Early impact of the COVID-19 pandemic on in-person outpatient care utilisation: a rapid review (original) (raw)
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Decline in hospitalization for all medical conditions during the COVID-19 pandemic
Romanian Journal of Orthopaedic Surgery and Traumatology, 2020
Introduction: Hospital admissions fell dramatically in Romania during the COVID-19 pandemic partially due to urgent legislation for controlling the infection rates that influenced the selection criteria for hospitalization and also due to fear of infection with SARS-CoV-2 which resulted in avoiding medical services. Aim: This study aimed to assess the impact of COVID-19 pandemic on the population availability to access medical services by comparing the admission rates for all departments of the University Emergency Hospital, Bucharest, from March to August 2019 and March to August 2020. Methods: A cohort of 38.730 patients was analyzed according to hospitalization rate from March to August 2019 and March to August 2020. Results: From March to August 2020 patients were hospitalized as a result of a medical emergency rather than an appointment, as outpatient and hospitalization rates changed dramatically. Thus, 67.4% accessed hospitalization from March to August 2019 and 32.6% accesse...
Burden of COVID-19 on Primary Care: a Prospective Nationwide Observational Study
BackgroundThe COVID-19 outbreak had an important impact on general practice, e.g., the lack of personal protective equipment (PPE) and the switch to telephone consultations. We installed a monitoring instrument and reported the burden the COVID-19 pandemic placed on Belgian general practitioners (GPs) during the first wave of the pandemic.MethodsWe conducted an observational longitudinal prospective study from the 19th of March until the 17th of August 2020. Daily data were collected by using a structured electronic form integrated into the GPs’ electronic medical records (EMRs). Data were collected on the GPs’ need for support and workload, epidemiological indicators and the availability of PPE. Reports with graphical presentations were made for GP circles and primary care zones, and governments of different administrative levels had access to all data to guide their policy.ResultsA total of 3.769 different GP centres participated, which included more than 10.000 GPs. Throughout th...
Impact of COVID-19 Outbreak on Emergency Visits and Emergency Consultations: A Cross-Sectional Study
Cureus, 2021
Background This study aimed to determine the effect of the COVID-19 outbreak on emergency department (ED) visits and emergency consultations according to the triage levels indicating the patients' urgency. Methods A cross-sectional retrospective study was performed in the ED of a tertiary training and research hospital between 1 April and 31 May 2020 in İstanbul, Turkey. The daily count of emergency visits and the count of the emergency consultations during the study period were recorded. The emergency visits and consultations in the same months of the previous year (1 April-31 May 2019) were included as a control group. Results Approximately 50% reduction in ED visits and a 30% reduction in emergency consultations were detected. A significant decrease was detected in all triage levels of visits and emergency consultations (p < 0.001). Within total ED visits, a significant increase was found in the red (4.32% vs. 4.74%) and yellow (21.66% vs. 33.16%) triage levels visit rates, while the green (74.01% vs. 62.1%) level was decreased. Within total emergency consultations, anesthesiology (0.83% vs. 1.56%) and cardiology (3.17% vs. 3.75%) consultation rates increased, neurology (2.22% vs. 1.15%), orthopedics (3.53% vs. 3.01%), and ophthalmology (2.89% vs. 1.57%) consultation rates decreased, internal medicine (2.45% vs. 2.49%), and general surgery (4.46% vs. 4.64%) consultation rates did not change. Conclusions During the COVID-19 pandemic, ED visits at all triage levels decreased. While the rate of critical patient visits increased, non-emergency patient visit rates decreased. The total count of consultations decreased, while the total consultation rates increased. The management of the COVID-19 pandemic will be easier by using or developing appropriate triage scores, as well as establishing good interdisciplinary coordination.
Annals of Emergency Medicine, 2021
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Primary health care and hospital management during COVID-19
International journal of health sciences
Introduction: The COVID-19 outbreak has brought to light the issues and risks that frontline healthcare professionals face (HCW). The goal of this study was to describe the clinical outcomes and risk variables in HCW infected with SARS-CoV-2 and thus evaluate the primary health care and hospital management. Methods: A total of 328 articles were found after searching three databases. Only 97 full-text articles were screened because 225 articles did not match the inclusion criteria. Finally, 30 articles were included in the systematic review and 28 were used in the meta-analysis following further revision. Results: Twenty-eight studies with a total of 119,883 patients were found. The patients' average age was 38.37 years (95 percent CI 36.72–40.03), and males made up 21.4 percent of the HCW population (95 percent CI 12.4–34.2). COVID-19 positivity was found in 51.7 percent of HCW (95 percent confidence interval: 34.7–68.2). In seven investigations, the overall prevalence of comorb...
Journal of General Internal Medicine, 2022
BACKGROUND: The first surge of the COVID-19 pandemic entirely altered healthcare delivery. Whether this also altered the receipt of high-and low-value care is unknown. OBJECTIVE: To test the association between the April through June 2020 surge of COVID-19 and various high-and low-value care measures to determine how the delivery of care changed. DESIGN: Difference in differences analysis, examining the difference in quality measures between the April through June 2020 surge quarter and the January through March 2020 quarter with the same 2 quarters' difference the year prior. PARTICIPANTS: Adults in the MarketScan® Commercial Database and Medicare Supplemental Database. MAIN MEASURES: Fifteen low-value and 16 high-value quality measures aggregated into 8 clinical quality composites (4 of these low-value). KEY RESULTS: We analyzed 9,352,569 adults. Mean age was 44 years (SD, 15.03), 52% were female, and 75% were employed. Receipt of nearly every type of low-value care decreased during the surge. For example, low-value cancer screening decreased 0.86% (95% CI, −1.03 to −0.69). Use of opioid medications for back and neck pain (DiD +0.94 [95% CI, +0.82 to +1.07]) and use of opioid medications for headache (DiD +0.38 [95% CI, 0.07 to 0.69]) were the only two measures to increase. Nearly all highvalue care measures also decreased. For example, highvalue diabetes care decreased 9.75% (95% CI, −10.79 to −8.71). CONCLUSIONS: The first COVID-19 surge was associated with receipt of less low-value care and substantially less high-value care for most measures, with the notable exception of increases in low-value opioid use.
Difference in impact on emergency department visits following four major peaks of COVID-19 cases
Journal of Hospital Administration
Objective: Several variants of SARS-CoV-2 have emerged since its first appearance in 2019, greatly impacting healthcare systems across the globe. Previous literature indicated a substantial decline in emergency department (ED) visits in hospitals since the start of the COVID-19 pandemic. However, little research has been done to compare different variants’ (Ancestral, Alpha, Delta, Omicron, etc.) impact on patients presenting to the ED. Thus, the purpose of this retrospective observational study is to compare the changes in total ED volume following four major peaks of SARS-CoV-2 infection within a multi-hospital health system.Methods: Utilizing electronic healthcare record (EHR) data, total ED visits (484,268) and COVID-19 case counts (24,358) were collected and analyzed to compare ED census and COVID-19 trends across four years and four variant peak periods, from January 2019 to June 2022.Results: Results showed that ED visits declined after the first two major peaks (Ancestral an...
Evaluating the Impact of the COVID-19 Pandemic on Monthly Trends in Primary Care
Cureus, 2022
Introduction As the COVID-19 pandemic progressed, multiple barriers arose for patients and providers in the primary care setting. Despite the attempt to utilize telemedicine to overcome barriers, visits remained lower than prepandemic levels. This raises concern for preventative medicine and chronic disease management. Methods This study aimed to evaluate the impact of the pandemic in primary care by utilizing two years of data from a family medicine clinic. Data obtained from the electronic medical record for March 2019 through February 2020 and March 2020 through February 2021 were used to evaluate monthly trends from the year before the pandemic and the first year of the pandemic in the following six categories: hypertension control, diabetes control, lipid profile screening, breast cancer screening, colorectal cancer screening, and cervical cancer screening. Results The paired t-tests found a significant difference in the averages between the two years for all categories except hypertension control. The results for chi-square demonstrated a significant difference in four months for cervical cancer screening, five months for hypertension control and colorectal cancer screening, nine months for diabetes control and lipid profile screening, and 10 months for breast cancer screening. Conclusion These results show a profound impact of the pandemic on both preventative medicine and chronic disease management. This study had a large sample size but is not generalizable to the entire population. These results can help guide quality improvement measures going forward. However, further research is necessary to better understand the full extent of COVID-19's impact on primary care.
Effect of covid-19 pandemic on in-hospital mortality
2021
Objective: This study aimed to examine the effect of the pandemic on hospital mortality and patient admission in four months since March 2020 when the Ministry of Health announced the first confirmed COVID-19 case in Turkey and the first wave occurred. Material-Method: This research is a single-centre, retrospective, cross-sectional descriptive study. It covers the periods between March 01 and Jun 30 of 2018, 2019, and 2020. Results: Between 2018-2020, 897522, 972799, and 395438 patients were admitted to our Hospital, respectively. It was observed that the number of admissions decreased by 5560% in 2020 compared to the previous years (p=0.001). Moreover, 205318 (22.9%) of the admissions in 2018, 229278 (23.6%) of the admissions in 2019, and 1127293 (32%) of the admissions in 2020 were emergency room (ER) admissions. Especially in 2020, there was a significant increase in the overall in-hospital (p=0.001) and ER (p=0.001 mortality rates compared to previous years. In-hospital mortali...
JAMA Health Forum, 2021
IMPORTANCE While the COVID-19 pandemic has been associated with some substitution of telemedicine for office-based care in the US, to our knowledge, little is known regarding the pandemic's association with the clinical content of ambulatory care. OBJECTIVE To characterize changes in the clinical content of ambulatory care among office-based vs telemedicine encounters in the US before vs during the COVID-19 pandemic. DESIGN, SETTINGS, AND PARTICIPANTS This analysis of serial cross-sectional data from the IQVIA National Disease and Therapeutic Index was a 2-stage, stratified nationally representative audit of outpatient care in the US from January 1, 2018, through December 31, 2020. The National Disease and Therapeutic Index generates approximately 33 617 quarterly visits that are projected to 306.7 million national visits based on the survey design. MAIN OUTCOMES AND MEASURES (1) Prevalence of common diagnoses and (2) mix of long-term, short-term, and preventive care. RESULTS The mean (SD) number of projected quarterly, in-person, office-based visits was 282.1