Impact of COVID-19 on prescribing in English general practice: March 2020

OpenPrescribing.net has been updated this week with the latest release of prescribing data covering March 2020. In-depth analysis will be needed over the coming months, but this release gives us the first glimpse into the impact that COVID-19 has had on prescribing. At the Bennett Institute we have been quite busy with the new secure analytics platform OpenSAFELY but the following blog is a rapid analysis of the March prescribing data which others may find helpful to focus their own investigations. As always, all our analytical code is openly available on our GitHub for inspection and reuse by anyone.

What is the overall prescribing impact?

Overall, there has been an increase of 8.5 million items (9.3%) in March 2020 and additional costs of £118 million (17.6%) compared to March 2019. There are really interesting changes when we inspect these increases by chemical substance (table 1).

Salbutamol inhalers (Brand names: Ventolin, Salamol) saw a massive 55% increase in March which along with a similar increase for Beclometasone inhalers that confirms various news reports (BBC, Pharmaceutical Journal) at the end of March about concerns for availability of inhalers due to the increased demand.

Paracetamol also saw a substantial increase in prescriptions as well as the reported increase in over the counter purchases.

The rest of the top 10 increases are made up of medicines that are issued as repeat prescriptions for long-term conditions and regularly make the top 10 commonly prescribed medicines. Prior to lockdown it is quite likely that people ordered repeat prescriptions and it will be interesting to see if this increase is sustained in future months.

You may be interested to look at prescribing of other specific medicines, and you can do this using OpenPrescribing analyse or chemical trends pages. For example, we can also see that hydroxychloroquine has seen an increase, and further work will be needed to understand if this has been caused by increased ordering of repeat medications or proclaimed benefit in COVID-19.

What has happened with antibiotics?

There are many groups of medicines to investigate but here we focus first on changes to antibiotic prescriptions. We have chosen to look at this group as: they may be used to treat bacterial infections that occur at the same time as viral infection, inappropriate usage may contribute to antibiotic resistance, and finally in March rumours began to circulate on the internet (see ITV news report) that encouraged people to go to their GP for “rescue packs” which include antibiotics. Table 2 shows the biggest changes. Doxycycline and amoxicillin show the largest increases in items. The causes of the increases will require further in-depth reports as these two antibiotics are commonly used in rescue packs and also used by GPs to treat bacterial infections. Interestingly, we see substantial drops in flucloxacillin, an antibiotic commonly used to treat skin infections, and in antibiotics commonly used to treat urinary tract infections (nitrofurantoin and trimethoprim). This could be caused by reductions in the volume of people presenting with conditions that perhaps they consider can wait for attention.

We hope you have found this rapid pragmatic analysis useful. We will endeavour to take a closer look in the coming months, but in the interim feel free to use this analysis to guide your own investigations. Please get in touch [feedback@openprescribing.net](mailto: feedback@openprescribing.net) if you spot anything interesting.