Abstract：
BACKGROUND: Ongoing psychiatric follow-up and medication adherence improve outcomes for patients with psychotic disorders. Due to COVID-19, outpatient care may have been disrupted, impacting healthcare utilization.
METHODS: A retrospective population-wide study was conducted for adults in Manitoba, Canada. Medication adherence and healthcare utilization were examined from 2019 to 2021. The presence of a diagnosed psychotic disorder was identified in the five years before the index date in each year. The LAI and clozapine cohorts consisted of those who received at least two prescriptions in each year 180 days before the March 20th index date. The change in adherence was measured using the average Medication Possession Ratio. Healthcare utilization rates were compared using Generalized Estimating Equation models.
RESULTS: There were no significant differences between LAI and clozapine discontinuation rates before and during the pandemic. In the LAI cohort, general practitioner visits decreased significantly (-3.5 %, p = 0.039) across four quarters of 2021 versus 2019. All-cause hospitalizations decreased by 16.8 % in 2020 versus 2019 (p = 0.0055), while psychiatric hospitalizations decreased by 18.7 % across four quarters in 2020 (p = 0.0052) and 13.7 % in 2021 (p = 0.0425), versus 2019 in the LAI cohort. There was a significant transition to virtual care during the first wave of COVID-19 (71 % in clozapine, 51 % in LAI cohorts). Trends in total outpatient visits and non-psychiatric hospitalizations remained stable.
CONCLUSIONS: COVID-19 had no substantial impact on LAI and clozapine discontinuation rates for patients previously adherent. Outpatient care remained stable, with a significant proportion of visits being done virtually at the outset of the pandemic.
METHODS: A retrospective population-wide study was conducted for adults in Manitoba, Canada. Medication adherence and healthcare utilization were examined from 2019 to 2021. The presence of a diagnosed psychotic disorder was identified in the five years before the index date in each year. The LAI and clozapine cohorts consisted of those who received at least two prescriptions in each year 180 days before the March 20th index date. The change in adherence was measured using the average Medication Possession Ratio. Healthcare utilization rates were compared using Generalized Estimating Equation models.
RESULTS: There were no significant differences between LAI and clozapine discontinuation rates before and during the pandemic. In the LAI cohort, general practitioner visits decreased significantly (-3.5 %, p = 0.039) across four quarters of 2021 versus 2019. All-cause hospitalizations decreased by 16.8 % in 2020 versus 2019 (p = 0.0055), while psychiatric hospitalizations decreased by 18.7 % across four quarters in 2020 (p = 0.0052) and 13.7 % in 2021 (p = 0.0425), versus 2019 in the LAI cohort. There was a significant transition to virtual care during the first wave of COVID-19 (71 % in clozapine, 51 % in LAI cohorts). Trends in total outpatient visits and non-psychiatric hospitalizations remained stable.
CONCLUSIONS: COVID-19 had no substantial impact on LAI and clozapine discontinuation rates for patients previously adherent. Outpatient care remained stable, with a significant proportion of visits being done virtually at the outset of the pandemic.
摘要：
背景：持续的精神病随访和药物依从性可改善精神病患者的预后。由于COVID-19，门诊护理可能已经中断，影响医疗保健利用率。
方法：对曼尼托巴省的成年人进行了一项全人群回顾性研究，加拿大。2019年至2021年检查了药物依从性和医疗保健利用情况。在每年的索引日期之前的五年中确定诊断出的精神病的存在。LAI和氯氮平队列由每年3月20日指标日期前180天接受至少两种处方的人组成。使用平均药物持有率测量依从性的变化。使用广义估计方程模型比较了医疗保健利用率。
结果：在大流行之前和期间，LAI和氯氮平的停药率没有显著差异。在LAI队列中，全科医生访视率显着下降（-3.5％，p=0.039），2021年四个季度与2019年相比。与2019年相比，2020年全因住院率下降了16.8%（p=0.0055），2020年四个季度的精神病住院率下降了18.7%(p=0.0052)，2021年下降了13.7%(p=0.0425)，与2019年的LAI队列相比。在第一波COVID-19期间，向虚拟护理的转变显著(71%的氯氮平，LAI队列中的51%)。总门诊和非精神病住院的趋势保持稳定。
结论：COVID-19对先前坚持的患者的LAI和氯氮平停药率没有实质性影响。门诊护理保持稳定，很大一部分访问实际上是在大流行开始时进行的。
方法：对曼尼托巴省的成年人进行了一项全人群回顾性研究，加拿大。2019年至2021年检查了药物依从性和医疗保健利用情况。在每年的索引日期之前的五年中确定诊断出的精神病的存在。LAI和氯氮平队列由每年3月20日指标日期前180天接受至少两种处方的人组成。使用平均药物持有率测量依从性的变化。使用广义估计方程模型比较了医疗保健利用率。
结果：在大流行之前和期间，LAI和氯氮平的停药率没有显著差异。在LAI队列中，全科医生访视率显着下降（-3.5％，p=0.039），2021年四个季度与2019年相比。与2019年相比，2020年全因住院率下降了16.8%（p=0.0055），2020年四个季度的精神病住院率下降了18.7%(p=0.0052)，2021年下降了13.7%(p=0.0425)，与2019年的LAI队列相比。在第一波COVID-19期间，向虚拟护理的转变显著(71%的氯氮平，LAI队列中的51%)。总门诊和非精神病住院的趋势保持稳定。
结论：COVID-19对先前坚持的患者的LAI和氯氮平停药率没有实质性影响。门诊护理保持稳定，很大一部分访问实际上是在大流行开始时进行的。
