School of Public Health, Imperial College London Faculty of Medicine, London, UK.
Imperial College London, London, UK.
BMJ Open. 2024 Sep 25;14(9):e076791. doi: 10.1136/bmjopen-2023-076791.
The global prevalence of mental health disorders has risen significantly since the beginning of the COVID-19 pandemic. The pandemic has additionally caused disruption to mental health services, leading to a shift from in-person to remote service delivery. Given its long-term impact, it has become critical to evaluate whether changes in health delivery during the pandemic have had an effect on prescribing patterns for commonly prescribed psychotropic drugs. This study aims to assess the impact of the COVID-19 pandemic on changes in psychotropic prescribing patterns in adults, as well as differences in prescribing in different healthcare delivery approaches across various geographical contexts.
Systematic review of cohort, interrupted time-series and cross-sectional studies examining prescribing trends for at least one commonly prescribed psychotropic drug during and after COVID-19 in accessing care remotely or face to face between 1 January 2020 and 17 June 2022.
MEDLINE, EMBASE, CINAHL, HMIC and PsycINFO databases were searched in addition to citation chaining of relevant reviews.
Study screening, data extraction and quality assessment were completed by two independent reviewers. The PECO strategy was used to devise the systematic review and findings were synthesised narratively.
16 studies were eligible for inclusion. Studies documenting changes in psychotropic prescribing trends provided very conflicting findings. There were no stark differences in prescribing outcomes between different healthcare delivery methods (ie, face-to-face consultations vs remote consultations). A noteworthy finding was that the prescribing rate of benzodiazepines was higher in women than men. No particular trends were observed for the prescription rates of hypnotics, antidepressants or antipsychotics.
Findings support mixed trends in the prescription of psychotropic medications in a range of settings, hindering conclusive statements on COVID-19's impact on prescribing. In areas where remote consultations are in use, more comprehensive research is required to assess the safety of prescribing in these settings to inform public health policy and assess if the observed trends in our systematic review persist over time (given the increased consideration of remote and telehealth care in delivering services), particularly the safe and effective deployment of these services.
自 COVID-19 大流行开始以来，全球心理健康障碍的患病率显著上升。大流行还扰乱了精神卫生服务，导致从面对面服务向远程服务转变。鉴于其长期影响，评估大流行期间卫生服务的变化是否对常用精神药物的处方模式产生影响变得至关重要。本研究旨在评估 COVID-19 大流行对成年人精神药物处方模式变化的影响，以及在不同地理背景下不同医疗保健提供方式中的处方差异。
系统评价队列、中断时间序列和横断面研究，这些研究在 2020 年 1 月 1 日至 2022 年 6 月 17 日期间，评估远程或面对面获得护理时至少一种常用精神药物的处方趋势，以及 COVID-19 之后。
除了对相关综述进行引文链接外，还检索了 MEDLINE、EMBASE、CINAHL、HMIC 和 PsycINFO 数据库。
两名独立审查员完成了研究筛选、数据提取和质量评估。使用 PECO 策略设计系统评价，并用叙述性方法综合研究结果。
有 16 项研究符合纳入标准。记录精神药物处方趋势变化的研究提供了非常矛盾的发现。不同医疗保健提供方法（即面对面咨询与远程咨询）之间的处方结果没有明显差异。一个值得注意的发现是，女性的苯二氮䓬类药物处方率高于男性。催眠药、抗抑郁药或抗精神病药的处方率没有观察到特定趋势。
研究结果支持在各种环境下精神药物处方的混合趋势，这使得难以就 COVID-19 对处方的影响得出明确结论。在使用远程咨询的地区，需要进行更全面的研究，以评估这些环境下处方的安全性，为公共卫生政策提供信息，并评估我们系统评价中的观察趋势是否随着时间的推移而持续（鉴于远程和远程医疗服务在提供服务方面的考虑增加），特别是这些服务的安全有效部署。
