The Impact of COVID-19 on Primary Care General Practice Consultations in a Teaching Hospital in Shanghai, China

Abstract

Background: The COVID-19 (2019 novel coronavirus disease) pandemic is deeply concerning because of its massive mortality and morbidity, creating adverse perceptions among patients likely to impact on their overall medical care. Thus, we evaluated the impact of the COVID-19 pandemic on the pattern of primary care consultations within a Shanghai health district. Methods: A retrospective observational cohort study was performed, with data analyzed concerning the pattern of patient visits to general practitioners within the Tongren Hospital network (the sole provider of general practice to the population of 700,000). Data from all general practice consultations for adults were collected for the first 6 months of 2020, which included a 60-day lockdown period (January 24-March 24, 2020) and compared to corresponding data from the first 6 months of 2019. We evaluated changes to the numbers and patterns of primary care consultations, including subgroup analysis based on age, sex, and primary diagnosis. Results: A substantial reduction in patient visits, associated with increased median age, was observed during the first wave of the pandemic in the first 6 months of 2020, compared to the same interval during 2019. Additionally, reduced reappointments and waiting times, but increased costs per visit were observed. When analyzed by primary disease diagnosis, patient visits were reduced for all the major systems. The most striking visit reductions were in cardiovascular, respiratory, endocrine, and gastrointestinal diseases. However, psychological disorders were increased following lockdown, but there was also a dramatic fall in consultations for depression. Reduced monthly patient numbers correlated with both rate of reappointment and average waiting time during the first 6 months of both 2019 and 2020, but an inverse correlation was observed between cost per visit and monthly patient numbers. Specifically during the lockdown period, there was ~50% reduced patient visits. Conclusions: The lockdown has had a serious impact on patients' physical and psychological health. Our analysis provides objective health-related data that may inform the current controversy concerning the balance between the detrimental effects of the use of lockdown vs. the use of a more targeted approach to eliminate viral transmission. These data may improve decision-making in medical practice, policy, and education.

Keywords: COVID-19; GP; demographic pattern; lockdown; primary care; psychological disorders.

Figure 1

Outpatients visits at Tongren Hospital primary care clinics during the first 6 months of 2020 (black) compared to 2019 (empty) (A); age distribution of patients in 2020 versus 2019 (B); outpatients visits each month over the first six months of 2020 (black) and 2019 (empty) (C). **p < 0.01, ***p < 0.001.

Figure 2

Demographics of patient visits stratified by age and sex. Patients visits for the three aged groups over the first 6 months (<40, 40–64, ≥65 years) (A); monthly distribution of patients visits for the subgroups <40 years (B); 40–64 years (C), and ≥65 years (D); patient visits for male or female patients in 2020 compared to 2019 (E); monthly distribution of patients visits for males (F) and females (G). *p < 0.05, **p < 0.01, ***p < 0.001.

Figure 3

Demographics of the cost per visit among patients over the 6 months in 2020 and 2019 (A); the monthly distribution of patients cost per visit (B); reappointment rates (C) and average waiting time (D) in 2020 and 2019. **p < 0.01, ***p < 0.001.

Figure 4

Subgroup analysis by primary diagnosis of patient visits for the eight major diagnostic systems, plus others (unclassified) in 2020 and 2019. *p < 0.05, ***p < 0.001.

Figure 5

Subgroup analysis of monthly distributions of visits stratified by primary diagnosis, cardiovascular disease (A), respiratory (B), endocrine (C), gastrointestinal (D), neurology (E), urology (F), muscular-skeletal (G), hematology (H), and others (unclassified) (I), respectively. *p < 0.05, **p < 0.01.

Figure 6

Demographics of patient visits with a primary diagnosis of psychological disorders, including depression, anxiety, insomnia, and the total number of psychological visits in 2020 and 2019 (A); subgroup analysis of monthly distributions of all psychology patients (B), depression (C), anxiety (D), insomnia (E) over the first 6 months in 2020 and 2019. **p < 0.01, ***p < 0.001.

Figure 7

Correlation between patient visits per month and reappointment rate (A), average waiting time (B), or cost per visit (C) in the first 6 months of both 2020 and 2019, or number of confirmed COVID-19 patients in Shanghai (D) in the first 6 months of 2020.

Figure 8

Number of daily patient visits over a 67-day period in 2020 (empty) compared to 2019 (gray). The days were aligned by Chinese New Year (February 5, 2019, and January 25, 2020). Day 1 corresponds to the first day of lockdown (January 24, 2020). ***p < 0.001.

Figure 9

Correlation between the number of daily visit to outpatients in Tongren Hospital and the number of confirmed COVID-19 patients within Shanghai.