[What have we missed because of COVID-19? Missed diagnoses and delayed follow-ups. SESPAS Report 2022]

Abstract

The COVID-19 pandemic and the associated public health emergency have affected patients and health services in non-COVID-19 pathologies. Several studies have shown its dissociation from health services, with a decrease in emergency department visits, in hospital admissions for non-COVID-19 pathologies, as well as in the reported weekly incidence of acute illnesses and new diagnoses in primary care. In parallel, the pandemic has had direct and indirect effects on people with chronic diseases; the difficulties in accessing health services, the interruption of care, the saturation of the system itself and its reorientation towards non-face-to-face formats has reduced the capacity to prevent or control chronic diseases. All this has also had an impact on the different areas of people's lives, creating new social and economic difficulties, or aggravating those that existed before the pandemic. All these circumstances have changed with each epidemic wave. We present a review of the most relevant studies that have been analyzing this problem and incorporate as a case study the results of a retrospective observational study carried out in Primary Care in the Madrid Health Service, which provides health coverage to a population of more than 6 million people, and whose objective was to analyze the loss of new diagnoses in the most prevalent pathologies such as common mental health problems, cardiovascular and cerebrovascular diseases, type 2 diabetes, chronic obstructive pulmonary disease, and breast and colon tumors, in the first and second waves. Annual incidence rates with their confidence interval were calculated for each pathology and the monthly frequency of new codes recorded between 1/01/2020 and 12/31/2020 was compared with the monthly mean of observed counts for the same months between 2016 and 2019. The annual incidence rate for all processes studied decreased in 2020 except for anxiety disorders. Regarding the recovery of lost diagnoses, heart failure is the only diagnosis showing an above-average recovery after the first wave. To return to pre-pandemic levels of diagnosis and follow-up of non-COVID-19 pathology, the healthcare system must reorganize and contemplate specific actions for the groups at highest risk.

Keywords: Atención primaria; COVID-19; Chronic diseases; Diagnósticos perdidos; Enfermedades crónicas; Follow-up; Health services; Missed diagnoses; Primary health care; SARS-CoV-2; Seguimientos; Servicios de salud.

Figura 1

Número de pacientes/día con sospecha o COVID-19 confirmada, número de pacientes con protocolo de seguimiento/día y número de pacientes hospitalizados/día del 1 de marzo al 30 de abril en la Comunidad de Madrid. (Tomada de ref. 20.)

Figura 2

Número de nuevas codificaciones diagnósticas registradas en la historia clínica electrónica de atención primaria de la Comunidad de Madrid según la CIAP 2 por mes de evolución y año de registro en 2020, en comparación con el periodo 2016-2019.

Figura 3

Nuevos diagnósticos registrados en el año 2020 en comparación con la media mensual de los mismos meses en 2016-2019, en atención primaria de la Comunidad de Madrid.

Figura 4

Nuevas codificaciones diagnósticas relacionadas con la infección por SARS-CoV-2 con diagnóstico confirmado (CIAP A77.01) o con sospecha clínica (CIAP A77) registradas en la historia clínica electrónica de atención primaria durante las dos primeras olas pandémicas en la Comunidad de Madrid (28-2-2020 a 6-12-2020). (Fuente: Espacio Información COVID. Gerencia Asistencial de Atención Primaria Madrid.)