The impact of the coronavirus disease (COVID-19) pandemic on outpatient epilepsy care: An analysis of physician practices in Germany

Abstract

Objective To gain insight into epilepsy care during coronavirus disease (COVID-19) pandemic, we analyzed prescription data of a large cohort of persons with epilepsy (PWE) during lockdown in Germany. Methods Information was obtained from the Disease Analyzer database, which collects anonymous demographic and medical data from practice computer systems of general practitioners (GP) and neurologists (NL) throughout Germany. We retrospectively compared prescription data for anti-seizure medication (ASM) and physicians’ notes of “known” and “new” PWE from January 2020 until May 2020 with the corresponding months in the three preceding years 2017–2019. Adherence was estimated by calculating the proportion of patients with follow-up prescriptions within 90 days after initial prescriptions in January or February. We additionally analyzed hospital referrals of PWE. The significance level was set to 0.01 to adjust for multiple comparisons. Results A total of 52,844 PWE were included. Anti-seizure medication prescriptions for known PWE increased in March 2020 (GP + 36%, NL + 29%; P < 0.01). By contrast, a decrease in prescriptions to known and new PWE was observed in April and significantly in May 2020 ranging from −16% to −29% ( P < 0.01). The proportion of PWE receiving follow-up prescriptions was slightly higher in 2020 (73.5%) than in 2017–2019 (70.7%, P = 0.001). General practitioners and NL referred fewer PWE to hospitals in March 2020 (GP: −30%, P < 0.01; NL: −12%), April 2020 (GP: −29%, P < 0.01; NL: −37%), and May 2020 (GP: −24%, P < 0.01; NL: −16%). Conclusion Adherence of known PWE to ASM treatment appeared to remain stable during lockdown in Germany. However, this study revealed findings which point to reduced care for newly diagnosed PWE as well as fewer hospital admissions. These elements may warrant consideration during future lockdown situations.

Drop in biological initiation for patients with psoriasis during the COVID‐19 pandemic

“…These results were also observed for other chronic diseases with a care reduction for newly diagnosed persons (e.g. epilepsy), whereas adherence to treatment remained stable for patients who were already being treated 6 . A decrease in the dispensation of systemic anticancer therapy delivery was also observed during the first wave of the pandemic, with a global treatment reduction of 30% (from 20% for breast cancer to 43% for colorectal cancer) 7 .…”

Effects of the COVID-19 pandemic on medication adherence: In the case of antiseizure medications, A scoping review

“…Of these, eleven were excluded as the focus was on caregivers (n=2), epileptologists (n=1), focus on children (n=1), or had outcomes irrelevant to search (n=7). Lastly, six articles were eligible, of which one had a retrospective cohort design [22] , two had a prospective cohort design [23] [24] , one had a case-control study design [25] , and two a cross-sectional design [26] [27] , yielding a total sample of 54585 people with epilepsy. We identified four overarching aspects: change of ASM compliance, and as risk factors, follow-up, difficulties accessing ASM, and behavioural risk factors found to be associated with adherence.…”

“…In four studies, it was self reported, [24] [25] [26] [27] of which one used the modified Morisky scale was used [24] , one study provided no definitions [23] and one study used prescription data as a proxy for adherence during the lockdown. [22] …”

“…Three studies used internal or external control groups. Two studies compared pre-COVID-19 to COVID-19 outcomes [22] [25] , and one study compared people with epilepsy to people without during COVID-19. [25] Two studies did not use control groups.…”

Prioritizing Seizure Safety and SUDEP Counseling in People With Epilepsy and Their Caregivers During the COVID-19 Pandemic

“… 2 In a recent international survey, most PWE (74.2%) reported satisfaction with either a phone or video consult with their neurologist as an alternative to in-person appointments. 4 Similarly, in a survey of PWE and their clinicians, tele-medicine was found to be both effective and satisfactory in the delivery of chronic outpatient care to PWE. 5 However, the suitability/appropriateness of telemedicine practice for newly diagnosed PWE has been questioned by some clinicians.…”