Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Aug 2;4(8):e2118441.
doi: 10.1001/jamanetworkopen.2021.18441.

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

Michael A Campitelli  1 , Susan E Bronskill  1   2   3   4 , Laura C Maclagan  1 , Daniel A Harris  1   5 , Cecilia A Cotton  6 , Mina Tadrous  1   4   7 , Andrea Gruneir  1   4   8 , David B Hogan  9 , Colleen J Maxwell  1   10   11
Affiliations
Observational Study

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

Michael A Campitelli et al. JAMA Netw Open. .

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Bronskill reported receiving grants from the Canadian Institutes of Health Research (CIHR), nonfinancial support from ICES (formerly Institute for Clinical Evaluative Sciences), and grants from the Ontario Health Data Platform (OHDP) during the conduct of the study. Dr Tadrous reported receiving grants from the Ontario Ministry of Health (MOH) and the Ministry of Long-term Care (MLTC) during the conduct of the study. Dr Maxwell reported receiving grants from the CIHR, nonfinancial support from the ICES, and grants from the OHDP during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Observed Weekly Proportion of Residents Dispensed Antipsychotics, Trazodone, Benzodiazepines, and Antidepressants Compared With Projected Use
Data were plotted from March 2019 to September 2020 to provide greater resolution for trends during the pandemic period.
Figure 2.
Figure 2.. Observed Weekly Proportion of Residents Dispensed Anticonvulsants and Opioids Compared With Projected Use
Data were plotted from March 2019 to September 2020 to provide greater resolution for trends during the pandemic period.
Figure 3.
Figure 3.. Observed Weekly Proportion of Residents Dispensed Antibiotics, Angiotensin Receptor Blockers (ARBs), and Angiotensin-Converting Enzyme (ACE) Inhibitors Compared With Projected Use
Data were plotted from March 2019 to September 2020 to provide greater resolution for trends during the pandemic period.
See this image and copyright information in PMC

Comment in

References

    1. Le Couteur DG, Anderson RM, Newman AB. COVID-19 through the lens of gerontology. J Gerontol A Biol Sci Med Sci. 2020;75(9):e119-e120. doi:10.1093/gerona/glaa077 - DOI - PMC - PubMed
    1. Montero-Odasso M, Hogan DB, Lam R, et al. . Age alone is not adequate to determine health-care resource allocation during the COVID-19 pandemic. Can Geriatr J. 2020;23(1):152-154. doi:10.5770/cgj.23.452 - DOI - PMC - PubMed
    1. White EM, Santostefano CM, Feifer RA, et al. . Asymptomatic and presymptomatic severe acute respiratory syndrome coronavirus 2 infection rates in a multistate sample of skilled nursing facilities. JAMA Intern Med. 2020;180(12):1709-1711. doi:10.1001/jamainternmed.2020.5664 - DOI - PMC - PubMed
    1. Arons MM, Hatfield KM, Reddy SC, et al. ; Public Health–Seattle and King County and CDC COVID-19 Investigation Team . Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility. N Engl J Med. 2020;382(22):2081-2090. doi:10.1056/NEJMoa2008457 - DOI - PMC - PubMed
    1. Richardson S, Hirsch JS, Narasimhan M, et al. ; the Northwell COVID-19 Research Consortium . Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323(20):2052-2059. doi:10.1001/jama.2020.6775 - DOI - PMC - PubMed

Publication types

MeSH terms