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

• Published in: BMJ mental health Vol. 26; no. 1; p. e300775
• Main Authors: Macdonald, Orla, Green, Amelia, Walker, Alex, Curtis, Helen, Croker, Richard, Brown, Andrew, Butler-Cole, Ben, Andrews, Colm, Massey, Jon, Inglesby, Peter, Morton, Caroline, Fisher, Louis, Morley, Jessica, Mehrkar, Amir, Bacon, Sebastian, Davy, Simon, Evans, David, Dillingham, Iain, Ward, Tom, Hulme, William, Bates, Chris, Cockburn, Jonathan, Parry, John, Hester, Frank, Harper, Sam, O'Hanlon, Shaun, Eavis, Alex, Jarvis, Richard, Avramov, Dima, Parkes, Nasreen, Wood, Ian, Goldacre, Ben, Mackenna, Brian
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd, Royal College of Psychiatrists and British Psychological Society 01.09.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: adult psychiatry; Antipsychotic Agents - therapeutic use; Antipsychotics; Autism; Autistic Disorder - drug therapy; Behavior; Communicable Disease Control; COVID-19; delirium & cognitive disorders; Dementia; Dementia - drug therapy; Disability; Electronic health records; Ethnicity; Humans; impulse control disorders; Learning disabilities; Learning Disabilities - drug therapy; Medical research; Mental disorders; Palliative care; Pandemics; Patients; Pharmacological Treatments; Population; Prescriptions; Primary care; Primary Health Care; Psychotropic drugs; Retrospective Studies; Sensitivity analysis; Software; Trends; United Kingdom > UK; England; COVID-19; impulse control disorders; adult psychiatry; delirium & cognitive disorders
• ISSN: 2755-9734; 2755-9734
• DOI: 10.1136/bmjment-2023-300775

BackgroundThe COVID-19 pandemic affected how care was delivered to vulnerable patients, such as those with dementia or learning disability.ObjectiveTo explore whether this affected antipsychotic prescribing in at-risk populations.MethodsWith 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 calculated the monthly prevalence of antipsychotic prescribing in these groups, as well as the incidence of new prescriptions in each month.FindingsThe average monthly rate of antipsychotic prescribing increased in dementia from 82.75 patients prescribed an antipsychotic per 1000 patients (95% CI 82.30 to 83.19) in January–March 2019 to 90.1 (95% CI 89.68 to 90.60) in October–December 2021 and from 154.61 (95% CI 153.79 to 155.43) to 166.95 (95% CI 166.23 to 167.67) 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 rate of prescribing per 1000 decreased from 122.97 (95% CI 122.29 to 123.66) to 119.29 (95% CI 118.68 to 119.91) and from 54.91 (95% CI 54.52 to 55.29) to 51.04 (95% CI 50.74 to 51.35), respectively.Conclusion and implicationsWe observed a spike in antipsychotic prescribing in the dementia and care home groups, which correlated with lockdowns and was likely due to prescribing of antipsychotics for palliative care. We observed gradual increases in antipsychotic use in dementia and care home patients and decreases in their use in patients with learning disability or autism.