Early impact of the COVID-19 pandemic on in-person outpatient care utilisation: a rapid review

Abstract

Objectives: To quantitatively assess the early impact of the COVID-19 pandemic on in-person outpatient care utilisation worldwide, as well as across categories of services, types of care and medical specialties.

Design: Rapid review.

Method: A search of MEDLINE and Embase was conducted to identify studies published from 1 January 2020 to 12 February 2021, which quantitatively reported the impact of the COVID-19 pandemic on the amount of outpatient care services delivered (in-person visits, diagnostic/screening procedures and treatments). There was no restriction on the type of medical care (emergency/primary/specialty care) or target population (adult/paediatric). All articles presenting primary data from studies reporting on outpatient care utilisation were included. Studies describing conditions requiring hospitalisation or limited to telehealth services were excluded.

Results: A total of 517 articles reporting 1011 outpatient care utilisation measures in 49 countries worldwide were eligible for inclusion. Of those, 93% focused on the first semester of 2020 (January to June). The reported results showed an almost universal decline in in-person outpatient care utilisation, with a 56% overall median relative decrease. Heterogeneity across countries was high, with median decreases ranging from 10% to 91%. Diagnostic and screening procedures (-63%), as well as in-person visits (-56%), were more affected than treatments (-36%). Emergency care showed a smaller relative decline (-49%) than primary (-60%) and specialty care (-58%).

Conclusions: The provision of in-person outpatient care services has been strongly impacted by the COVID-19 pandemic, but heterogeneously across countries. The long-term population health consequences of the disruption of outpatient care service delivery remain currently unknown and need to be studied.

Prospero registration number: CRD42021237366.

Keywords: COVID-19; International Health Services; organisation of health services; paediatric A&E and ambulatory care; primary care; public health.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.

Figure 2

Median relative impact of the COVID-19 pandemic on in-person outpatient care utilisation, by country.

Figure 3

Relative impact of the COVID-19 pandemic on in-person outpatient care utilisation, by type of care and category of service. Dx, diagnostic/screening procedure; Tx, treatment. Whiskers extend to the lowest and highest values within 1.5 times the IQR from the lower and upper quartiles. The dots represent individual values that fall outside this range.