(106) The Effects of Virtual Care Use on Prescription Drug Claims Among Older Adults with Dementia Before and During COVID-19

Publication Number: 1151

Background: The COVID-19 pandemic led to rapid uptake of virtual modalities for delivering healthcare, even among vulnerable groups such as older adults with dementia, who have more barriers to accessing technology yet have greater health needs. However, the impact of rapid virtualization on prescriptions is unknown. Some early evidence has suggested the potential for overprescribing, while others have raised concerns of the potential for treatment disruptions and non-adherence among those most vulnerable.

Objectives: To compare the volumes of prescriptions and other healthcare service use, and average costs between high and low users of virtual care with dementia before and during the pandemic.

Methods: We conducted a population-based, weekly cross-sectional study from January 2018 to March 2021 using administrative data from Ontario, Canada. All residents aged 65+ with valid healthcare coverage and a diagnosis of dementia were included. Patients were categorized as high users of virtual care if they attended two or more virtual visits during the pandemic, while low users attended none or one virtual visit. We compared total and new prescriptions between high and low users. Secondary outcomes included the number of hospitalizations, emergency department visits, outpatient visits, and laboratory testing, and mean costs per patient.

Results: The average weekly number of total prescriptions decreased steadily from pre-pandemic to during in low virtual care users (96,185 to 38,944, or -60%), while numbers continuously increased in high users even during the pandemic (95,730 to 115,032, or +20%). Similarly, the number of new prescriptions decreased in low users (3410 to 935, or -73%), but remained stable throughout in high users (3338 to 3396, or +2%). Both low and high users experienced notable reductions in hospitalizations, emergency department visits, and lab tests due to the pandemic, but only high users returned to pre-pandemic levels. In contrast, the pandemic did not affect outpatient visit trends in high users, with volumes continuing to increase (19,093 to 21,108, or +11%), while low users saw a decrease. Mean costs per patient were stable but surprisingly greater among low users than high users pre-pandemic. Both groups saw an immediate reduction in costs when the pandemic began, however only high users rose to pre-pandemic trends (low: 430 to 229, or -47% vs high: 221 to 305, or +38%).

Conclusions: Use of prescriptions and other healthcare services were mostly unaffected by the pandemic among high virtual care users. This suggests that virtual care helped dementia patients maintain access to care during times of physical distancing, while those who did not access virtual care may have been less ill or had unmet needs for care during this time.