Impact of the COVID-19 pandemic on the intensity of health services use in general practice

Background

The COVID-19 pandemic affects non-COVID-19-related health services use due to shutdown measures and fears of potential coronavirus infection or fears of overwhelmed health systems. We aimed to explore the impact of the shutdown in spring 2020 on the intensity of health services use (consultation counts, chronic disease measurement counts) in Swiss general practice.

Methods

Based on electronic medical records from 278 general practitioners in Switzerland, we built two patient cohorts: (1) Jan-Jun 2019 (173,523 patients); (2) Jan-Jun 2020 (179,086 patients). We used linear regression analysis to model weekly consultation counts, as well as weekly blood pressure (BP) and glycated hemoglobin (HbA1c) measurement counts, per 100 patients. We calculated expected values in absence of a shutdown and compared them to actual observed values in 2020. The analyses were repeated for selected at-risk groups (patients with hypertension, diabetes, or cardiovascular disease) and different age groups (<60 years, 60-80 years, and >80 years).

Results

During the shutdown period (calendar weeks 13-19 in 2020), weekly consultation counts were lower than non-shutdown models predicted. Consultation rates reduced by 17.2% for the total population, 16.5% for patients with hypertension, 17.5% for patients with diabetes, and 17.6% for patients with cardiovascular disease. Between different age groups, consultation counts reduced by 15.7% for patients aged <60 years, 20.4% for patients aged 60-80 years, and 14.5% for patients aged >80 years. Weekly BP counts reduced by 35.3% in the total population and by 35.0% for patients with hypertension. Weekly HbA1c counts reduced by 33.2% in the total population and by 29.8% for patients with diabetes. P-values were <0.001 for all reported estimates.

Conclusions

We found a significant decrease in the intensity of health services use in Swiss general practice during the shutdown in spring 2020.

Key messages

We demonstrate that the intensity of health services use in general practice decreased during the first Swiss shutdown in spring 2020, overall and among patients with chronic conditions. It is crucial that health systems remain able to meet the non-COVID-19-related health care needs of patients during shutdowns, especially for patients with chronic conditions who require regular care.

Continuity of care during the COVID-19 pandemic: Qualitative results from a mixed-methods study

Background

Decreases in health service use were observed globally during the COVID-19 pandemic. In the quantitative part of this mixed-methods study, we documented similar trends in Switzerland, with a retrospective cohort study showing a 15-20% decrease in general practitioner (GP) consultations/chronic disease monitoring in spring 2020. These changes need to be understood, particularly for individuals at risk of COVID-19 complications, as many have conditions requiring regular monitoring.

Methods

With a mixed-methods design, we examine continuity of care for at-risk groups (people: ≥65-years-old, with cancer, diabetes, respiratory disease, etc.) between Mar-2020 and Apr-2021. Following quantitative analyses, we qualitatively studied changes in GP/patient practices thru semi-structured interviews with 23 GPs and 36 at-risk patients. We here focus on thematically analyzed qualitative results.

Results

Qualitative data helped explain observed reductions in consultations/monitoring: 1) some patients were discouraged to seek care by official recommendations and/or GPs during the first semi-shutdown; 2) some patients perceived GP offices as closed/overburdened; 3) some patients feared contracting coronavirus; 4) some patients sought alternatives to traditional primary care consultations (e.g., tele-consultations, consulting pharmacists/other professionals, self-reliance). Many patients did not feel that there was discontinuity of their cares. GPs commonly described feeling like an underutilized resource during the pandemic and explained how they could have been mobilized for population needs.

Conclusions

During the first wave, there was a mismatch between 1) GPs' reported availability/preparedness to adequately care for at-risk patients, and 2) some GPs discouraging at-risk patients to come for consultations, at-risk patients' perceptions that their care was not “urgent” in a pandemic setting, and patient perceptions that GPs were otherwise unavailable/overburdened.

Key messages

Qualitative data offer explanations for health service use reductions during the COVID-19 pandemic.

Results provide potential paths forward and highlight GP views of being an underutilized resource.