Long-acting injectable antipsychotic (LAI) prescribing trends during COVID-19 restrictions in Canada: a retrospective observational study.

BACKGROUND: The COVID-19 pandemic has had significant impacts on how mental health services are delivered to patients throughout Canada. The reduction of in-person healthcare services have created unique challenges for individuals with psychotic disorders that require regular clinic visits to administer and monitor long-acting injectable antipsychotic medications. METHODS: To better understand how LAI usage was impacted, national and provincial patient-level longitudinal prescribing data from Canadian retail pharmacies were used to examine LAI prescribing practices during the pandemic. Prescribing data on new starts of medication, discontinuations of medications, switches between medications, antipsychotic name, concomitant medications, payer plan, gender and age were collected from January 2019 to December 2020 for individuals ≥18-years of age, and examined by month, as well as by distinct pandemic related epochs characterized by varying degrees of public awareness, incidence of COVID-19 infections and public health restrictions. RESULTS: National, and provincial level data revealed that rates of LAI prescribing including new starts, discontinuations and switches between LAI products remained highly stable (i.e., no statistically significant differences) throughout the study period. CONCLUSIONS: Equal numbers of LAI new starts and discontinuations prior to and during the pandemic suggests prescribing of LAI antipsychotics, for those already in care, continued unchanged throughout the pandemic. The observed consistency of LAI prescribing contrasts with other areas of healthcare, such as cardiovascular and diabetes care, which experienced decreases in medication prescribing during the COVID-19 pandemic.

Examination of the impact of COVID-19 public health quarantine measures on acute mental health care services: A retrospective observational study.

This study assesses for the impact of Covid-19 public health quarantine measures on acute care psychiatric admissions, by comparing admission data from the quarantine period to a comparator period. A chart review was conducted for all admissions to an urban acute care psychiatric centre from Mar 22 - June 5 2020 (quarantine) and January 5 - Mar 21 2020 (comparator). Data was collected on the number of admissions, demographics, patients' psychiatric history, characteristics of admissions, discharge information, patients' substance use and social factors. Data was analyzed using a student's t-test for continuous variables and Chi squared analyses for categorical variables. Results demonstrated 185 admissions during quarantine and 190 during the comparator, with no significant differences in the distribution of admissions across time periods. There was a significantly greater frequency of admissions in the 35-44 age bracket and admissions involving substance use during quarantine. Additionally, admissions during quarantine were significantly shorter, with increased frequency of involuntary status and use of seclusion. The data suggests a vulnerability specific to individuals in their 30-40s during quarantine and demonstrates a need to better understand factors impacting this group. It also suggests that quarantine is associated with changes to substance use, potentiating high acuity illness requiring admission.