Provision of COVID-19 treatments to non-hospitalised patients in Northern Ireland: an evaluation

Abstract

Abstract Background The first UK interim clinical commissioning policy for the treatment of non-hospitalised patients with COVID-19 was published in December 2021. A service was established in Northern Ireland, with implementation and developments overseen by a multi-agency group. We investigated the reach, uptake and equity of the programme to understand performance and offer recommendations for improvement. Description of the problem Data were extracted for 16 December 2021 to 16 December 2022. The objectives were to: 1) describe referrals over time using weekly aggregate returns sourced from the commissioning agency for all of NI and; 2) for a subset of providers, to describe treatment acceptance and those treated by age group, sex, deprivation quintile and all-cause mortality using anonymised, linked administrative data. Treatment acceptance was analysed using logistic regression. Results Overall, 16,454 patients were referred of whom 9,536 (58%) were eligible for treatment. Of these, 5,849 (61.3%) accepted, 1,215 (12.7%) declined, 1,140 (12%) were already an inpatient and the remainder unknown (1,332; 14%). Using the subset, treatment acceptance was associated with increasing age (likelihood ratio test (LRT) P = 0.02) but not deprivation (LRT P = 0.83). Of those treated (3,645 people) the majority were aged 18-64 years (68%) and were female (59%). Just 8% lived in the ‘most deprived’ quintile, compared to 20% in all others. The 28-day all-cause mortality for those recommended treatment was <1%. Lessons This was a rapidly established service which has treated 5,849 people. Acceptance of treatment increased with age but was not affected by deprivation. However, a higher percentage of those treated were from least deprived areas. Recommendations include monitoring equitability of access and a greater focus on those eligible for treatment but who decline, both highlighting the importance of engaging and empowering service users to make an informed choice around COVID-19 treatment. Key messages • Almost 6,000 people in the community have received a COVID-19 treatment since the inception of the service in Northern Ireland. • Equitability of access should continue to be monitored.