The Impact of the COVID-19 Pandemic on Utilization of Healthcare Services among Individuals with Schizophrenia in the United States

Author(s): Joshua N. Liberman, Jacqueline Pesa, Mary Pat Petrillo

Background: Individuals with schizophrenia were at high risk for negative outcomes during the COVID-19 pandemic.

Objective: Determine if the COVID-19 pandemic disrupted healthcare utilization among individuals with schizophrenia.

Methods: Using insurance claims licensed from Clarivate, a retrospective cohort study was conducted among 493,796 adults with schizophrenia between 1/1/2019 and 9/30/2020. Healthcare utilization was measured six months prior to (baseline) and following (follow up) 3/1/2020 and included primary care, psychiatry, psychotherapy, Community Mental Health Centers (CMHC), Emergency Department (ED), partial-day and inpatient hospitalizations, and medication use. Changes in long-acting injectable (LAI) antipsychotic use were presented by state-level policies authorizing pharmacists to administer drugs.

Results: During follow up, primary care utilization increased 11%, inperson visits declined 32.5% and telehealth-delivered visits increased 496%. Psychiatry and psychotherapy visits increased 36.6% and 17.2%, with a 53% and 40.4% decline in in-person visits offset by 1174% and 4836% increase in telehealth-delivered services. Partial-day hospitalizations declined by 37.8% and CMHC visits declined 15.1%. Oral antipsychotic medication days’ supply increased by 2.8%, driven by a sustained increase in 90-day supply of prescription fills. LAI antipsychotic use declined 1.3% and change in LAI utilization varied among states with different policies regarding pharmacist authorization to administer LAI antipsychotic medications.

Conclusions: Following pandemic onset, partial-day hospitalizations and CMHC visits declined substantially but primary care and other outpatient mental healthcare services increased. Sustained use of telehealth suggests the acceptability of this modality to both patients and providers. LAI utilization varied among states with different policies that authorize pharmacist administration.