Paper information
- Authors
-
- Orla Macdonald,
- Millie Green,
- Alex Walker,
- Helen Curtis,
- Richard Croker,
- Andrew Brown,
- Ben Butler-Cole,
- Colm Andrews,
- Jon Massey,
- Peter Inglesby,
- Caroline Morton,
- Louis Fisher,
- Jess Morley,
- Amir Mehrkar,
- Seb Bacon,
- Simon Davy,
- Dave Evans,
- Iain Dillingham,
- Tom Ward,
- Will Hulme,
- Chris Bates,
- Jonathan Cockburn,
- John Parry,
- Frank Hester,
- Sam Harper,
- Shaun O'Hanlon,
- Alex Eavis,
- Richard Jarvis,
- Dima Avramov,
- Nasreen Parkes,
- Ian Wood,
- Ben Goldacre,
- Brian MacKenna
- Citation
- Macdonald O, Green A, Walker A et al. The impact of the COVID-19 pandemic on Antipsychotic Prescribing in individuals with autism, dementia, learning disability, serious mental illness or living in a care home: A federated analysis of 59 million patients’ primary care records in situ using OpenSAFELY. BMJ Ment Health 2023;26:e300775
- Categories
Abstract
Background
The COVID-19 pandemic significantly affected health and social care services. We aimed to explore whether this impacted the prescribing rates of antipsychotics within at-risk populations.
Methods
With the approval of NHS England, we completed a retrospective cohort study, using the OpenSAFELY platform to explore primary care data of 59 million patients. We identified patients in five at-risk groups: autism, dementia, learning disability, serious mental illness and care home residents. We then calculated the monthly prevalence of antipsychotic prescribing in the population, as well as the incidence of new prescriptions in each month over the study period (Jan 2019-Dec 2021).
Results
The average monthly rate of antipsychotic prescribing increased in dementia from 82.75 patients prescribed an antipsychotic per 1000 patients (95% CI 82.30-83.19) in Q1 2019 to 90.1 (95% CI 89.68-90.60) in Q4 2021 and from 154.61 (95% CI 153.79-155.43) in Q1 2019 to 166.95 (95% CI 166.23-167.67) in Q4 2021 in care homes. There were notable spikes in the rate of new prescriptions issued to patients with dementia and in care homes. In learning disability and autism groups, the average monthly rate of prescribing per 1000 decreased from 122.97 (95% CI 122.29-123.66) in Q1 2019 to 119.29 (95% CI 118.68-119.91) in Q4 2021, and from 54.91 (95% CI 54.52-55.29) in Q1 2019 to 51.04 (95% CI 50.74-51.35) in Q4 2021 respectively.
Conclusions
During each of the lockdowns in 2020, we observed a significant spike in antipsychotic prescribing in the dementia and care home groups. We have shown that these peaks are likely due to prescribing of antipsychotics for palliative care purposes and may have been linked to pre-emptive prescribing, when on-site medical visits would have been restricted. Over the study period, we observed gradual increases in antipsychotic use in patients with dementia and in care homes and a decrease in their use in patients with learning disability or autism.