Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study

To date, research on the indirect impact of the COVID-19 pandemic on the health of the population and the health-care system is scarce. We aimed to investigate the indirect effect of the COVID-19 pandemic on general practice health-care usage, and the subsequent diagnoses of common physical and ment...

Full description

Saved in:
Bibliographic Details
Published in:The Lancet. Public health Vol. 5; no. 10; pp. e543 - e550
Main Authors: Williams, Richard, Jenkins, David A, Ashcroft, Darren M, Brown, Ben, Campbell, Stephen, Carr, Matthew J, Cheraghi-sohi, Sudeh, Kapur, Navneet, Thomas, Owain, Webb, Roger T, Peek, Niels
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01.10.2020
Elsevier, Ltd
Subjects:
Adult
Cardiovascular Diseases - diagnosis
Cerebrovascular Disorders - diagnosis
Coronavirus Infections - epidemiology
COVID-19
Diabetes Mellitus, Type 2 - diagnosis
Diagnosis
Female
General Practice - statistics & numerical data
Humans
Internal Medicine
Male
Mental Disorders - diagnosis
Middle Aged
Models, Statistical
Neoplasms - diagnosis
Pandemics
Pneumonia, Viral - epidemiology
Primary Health Care - statistics & numerical data
Public Health
Retrospective Studies
United Kingdom - epidemiology
Young Adult
United Kingdom
ISSN:2468-2667, 2468-2667
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:To date, research on the indirect impact of the COVID-19 pandemic on the health of the population and the health-care system is scarce. We aimed to investigate the indirect effect of the COVID-19 pandemic on general practice health-care usage, and the subsequent diagnoses of common physical and mental health conditions in a deprived UK population. We did a retrospective cohort study using routinely collected primary care data that was recorded in the Salford Integrated Record between Jan 1, 2010, and May 31, 2020. We extracted the weekly number of clinical codes entered into patient records overall, and for six high-level categories: symptoms and observations, diagnoses, prescriptions, operations and procedures, laboratory tests, and other diagnostic procedures. Negative binomial regression models were applied to monthly counts of first diagnoses of common conditions (common mental health problems, cardiovascular and cerebrovascular disease, type 2 diabetes, and cancer), and corresponding first prescriptions of medications indicative of these conditions. We used these models to predict the expected numbers of first diagnoses and first prescriptions between March 1 and May 31, 2020, which were then compared with the observed numbers for the same time period. Between March 1 and May 31, 2020, 1073 first diagnoses of common mental health problems were reported compared with 2147 expected cases (95% CI 1821 to 2489) based on preceding years, representing a 50·0% reduction (95% CI 41·1 to 56·9). Compared with expected numbers, 456 fewer diagnoses of circulatory system diseases (43·3% reduction, 95% CI 29·6 to 53·5), and 135 fewer type 2 diabetes diagnoses (49·0% reduction, 23·8 to 63·1) were observed. The number of first prescriptions of associated medications was also lower than expected for the same time period. However, the gap between observed and expected cancer diagnoses (31 fewer; 16·0% reduction, −18·1 to 36·6) during this time period was not statistically significant. In this deprived urban population, diagnoses of common conditions decreased substantially between March and May 2020, suggesting a large number of patients have undiagnosed conditions. A rebound in future workload could be imminent as COVID-19 restrictions ease and patients with undiagnosed conditions or delayed diagnosis present to primary and secondary health-care services. Such services should prioritise the diagnosis and treatment of these patients to mitigate potential indirect harms to protect public health. National Institute of Health Research.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:2468-2667
2468-2667
DOI:10.1016/S2468-2667(20)30201-2