Impact of COVID-19 pandemic on routine clinical management of patients with neurological diseases: a descriptive retrospective cohort study

Date of ISAC Approval: 
2021-01-13 00:00:00
Lay Summary: 
COVID-19 led to an unprecedented and global health crisis that may have profoundly impacted the clinical management of patients due to changes in treatment guidelines and patient’s health behaviour. A recent survey of patients with chronic conditions across Europe and the US reported an impact on medical consultations, treatment intake and psychological wellbeing. For future real-world data studies in neurological disease populations, it is important to understand how the COVID-19 pandemic impacts the routine clinical management of different types of neurological diseases. For this purpose, we propose to describe routine clinical management of patients with selected neurological disease (i.e., Autism Spectrum Disorder (ASD), Multiple Sclerosis (MS), Parkinson’s Disease (PD) and Alzheimer’s disease (AD)) during the COVID-19 pandemic peak period to the same time period in previous years (2015-2019). Specifically, we will investigate the number of medical consultations, referrals and prescriptions as well as psychological symptoms. In addition, we will explore how these outcomes relate to the daily COVID-19 case numbers and timing of governmental “lockdown” measures to reduce the spread of COVID-19. We will use these findings to inform future studies analyzing primary care data in the UK.
Technical Summary: 
The COVID-19 pandemic may have profoundly changed the clinical management of patients with chronic conditions. A recent survey of patients with chronic conditions across Europe and the US (N= 6780) reported that 41% of patients had less medical visits than usual, 46% had postponed or cancelled medical visits or surgeries and 10% had a treatment modification [1]. For future real-world data studies in neurological disease populations, it is important to confirm and quantify the evidence - which was mostly collected in surveys - in real-world data to better understand how the COVID-19 pandemic impacts the routine clinical management of different types of neurological diseases. This retrospective cohort study of prevalent and incident patients with selected neurological disorders (i.e., Autism Spectrum Disorder, Multiple Sclerosis, Parkinson’s Disease and Alzheimer’s disease) aims at describing the impact of the COVID-19 pandemic on primary care data in England. For this purpose, we compare healthcare resource utilisation during the COVID-19 pandemic peak period in 2020 to the same periods in 2015-2019 using CPRD. Specifically, we quantify the incidence of the selected neurological diseases, proportion and average number of medical consultations, referrals, and prescriptions including antidepressants and anxiolytics. Additionally, we explore the relation of these outcomes to the daily COVID-19 case numbers and the timing of the UK governmental measures to prevent the spread of SARS-CoV-2 using interrupted time series analysis. The findings contribute to our understanding how the COVID-19 pandemic impacted primary care management in England. This can inform future studies generating real-world evidence based on this real-world data source. Moreover, our results could generate hypotheses on the impact of different COVID-19 policies on routine clinical care.
Health Outcomes to be Measured: 
Separately for each year 2015-2020 in Autism Spectrum Disorder (ASD), Multiple Sclerosis (MS), Parkinson’s Disease (PD) and Alzheimer’s disease (AD) patients: Incidence of respective neurological disease; Number and type of medical consultations; Number of referrals and type of speciality; Number of prescriptions and drug class including antidepressants and anxiolytics
Collaborators: 

Teresa Karrer - Chief Investigator - F. Hoffmann - La Roche Ltd
Paul Dillon - Collaborator - F. Hoffmann - La Roche Ltd
Isaac Gravestock - Collaborator - F. Hoffmann - La Roche Ltd
Julie Mouchet - Collaborator - F. Hoffmann - La Roche Ltd
Loes Rutten-Jacobs - Collaborator - F. Hoffmann - La Roche Ltd
Teresa Karrer - Corresponding Applicant - F. Hoffmann - La Roche Ltd