(107) Impact of the COVID-19 Pandemic on Use of Medication and Healthcare Services Among Individuals with Intellectual and Developmental Disabilities in Ontario, Canada

Publication Number: 444

Background: The declaration of a state of emergency for COVID-19 led to lockdown restrictions and reduced capacity for provision of healthcare services across Canada. Individuals with intellectual and developmental disabilities (IDD) require regular access to the healthcare system as they often have complex health profiles and high use of prescription medications.

Objectives: To evaluate the impact of the COVID-19 pandemic on trends in psychoactive medication use and health services utilization among individuals with IDD in Ontario, Canada.

Methods: We conducted a cross-sectional study on individuals with IDD eligible for public drug benefits between April 3, 2016 and February 27, 2021. We examined trends in the weekly rate of psychoactive medications dispensed through Ontario’s public drug program, stratified by medication type (antidepressants, anticonvulsants, antipsychotics, benzodiazepines, opioids, stimulants) and provision of healthcare services, including professional pharmacy services (i.e., MedsCheck Reviews) and outpatient physician visits, stratified by method of delivery (i.e., virtual or in-person). We used interventional autoregressive integrated moving average models to determine the impact of COVID-19 restrictions (March 17, 2020) on these outcomes.

Results: Following declaration of emergency for COVID-19, there were no significant changes in the rate of psychoactive medication dispensing to patients with IDD; however, the weekly rate of MedsCheck Reviews conducted declined (-1.75%; p-value = 0.05). Antipsychotics were the most commonly dispensed psychoactive medication over the study period (weekly range: 29.2% to 34.4%) followed by antidepressants (weekly range: 25.0% to 32.7%). Although the overall rate of outpatient physician visits did not significantly change in March 2020 (p=0.10), there was a shift in mode of delivery, as virtual visits significantly increased (53.3%; p-value < 0.0001), and in-person visits significantly declined (-64.1%; p-value < 0.0001). While the weekly rate of in-person physician visits subsequently increased in later waves of the pandemic, a greater proportion of outpatient physician visits continued to be conducted virtually.

Conclusions: Although prescribing trends for psychoactive medications did not change over the first year of the COVID-19 pandemic, dispensing rates for antipsychotics remained high among people with IDD, while provision of medication reconciliations such as MedsChecks decreased. Future research is needed to better understand whether antipsychotic prescribing among patients with IDD is in agreement with clinical guidelines.