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

Abstract

Abstract 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.