(P-247) Impact of the COVID-19 Pandemic on Routine Clinical Management of Patients with Neurological Conditions: A Retrospective Cohort Study in UK Primary Care (CPRD)

Background: The COVID-19 pandemic may have profoundly changed the clinical management of patients with chronic conditions due to changes in treatment guidelines and patient’s health behaviour as recent patient and physician surveys reported.

Objectives: To inform future real-world data studies in neurological disease populations, we aimed to quantify how the COVID-19 pandemic impacted the routine clinical care of different types of neurological conditions.

Methods: This is a retrospective cohort study of patients with Autism Spectrum Disorder (ASD), Multiple Sclerosis (MS), Parkinson’s Disease (PD) and Alzheimer’s Disease (AD) comparing healthcare resource utilisation during the first COVID-19 pandemic peak period in early 2020 (i.e. 2020/03/24 - 2020/05/10) to the same periods in 2015-2019 using primary care data in England (Clinical Practice Research Datalink; ISAC protocol number: 20_000275). Cohorts were defined using at least one corresponding Read code recorded at any time before the index date (i.e. 2020/03/24); in addition to having research acceptable records and evidence of continuous enrollment in the year prior to the index date. Specifically, we quantified the proportion and mean number of any medical consultations, referrals, tests and prescriptions per patient.

Results: Across the selected neurological conditions (AD: N=1287; ASD: N=3069; MS: N=1536; PD: N=1998), we observed moderate changes in the number of consultations (ASD: -9.2%; PD: -8.4%; MS: -4.0%; AD: -3.1%) and prescriptions issued (ASD: -11.6%; MS: -3.6%; AD: +2.5%; PD: +5.5%) during the COVID-19 pandemic period compared to the mean of previous years. The number of referrals (ASD: -64.1%; MS: -63.7%; PD: -52.8%; AD: -40.0%) and tests (ASD: -80%; AD: -73.0%; MS: -65.0%; PD: -63.5%) were however strongly reduced during the COVID-19 pandemic period. The impact differed by type of condition, with the greatest impact on ASD; and by different subtypes of healthcare utilisation variables e.g. face-to-face consultations decreased during the COVID-19 pandemic period whereas telephone consultations increased.

Conclusions: These findings indicate changes in the number of referrals and tests in a primary care setting during the COVID-19 pandemic period. Such changes in healthcare resource utilisation and their potential impact on diagnoses and clinical outcomes need to be considered by future studies generating real world evidence. Further studies are needed to evaluate whether these findings generalise to neurology settings where these disorders are primarily managed and to examine disease-specific prescription trends.