Comparison of Medication Prescribing Before and After the COVID-19 Pandemic Among Nursing Home Residents in Ontario, Canada

Key Points

Question

How are COVID-19 and related disruptions in care associated with changes in the dispensation of medications commonly used among nursing home residents?

Findings

In this population-based cohort study with an interrupted time-series analysis of all nursing home residents from the 630 facilities in Ontario, Canada, the emergence of the COVID-19 pandemic was associated with significant increases in the use of antipsychotics, benzodiazepines, antidepressants, anticonvulsants, and opioids and no meaningful changes in the use of antibiotics or selected cardiovascular medications.

Meaning

The finding of increased use of medications with the potential for adverse effects among nursing home residents during the initial wave of the pandemic warrants ongoing monitoring for prescribing appropriateness and related resident outcomes.

Abstract

Importance

COVID-19 has had devastating effects on the health and well-being of older adult residents and health care professionals in nursing homes. Uncertainty about the associated consequences of these adverse effects on the use of medications common to this care setting remains.

Objective

To examine the association between the COVID-19 pandemic and prescription medication changes among nursing home residents.

Design, Setting, and Participants

This population-based cohort study with an interrupted time-series analysis used linked health administrative data bases for residents of all nursing homes (N = 630) in Ontario, Canada. During the observation period, residents were divided into consecutive weekly cohorts. The first observation week was March 5 to 11, 2017; the last observation week was September 20 to 26, 2020.

Exposures

Onset of the COVID-19 pandemic on March 1, 2020.

Main Outcomes and Measures

Weekly proportion of residents dispensed antipsychotics, benzodiazepines, antidepressants, anticonvulsants, opioids, antibiotics, angiotensin receptor blockers (ARBs), and angiotensin-converting enzyme (ACE) inhibitors. Autoregressive integrated moving average models with step and ramp intervention functions tested for level and slope changes in weekly medication use after the onset of the pandemic and were fit on prepandemic data for projected trends.

Results

Across study years, the annual cohort size ranged from 75 850 to 76 549 residents (mean [SD] age, 83.4 [10.8] years; mean proportion of women, 68.9%). A significant increased slope change in the weekly proportion of residents who were dispensed antipsychotics (parameter estimate [β] = 0.051; standard error [SE] = 0.010; P < .001), benzodiazepines (β = 0.026; SE = 0.003; P < .001), antidepressants (β = 0.046; SE = 0.013; P < .001), trazodone hydrochloride (β = 0.033; SE = 0.010; P < .001), anticonvulsants (β = 0.014; SE = 0.006; P = .03), and opioids (β = 0.038; SE = 0.007; P < .001) was observed. The absolute difference in observed vs estimated use in the last week of the pandemic period ranged from 0.48% (for anticonvulsants) to 1.52% (for antipsychotics). No significant level or slope changes were found for antibiotics, ARBs, or ACE inhibitors.

Conclusions and Relevance

In this population-based cohort study, statistically significant increases in the use of antipsychotics, benzodiazepines, antidepressants, anticonvulsants, and opioids followed the onset of the COVID-19 pandemic, although absolute differences were small. There were no significant changes for antibiotics, ARBs, or ACE inhibitors. Studies are needed to monitor whether changes in pharmacotherapy persist, regress, or accelerate during the course of the pandemic and how these changes affect resident-level outcomes.

Abstract

This population-based cohort study examines the association between the initial wave of the COVID-19 pandemic and changes in medication dispensation patterns among nursing home residents in the province of Ontario, Canada.