Impact of COVID-19 pandemic on medication use in the older Italian population

Trends in medication use during the COVID-19 pandemic in Quebec, Canada

The COVID-19 pandemic has disrupted health and services worldwide. We aimed to describe the changes in medication use during the COVID-19 pandemic in Quebec, Canada. Using a large healthcare database, we created weekly cohorts of all individuals ≥ 1 year old covered by the public drug plan from January 2016 to March 2022. We calculated the weekly number of prevalent and new users of different medications, including both chronic and short-term medications. We integrated the 2016-2019 weekly numbers in Quasi-Poisson regressions, with each gender and age group fitted separately. From these models, we estimated the weekly proportions of prevalent and new users expected for 2020-2021 and their 99% prediction interval [99% PI]. Results were analyzed using the ratio of the overall weekly proportion of users (observed/expected) across four periods, selected according to the different waves of the pandemic: Period 1: 1st wave (February 2020-August 2020), Period 2: 2nd wave (August 2020-March 2021), Period 3: 3rd and 4th waves (March 2021-December 2021), and Period 4: 5th and 6th waves (December 2021-March 2022). Each cohort included over 3,000,000 individuals (53% female). The proportion of new users of most medications dropped in Period 1, with exceptions like antipsychotics (ratio of adjusted overall weekly proportion observed/expected [99% PI] 1.02 [1.00-1.04]). From Period 2 onwards, the initiation of antidiabetics, lipid-lowering medications and attention deficit hyperactivity disorder (ADHD) medications, among others, exceeded expected trends, but remained below expectations notably for systemic antibiotics (Period 4: 0.71 [0.69-0.72]), nasal/oral corticosteroids (Period 4: 0.69 [0.67-0.70]/Period 4: 0.69 [0.67-0.70]) and medications for obstructive lung diseases (Period 4: 0.69 [0.68-0.71]). While the prevalent use of most chronic medications remained relatively close to expectations, observed immediate and long-term variations in medication use should be considered in studies including pandemic years and anticipated in public health planning in case of future pandemics.

Evaluating the utilisation patterns of pharmacological therapy in COVID-19 patients: an ecological study in Italy

Backgound

The drug central monitoring system set up in Italy to evaluate the real-time trends of medicines used in hospital and primary care settings contributed to inform drug supplies, avoided stockpiling and allowed to monitor adherence to clinical practice guidelines for the treatment of COVID-19 patients. The primary objective of the study is to understand how and to what extent the drug utilisation tracked the evolution of COVID-19 pandemic and evaluate the different pharmacological approaches adopted in hospital and primary care settings.

Methods

A national ecological study correlating the drug utilisation of specific categories of drugs related to SARS-CoV-2 with the number of SARS-CoV-2 hospitalised or positive subjects. The correlation is estimated by using linear regression models and reporting the angular coefficients (slope) with relative p value.

Results

Overall, 15 drug categories are identified: 7 categories are available in both settings, 6 categories are prevalent in hospital setting and 2 categories are used in primary care. As for drugs common to both settings, a statistically significant positive association between the number of SARS-CoV-2-positive subjects and drug consumption is found only for low-molecular-weight heparin, oxygen, azithromycin and steroids. As regards drugs used exclusively in hospital, a significant correlation is observed for cardiac stimulants, general anaesthetics, hypnotics and sedatives as well as muscle relaxant drugs. Among drugs used exclusively in primary care, the study has shown a positive correlation only for vitamin D. Finally, the adoption in clinical practice of the recommendations issued by the competent authorities was assessed: at hospital level, the use of drugs with a negative recommendation (such as hydroxychloroquine and azithromycin) was promptly stopped.

Conclusions

Study findings show a positive correlation between the use of specific drug categories used during the pandemic and the number of COVID-19-positive and hospitalised patients, suggesting the relevant role of evaluating drug utilisation patterns in tracking the evolution of pandemics and guideline adherence in clinical practice.

Utilization of antidepressants, anxiolytics, and hypnotics during the COVID-19 pandemic

Since the onset of the COVID-19 pandemic, there have been concerns over the mental health impact of COVID-19. This is a review of the utilization of antidepressants, anxiolytics, and hypnotics since the COVID-19 pandemic was declared on March the 11th 2020. A number of reports so far have been based on large prescription databases for administrative use at the national or regional level, but mainly in high-income countries. We found studies reporting increased prescription rates of antidepressants, anxiolytics, and hypnotics during March 2020, which has been interpreted as hoarding of such medications. In the following months, most studies of antidepressant prescription rates did not display a clear pattern of change compared with prepandemic trends. In later phases of the pandemic small increases in utilization of antidepressants, with higher than predicted prescription rates, have been the most consistent finding, especially in youth. In most high-income countries, there were increasing trends in utilization of antidepressants also before 2020, which needs to be considered when estimating utilization during the pandemic, whereas for anxiolytics and hypnotics, the prepandemic patterns of prescriptions were more varying. Overall, after March 2020 we could not find any distinct changes in the utilization of anxiolytics and hypnotics during the COVID-19 pandemic. Most studies did not contain information about the prevalence of indicated psychiatric disorders in the studied populations. More studies are needed about the long-term effects of COVID-19, particularly regarding utilization of antidepressants. Research relating antidepressant utilization with the prevalence of major depression and anxiety disorders would promote a better understanding of how well antidepressant prescription rates reflect the needs of the population.

Impact of the COVID-19 Pandemic on the Use of Antidepressants by Young Adults in the ASL TO4 Regione Piemonte (Italy)

The association between younger age and poorer mental health during the COVID-19 pandemic has been documented. Whether these changes were associated with a change in antidepressant (AD) use is not well understood. This study aimed to estimate the impact of the COVID-19 pandemic on AD use by young adults in the ASL TO4 Regione Piemonte (Italy). The impact of the pandemic on the weekly prevalence of AD users was assessed using interrupted time-series analysis with autoregressive integrated moving average models. A total of 1071 subjects (18-22 years with ≥1 AD dispensation) were included in the study. The observed prevalence was lower than the predicted value for several weeks after the introduction of the lockdown. However, it was consistently higher than the predicted values from week 134. The maximum difference between observed and predicted values (25 subjects per 10,000 young adults) was found at week 170. Changes in AD use were observed in both genders and were more pronounced for selective serotonin reuptake inhibitors. In conclusion, the impact of the COVID-19 pandemic on the mental health of young adults is likely to be significant in the coming years, which may place a future burden on pharmaceutical public health and community health.

Impact of COVID-19 on patterns of drug utilization: A case study at national hospital

BACKGROUND

The Coronavirus disease of 2019 (COVID-19) pandemic and the corresponding mitigation measures have had a discernible impact on drug utilization among outpatients. However, limited research exists on the prescription trends in the elderly population during the pandemic period in Viet Nam.

OBJECTIVES

This study aims to analyze the effects of COVID-19 on outpatient drug utilization patterns at a national geriatric hospital in Ho Chi Minh City before and after the early onset of the pandemic.

METHODS

Data was collected from the prescriptions and administration claims, encompassing the period from January 2016 to December 2022. The dataset was divided into two periods: Period 1: January 2016 to December 2020 and Period 2: January 2021 to December 2022. The drug utilization was measured using DDD/1000P (defined daily doses-DDD per 1000 prescriptions) on a monthly basis. The analysis employed interrupted time series using Autoregressive Integrated Moving Average (ARIMA) to detect changes in drug use levels and rates.

RESULTS

A total of 1,060,507 and 644,944 outpatient prescriptions from Thong Nhat Hospital were included in Period 1 and Period 2, respectively. The median age of the patients were 58 in Period 1 and 67 years old in Period 2. The most common comorbidities were dyslipidemia, hypertension, and diabetes mellitus. In terms of medication utilization, cardiovascular drugs were the most frequently prescribed, followed by drugs active on the digestive and hormonal systems. The study observed significant surges in the number of prescriptions and the average number of drugs per prescription. However, there were no significant changes in the overall consumption of all drugs. Among the drug groups related to the cardiovascular system, three subgroups experienced a sudden and significant increase: cardiac therapy, beta-blocking agents, and antihypertensives, with increasing consumption levels of 1,177.73 [CI 95%: 79.29; 2,276.16], 73.32 [CI 95%: 28.18; 118.46], and 36.70 [CI 95%: 6.74; 66.66] DDD/1000P, respectively. On the other hand, there was a significant monthly decrease of -31.36 [CI 95%: -57.02; -5.70] DDD/1000P in the consumption of anti-inflammatory and antirheumatic products. Interestingly, there was a significant increase of 74.62 [CI 95%: -0.36; 149.60] DDD/1000P in the use of antigout preparations.

CONCLUSION

COVID-19 resulted in a sudden, non-significant increase in overall drug consumption levels among outpatients. Notably, our findings highlight significant increases in the utilization of three drug groups related to the cardiovascular system, specifically cardiac therapy, beta-blocking agents, and antihypertensives. Intriguingly, there was a statistically significant increase in the consumption of antigout preparations, despite a decline in the monthly consumption rate of non-steroidal anti-flammatory drugs (NSAIDs). Further studies in the following years are necessary to provide a more comprehensive understanding of the impact of COVID-19 on outpatient drug utilization patterns.

Appropriateness of the Prescription and Use of Medicines: An Old Concept but More Relevant than Ever

The availability of drugs to treat diseases, control symptoms, or prevent their onset is one of the most important resources for maintaining health [...].