Reorganisation of primary care for older adults during COVID-19: a cross-sectional database study in the UK

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a rapid change in workload across healthcare systems. Factors related to this adaptation in UK primary care have not yet been examined.

Aim: To assess the responsiveness and prioritisation of primary care consultation type for older adults during the COVID-19 pandemic.

Design and setting: A cross-sectional database study examining consultations between 17 February and 10 May 2020 for patients aged ≥65 years, drawn from primary care practices within the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network, UK.

Method: The authors reported the proportion of consultation type across five categories: clinical administration, electronic/video, face-to-face, telephone, and home visits. Temporal trends in telephone and face-to-face consultations were analysed by polypharmacy, frailty status, and socioeconomic group using incidence rate ratios (IRR).

Results: Across 3 851 304 consultations, the population median age was 75 years (interquartile range [IQR] 70-82); and 46% (n = 82 926) of the cohort (N = 180 420) were male. The rate of telephone and electronic/video consultations more than doubled across the study period (106.0% and 102.8%, respectively). Face-to-face consultations fell by 64.6% and home visits by 62.6%. This predominantly occurred across week 11 (week commencing 9 March 2020), coinciding with national policy change. Polypharmacy and frailty were associated with a relative increase in consultations. The greatest relative increase was among people taking ≥10 medications compared with those taking none (face-to-face IRR 9.90, 95% CI = 9.55 to 10.26; telephone IRR 17.64, 95% CI = 16.89 to 18.41).

Conclusion: Primary care has undergone an unprecedented in-pandemic reorganisation while retaining focus on patients with increased complexity.

Keywords: COVID-19; frailty; polypharmacy; remote consultation; workload.

Figure 1.

Trend in consultation rates per 100 000 of the registered practice population by consultation type for weeks 8 to week 19, year 2020.

Figure 2.

Counts of telephone consultations and face-to-face consultations by week (of 2020) as well as by prescriptions group, frailty category, and IMD quintiles. IMD = Index of Multiple Deprivation.

Figure 3.

Relative proportion of face-to-face (F2F) compared to telephone (TP) consultations at practices within the network. ISO = International Organization for Standardization.