Effect of COVID-19 on community drug dispensing: a national cohort analysis

Fatemeh Torabi*, Ashley Akbari*, Laura North, Daniel Harris, Gareth Davies, Mike Gravenor, Rowena Griffiths, Jane Lyons, Neil Jenkins, Andrew Morris, Julian Halcox, Ronan A. Lyons

Abstract

Background

Medication prescribing and dispensing often regarded as one of the most effective ways to manage and improve population's health. Prescribed and dispensed medications can be monitored through data linkage for each patient. We hypothesised that changes in patient care resulting from the COVID-19, changed the way patients access their prescribed medication.

Objective To develop an efficient approach for evaluation of the impact of COVID-19 on drug dispensing patterns.

Methods

Retrospective observational study using national patient-level dispensing records in Wales-UK. Total dispensed drug items between 01-Jan-2016 and 31-Dec-2019 (counterfactual pre-COVID-19) were compared to 2020 (COVID-19 year). We compared trends of dispensed items in three main British National Formulary (BNF) sections(Cardiovascular system, Central Nervous System, Immunological & Vaccine) using European Age-Standardized rates. We developed an online tool to enable monitoring of changes in dispensing as the pandemic evolves.

Results

Amongst all BNF chapters, 67,791,196 items were dispensed in 2020 compared to 69,221,265 items in 2019 demonstrating a relative decrease of 2% in 2020(95%CI[-4.81,4.81]). Comparison of monthly patterns of 2020 and 2019 dispensed items showed a notable difference between the total number of dispensed drug items each month, with an average difference (D) of -119,172 and average Relative Change (RC) of -1.77%. The greatest RC was observed in a substantial March-2020 increase (D=+1,599,212 and RC=+28.75%), followed by second peak in June (D= +624,358, RC= +11.65%). A third peak representing an 11.72% greater number of dispensed items was observed in September 2020 compared to September 2019 (D= +662,837, RC= +11.72). Cardiovascular categories were characterised, across all age groups, by dramatic March-2020 increases, at the epidemic peak, followed by months of lower than expected dispensing, and gradual recovery by 2021. The Central Nervous System category was similar, but with a notable decline at the end of the year in November and December followed by a quicker recovery by 2021. A stand-out grouping was Immunological and Vaccine, which dropped to very low levels across all age groups, and all months (including the March dispensing peak).

Conclusions

Aberration in routine clinical service during COVID-19 led to substantial changes in community pharmacy drug dispensing. This change may contribute to a long-term burden of COVID-19, raising the importance of a comprehensive and timely monitoring of changes for evaluation of the potential impact on clinical care and outcomes.

Note for researchers: Please ensure to use appropriate citation if you are using materials or data available from this website

This web application is developed by Fatemeh Torabi. Source code is available on GitHub. For queries about this web application or suggestions for additional functionalities, please contact via twitter @fatemetrb | via email: fatemeh.torabi@swansea.ac.uk

Total number of dispensed items per BNF chapter per month

Age-standardized dispensing rates in last selected month of dispensing and selected BNF chapter

Monthly breakdown: Age-standardized dispensing rates in the selected BNF chapter and all months up to the selected month of Dispensing (use slider on top of the page to select month of dispensing)

[1: January | 2: February | 3: March | 4: April | 5: May | 6: June | 7: July | 8: August | 9: September | 10: October | 11: November | 12: December]
Welsh Dispensing DataSet

Total number of dispensed item per Year, Month and BNF Chapter

Total number of dispensed item per month of year per BNF chapter between 1st of January 2016 and 30th of September 2020. (any counts <10 were removed)

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Welsh Dispensing DataSet

European Standardized Rates (ESR) dispensing rates per Month, age band and BNF Chapter

Age-standardised dispensing rates per 100,000 population for all ages up to 95+ using the 2013 European Standard Population (ESP)

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