Physician visits and medication prescriptions for major chronic diseases during the COVID-19 pandemic in Japan: retrospective cohort study.

ABSTRACT

OBJECTIVES: There have been concerns that patients with chronic conditions may be avoiding in-person physician visits due to fear of COVID-19, leading to lower quality of care. We aimed to investigate changes in physician visits and medication prescriptions for chronic diseases before and during the COVID-19 pandemic at the population level. DESIGN: Retrospective cohort study. SETTING: Nationwide claims data in Japan, 2018-2020. PARTICIPANTS: Working-age population (aged 18-74 years) who visited physicians and received any prescriptions for major chronic diseases (hypertension, diabetes and dyslipidaemia) before the pandemic. OUTCOME MEASURES: The outcomes were the monthly number of physician visits, the monthly proportion of physician visits and the monthly proportion of days covered by prescribed medication (PDC) during the pandemic (April-May 2020, as the first state of emergency over COVID-19 was declared on 7 April, and withdrawn nationally on 25 May). RESULTS: Among 10 346 patients who visited physicians for chronic diseases before the pandemic, we found a temporary decline in physician visits (mean number of visits was 1.9 in March vs 1.7 in April; p<0.001) and an increase in the proportion of patients who did not visit any physicians during the pandemic (15% in March vs 24% in April; p<0.001). Physician visits returned to the baseline in May (the mean number of visits 1.8, and the proportion of patients who did not visit any physicians 9%). We observed no clinically meaningful difference in PDC between before and during the pandemic (eg, 87% in March vs 87% in April; p=0.45). A temporary decline in physician visits was more salient in seven prefectures with a larger number of COVID-19 cases than in other areas. CONCLUSIONS: Although the number of physician visits declined right after the COVID-19 outbreak, it returned to the baseline one month later; patients were not skipping medications during the pandemic.