95%CI 8.5%;9.6%). There was an increase in acute diagnoses of 5.1% (95%CI 4.2%;6.0%) and a decrease in the selected chronic diagnoses of 12.8% (95% CI 7.0%;18.4%). Obesity was an exception with an overall incidence increase. The pandemic led to strong fluctuations in care provision that were not the same for all types of care and all demographic groups in Flanders. Relative to other groups in the population, the pandemic caused a reduction in care provision for children aged 0–17 year and patients from a lower socio-economic situation. Conclusion This paper strengthened the claim that Covid-19 should be considered as a syndemic instead of a pandemic. During the first Covid-19 year, overall care provision and the incidence of acute diagnoses increased, whereas chronic diseases’ incidence decreased, except for obesity diagnoses which increased. More granular, care provision and chronic diseases’ incidence decreased during the lockdowns, especially for people with a lower socio-economic status. After the lockdowns they both returned to baseline.

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“…The present study used data extracted from a Japanese employment-based health insurance database managed by MinaCare Co, Ltd (Tokyo, Japan). The database comprised periodically updated health checkup data and medical/pharmaceutical claims data of employees and their dependent family members, covering approximately 7.5% of the Japanese working-age population in 2020 24 . The database covered a wide age range up to 74 years, including those working in large-scale nationwide retailing industries, manufacturers, and food, information, transportation, and energy industries, and their dependents.…”

Section: Methodsmentioning

confidence: 99%

Inverse Association Between Persistence With Antidepressant Medication and Onset of Chronic Pain in Patients With Depression

Higa

Nakamura²,

Ohwaki

2022

J Clin Psychopharmacol

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Purpose/BackgroundDespite the known involvement of depression in chronic pain, the association between persistence with and adherence to antidepressant medication and onset of chronic pain in patients with depression remains unclear.Methods/ProceduresThis retrospective cohort study used a Japanese claims database to extract data for adult patients with depression who were prescribed antidepressants between April 2014 and March 2020. Patients were divided into groups according to duration of continuous prescription of antidepressants (≥6 months [persistent group] and <6 months [nonpersistent group]) and medication possession ratio (≥80% [good adherence group] and <80% [poor adherence group]). The outcome was onset of chronic pain, which was defined as continuous prescription >3 months of analgesics and diagnosis of pain-related condition after discontinuation of the first continuous antidepressant prescription. The risk of onset of chronic pain was compared between the paired groups.Findings/ResultsA total of 1859 patients were selected as the study population and categorized as the persistent (n = 406) and nonpersistent (n = 1453) groups, and good adherence (n = 1551) and poor adherence (n = 308) groups. Risk of onset of chronic pain was significantly lower in the persistent group than in the nonpersistent group after controlling for confounding via standardized mortality ratio weighting (hazard ratio, 0.38; 95% confidence interval, 0.18–0.80; P = 0.011). There was no significant difference between the good and poor adherence groups.Implications/ConclusionsAntidepressant persistence for ≥6 months is recommended and may reduce the onset of chronic pain in patients with depression.

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Physician visits and medication prescriptions for major chronic diseases during the COVID-19 pandemic in Japan: retrospective cohort study

Cited by 25 publications

References 14 publications

Impact of COVID-19 pandemic on healthcare service use for non-COVID-19 patients in Japan: retrospective cohort study

Impact of COVID-19 pandemic on healthcare service use for non-COVID-19 patients in Japan: retrospective cohort study

The impact of the Covid-19 pandemic on the incidence of diseases and the provision of primary care: A registry-based study

Inverse Association Between Persistence With Antidepressant Medication and Onset of Chronic Pain in Patients With Depression

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