Ambulatory Medication Safety Events in High-risk Patients With Diabetes Before and After a COVID-19 Clinic Slowdown.

Objectives: We aimed to assess possible changes in medication safety over a mandatory pre-/post- COVID-19 clinic slowdown in a high-risk population of patients with diabetes seen at a safety net clinic.

Methods: Retrospective chart review of all patient encounters 1 year before and after the slowdown. The study cohort were all patients with poorly controlled diabetes established pre-COVID-19 who were prescribed 4+ chronic medications. Each clinic note was abstracted for reports of any medication-related problems. The primary outcomes were measures of health care system utilization and potential adverse drug events (ADEs).

Results: Out of 762 patients with diabetes, 59 were poorly controlled and formed the high-risk study cohort: age 53.0±11 years, 69% female, 17% White, 29% Hispanic, and 43% African American. There were similar numbers of patient encounters pre-/post-slowdown (7.68 clinic visits vs. 4.2 clinic visits plus 3.19 telehealth visits), cancellations (2.54 vs. 2.97), and no-shows (2.17 vs. 1.98). There was no change in the number of prescribed medications pre-/post-slowdown (12.1 vs. 11.7), but more potential adverse medication events (6/380 (1.6%) vs. 17/429 (4.0%), P=0.04). Of all abstracted medication-related problems, the majority were in diabetic medications 57/78 (73.1%), and of those, most involved insulin 43/57 (75.4%). Eleven preventable ADEs over the 2-year period were observed, all involved insulin, and were often affected by patient work system challenges such as self-administration and timing.

Conclusions: There was a small increase in potential adverse medication events among a cohort of high-risk patients during the COVID-19 pandemic. The most common ADE was hypoglycemia associated with insulin.