Evidence map›Paper›PMID 37714668›Full record

ArticleBMJ mental health2023

Impact of the COVID-19 pandemic on antipsychotic prescribing in individuals with autism, dementia, learning disability, serious mental illness or living in a care home: a federated analysis of 59 million patients' primary care records in situ using OpenSAFELY.

Orla Macdonald, Amelia Green, Alex Walker, Helen Curtis, Richard Croker, Andrew Brown, Ben Butler-Cole, Colm Andrews, Jon Massey, Peter Inglesby and 23 more

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ mental health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
4.1field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 13 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

33 authors at 3 institutions in 1 country.

Orla Macdonald *Pharmacy, Oxford Health NHS Foundation Trust, Oxford, UK orla.macdonald@oxfordhealth.nhs.uk.ORCID 0000-0003-2774-0001
Amelia Green *Nuffield Department of Primary Care, Oxford University, Oxford, UK.
Alex WalkerNuffield Department of Primary Care, Oxford University, Oxford, UK.
Helen CurtisNuffield Department of Primary Care, Oxford University, Oxford, UK.
Richard CrokerNuffield Department of Primary Care, Oxford University, Oxford, UK.
Andrew BrownNuffield Department of Primary Care, Oxford University, Oxford, UK.
Ben Butler-ColeNuffield Department of Primary Care, Oxford University, Oxford, UK.
Colm AndrewsNuffield Department of Primary Care, Oxford University, Oxford, UK.
Jon MasseyNuffield Department of Primary Care, Oxford University, Oxford, UK.
Peter InglesbyNuffield Department of Primary Care, Oxford University, Oxford, UK.
Caroline MortonNuffield Department of Primary Care, Oxford University, Oxford, UK.
Louis FisherNuffield Department of Primary Care, Oxford University, Oxford, UK.
Jessica MorleyNuffield Department of Primary Care, Oxford University, Oxford, UK.
Amir MehrkarNuffield Department of Primary Care, Oxford University, Oxford, UK.
Sebastian BaconNuffield Department of Primary Care, Oxford University, Oxford, UK.
Simon DavyNuffield Department of Primary Care, Oxford University, Oxford, UK.
David EvansNuffield Department of Primary Care, Oxford University, Oxford, UK.
Iain DillinghamNuffield Department of Primary Care, Oxford University, Oxford, UK.
Tom WardNuffield Department of Primary Care, Oxford University, Oxford, UK.
William HulmeNuffield Department of Primary Care, Oxford University, Oxford, UK.
Chris BatesTPP-UK, Leeds, UK.
Jonathan CockburnTPP-UK, Leeds, UK.
John ParryTPP-UK, Leeds, UK.
Frank HesterTPP-UK, Leeds, UK.
Sam HarperTPP-UK, Leeds, UK.
Shaun O'HanlonEMIS Group PLC, Leeds, UK.
Alex EavisEMIS Group PLC, Leeds, UK.
Richard JarvisEMIS Group PLC, Leeds, UK.
Dima AvramovEMIS Group PLC, Leeds, UK.
Nasreen ParkesEMIS Group PLC, Leeds, UK.
Ian WoodEMIS Group PLC, Leeds, UK.
Ben GoldacreNuffield Department of Primary Care, Oxford University, Oxford, UK.
Brian MackennaNuffield Department of Primary Care, Oxford University, Oxford, UK.
University of Oxford · GBWPP (United Kingdom) · GBOxford Health NHS Foundation Trust · GB

Funding

Medical Research Council MC_PC_20058Medical Research Council MC_PC-20059Medical Research Council MR/V015757/1Medical Research Council MR/W016729/1Wellcome TrustWellcome Trust 222097/Z/20/Z
6 · The paper itself

Abstract

backgroundThe COVID-19 pandemic affected how care was delivered to vulnerable patients, such as those with dementia or learning disability.

objectiveTo explore whether this affected antipsychotic prescribing in at-risk populations.

methodsWith the approval of NHS England, we completed a retrospective cohort study, using the OpenSAFELY platform to explore primary care data of 59 million patients. We identified patients in five at-risk groups: autism, dementia, learning disability, serious mental illness and care home residents. We calculated the monthly prevalence of antipsychotic prescribing in these groups, as well as the incidence of new prescriptions in each month.

findingsThe average monthly rate of antipsychotic prescribing increased in dementia from 82.75 patients prescribed an antipsychotic per 1000 patients (95% CI 82.30 to 83.19) in January-March 2019 to 90.1 (95% CI 89.68 to 90.60) in October-December 2021 and from 154.61 (95% CI 153.79 to 155.43) to 166.95 (95% CI 166.23 to 167.67) in care homes. There were notable spikes in the rate of new prescriptions issued to patients with dementia and in care homes. In learning disability and autism groups, the rate of prescribing per 1000 decreased from 122.97 (95% CI 122.29 to 123.66) to 119.29 (95% CI 118.68 to 119.91) and from 54.91 (95% CI 54.52 to 55.29) to 51.04 (95% CI 50.74 to 51.35), respectively. CONCLUSION AND IMPLICATIONS: We observed a spike in antipsychotic prescribing in the dementia and care home groups, which correlated with lockdowns and was likely due to prescribing of antipsychotics for palliative care. We observed gradual increases in antipsychotic use in dementia and care home patients and decreases in their use in patients with learning disability or autism.

Indexed as

Antipsychotic AgentsAutistic DisorderCOVID-19DementiaLearning DisabilitiesCommunicable Disease ControlHumansPandemicsPrimary Health CareRetrospective StudiesAntipsychotic Agentsadult psychiatryCOVID-19delirium & cognitive disordersimpulse control disorders

Identifiers

PMID37714668
PMCPMC11146375
OpenAlexW4386768757

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.