A population-based study of incident prescribing for hypercholesterolaemia and hypertension in Scotland: is the healthcare system recovering from the impact of COVID-19?

Background: COVID-19 pandemic caused significant disruptions in healthcare services, with previous studies estimated that the early months of the pandemic led to a substantial decline in new prescriptions for hypercholesterolemia and hypertension. The long-term recovery of healthcare systems in addressing these gaps remains uncertain. We aimed to assess the recovery of the healthcare system in Scotland regarding the initiation of treatments for hypercholesterolemia and hypertension post-COVID-19 pandemic.

Method: This retrospective cohort study analysed prescription data from January 2020 to December 2022 in Scotland, as well as In-hours encounters with general practitioners. Incident prescribing patterns for drugs used in the treatment of hypercholesterolemia and hypertension were compared against pre-pandemic averages from 2018 to 2019. Data were stratified by health regions and socioeconomic status.

Results: New treatment initiations for drugs used in the treatment of hypercholesterolemia and hypertension significantly increased from mid-2021 onwards, surpassing pre-pandemic levels. By December 2022, there were approximately 40,000 and 60,000 additional new treatments for drugs used to treat hypercholesterolemia and hypertension, respectively, compared to the expected numbers based on 2018-2019 averages. The stratified analysis showed a relatively higher increase in less deprived quintiles. GP encounter activities mirrored trends in new antihypertensive and lipid-lowering initiations, with a significant reduction starting in March 2020 due to the first COVID-19 lockdown. Encounter rates gradually recovered from May 2020, reaching near pre-pandemic levels by March 2021. Notably, the encounter rate slopes during the reference period (2018-2019) and post-recovery phase (May 2021-December 2022) showed no significant difference [-0.7 (95% CI: -4.0, 2.5) vs. 0.9 (95% CI: -3.1, 4.9)].

Conclusions: The observed increase in new treatments for drugs to treat hypercholesterolemia and hypertension suggests recovery of the healthcare system in Scotland following the COVID-19 pandemic. These higher prescribing rates post-pandemic hypothesise potential long-term sequelae associated with COVID-19. The findings demonstrate the potential for improved pharmacotherapy strategies that address both the backlog of untreated cases and new-onset conditions linked to COVID-19. This underscores the need for ongoing surveillance and flexible healthcare responses to manage emerging health challenges effectively. Additionally, our findings suggest novel research areas that could offer a more comprehensive understanding of the COVID-19 pandemic's influence on the prescribing patterns of these widely used medications.