Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May 7:66:635508.
doi: 10.3389/ijph.2021.635508. eCollection 2021.

Impact of the COVID-19 Pandemic on the Intensity of Health Services Use in General Practice: A Retrospective Cohort Study

Yael Rachamin  1 , Oliver Senn  1 , Sven Streit  2 , Julie Dubois  3 , Michael J Deml  4 , Katharina Tabea Jungo  2   5
Affiliations

Impact of the COVID-19 Pandemic on the Intensity of Health Services Use in General Practice: A Retrospective Cohort Study

Yael Rachamin et al. Int J Public Health. .

Abstract

Objectives: We aimed to explore the impact of the Swiss shutdown in spring 2020 on the intensity of health services use in general practice. Methods: Based on an electronic medical records database, we built one patient cohort each for January-June 2019 (control, 173,523 patients) and 2020 (179,086 patients). We used linear regression to model weekly consultation counts and blood pressure (BP) and glycated hemoglobin (HbA1c) measurement counts per 100 patients and predicted non-shutdown values. Analyses were repeated for selected at-risk groups and different age groups. Results: During the shutdown, weekly consultation counts were lower than predicted by -17.2% (total population), -16.5% (patients with hypertension), -17.5% (diabetes), -17.6% (cardiovascular disease), -15.7% (patients aged <60 years), -20.4% (60-80 years), and -14.5% (>80 years). Weekly BP counts were reduced by -35.3% (total population) and -35.0% (hypertension), and HbA1c counts by -33.2% (total population) and -29.8% (diabetes). p-values <0.001 for all reported estimates. Conclusion: Our results document consequential decreases in consultation counts and chronic disease monitoring during the shutdown. It is crucial that health systems remain able to meet non-COVID-19-related health care needs.

Keywords: COVID-19; SARS-CoV-2; Switzerland; chronic conditions; general practice; health services use; primary care; risk groups.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of general practitioner and patient selection. Patients of eligible general practitioners were included in the 2019 and/or 2020 cohort if they had at least one consultation before and one consultation during the year of observation. Abbreviations: FIRE, Family medicine International Classification of Primary Care Research using electronic medical records; GP, general practitioner (Impact of the COVID-19 Pandemic on the Intensity of Health Services Use in General Practice: A Retrospective Cohort Study, Switzerland, 2019-2020).
FIGURE 2
FIGURE 2
Weekly consultation counts per 100 patients in 2020, for the total general practice population and the at-risk patient groups. Black dashed lines represent predicted values with 95% prediction interval (grey area). Blue lines represent observed values. The asterisks indicate the date of the first confirmed COVID-19 patient in Switzerland. Grey vertical lines indicate 1) introduction of major mitigation measures, 2) relief of ban on non-urgent general practice visits, and 3) relief of most restrictions. Temporary decrease in predicted consultation counts are attributable to public holidays: Easter, Ascension Day (Asc.), and Whitsun (Wh.). (Impact of the COVID-19 Pandemic on the Intensity of Health Services Use in General Practice: A Retrospective Cohort Study, Switzerland, 2019-2020).
FIGURE 3
FIGURE 3
Weekly consultation counts per 100 patients in 2020, for different age groups. Black dashed lines represent predicted values with 95% prediction interval (grey area). Blue lines represent observed values. The asterisks indicate the date of the first confirmed COVID-19 patient in Switzerland. Grey vertical lines indicate 1) introduction of major mitigation measures, 2) relief of ban on non-urgent general practice visits, and 3) relief of most restrictions. Temporary decrease in predicted consultation counts are attributable to public holidays: Easter, Ascension Day (Asc.), and Whitsun (Wh.). (Impact of the COVID-19 Pandemic on the Intensity of Health Services Use in General Practice: A Retrospective Cohort Study, Switzerland, 2019-2020).
FIGURE 4
FIGURE 4
Weekly measurement counts per 100 patients in 2020, for the total general practice population and the relevant condition (A) Blood pressure (BP) measurements for the total general practice population and patients with hypertension (B) Glycated hemoglobin (HbA1c) measurements for the total general practice population and patients with diabetes. Black dashed lines represent predicted values with 95% prediction interval (grey area). Blue lines represent observed values. The asterisks indicate the date of the first confirmed COVID-19 patient in Switzerland. Grey vertical lines indicate 1) introduction of major mitigation measures, 2) relief of ban on non-urgent general practice visits, and 3) relief of most restrictions. Temporary decrease in predicted consultation counts are attributable to public holidays: Easter, Ascension Day (Asc.), and Whitsun (Wh.). (Impact of the COVID-19 Pandemic on the Intensity of Health Services Use in General Practice: A Retrospective Cohort Study, Switzerland, 2019-2020).
See this image and copyright information in PMC

References

    1. Benini F. [For Fear of Infection: Seriously Ill Patients Avoid Hospitals in Emergencies]. Neue Zürcher Zeitung NZZ (2020). 04.04.2020.
    1. Verhoeven V, Tsakitzidis G, Philips H, Van Royen P. Impact of the COVID-19 Pandemic on the Core Functions of Primary Care: Will the Cure Be Worse Than the Disease? A Qualitative Interview Study in Flemish GPs. BMJ open (2020). 10(6):e039674. 10.1136/bmjopen-2020-039674 - DOI - PMC - PubMed
    1. Khera A, Baum SJ, Gluckman TJ, Gulati M, Martin SS, Michos ED, et al. Continuity of Care and Outpatient Management for Patients with and at High Risk for Cardiovascular Disease during the COVID-19 Pandemic: A Scientific Statement from the American Society for Preventive Cardiology. Am J Prev Cardiol (2020). 1:100009. 10.1016/j.ajpc.2020.100009 - DOI - PMC - PubMed
    1. Beran D, Aebischer Perone S, Castellsague Perolini M, Chappuis F, Chopard P, Haller DM, et al. Beyond the Virus: Ensuring Continuity of Care for People with Diabetes during COVID-19. Prim Care Diabetes (2020). 15:16-7. 10.1016/j.pcd.2020.05.014 - DOI - PMC - PubMed
    1. Barten DG, Latten GHP, van Osch FHM. Reduced Emergency Department Utilization during the Early Phase of the COVID-19 Pandemic: Viral Fear or Lockdown Effect?. Disaster Med Public Health Prep Disaster Medicine Public Health Preparedness (2020). 1–4. 10.1017/dmp.2020.303 - DOI - PMC - PubMed