[Skip to Content]
[Skip to Content Landing]

Comparison of Medication Prescribing Before and After the COVID-19 Pandemic Among Nursing Home Residents in Ontario, Canada

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  How are COVID-19 and related disruptions in care associated with changes in the dispensation of medications commonly used among nursing home residents?

Findings  In this population-based cohort study with an interrupted time-series analysis of all nursing home residents from the 630 facilities in Ontario, Canada, the emergence of the COVID-19 pandemic was associated with significant increases in the use of antipsychotics, benzodiazepines, antidepressants, anticonvulsants, and opioids and no meaningful changes in the use of antibiotics or selected cardiovascular medications.

Meaning  The finding of increased use of medications with the potential for adverse effects among nursing home residents during the initial wave of the pandemic warrants ongoing monitoring for prescribing appropriateness and related resident outcomes.


Importance  COVID-19 has had devastating effects on the health and well-being of older adult residents and health care professionals in nursing homes. Uncertainty about the associated consequences of these adverse effects on the use of medications common to this care setting remains.

Objective  To examine the association between the COVID-19 pandemic and prescription medication changes among nursing home residents.

Design, Setting, and Participants  This population-based cohort study with an interrupted time-series analysis used linked health administrative data bases for residents of all nursing homes (N = 630) in Ontario, Canada. During the observation period, residents were divided into consecutive weekly cohorts. The first observation week was March 5 to 11, 2017; the last observation week was September 20 to 26, 2020.

Exposures  Onset of the COVID-19 pandemic on March 1, 2020.

Main Outcomes and Measures  Weekly proportion of residents dispensed antipsychotics, benzodiazepines, antidepressants, anticonvulsants, opioids, antibiotics, angiotensin receptor blockers (ARBs), and angiotensin-converting enzyme (ACE) inhibitors. Autoregressive integrated moving average models with step and ramp intervention functions tested for level and slope changes in weekly medication use after the onset of the pandemic and were fit on prepandemic data for projected trends.

Results  Across study years, the annual cohort size ranged from 75 850 to 76 549 residents (mean [SD] age, 83.4 [10.8] years; mean proportion of women, 68.9%). A significant increased slope change in the weekly proportion of residents who were dispensed antipsychotics (parameter estimate [β] = 0.051; standard error [SE] = 0.010; P < .001), benzodiazepines (β = 0.026; SE = 0.003; P < .001), antidepressants (β = 0.046; SE = 0.013; P < .001), trazodone hydrochloride (β = 0.033; SE = 0.010; P < .001), anticonvulsants (β = 0.014; SE = 0.006; P = .03), and opioids (β = 0.038; SE = 0.007; P < .001) was observed. The absolute difference in observed vs estimated use in the last week of the pandemic period ranged from 0.48% (for anticonvulsants) to 1.52% (for antipsychotics). No significant level or slope changes were found for antibiotics, ARBs, or ACE inhibitors.

Conclusions and Relevance  In this population-based cohort study, statistically significant increases in the use of antipsychotics, benzodiazepines, antidepressants, anticonvulsants, and opioids followed the onset of the COVID-19 pandemic, although absolute differences were small. There were no significant changes for antibiotics, ARBs, or ACE inhibitors. Studies are needed to monitor whether changes in pharmacotherapy persist, regress, or accelerate during the course of the pandemic and how these changes affect resident-level outcomes.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: May 21, 2021.

Published: August 2, 2021. doi:10.1001/jamanetworkopen.2021.18441

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Campitelli MA et al. JAMA Network Open.

Corresponding Author: Colleen J. Maxwell, PhD, School of Pharmacy, University of Waterloo, 200 University Ave West, Waterloo, ON N2L 3G1, Canada (colleen.maxwell@uwaterloo.ca).

Author Contributions: Mr Campitelli had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Campitelli, Bronskill, Maclagan, Harris, Cotton, Tadrous, Gruneir, Maxwell.

Acquisition, analysis, or interpretation of data: Campitelli, Bronskill, Cotton, Tadrous, Gruneir, Hogan, Maxwell.

Drafting of the manuscript: Campitelli, Hogan, Maxwell.

Critical revision of the manuscript for important intellectual content: Campitelli, Bronskill, Maclagan, Harris, Cotton, Tadrous, Gruneir, Maxwell.

Statistical analysis: Campitelli, Maclagan, Harris, Cotton, Gruneir.

Obtained funding: Bronskill, Maxwell.

Administrative, technical, or material support: Harris.

Supervision: Bronskill, Tadrous, Maxwell.

Conflict of Interest Disclosures: Dr Bronskill reported receiving grants from the Canadian Institutes of Health Research (CIHR), nonfinancial support from ICES (formerly Institute for Clinical Evaluative Sciences), and grants from the Ontario Health Data Platform (OHDP) during the conduct of the study. Dr Tadrous reported receiving grants from the Ontario Ministry of Health (MOH) and the Ministry of Long-term Care (MLTC) during the conduct of the study. Dr Maxwell reported receiving grants from the CIHR, nonfinancial support from the ICES, and grants from the OHDP during the conduct of the study. No other disclosures were reported.

Funding/Support: This research was funded by the CIHR through operating grant MOP-136854 (Exploring frailty and its role in the assessment of high-risk medications and risk of poor health outcomes in vulnerable populations), by ICES through an annual grant from the Ontario MOH and the MLTC; and by the OHDP, a Province of Ontario initiative to support Ontario’s ongoing response to COVID-19 and its related effects.

Role of the Funder/Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The opinions, results and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by the ICES, the MOH or MLTC, OHDP, its partners, or the Province of Ontario is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the CIHI; however, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of CIHI.

Additional Contributions: We thank IQVIA Solutions Canada Inc. for use of their Drug Information Database.

Additional Information: The data set from this study is held securely in coded form at ICES. Although data sharing agreements prohibit ICES from making the data set publicly available, access may be granted to those who meet prespecified criteria for confidential access at https://www.ices.on.ca/DAS. Please contact the authors for any supplemental information related to the study such as the study protocol, analysis plan, or analytic code. The full data set creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely on coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.

Le Couteur  DG , Anderson  RM , Newman  AB .  COVID-19 through the lens of gerontology.   J Gerontol A Biol Sci Med Sci. 2020;75(9):e119-e120. doi:10.1093/gerona/glaa077 PubMedGoogle ScholarCrossref
Montero-Odasso  M , Hogan  DB , Lam  R ,  et al.  Age alone is not adequate to determine health-care resource allocation during the COVID-19 pandemic.   Can Geriatr J. 2020;23(1):152-154. doi:10.5770/cgj.23.452 PubMedGoogle ScholarCrossref
White  EM , Santostefano  CM , Feifer  RA ,  et al.  Asymptomatic and presymptomatic severe acute respiratory syndrome coronavirus 2 infection rates in a multistate sample of skilled nursing facilities.   JAMA Intern Med. 2020;180(12):1709-1711. doi:10.1001/jamainternmed.2020.5664 PubMedGoogle ScholarCrossref
Arons  MM , Hatfield  KM , Reddy  SC ,  et al; Public Health–Seattle and King County and CDC COVID-19 Investigation Team.  Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility.   N Engl J Med. 2020;382(22):2081-2090. doi:10.1056/NEJMoa2008457 PubMedGoogle ScholarCrossref
Richardson  S , Hirsch  JS , Narasimhan  M ,  et al; the Northwell COVID-19 Research Consortium.  Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.   JAMA. 2020;323(20):2052-2059. doi:10.1001/jama.2020.6775 PubMedGoogle ScholarCrossref
Myers  LC , Parodi  SM , Escobar  GJ , Liu  VX .  Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California.   JAMA. 2020;323(21):2195-2198. doi:10.1001/jama.2020.7202 PubMedGoogle ScholarCrossref
Comas-Herrera  A , Zalakaín  J , Lemmon  E ,  et al. Mortality associated with COVID-19 in care homes: international evidence. Updated February 1, 2021. Accessed May 4, 2020. https://ltccovid.org/2020/04/12/mortality-associated-with-covid-19-outbreaks-in-care-homes-early-international-evidence/
McMichael  TM , Currie  DW , Clark  S ,  et al; Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team.  Epidemiology of COVID-19 in a long-term care facility in King County, Washington.   N Engl J Med. 2020;382(21):2005-2011. doi:10.1056/NEJMoa2005412 PubMedGoogle ScholarCrossref
Barnett  ML , Grabowski  DC .  Nursing homes are ground zero for COVID-19 pandemic.   JAMA Health Forum. 2020;1(3):e200369. doi:10.1001/jamahealthforum.2020.0369 Google Scholar
Ouslander  JG , Grabowski  DC .  COVID-19 in nursing homes: calming the perfect storm.   J Am Geriatr Soc. 2020;68(10):2153-2162. doi:10.1111/jgs.16784 PubMedGoogle ScholarCrossref
Van Houtven  CH , DePasquale  N , Coe  NB .  Essential long-term care workers commonly hold second jobs and double- or triple-duty caregiving roles.   J Am Geriatr Soc. 2020;68(8):1657-1660. doi:10.1111/jgs.16509 PubMedGoogle ScholarCrossref
McGregor  MJ , Harrington  C .  COVID-19 and long-term care facilities: does ownership matter?   CMAJ. 2020;192(33):E961-E962. doi:10.1503/cmaj.201714 PubMedGoogle ScholarCrossref
Xu  H , Intrator  O , Bowblis  JR .  Shortages of staff in nursing homes during the COVID-19 pandemic: what are the driving factors?   J Am Med Dir Assoc. 2020;21(10):1371-1377. doi:10.1016/j.jamda.2020.08.002 PubMedGoogle ScholarCrossref
McGarry  BE , Grabowski  DC , Barnett  ML .  Severe staffing and personal protective equipment shortages faced by nursing homes during the COVID-19 pandemic.   Health Aff (Millwood). 2020;39(10):1812-1821. doi:10.1377/hlthaff.2020.01269 PubMedGoogle ScholarCrossref
Verbeek  H , Gerritsen  DL , Backhaus  R , de Boer  BS , Koopmans  RTCM , Hamers  JPH .  Allowing visitors back in the nursing home during the COVID-19 crisis: a Dutch national study into first experiences and impact on well-being.   J Am Med Dir Assoc. 2020;21(7):900-904. doi:10.1016/j.jamda.2020.06.020 PubMedGoogle ScholarCrossref
Ailabouni  NJ , Hilmer  SN , Kalisch  L , Braund  R , Reeve  E .  COVID-19 pandemic: considerations for safe medication use in older adults with multimorbidity and polypharmacy.   J Gerontol A Biol Sci Med Sci. 2021;76(6):1068-1073. doi:10.1093/gerona/glaa104 PubMedGoogle ScholarCrossref
Howard  R , Burns  A , Schneider  L .  Antipsychotic prescribing to people with dementia during COVID-19.   Lancet Neurol. 2020;19(11):892. doi:10.1016/S1474-4422(20)30370-7 PubMedGoogle ScholarCrossref
Leontjevas  R , Knippenberg  IAH , Smalbrugge  M ,  et al.  Challenging behavior of nursing home residents during COVID-19 measures in the Netherlands.   Aging Ment Health. 2020;1-6. PubMedGoogle Scholar
Stall  NM , Zipursky  JS , Rangrej  J ,  et al.  Assessment of psychotropic drug prescribing among nursing home residents in Ontario, Canada, during the COVID-19 pandemic.   JAMA Intern Med. 2021;181(6):861-863. doi:10.1001/jamainternmed.2021.0224 PubMedGoogle ScholarCrossref
Canadian Institute for Health Information [CIHI]. Drug use among seniors in Canada, 2016. Canadian Institute for Health Information; 2018. Accessed December 16, 2020. https://www.cihi.ca/sites/default/files/document/drug-use-among-seniors-2016-en-web.pdf
Maclagan  LC , Maxwell  CJ , Gandhi  S ,  et al.  Frailty and potentially inappropriate medication use at nursing home transition.   J Am Geriatr Soc. 2017;65(10):2205-2212. doi:10.1111/jgs.15016 PubMedGoogle ScholarCrossref
Iaboni  A , Bronskill  SE , Reynolds  KB ,  et al.  Changing pattern of sedative use in older adults: a population-based cohort study.   Drugs Aging. 2016;33(7):523-533. doi:10.1007/s40266-016-0380-3 PubMedGoogle ScholarCrossref
Iaboni  A , Campitelli  MA , Bronskill  SE ,  et al.  Time trends in opioid prescribing among Ontario long-term care residents: a repeated cross-sectional study.   CMAJ Open. 2019;7(3):E582-E589. doi:10.9778/cmajo.20190052 PubMedGoogle ScholarCrossref
Daneman  N , Campitelli  MA , Giannakeas  V ,  et al.  Influences on the start, selection and duration of treatment with antibiotics in long-term care facilities.   CMAJ. 2017;189(25):E851-E860. doi:10.1503/cmaj.161437 PubMedGoogle ScholarCrossref
Maust  DT , Kim  HM , Chiang  C , Kales  HC .  Association of the Centers for Medicare & Medicaid Services’ national partnership to improve dementia care with the use of antipsychotics and other psychotropics in long-term care in the United States from 2009 to 2014.   JAMA Intern Med. 2018;178(5):640-647. doi:10.1001/jamainternmed.2018.0379 PubMedGoogle ScholarCrossref
Zhao  D , Shridharmurthy  D , Alcusky  MJ ,  et al.  The prevalence and factors associated with antiepileptic drug use in US nursing home residents.   Drugs Aging. 2020;37(2):137-145. doi:10.1007/s40266-019-00732-2 PubMedGoogle ScholarCrossref
Cohen  JB , D’Agostino McGowan  L , Jensen  ET , Rigdon  J , South  AM .  Evaluating sources of bias in observational studies of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use during COVID-19: beyond confounding.   J Hypertens. 2021;39(4):795-805. doi:10.1097/HJH.0000000000002706PubMedGoogle ScholarCrossref
Danser  AHJ , Epstein  M , Batlle  D .  Renin-angiotensin system blockers and the COVID-19 pandemic: at present there is no evidence to abandon renin-angiotensin system blockers.   Hypertension. 2020;75(6):1382-1385. doi:10.1161/HYPERTENSIONAHA.120.15082 PubMedGoogle ScholarCrossref
Vaduganathan  M , Vardeny  O , Michel  T , McMurray  JJV , Pfeffer  MA , Solomon  SD .  Renin-angiotensin-aldosterone system inhibitors in patients with COVID-19.   N Engl J Med. 2020;382(17):1653-1659. doi:10.1056/NEJMsr2005760 PubMedGoogle ScholarCrossref
Quinn  KL , Fralick  M , Zipursky  JS , Stall  NM .  Renin-angiotensin-aldosterone system inhibitors and COVID-19.   CMAJ. 2020;192(20):E553-E554. doi:10.1503/cmaj.200619 PubMedGoogle ScholarCrossref
Hippisley-Cox  J , Young  D , Coupland  C ,  et al.  Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: cohort study including 8.3 million people.   Heart. 2020;106(19):1503-1511. doi:10.1136/heartjnl-2020-317393 PubMedGoogle ScholarCrossref
Fosbøl  EL , Butt  JH , Østergaard  L ,  et al.  Association of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use with COVID-19 diagnosis and mortality.   JAMA. 2020;324(2):168-177. doi:10.1001/jama.2020.11301 PubMedGoogle ScholarCrossref
Reynolds  HR , Adhikari  S , Pulgarin  C ,  et al.  Renin-angiotensin-aldosterone system inhibitors and risk of COVID-19.   N Engl J Med. 2020;382(25):2441-2448. doi:10.1056/NEJMoa2008975 PubMedGoogle ScholarCrossref
World Health Organization. COVID-19 and the use of angiotensin-converting enzyme inhibitors and receptor blockers. May 7, 2020. Accessed December 22, 2020. https://www.who.int/news-room/commentaries/detail/covid-19-and-the-use-of-angiotensin-converting-enzyme-inhibitors-and-receptor-blockers
Vaduganathan  M , van Meijgaard  J , Mehra  MR , Joseph  J , O’Donnell  CJ , Warraich  HJ .  Prescription fill patterns for commonly used drugs during the COVID-19 pandemic in the United States.   JAMA. 2020;323(24):2524-2526. doi:10.1001/jama.2020.9184 PubMedGoogle ScholarCrossref
Government of Ontario. Personal Health Information Protection Act, 2004, S.O. 2004, Chapter. 3, Schedule. A. Updated June 3, 2021. Accessed June 25, 2021. https://www.ontario.ca/laws/statute/04p03
Langan  SM , Schmidt  SA , Wing  K ,  et al.  The Reporting of Studies Conducted Using Observational Routinely Collected Health Data Statement for Pharmacoepidemiology (RECORD-PE).   BMJ. 2018;363:k3532. doi:10.1136/bmj.k3532 PubMedGoogle Scholar
Ng  R , Lane  N , Tanuseputro  P ,  et al.  Increasing complexity of new nursing home residents in Ontario, Canada: a serial cross-sectional study.   J Am Geriatr Soc. 2020;68(6):1293-1300. doi:10.1111/jgs.16394 PubMedGoogle ScholarCrossref
Campitelli  MA , Bronskill  SE , Hogan  DB ,  et al.  The prevalence and health consequences of frailty in a population-based older home care cohort: a comparison of different measures.   BMC Geriatr. 2016;16:133. doi:10.1186/s12877-016-0309-z PubMedGoogle ScholarCrossref
Austin  PC .  Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.   Stat Med. 2009;28(25):3083-3107. doi:10.1002/sim.3697 PubMedGoogle ScholarCrossref
Bernal  JL , Cummins  S , Gasparrini  A .  Interrupted time series regression for the evaluation of public health interventions: a tutorial.   Int J Epidemiol. 2017;46(1):348-355.PubMedGoogle Scholar
Public Health Ontario. Daily epidemiologic summary: COVID-19 in Ontario: January 15, 2020 to December 21, 2020. 2020. Accessed January 8, 2021. https://files.ontario.ca/moh-covid-19-report-en-2020-12-22.pdf
Helfenstein  U .  The use of transfer function models, intervention analysis and related time series methods in epidemiology.   Int J Epidemiol. 1991;20(3):808-815. doi:10.1093/ije/20.3.808 PubMedGoogle ScholarCrossref
Dickey  DA , Fuller  WA .  Distribution of the estimators for autoregressive time series with a unit root.   J Am Stat Assoc. 1979;74(366):427-431. doi:10.2307/2286348Google ScholarCrossref
Abbasi  J .  Social isolation—the other COVID-19 threat in nursing homes.   JAMA. 2020;324(7):619-620. doi:10.1001/jama.2020.13484 PubMedGoogle ScholarCrossref
Ontario Drug Policy Research Network. COVID-19 Ontario prescription drug utilization tool. Updated June 16, 2021. Accessed December 22, 2020. https://odprn.ca/covid19-ontario-prescription-drug-utilization-tool/
Macri  JC , Iaboni  A , Kirkham  JG ,  et al.  Association between antidepressants and fall-related injuries among long-term care residents.   Am J Geriatr Psychiatry. 2017;25(12):1326-1336. doi:10.1016/j.jagp.2017.08.014 PubMedGoogle ScholarCrossref
Watt  JA , Gomes  T , Bronskill  SE ,  et al.  Comparative risk of harm associated with trazodone or atypical antipsychotic use in older adults with dementia: a retrospective cohort study.   CMAJ. 2018;190(47):E1376-E1383. doi:10.1503/cmaj.180551 PubMedGoogle ScholarCrossref
Bronskill  SE , Campitelli  MA , Iaboni  A ,  et al.  Low-dose trazodone, benzodiazepines, and fall-related injuries in nursing homes: a matched-cohort study.   J Am Geriatr Soc. 2018;66(10):1963-1971. doi:10.1111/jgs.15519 PubMedGoogle ScholarCrossref
Hsu  J .  How COVID-19 is accelerating the threat of antimicrobial resistance.   BMJ. 2020;369:m1983. doi:10.1136/bmj.m1983 PubMedGoogle Scholar
Strathdee  SA , Davies  SC , Marcelin  JR .  Confronting antimicrobial resistance beyond the COVID-19 pandemic and the 2020 US election.   Lancet. 2020;396(10257):1050-1053. doi:10.1016/S0140-6736(20)32063-8 PubMedGoogle ScholarCrossref
Arshad  M , Mahmood  SF , Khan  M , Hasan  R .  COVID-19, misinformation, and antimicrobial resistance.   BMJ. 2020;371:m4501. doi:10.1136/bmj.m4501 PubMedGoogle Scholar
Langford  BJ , So  M , Raybardhan  S ,  et al.  Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis.   Clin Microbiol Infect. 2020;26(12):1622-1629. doi:10.1016/j.cmi.2020.07.016 PubMedGoogle ScholarCrossref
Armitage  R , Nellums  LB .  Antibiotic prescribing in general practice during COVID-19.   Lancet Infect Dis. 2021;21(6):e144. doi:10.1016/S1473-3099(20)30917-8PubMedGoogle Scholar
Daneman  N , Bronskill  SE , Gruneir  A ,  et al.  Variability in antibiotic use across nursing homes and the risk of antibiotic-related adverse outcomes for individual residents.   JAMA Intern Med. 2015;175(8):1331-1339. doi:10.1001/jamainternmed.2015.2770 PubMedGoogle ScholarCrossref
Taipale  H , Särkilä  H , Tanskanen  A ,  et al.  Incidence of and characteristics associated with long-term benzodiazepine use in Finland.   JAMA Netw Open. 2020;3(10):e2019029. doi:10.1001/jamanetworkopen.2020.19029 PubMedGoogle Scholar
Lornstad  MT , Aarøen  M , Bergh  S , Benth  JS , Helvik  AS .  Prevalence and persistent use of psychotropic drugs in older adults receiving domiciliary care at baseline.   BMC Geriatr. 2019;19(1):119. doi:10.1186/s12877-019-1126-y PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity


My Saved Searches

You currently have no searches saved.


My Saved Courses

You currently have no courses saved.