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Yu W, Tian J, Li P, Guo Z, Zcm D, Li M, Ge Y, Liu X. Characteristics and influencing factors of caregivers' healthcare preferences for young children under COVID-19 lockdown: a cross-sectional study in Shanghai, China. BMC PRIMARY CARE 2024; 25:263. [PMID: 39033156 PMCID: PMC11264815 DOI: 10.1186/s12875-024-02484-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 06/24/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Missed or delayed child healthcare caused by the COVID-19 lockdown has threatened young children's health and has had an unpredictable influence on caregivers' child healthcare preferences. This study investigated caregivers' child healthcare preferences and the factors that influence them among families with young children (0-3 years) during the lockdown in Shanghai. METHODS Participants in this cross-sectional study were enrolled through random encounter sampling. Questionnaires were distributed online from June 1 to November 10, 2022, in Shanghai. A total of 477 valid questionnaires were received. The demographics of caregivers and their families, children's characteristics, COVID-19-related information, and caregivers' healthcare preferences were analyzed. The statistical analyses included frequency and percentage, chi-square tests, and multinomial logistic regression. RESULTS Caregivers preferred child healthcare professionals in the community health service system (CHS; 47.6%) followed by hospital pediatricians (40.0%) during lockdown. Caregivers with the following characteristics preferred CHS: those with an annual household income of CNY 200,000-300,000, those whose youngest children were aged 8-12 months, and those who experienced early childhood physical development issues. Caregivers preferred hospitals if they had experienced healthcare-seeking-related difficulties in accessing professional guidance from hospital pediatricians. CONCLUSIONS During pandemic lockdowns, policymakers should allocate more resources to CHS to meet caregivers' childcare demands. Moreover, special attention should be given to the healthcare needs for CHS among families with specific demographics. TRIAL REGISTRATION Approval was obtained from the Ethics Committee of Shanghai Jiao Tong University School of Medicine School of Public Health (SJUPN-202,109; June 1, 2022).
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Affiliation(s)
- Wenya Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jiahe Tian
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Panpan Li
- Department of Prevention and Health Care, Dapuqiao Community Health Service Center of Huangpu District, Shanghai, 200001, China
| | - Zhichao Guo
- Department of Prevention and Health Care, Yuepu Town Community Health Service Center of Baoshan District, Shanghai, 200941, China
| | - Dan Zcm
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Meina Li
- Department of Military Medical Service, Faculty of Military Health Service, Naval Medical University, Shanghai, 200433, China
| | - Yang Ge
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Xiang Liu
- Affiliated Xihu Hospital, Hangzhou Medical College, Hangzhou, 310000, China.
- Department of Respiratory Disease, The 903rd Hospital of PLA, Hangzhou, 310000, China.
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Guo C, Yuan D, Tang H, Hu X, Lei Y. Impact of a pandemic shock on unmet medical needs of middle-aged and older adults in 10 countries. BMJ Health Care Inform 2024; 31:e100865. [PMID: 38589212 PMCID: PMC11015184 DOI: 10.1136/bmjhci-2023-100865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/09/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE The objective is to explore the impact of the pandemic shock on the unmet medical needs of middle-aged and older adults worldwide. METHODS The COVID-19 pandemic starting in 2020 was used as a quasiexperiment. Exposure to the pandemic was defined based on an individual's context within the global pandemic. Data were obtained from the Integrated Values Surveys. A total of 11 932 middle-aged and older adults aged 45 years and above from 10 countries where the surveys conducted two times during 2011 and 2022 were analysed. We used logistic regression models with the difference-in-difference method to estimate the impact of pandemic exposure on unmet medical needs by comparing differences before and after the pandemic across areas with varying degrees of severity. RESULTS Among the 11 932 middle-aged and older adults, 3647 reported unmet medical needs, with a pooled unmet rate of 30.56% (95% CI: 29.74% to 31.40%). The pandemic significantly increased the risk of unmet medical needs among middle-aged and older adults (OR: 2.33, 95% CI: 1.94 to 2.79). The deleterious effect of the pandemic on unmet medical needs was prevalent among middle-aged adults (2.53, 2.00 to 3.20) and older adults (2.00, 1.48 to 2.69), as well as among men (2.24, 1.74 to 2.90) and women (2.34, 1.82 to 3.03). The results remained robust in a series of sensitivity analyses. CONCLUSION These findings suggest that efforts should be made by policymakers and healthcare professionals to balance healthcare resources to adequately address the comprehensive healthcare demands of individuals regarding multiple health issues, taking into account the challenges posed by pandemics.
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Affiliation(s)
- Chao Guo
- Institute of Population Research, Peking University, Beijing, China
- APEC Health Science Academy, Peking University, Beijing, China
| | - Dianqi Yuan
- Institute of Population Research, Peking University, Beijing, China
| | - Huameng Tang
- Institute of Population Research, Peking University, Beijing, China
| | - Xiyuan Hu
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yiyang Lei
- Institute of Population Research, Peking University, Beijing, China
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Islam MT, Bruce M, Alam K. Patterns and determinants of healthcare utilization and medication use before and during the COVID-19 crisis in Afghanistan, Bangladesh, and India. BMC Health Serv Res 2024; 24:416. [PMID: 38570763 PMCID: PMC10988829 DOI: 10.1186/s12913-024-10789-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND COVID-19 rapidly spread through South Asian countries and overwhelmed the health systems that were unprepared for such an outbreak. Evidence from high-income countries showed that COVID-19 impacted healthcare utilization, including medication use, but empirical evidence is lacking in South Asia. This study aimed to investigate the effect of COVID-19 on healthcare utilization and medication use in South Asia. METHOD The current study used longitudinal data from the 'Premise Health Service Disruption Survey' 2020 and 2021. The countries of interest were limited to Afghanistan, Bangladesh, and India. In these surveys, data related to healthcare utilization and medication use were collected for three-time points; 'Pre-COVID phase', 'Initial phase of COVID-19 outbreak', and 'One year of COVID-19 outbreak'. Generalized estimating equation (GEE) along with McNemar's test, Kruskal-Wallis test and χ2 test were applied in this study following the conceptualization of Andersen's healthcare utilization model. RESULT The use of healthcare and medication was unevenly impacted by the COVID-19 epidemic in Afghanistan, Bangladesh, and India. Immediately after the COVID-19 outbreak, respondents in Bangladesh reported around four times higher incomplete healthcare utilization compared to pre-COVID phase. In contrast, respondents in Afghanistan reported lower incomplete utilization of healthcare in a similar context. In the post COVID-19 outbreak, non-adherence to medication use was significantly higher in Afghanistan (OR:1.7; 95%CI:1.6,1.9) and India (OR:1.3; 95%CI:1.1,1.7) compared to pre-COVID phase. Respondents of all three countries who sought assistance to manage non-communicable diseases (NCDs) had higher odds (Afghanistan: OR:1.5; 95%CI:1.3,1.8; Bangladesh: OR: 3.7; 95%CI:1.9,7.3; India: OR: 2.3; 95% CI: 1.4,3.6) of non-adherence to medication use after the COVID-19 outbreak compared to pre-COVID phase. CONCLUSION The present study documented important evidence of the influence of COVID-19 epidemic on healthcare utilization and medication use in three countries of South Asia. Lessons learned from this study can feed into policy responses to the crisis and preparedness for future pandemics.
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Affiliation(s)
- Md Tauhidul Islam
- Murdoch Business School, Murdoch University, 6150, Perth, WA, Australia.
| | - Mieghan Bruce
- School of Veterinary Medicine and Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, 6150, Perth, WA, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, 6150, Perth, WA, Australia
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Lu Y, Chen Q, Ren S, Zhang Y, Yi L, Qian C, Shen J, Liu X, Jiang M, Wang B, Song J, Shao X, Zhang T, Tian J, Zhao G. Impact of COVID-19 Nonpharmaceutical Interventions on Respiratory Syncytial Virus Infections in Hospitalized Children. Influenza Other Respir Viruses 2024; 18:e13291. [PMID: 38653953 DOI: 10.1111/irv.13291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Nonpharmaceutical interventions (NPIs) targeted at SARS-CoV-2 have remarkably affected the circulation of other respiratory pathogens, including respiratory syncytial virus (RSV). This study aimed to assess the changes in epidemiological and clinical characteristics of RSV infections in hospitalized children before and during the pandemic in Suzhou, China. METHODS We prospectively enrolled children aged < 18 years who were hospitalized in Soochow University Affiliated Children's Hospital with acute lower respiratory infection (ALRIs) from January 2018 to July 2022. Changes in epidemiological and clinical characteristics of RSV infections were analyzed. RESULTS Compared with the same period in 2018-2019, the difference in the overall positive rate of RSV was not statistically significant in 2020, while it increased significantly in 2021 (11.8% [662/5621] vs. 20.8% [356/1711], p < 0.001) and 2022 (9.0% [308/3406] vs. 18.9% [129/684], p < 0.001). Specifically, the positive rates declined considerably from October to December 2020 but sharply increased during the summer of 2021. Compared to prepandemic period, RSV infections were more frequently observed in older children during the pandemic. RSV-positive children exhibited milder clinical characteristics during the COVID-19 pandemic, including decreased proportion of patients with hospital stay ≥ 11 days (10.3% vs. 6.7%, p < 0.05), less requirement for oxygen therapy (13.7% vs. 6.9%, p < 0.001), and fewer cases of polypnea (12.2% vs. 9.7%, p < 0.05) and wheeze (50.1% vs. 42.9%, p < 0.001). CONCLUSIONS The implementation of multilayered NPIs targeted at COVID-19 has affected the activity of RSV. Ongoing monitoring of RSV is warranted as the changing RSV epidemiology can provide valuable insights for future healthcare system planning.
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Affiliation(s)
- Yingfeng Lu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Qinghui Chen
- Department of Infectious Diseases, Soochow University Affiliated Children's Hospital, Suzhou, China
| | - Shaolong Ren
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Youyi Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Liping Yi
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Chen Qian
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Jiaming Shen
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Xiaofei Liu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Miao Jiang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Biying Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Jian Song
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Xuejun Shao
- Clinical Laboratory, Soochow University Affiliated Children's Hospital, Suzhou, China
| | - Tao Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Jianmei Tian
- Department of Infectious Diseases, Soochow University Affiliated Children's Hospital, Suzhou, China
| | - Genming Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
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Matovelle P, Oliván-Blázquez B, Domínguez-García M, Casado-Vicente V, Pascual de la Pisa B, Magallón-Botaya R. Health Outcomes for Older Patients with Chronic Diseases During the First Pandemic Year. Clin Interv Aging 2024; 19:385-397. [PMID: 38464598 PMCID: PMC10924748 DOI: 10.2147/cia.s444716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
Background Worldwide, chronic diseases are prevalent among the older adults, significantly affecting their health and healthcare system. The COVID-19 pandemic exacerbated these challenges, disrupting healthcare services. Our study assesses the impact on older individuals with chronic diseases who were not infected with COVID-19, analyzing comorbidities, medication use, mortality rates, and resource utilization using real data from Aragon, Spain. Methods A retrospective observational study, conducted in Aragon, Spain, focused on individuals aged 75 and older with at least one chronic disease, who were not infected of COVID-19. The research used actual data collected during three distinct periods: the first covered the six months prior to the pandemic, the second the six months after the lockdown, and the third the period between six and twelve months. Key variables included socio-demographics, comorbidities, clinical parameters, medication use, and health services utilization. Results We included 128.130 older adults. Mean age was 82.88 years, with 60.3% being women. The most common chronic diseases were hypertension (73.2%), dyslipidemia (52.5%), and dorsopathies (31.5%). More than 90% had more than 2 conditions. A notable decline in new chronic disease diagnoses was observed, particularly pronounced in the six to twelve months period after lockdown. Although statistically significant differences were observed in all clinical variables analyzed, they were considered clinically irrelevant. Furthermore, a decrease in healthcare services utilization and medication prescriptions was reported. Conclusion Our study highlights a decrease in new chronic disease diagnoses, ongoing reductions in healthcare utilization, and medication prescriptions for older adults with pre-existing chronic conditions, unaffected by COVID-19.
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Affiliation(s)
- Priscila Matovelle
- Department of Geriatrics, San Juan de Dios Hospital, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), RD21/0016/0005, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Marta Domínguez-García
- Primary Care Research Unit (GAIAP), Aragon Health Research Institute (IISA), Zaragoza, Spain
- Aragonese Healthcare Service, Zaragoza, Spain
| | - Verónica Casado-Vicente
- Parquesol Primary Care Center, Valladolid, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
| | - Beatriz Pascual de la Pisa
- Santa María de Gracia Primary Care, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), RD21/0016/0015, Zaragoza, Spain
| | - Rosa Magallón-Botaya
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), RD21/0016/0005, Zaragoza, Spain
- Parquesol Primary Care Center, Valladolid, Spain
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Zhang J, Xu Z, Wei X, Fu Y, Zhu Z, Wang Q, Wang Q, Liu Q, Guo J, Hao Y, Yang L. Analysis of health service utilization and influencing factors due to COVID-19 in Beijing: a large cross-sectional survey. Health Res Policy Syst 2024; 22:31. [PMID: 38439096 PMCID: PMC10910832 DOI: 10.1186/s12961-024-01118-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND In the wake of China's relaxed zero-COVID policy, there was a surge in coronavirus disease 2019 (COVID-19) infections. This study aimed to examine the infection status and health service utilization among Beijing residents during a widespread outbreak, and to explore the factors that affected utilization of health services due to COVID-19. METHODS A cross-sectional survey was conducted among Beijing residents from 13 January to 13 February 2023, collecting information on socio-demographic characteristics, health behaviours, COVID-19 infection status, utilization of health services and depressive symptoms. Multivariate Tobit regression was used for data analysis. RESULTS Among the 53 924 participants, 14.7% were older than 60 years, 63.7% were female and 84.8% were married. In total, 44 992 of the 53 924 individuals surveyed (83.4%) contracted COVID-19 during 2020-2023, and 25.2% (13 587) sought corresponding health services. The majority of individuals (85.6%) chose in-person healthcare, while 14.4% chose internet-based healthcare. Among those who chose in-person healthcare, 58.6% preferred primary healthcare institutions and 41.5% were very satisfied with the treatment. Factors affecting health service utilization include being female (β = -0.15, P < 0.001), older than 60 years (β = 0.23, P < 0.01), non-healthcare workers (β = -0.60, P < 0.001), rich self-rated income level (β = 0.59, P < 0.001), having underlying disease (β = 0.51, P < 0.001), living alone (β = -0.19, P < 0.05), depressive symptoms (β = 0.06, P < 0.001) and healthy lifestyle habits, as well as longer infection duration, higher infection numbers and severe symptoms. CONCLUSION As COVID-19 is becoming more frequent and less severe, providing safe and accessible healthcare remains critical. Vulnerable groups such as the elderly and those with underlying conditions need reliable health service. Prioritizing primary healthcare resources and online medical services have played a vital role in enhancing resource utilization efficiency.
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Affiliation(s)
- Jiawei Zhang
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Zhihu Xu
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Xia Wei
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | - Yaqun Fu
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Zheng Zhu
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Quan Wang
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
- Brown School, Washington University in St. Louis, St. Louis, Missouri, 63130, United States of America
| | - Qingbo Wang
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Qing Liu
- General Practice Department, Second Outpatient Section, Peking University Third Hospital, Xisanqi Street, Haidian District, Beijing, 100096, China
| | - Jing Guo
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Yuantao Hao
- Center for Public Health and Epidemic Preparedness and Response, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Li Yang
- Department of Health Policy and Management, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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Chon HK, Lee EJ, Lee YC, Kim SH. Impact of Coronavirus Disease 2019 on the Diagnosis and Treatment of Pancreatic Cancer: An Observational Cohort Study. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2024; 35:408-417. [PMID: 39115263 PMCID: PMC11181164 DOI: 10.5152/tjg.2024.23563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/11/2023] [Indexed: 08/11/2024]
Abstract
Early pancreatic cancer diagnosis is crucial for timely intervention and better outcomes. The coronavirus disease 2019 (COVID-19) pandemic has disrupted routine health care globally. The COVID-19 pandemic has disrupted routine health care globally. This study aimed to evaluate the impact of COVID-19 on the diagnosis and treatment of pancreatic cancer. This retrospective study compared pancreatic cancer patients from 2 tertiary hospitals in pre and COVID-19 periods. Pre-COVID-19 period spanned from January 1, 2018, to January 19, 2020, while the COVID-19 period extended from January 20, 2020, to December 31, 2021. Results: A total of 542 patients were included. In the pre-COVID-19 period, 280 new cases of pancreatic cancer were enrolled, compared to 262 during COVID-19. The annual incidence rates were 136.63 and 134.50 patients, respectively. The median age was significantly lower during COVID-19 (71.5 years) compared to pre-COVID-19 (77 years) (P < .001). In subgroup analyses for stage 3 and 4, the proportion of stage 4 pancreatic cancer increased during COVID-19 (χ2 = 5.53, P = .019), and the COVID-19 group had younger diagnoses, better performance status, more surgery, higher use of FOLFIRINOX chemotherapy, fewer hospital referrals, and better median overall survival compared to the pre-COVID-19 group. This study revealed changes in the characteristics and treatment of patients diagnosed with pancreatic cancer during the COVID-19 pandemic. Although further large-scale research is necessary, the findings of this study can function as foundational data for formulating policies for the management of patients with pancreatic cancer during future pandemics of other infectious diseases.
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Affiliation(s)
- Hyung Ku Chon
- Division of Biliopancreas, Department of Internal Medicine, Wonkwang University Medical School and Hospital, Iksan, Korea
- Institute of Wonkwang Medical Science, Iksan, Korea
| | - Eun Jee Lee
- Research Institute of Nursing Science, Jeonbuk National University College of Nursing, Jeonju, Korea
| | - Yun Chae Lee
- Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Korea
| | - Seong-Hun Kim
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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Nunes A, Costa C, Martins JP, Ferreira PL, Pimenta R. Demand for emergency services during the COVID-19 pandemic and disease burden: a case study in Portugal. Front Public Health 2024; 11:1294204. [PMID: 38288431 PMCID: PMC10822959 DOI: 10.3389/fpubh.2023.1294204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/11/2023] [Indexed: 01/31/2024] Open
Abstract
Background The COVID-19 pandemic brought changes in the pattern of care use. A significant increase in the volume of emergencies was expected. However, a significant decrease was observed worldwide. Methods An observational, analytical and cross-sectional study of all records of emergency episodes of patients aged 18 years or older admitted to the emergency services of the University of Porto Hospital Centre (2018-2022) were analysed. Results During the pandemic, a significant reduction in emergency episode admissions (up to 40% during lockdowns), an increase in pre-emergency services, and discharges from Infectious Diseases and Internal Medicine was observed. The discharges from General Practice and General Practice and Family Medicine were residual. Conclusion The lower use and type of use of emergency services during the COVID-19 pandemic had a negative impact on the disease burden. This could be prevented in future pandemics through the development of strategies to promote confidence in the use of health resources and establishing contingency plans for virtual assistance.
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Affiliation(s)
- Alcina Nunes
- UNIAG, Instituto Politécnico de Bragança, Bragança, Portugal
| | - Catarina Costa
- Centro Hospitalar Universitário do Porto, EPE, Porto, Portugal
| | - João P. Martins
- Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- CEAUL – Centro de Estatística e Aplicações, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Pedro L. Ferreira
- Faculty of Economics, University of Coimbra, Coimbra, Portugal
- Centre for Health Studies and Research of University of Coimbra, Centre for Innovative Biomedicine and Biotechnology, Coimbra, Portugal
| | - Rui Pimenta
- Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- Centre for Health Studies and Research of University of Coimbra, Centre for Innovative Biomedicine and Biotechnology, Coimbra, Portugal
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9
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Ramadani RV, Svensson M, Hassler S, Hidayat B, Ng N. Effects of the COVID-19 pandemic on healthcare utilization among older adults with cardiovascular diseases and multimorbidity in Indonesia: an interrupted time-series analysis. BMC Public Health 2024; 24:71. [PMID: 38166721 PMCID: PMC10763491 DOI: 10.1186/s12889-023-17568-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted healthcare utilization globally, but little is known about the effects among patients with cardiovascular diseases (CVDs) and other multimorbidities. This study analyzed the impacts of COVID-19 on healthcare utilization for patients aged 30 years and older with cardiovascular diseases (CVDs) with or without other chronic disease comorbidities in Indonesia. METHODS We designed a retrospective cohort study based on the Indonesian National Health Insurance (NHI) sample data from 2016-2020. We defined healthcare utilization as monthly outpatient and inpatient visits related to chronic diseases at the hospital and primary healthcare levels per 10,000 NHI members. We used interrupted time series analysis to evaluate how the healthcare utilization patterns had changed due to the COVID-19 pandemic. RESULTS Overall, hospital outpatient visits decreased by 39% when the pandemic occurred (95% Confidence Interval (CI): 0.48,0.76), inpatient visits by 28% (95% CI: 0.62,0.83), and primary healthcare visits by 34% (95% CI:0.55, 0.81). For patients with CVDs and multimorbidity, hospital outpatient and inpatient visit rates were reduced by 36% and 38%, respectively and primary healthcare visits by 32%. Some insignificant differences in the reduction of out-and inpatient visits were observed across diagnosis groups and regions. CONCLUSION Healthcare utilization among patients with chronic diseases decreased significantly during COVID-19 and consistently across different chronic diseases and regions. To cope with the unmet needs of healthcare utilization in the context of the pandemic, the healthcare system needs to be strengthened to cater to the needs of the population-at-risk, especially for patients with CVDs and multimorbidity.
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Affiliation(s)
- Royasia Viki Ramadani
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia.
| | - Mikael Svensson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, USA
| | - Sven Hassler
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Budi Hidayat
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
| | - Nawi Ng
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Gadeka DD, Aheto JMK. Healthcare utilization and associated factors during the first wave of COVID-19 pandemic in Ghana: A cross-sectional survey. Health Sci Rep 2024; 7:e1805. [PMID: 38213781 PMCID: PMC10781887 DOI: 10.1002/hsr2.1805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/12/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024] Open
Abstract
Background and Aims Understanding healthcare utilization during the coronavirus disease 2019 (COVID-19) pandemic is crucial to inform policy and to prepare health systems for future pandemics. We examined self-reported healthcare utilization and associated factors, including public health preventive practices, perceptions, and coping strategies among the general public in Ghana during the first wave of the COVID-19 pandemic. Methods We adopted a cross-sectional study design using a public survey to recruit 643 respondents between May 23, and July 11, 2020 during the first wave of confirmed COVID-19 cases and after the fifth week of a partial lockdown in Ghana. Descriptive, bivariate, and binary logistic regression analyses were carried out in Stata version 15. Results Overall, there was a high level of compliance with COVID-19 public health preventive measures. In terms of perception, 357 (55.5%) of respondents stated unnecessary worry was created about the disease. In relation to coping strategies, 376 (58.5%) of respondents stayed home for more than 6 h, while 35 (5%) reported drinking alcohol to overcome the fear created by the disease. The results showed that 176 (27.4%) of the respondents utilized healthcare while 44 (9.4%) did not utilized healthcare for fear of contracting the disease at the health facility. Marital status (adjusted odds ratio [aOR] = 0.63; 95% confidence interval [CI] = 0.409, 0.963), religion (aOR = 2.34; 95% CI = 1.10, 4.98), and possession of valid health insurance (aOR = 1.51; 95% CI = 1.020, 2.235) were associated with healthcare utilization. Conclusion There was low healthcare utilization coupled with fear of contracting the COVID-19 disease at the health facilities among the respondents. The findings suggest the need for effective public education that ensures that future pandemics' prevention information and recommendations are easily understandable by the general public. Additionally, investment in health insurance coverage may contribute to healthcare utilization during future pandemics.
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Affiliation(s)
- Dominic D. Gadeka
- Department of Health Policy, Planning and ManagementUniversity of Ghana School of Public HealthLegon‐AccraGhana
| | - Justice M. K. Aheto
- Department of BiostatisticsUniversity of Ghana School of Public HealthLegon‐AccraGhana
- WorldPop, School of Geography and Environmental ScienceUniversity of SouthamptonSouthamptonUK
- College of Public HealthUniversity of South FloridaTampaFloridaUSA
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11
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Thsehla E, Balusik A, Boachie MK, Tombe-Mdewa W, Kabudula C, Du Toit J, Kahn K, Gómez-Olivé FX, Tollman S, Goldstein S, Hofman K. Indirect effects of COVID-19 on maternal and child health in South Africa. Glob Health Action 2023; 16:2153442. [PMID: 36607314 PMCID: PMC9828580 DOI: 10.1080/16549716.2022.2153442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The unfinished burden of poor maternal and child health contributes to the quadruple burden of disease in South Africa with the direct and indirect effects of the COVID-19 pandemic yet to be fully documented. OBJECTIVE To investigate the indirect effects of COVID-19 on maternal and child health in different geographical regions and relative wealth quintiles. METHODS We estimated the effects of COVID-19 on maternal and child health from April 2020 to June 2021. We estimated this by calculating mean changes across facilities, relative wealth index (RWI) quintiles, geographical areas and provinces. To account for confounding by underlying seasonal or linear trends, we subsequently fitted a segmented fixed effect panel model. RESULTS A total of 4956 public sector facilities were included in the analysis. Between April and September 2020, full immunisation and first dose of measles declined by 6.99% and 2.44%, respectively. In the follow-up months, measles first dose increased by 4.88% while full immunisation remained negative (-0.65%) especially in poorer quintiles. At facility level, the mean change in incidence and mortality due to pneumonia, diarrhoea and severe acute malnutrition was negative. Change in first antenatal visits, delivery by 15-19-year olds, delivery by C-section and maternal mortality was positive but not significant. CONCLUSION COVID-19 disrupted utilisation of child health services. While reduction in child health services at the start of the pandemic was followed by an increase in subsequent months, the recovery was not uniform across different quintiles and geographical areas. This study highlights the disproportionate impact of the pandemic and the need for targeted interventions to improve utilisation of health services.
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Affiliation(s)
- Evelyn Thsehla
- SAMRC/WITS Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa,CONTACT Evelyn Thsehla Second Floor, Wits School of Public Health, Education Campus, University of the Witwatersrand, 27 St Andrew’s Road Parktown, Johannesburg2193, South Africa
| | - Adam Balusik
- SAMRC/WITS Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa,School of Statistics and Actuarial Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Micheal Kofi Boachie
- SAMRC/WITS Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Winfrida Tombe-Mdewa
- SAMRC/WITS Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Chodziwadziwa Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacques Du Toit
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Susan Goldstein
- SAMRC/WITS Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/WITS Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
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12
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King L, Alexander-Gabbadon K, Chin N, Hammond-Gabbadon C, Simmonds-Brooks P, Harris J, Martin H, Witter K, Bartlett R, Knight-Madden J, Asnani M. Telehealth: Navigating the COVID-19 Pandemic and Beyond: The Sickle Cell Unit Experience. Telemed J E Health 2023; 29:1781-1791. [PMID: 37092975 DOI: 10.1089/tmj.2023.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Introduction: To examine the use of telehealth for delivery of health care in persons with sickle cell disease in a resource-constrained country during the COVID-19 pandemic. Methods: This study was a retrospective review of patient encounters at the Sickle Cell Unit (SCU), Jamaica during a 3-year period, March 10, 2019 to March 9, 2022 and a comparison of endpoints between 1 year before and 2 years during the pandemic. Primary endpoints of registration numbers, day-care admissions, and study visits were obtained from logbooks and the electronic medical records. Additional endpoints included well visits, hydroxyurea (HU) visits, and bone pain crisis. Results: Patients registered at the clinic on 17,295 occasions, with 7,820 in the pre-pandemic year decreasing by 43.8% and 35% in the 2 subsequent pandemic years. Overall, study visits increased by 4.9% and 1.3% in the pandemic years. They increased in adults by 13.1% and 8.9% but fell by 3.2% and 6.2% in children. Fewer people were seen in the pandemic years, with children showing a 20.7% decline in numbers. Tele-visits accounted for 31.4% of all study visits during the pandemic years and increased by 23.6% between the pandemic years. There were more well-visits and HU visits, but fewer pain visits and day-care admissions in the pandemic years. Conclusions: The SCU maintained health care delivery for a high-risk population during the pandemic, with tele-visits mitigating the short-fall from in-person visits. Tele-visits may be more acceptable to adults with a chronic illness and may be a suitable alternative for delivering health care.
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Affiliation(s)
- Lesley King
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Kesha Alexander-Gabbadon
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Nicki Chin
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Christine Hammond-Gabbadon
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Patrice Simmonds-Brooks
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - June Harris
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Hopelyn Martin
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Krystal Witter
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Rachel Bartlett
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Jennifer Knight-Madden
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Monika Asnani
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
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13
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Yoo KJ, Lee Y, Lee S, Friebel R, Shin SA, Lee T, Bishai D. The road to recovery: impact of COVID-19 on healthcare utilization in South Korea in 2016-2022 using an interrupted time-series analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 41:100904. [PMID: 37780633 PMCID: PMC10541464 DOI: 10.1016/j.lanwpc.2023.100904] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023]
Abstract
Background The COVID-19 pandemic substantially disrupted healthcare utilization patterns, globally. South Korea had been praised widely in its efforts to contain the spread of the pandemic, which may have contributed to a significantly smaller reduction in healthcare utilization compared to neighboring countries. However, it remains unknown how the COVID-19 pandemic impacted utilization patterns across population sub-groups, particularly vulnerable patient groups in South Korea. This paper quantifies the changes in healthcare utilization attributable to COVID-19 and the COVID-19 vaccination by sub-groups. Methods An interrupted time series analysis was conducted to examine the impact of COVID-19 on healthcare utilization in South Korea from January 2016 to December 2022 using aggregated patient-level data from the national health insurance system that accounts for 99% of all healthcare services in South Korea. We applied negative binomial models adjusting for seasonality and serial correlation. Falsification tests were conducted to test the validity of breakpoints. Stratified analyses by type of healthcare services, age, sex, income level, health facility type, and avoidable/non-avoidable hospitalizations was performed, and we assessed differences in utilization trends between population groups across three phases of the pandemic. Findings In early 2020, the COVID-19 pandemic caused a reduction in monthly volume of outpatient utilization by 15.7% [95% CI 13.3%-18.1%, p < 0.001] and inpatient utilization by 11.6% [10.1%-13.0%, p < 0.001]. Most utilization recovered and rebounded to pre-COVID-19 levels as of December 2022 although variations existed. We observed heterogeneity in the magnitude of relative changes in utilization across types of services, varying from a 42.7% [36.8%-48.0%, p < 0.001] decrease for pediatrics, a 23.4% [20.1%-26.5%%, p < 0.001] reduction in utilization of public health centers, and a 24.2% [21.2%-27.0%, p < 0.001] reduction in avoidable hospitalizations compared to the pre-pandemic period. Contrary to global trends, health utilization among the elderly population (65 and older) in South Korea saw only marginal reductions compared to other age groups. Similarly, Medicaid patients and lower income groups experienced a smaller reduction compared to higher income groups. Interpretation The impact of the COVID-19 pandemic on healthcare utilization in South Korea was less pronounced compared to the global average. Utilization of vulnerable populations, including adults over 65 years old and lowest-income groups reduced less than other type of patients. Funding No funding.
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Affiliation(s)
- Katelyn Jison Yoo
- World Bank Group, South Korea
- Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Seulbi Lee
- National Health Insurance Service, South Korea
| | - Rocco Friebel
- London School of Economics and Political Science, England
| | | | | | - David Bishai
- Johns Hopkins Bloomberg School of Public Health, USA
- Hong Kong University, Hong Kong, China
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14
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Hermosilla M, Ni J, Wang H, Zhang J. Leveraging the E-commerce footprint for the surveillance of healthcare utilization. Health Care Manag Sci 2023; 26:604-625. [PMID: 37642859 DOI: 10.1007/s10729-023-09645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 05/11/2023] [Indexed: 08/31/2023]
Abstract
The utilization of healthcare services serves as a barometer for current and future health outcomes. Even in countries with modern healthcare IT infrastructure, however, fragmentation and interoperability issues hinder the (short-term) monitoring of utilization, forcing policymakers to rely on secondary data sources, such as surveys. This deficiency may be particularly problematic during public health crises, when ensuring proper and timely access to healthcare acquires special importance. We show that, in specific contexts, online pharmacies' digital footprint data may contain a strong signal of healthcare utilization. As such, online pharmacy data may enable utilization surveillance, i.e., the monitoring of short-term changes in utilization levels in the population. Our analysis takes advantage of the scenario created by the first wave of the Covid-19 pandemic in Mainland China, where the virus' spread lead to pervasive and deep reductions of healthcare service utilization. Relying on a large sample of online pharmacy transactions with full national coverage, we first detect variation that is strongly consistent with utilization reductions across geographies and over time. We then validate our claims by contrasting online pharmacy variation against credit-card transactions for medical services. Using machine learning methods, we show that incorporating online pharmacy data into the models significantly improves the accuracy of utilization surveillance estimates.
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Affiliation(s)
- Manuel Hermosilla
- Carey Business School, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Jian Ni
- Pamplin College of Business, Virginia Tech, Blacksburg, Virginia, USA
| | - Haizhong Wang
- School of Management, Sun Yat-sen University, Guangzhou, China
| | - Jin Zhang
- School of Management, Jinan University, Guangzhou, China
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15
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AIGBONOGA DANIELEHIS, OBAROMBI JOSHUATEMIDAYO, SHEKINAH WILLIAMSYOBUH, ADIAT TIJANISHEHU, OWOPUTI TAYEDAVID, JUBRIL ADEBIMPERUKAYAT, SALAWUDEEN AZEEZATMOROLAKE, LAWAL ABIODUNOPEYEMI, AKINTAYO ABIODUNDAVID, OLUWADAMILARE FAITHANUOLUWAPO, OLUWALANA SIMILOLUWAOLAMIDE, ADESOKAN DAYOSODIQ, OGUNTOYE RICHARDAYOBAMI. Impact of Covid-19 Pandemic on the Utilization and Delivery of Healthcare Services among Outpatients during the Early Phase of the Pandemic in Nigeria. J Public Health Afr 2023; 14:2317. [PMID: 38500694 PMCID: PMC10946298 DOI: 10.4081/jphia.2023.2317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
During the early phase of the COVID-19 pandemic, some infection control measures were implemented to keep people safe and control the spread of the virus. These measures however were observed to cause significant delay or interruption in the delivery and utilization of healthcare services. The purpose of this study was to determine the impact of the COVID-19 pandemic on the utilization and delivery of healthcare services by outpatients in Nigeria during the early phase of the pandemic. A retrospective cross-sectional study design was utilized. We sampled 373 outpatients who had received healthcare services before and during the pandemic in the University College Hospital, Ibadan using convenience sampling. Descriptive and inferential statistics (t-test) were carried out and the level of significance was set as P<0.05. Healthcare utilization was significantly impacted by the pandemic as there was a reduction in hospital visits by patients during the pandemic (P<0.0003). Restriction of movement and fear of contracting the virus was identified as reasons for the reduction in healthcare services utilization in about 59% of the participants. Patients rated the quality healthcare services delivered to them as 'average' during the pandemic as opposed to 'good' before the pandemic. The findings of this study showed that the COVID-19 pandemic had a significant impact on patients' utilization of healthcare services as well as the delivery of adequate healthcare services in the hospital during the early phases of the pandemic. Therefore, we recommend that efforts be made to improve hospitals and nationwide preparedness for future pandemics to prevent healthcare interference and delay.
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Affiliation(s)
- DANIEL EHIS AIGBONOGA
- College Research and Innovation Hub, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - WILLIAMS YOBUH SHEKINAH
- College Research and Innovation Hub, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - TIJANI SHEHU ADIAT
- College Research and Innovation Hub, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - TAYE DAVID OWOPUTI
- College Research and Innovation Hub, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - ADEBIMPE RUKAYAT JUBRIL
- College Research and Innovation Hub, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - ABIODUN OPEYEMI LAWAL
- College Research and Innovation Hub, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - ABIODUN DAVID AKINTAYO
- College Research and Innovation Hub, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | - DAYO SODIQ ADESOKAN
- College Research and Innovation Hub, College of Medicine, University of Ibadan, Ibadan, Nigeria
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16
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Boachie MK, Khoza M, Goldstein S, Munsamy M, Hofman K, Thsehla E. The Impact of COVID-19 Lockdown on Service Utilization Among Chronic Disease Patients in South Africa. Health Serv Insights 2023; 16:11786329231215040. [PMID: 38034855 PMCID: PMC10687941 DOI: 10.1177/11786329231215040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Globally, the COVID-19 pandemic has brought many disruptions in health service delivery. Evidence show that the pandemic has negatively affected routine healthcare utilization such as maternal and child health services, but the literature on the effect on non-communicable diseases (NCDs) is scant in South Africa. These disruptions can have long-term health and economic implications for patients. Objective To estimate the impact of COVID-19 lockdown on service utilization among chronic disease patients in South Africa using administrative data. Methods Using monthly data from the Centralized Chronic Medication Dispensing and Distribution (CCMDD) program database covering November 2018 to October 2021, we examined the effects of COVID-19 lockdown on utilization among patients receiving antiretroviral therapy (ART) medication only (ART-only), patients receiving both ART and NCD medication (ART + NCD), and patients receiving NCD medications only (NCD-only). We employed segmented interrupted time series approach to examine the changes. We stratified the analysis by socioeconomic status. Results We found that, overall, the lockdown was associated with increased utilization of CCMDD services by 10.8% (95% CI: 3.3%-19%) for ART-only and 10.3% (95% CI: 3.3%-17.7%) for NCD-only patients. The increase in utilization was not different across socioeconomic groups. For patients receiving ART + NCD medications, utilization declined by 56.6% (95% CI: 47.6%-64.1%), and higher reductions occurred in low SES districts. Conclusion Patients should be educated about the need to continue with utilization of disease programs during a pandemic and beyond. More efforts are needed to improve service use among patients with multi-morbidities.
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Affiliation(s)
- Micheal Kofi Boachie
- Discipline of Public Health Medicine, School of Nursing and Public Health, Howard College, University of KwaZulu-Natal, Durban, South Africa
- SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mariana Khoza
- SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Susan Goldstein
- SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Karen Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evelyn Thsehla
- SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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17
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Kang L, Li C, Du H. Predictors of Medical Care Delay or Avoidance Among Chinese Adults During the COVID-19 Pandemic. Patient Prefer Adherence 2023; 17:3067-3080. [PMID: 38027085 PMCID: PMC10680038 DOI: 10.2147/ppa.s436794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Medical care delay or avoidance increases morbidity and mortality risk and is costly for the national healthcare system. The objective of this study was to identify factors associated with medical care delay or avoidance among Chinese adults during the COVID-19 pandemic. Materials and Methods A cross-sectional analysis was conducted using data from the 2020 China Family Panel Study (CFPS). The CFPS was conducted from July to December 2020 during the COVID-19 pandemic. The final sample included 4369 adults. A logistic regression model was employed to identify the factors associated with medical care delay or avoidance. Results The empirical results indicate that regardless of rural-urban residence, older adults and adults with chronic conditions were less likely to delay or avoid medical care during the pandemic. However, individuals who had completed more than three years of college showed a higher likelihood of delaying or avoiding medical care. In urban areas, larger family sizes, greater general trust in physicians, and higher provider structural quality were associated with a decreased probability of delaying or avoiding medical care during the pandemic. In contrast, employed adults were more likely to delay or avoid medical care. In rural areas, current smokers were more likely to delay or avoid medical care during the pandemic. Conclusion This study has identified several factors affecting medical care delay or avoidance, some of which are amenable to policy changes. Policymakers can help improve the utilization of health facilities and patient health outcomes by implementing a series of reforms.
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Affiliation(s)
- Lili Kang
- School of Health Management, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Changle Li
- School of Health Management, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Huifeng Du
- School of Health Management, Inner Mongolia Medical University, Hohhot, People’s Republic of China
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18
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Mohd Ujang IR, Hamidi N, Ab Hamid J, Awang S, Zulkifli NW, Supadi R, Mohamed NE, Sooryanarayana R. The COVID-19 pandemic and disruptions to maternal and child health services in public primary care Malaysia: a retrospective time-series analysis. BMJ Glob Health 2023; 8:e013397. [PMID: 37949498 PMCID: PMC10649372 DOI: 10.1136/bmjgh-2023-013397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide. Maintaining essential health services, including maternal and child health (MCH), while addressing the pandemic is an enormous task. This study aimed to assess the impact of the COVID-19 pandemic on the utilisation of MCH services in Malaysian public primary care. METHODS A retrospective analysis was conducted using national administrative data from 1124 public primary care clinics. Eight indicators were selected to measure service utilisation covering antenatal, postnatal, women's health, child health, and immunisation services. Interrupted time-series analysis was used to evaluate changes in levels and trends of indicators during four different periods: pre-pandemic (January 2019-February 2020), during pandemic and first lockdown (March-May 2020), after the first lockdown was lifted (June-December 2020) and after the second lockdown was implemented (January-June 2021). RESULTS Most indicators showed no significant trend in monthly utilisation prior to the pandemic. The onset of the pandemic and first lockdown implementation were associated with significant decreasing trends in child health (-19.23%), women's health (-10.12%), antenatal care (-8.10%), contraception (-6.50%), postnatal care (-4.85%) and postnatal care 1-week (-3.52%) indicators. These indicators showed varying degrees of recovery after the first lockdown was lifted. The implementation of the second lockdown caused transient reduction ranging from -11.29% to -25.92% in women's health, contraception, child and two postnatal indicators, but no sustained reducing trend was seen afterwards. Two immunisation indicators appeared unaffected throughout the study period. CONCLUSION The COVID-19 pandemic significantly impacted MCH services utilisation in Malaysia. While most MCH services were negatively affected by the lockdown implementation with varying degrees of recovery, infant immunisation showed resilience throughout. This highlights the need for a targeted preparedness plan to ensure the resilience of MCH services in future crises.
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Affiliation(s)
- Izzatur Rahmi Mohd Ujang
- Centre for Healthcare Quality Research, Institute for Health Systems Research, Ministry of Health, Shah Alam, Malaysia
| | - Normaizira Hamidi
- Centre for Healthcare Quality Research, Institute for Health Systems Research, Ministry of Health, Shah Alam, Malaysia
| | - Jabrullah Ab Hamid
- Centre for Health Equity Research, Institute for Health Systems Research, Ministry of Health, Shah Alam, Malaysia
| | - Samsiah Awang
- Centre for Healthcare Quality Research, Institute for Health Systems Research, Ministry of Health, Shah Alam, Malaysia
| | | | - Roslina Supadi
- Centre for Healthcare Quality Research, Institute for Health Systems Research, Ministry of Health, Shah Alam, Malaysia
| | - Nur Ezdiani Mohamed
- Centre for Healthcare Quality Research, Institute for Health Systems Research, Ministry of Health, Shah Alam, Malaysia
| | - Rajini Sooryanarayana
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
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19
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Wang L, Zhou L, Zhu Y, Yan J, Bu N, Fei W, Wu F. Trends in prescription therapy for adolescents with depression in nine major areas of China during 2017-2021. Front Psychiatry 2023; 14:1175002. [PMID: 37953934 PMCID: PMC10639118 DOI: 10.3389/fpsyt.2023.1175002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Objective To date, no national-scale drug usage survey for adolescents with depression has been conducted in China, and the purpose of this study was to examine the national trends in prescriptions in Chinese adolescent depression patients from 2017 to 2021. Methods Prescribing data were extracted from the Hospital Prescription Analysis Cooperative Project. The average number of patients per year, the cost of treatment, and the prescription patterns (monotherapy vs. combination therapy) were analyzed, and subgroup analyses were conducted depending on age, sex, and drug class. Results The study included 674,099 patients from 136 hospitals located in nine major areas of China. Of all patients, the proportion of adolescents increased from 1.63% in 2017 to 6.75% in 2021. Visits by adolescent depression patients increased from 1,973 in 2017 to 9,751 in 2021, and the corresponding cost increased from 607,598 Chinese Yuan in 2017 to 2,228,884 Chinese Yuan in 2021. The incidence of adolescent depression among female individuals was far beyond that among male individuals. Combination therapy was more frequent than monotherapy, and the most commonly prescribed drugs were antidepressants, antipsychotics, antiepileptics, and antianxietics. Despite the use of sertraline decreasing from 47.90 to 43.39%, it was the most frequently used drug. Conclusion In summary, the prescriptions and cost of treatment for adolescent depression patients both increased rapidly. The widespread use of those drugs with weak clinical evidence reflects the current state of China, which should arouse our attention. The study can provide references for clinical treatment decisions and a basis for more efficient allocation of healthcare resources by the government.
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Affiliation(s)
- Li Wang
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linpo Zhou
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yao Zhu
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Yan
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Na Bu
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weidong Fei
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Wu
- Department of Pharmacy, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
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20
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Xiao H, Liu F, Unger JM. Dynamic zero-COVID policy and healthcare utilization patterns in China during the Shanghai COVID-19 Omicron outbreak. COMMUNICATIONS MEDICINE 2023; 3:143. [PMID: 37821531 PMCID: PMC10567791 DOI: 10.1038/s43856-023-00375-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND In April 2022, an outbreak of the SARS-CoV-2 virus Omicron variant in Shanghai precipitated an extensive lockdown. We assessed changes in healthcare utilization during this outbreak and investigated the relationship between the stringency of mitigation strategies and disruptions in healthcare utilization. METHODS Using provincial-level data from routine health information systems covering all hospitals across Mainland China, we conducted an interrupted time series analysis to examine changes in healthcare utilization during the Shanghai outbreak. Linear regression was used to evaluate the direction and magnitude of the association between the relative changes in the move-out movement index, a proxy for the stringency in population-level mitigation strategies, and the estimated relative changes in healthcare utilization. RESULTS Overall, there were 22.9 billion outpatient visits and 1.2 billion discharged inpatients during the study period from January 2016 to May 2022, including 9.1 billion (39.7%) and 0.46 billion (38.2%) in the post-COVID-19 period (January 2020-May 2022), respectively. From March through May 2022, the outbreak resulted in an accumulative loss of 23.5 million (47%) outpatient visits and 0.6 million (55%) discharged inpatients in Shanghai, and a loss of 150.3 million (14%) outpatient visits and 3.6 million (7%) discharged inpatients in other regions. We find that for every 10-percentage point reduction in the relative change of move-out index, a 2.7 (95% CI: 2.0-3.4) percentage point decline in the relative change of outpatient visits, and a 4.3 (95% CI: 3.5-5.2) percentage points decline in the relative change of inpatient discharges. CONCLUSIONS The Shanghai COVID-19 Omicron outbreak associates with a substantial reduction in outpatient visits and inpatient discharges within Shanghai and other regions in China. The stringency of the COVID-19 lockdown policies associates with more profound reductions in healthcare utilization.
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Affiliation(s)
- Hong Xiao
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Fang Liu
- Independent Researcher, Beijing, China
| | - Joseph M Unger
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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21
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Dlangalala T, Musekiwa A, Mashamba-Thompson T. Impact of COVID-19 on TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa. Sci Rep 2023; 13:16645. [PMID: 37789034 PMCID: PMC10547754 DOI: 10.1038/s41598-023-43589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023] Open
Abstract
We assessed the impact of the pandemic on TB diagnostics at primary healthcare clinics (PHCs) during the different stages of COVID-19 in eThekwini district, South Africa. Data from the District Health Information System (DHIS) were used to conduct an interrupted time series analysis that assessed the changes in TB investigations and confirmed TB cases during four pandemic periods: lockdown and the subsequent three peaks of infection compared to the two years prior (2018-2022). The initial lockdown resulted in - 45% (95% CI - 55 to - 31) and - 40% (95% CI - 59 to - 28) immediate declines in TB investigations and confirmed cases, respectively. Both indicators showed substantial recovery in the months after the first wave (p < 0.05). However, while TB investigations sustained smaller declines throughout the pandemic, they rebounded and surpassed pre-COVID-19 levels by the end of the investigation period. On the other hand, confirmed cases experienced reductions that persisted until the end of the investigation period. TB diagnostic services at PHCs were considerably disrupted by COVID-19, with the confirmation of cases being the most adversely affected throughout the pandemic. The reasons for these persistent declines in TB detection must be determined to inform the development of sustainable diagnostic systems that are capable of withstanding future pandemics.
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Affiliation(s)
- Thobeka Dlangalala
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, 0002, South Africa.
| | - Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, 0002, South Africa
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22
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Endehabtu BF, Angaw DA, Gonete TZ, Jisso M, Abera N, Alemayehu A, Fikre R, Abdissa B, Umer A, Kebede M, Mohammed H, Yazie B, Dessie K, Tamiso A, Sime H, Yesuf EA, Gurmu KK, Tilahun B. Availability of Maternal, Newborn care and Child Health Services at Primary Health Care Unit during COVID-19 Outbreak in Ethiopia. Ethiop J Health Sci 2023; 33:117-126. [PMID: 38352671 PMCID: PMC10859739 DOI: 10.4314/ejhs.v33i2.5s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/09/2023] [Indexed: 02/16/2024] Open
Abstract
Background The COVID-19 pandemic is putting a pressure on global health systems. The disruption of essential health services (EHS) has an impact on the health of mothers, neonate and children in developing countries. Therefore, the main aim of this study was assessing the availability of Maternal, Newborn care and Child health (MNCHS) services at primary health care unit during COVID-19 outbreak. Methods A cross-sectional survey was conducted in five regions of Ethiopia in 2021. Descriptive analyses were undertaken using STATA 16 software and the results presented using tables and different graphs. A continuity of EHS assessment tool adopted from WHO was used for data collection. Result During COVID -19 pandemic, 30 (69.8%) of woreda health offices, 52 (56.5%) of health centers (HCs), 7 (44.4%) of hospitals, and 165 (48%) of health posts (HPs) had a defined list of EHS. In comparison with other EHS, family planning is the least available service in all regions. At HPs level care for sick children and antenatal care (ANC) were available at 59.1 and 58.82% respectively. Except immunization services at SNNP, all other maternal, newborn, and child health EHS were not available to all HPs at full scale. Conclusion Immunization services were most available, while ANC and care for sick children were least available during COVID-19 at the HPs level. There was regional variation in MNCH EHS service availability at all levels.
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Affiliation(s)
- Berhanu Fikadie Endehabtu
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
- eHealthLab Ethiopia, University of Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | - Tajebew Zayede Gonete
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | - Meskerem Jisso
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | - Netsanet Abera
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | | | - Rekiku Fikre
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | - Biru Abdissa
- Jimma University, Institute of Health, Jimma, Ethiopia
| | - Abdurezak Umer
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Mesfin Kebede
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Hussen Mohammed
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Bekele Yazie
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Kassahun Dessie
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | - Alemu Tamiso
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | - Habtamu Sime
- Jimma University, Institute of Health, Jimma, Ethiopia
| | | | - Kassu Ketema Gurmu
- World Health Organization Country Office for Ethiopia, Universal Health Coverage/Life Course, Health System Strengthening Team, Ethiopia
| | - Binyam Tilahun
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
- eHealthLab Ethiopia, University of Gondar, Ethiopia
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23
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Angeles G, Silverstein H, Ahsan KZ, Kibria MG, Rakib NA, Escudero G, Singh K, Mpiima J, Simmons E, Weiss W. Estimating the effects of COVID-19 on essential health services utilization in Uganda and Bangladesh using data from routine health information systems. Front Public Health 2023; 11:1129581. [PMID: 37829090 PMCID: PMC10564984 DOI: 10.3389/fpubh.2023.1129581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 08/31/2023] [Indexed: 10/14/2023] Open
Abstract
Background Since March 2020, the coronavirus disease 2019 (COVID-19) pandemic has been a major shock to health systems across the world. We examined national usage patterns for selected basic, essential health services, before and during the COVID-19 pandemic in Uganda and Bangladesh, to determine whether COVID-19 affected reporting of service utilization and the use of health services in each country. Methods We used routine health information system data since January 2017 to analyze reporting and service utilization patterns for a variety of health services. Using time series models to replicate pre-COVID-19 trajectories over time we estimated what levels would have been observed if COVID-19 had not occurred during the pandemic months, starting in March 2020. The difference between the observed and predicted levels is the COVID-19 effect on health services. Results The time trend models for Uganda and Bangladesh closely replicated the levels and trajectories of service utilization during the 38 months prior to the COVID-19 pandemic. Our results indicate that COVID-19 had severe effects across all services, particularly during the first months of the pandemic, but COVID-19 impacts on health services and subsequent recovery varied by service type. In general, recovery to expected levels was slow and incomplete across the most affected services. Conclusion Our analytical approach based on national information system data could be very useful as a form of surveillance for health services disruptions from any cause leading to rapid responses from health service managers and policymakers.
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Affiliation(s)
- Gustavo Angeles
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hannah Silverstein
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Karar Zunaid Ahsan
- Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mohammad Golam Kibria
- Carolina Health Informatics Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Nibras Ar Rakib
- Carolina Health Informatics Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gabriela Escudero
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kavita Singh
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Elizabeth Simmons
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - William Weiss
- Department of International Health, Johns Hopkins University, Baltimore, MD, United States
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24
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Tannor EK, Quentin W, Busse R, Opoku D, Amuasi J. Impact of COVID-19 on health service utilisation in sub-Saharan Africa: protocol for a scoping review. BMJ Open 2023; 13:e074769. [PMID: 37751950 PMCID: PMC10533669 DOI: 10.1136/bmjopen-2023-074769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/30/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has exposed weaknesses in health systems of many countries, including those in sub-Saharan Africa. Despite comparatively low rates of COVID-19 admissions and deaths in sub-Saharan Africa, the pandemic still had a significant impact by disrupting health service utilisation (HSU). The aim of this scoping review is to synthesise the available evidence on HSU in sub-Saharan Africa during the COVID-19 pandemic, especially focusing on (1) changes in HSU compared with the prepandemic period, (2) changes in HSU among particular patient groups studied and (3) identifying factors determining changes in HSU as a result of the COVID-19 pandemic. METHOD AND ANALYSIS The scoping review will be guided by the methodological framework for conducting scoping reviews developed by Arskey and O'Malley. We will identify relevant studies on HSU in sub-Saharan Africa during the COVID-19 pandemic using PubMed (MEDLINE), Embase, Scopus and Web of Science databases from 1 December, 2019 to 31 March 2023. We will search grey literature, government and organisational websites for reports and conference proceedings. Included studies will be restricted to those reported in English or French. Two reviewers will independently screen articles at the title and abstract stage for inclusion into full text screening. We will provide a general descriptive overview, tabular summaries and content analysis for the extracted data. ETHICS AND DISSEMINATION Ethical approval is not required for the conduct of the scoping review. We will disseminate our findings via open access peer-reviewed journals and scientific presentations. Our scoping review findings will help to determine the feasibility of a subsequent systematic review (and meta-analysis) on HSU during the COVID-19 pandemic.
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Affiliation(s)
- Elliot Koranteng Tannor
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Global Health, German-West African Center for Global Health and Pandemic Preparedness, Kumasi, Ghana
| | - Wilm Quentin
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
- Department of Health Care Management, German-West African Center for Global Health and Pandemic Preparedness, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
- Department of Health Care Management, German-West African Center for Global Health and Pandemic Preparedness, Berlin, Germany
| | - Daniel Opoku
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Global Health, German-West African Center for Global Health and Pandemic Preparedness, Kumasi, Ghana
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - John Amuasi
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Global Health, German-West African Center for Global Health and Pandemic Preparedness, Kumasi, Ghana
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25
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Pakkiyaretnam M, Francis VR, Francis GR, Raheem S, Sanjeev R, Rajavarman R, Ramesh R. Demographic Characteristics and Disease Pattern Among Non-COVID-19 Patients Admitted to Medical Units of a Tertiary Care Hospital in Sri Lanka During Lockdown of the COVID-19 Pandemic: A Comparison During and Before Lockdown. Cureus 2023; 15:e45248. [PMID: 37842446 PMCID: PMC10576610 DOI: 10.7759/cureus.45248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND The COVID-19 infection was rapidly spreading almost all over the world, and the first case was confirmed on 27th January 2020 by a foreign tourist in Sri Lanka. The first Sri Lankan citizen with COVID-19 was confirmed on 11th March 2020. Soon after the confirmation of the disease, long days of lockdown were imposed in almost all parts of the world, including Sri Lanka, to control the spread of the disease. Objectives: To determine the demographic characteristics such as age, sex, number of patients, and disease pattern among non-COVID-19 patients admitted to the medical units during the lockdown of the COVID-19 pandemic and to compare these characteristics with the data before the lockdown. METHODS This was a cross-sectional analytical study. It was conducted at the Teaching Hospital in Batticaloa, Sri Lanka. All the non-COVID-19 patients admitted to medical wards and intensive care units (ICU) were included in this study. Patients admitted to the medical intensive care unit (MICU) and coronary care unit (CCU) were considered ICU admissions in this study. They were studied over a period of one month during lockdown (11th March 2020 to 10th April 2020) and compared with the patients admitted one month prior to the lockdown (11th February 2020 to 10th March 2020). RESULTS Totally, 2340 non-COVID-19 patients (52.5% males) were admitted before the lockdown, and 1376 non-COVID-19 patients (56.2% males) were admitted during the lockdown. This reduction in admission is statistically significant (p-value is <0.001, df=3715). Patients admitted to the wards before lockdown were 2283 (97.6%) and during lockdown were 1309 (95.1%). ICU admissions were N=57 (2.4%) before lockdown and N=67 (4.9%) during lockdown. The common age distribution before the lockdown showed that 26.4% were 31-50 and 41.5% were 51-70 years. Similarly, during lockdown, the age distribution disclosed that 28.9% were 31-50 years and 42.9% were 51-70 years. The disease pattern demonstrated that before lockdown, the majority of patients were admitted for routine hemodialysis (13.2%), to get an injection (9.9%), ischemic heart disease (8.4%), chronic kidney disease (7.3%), and viral fever, including dengue (7.2%). Likewise, during lockdown, more patients were admitted for routine hemodialysis (10.7%), viral fever, including dengue (9.3%), ischemic heart disease (8.8%), to get an injection (8.5%), and chronic kidney disease (5.9%). Conclusion: There was a significant reduction in the number of non-COVID-19-related admissions during the period of lockdown. However, there was not much difference in the proportion of admissions according to gender, age, and disease pattern before and during lockdown. More number of male patients were admitted than female patients. Most of the admitted patients were under the age group of 51-70 years. The highest number of patients were admitted for routine hemodialysis before and during lockdown. However, a slightly higher number of patients were admitted to the ICU during lockdown. Therefore, strengthening the ICU facilities may be an important preparation to accommodate more patients in the future if a similar kind of emergency lockdown occurs in a pandemic situation. In addition, admissions due to non-communicable diseases (NCD) didn't fall in proportion during the pre-COVID-19 period and the lockdown period. Therefore, the redistribution of healthcare facilities needs to be done wisely to face the challenges caused by the NCDs.
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Affiliation(s)
- Mayurathan Pakkiyaretnam
- Department of Clinical Sciences, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
- University Medical Unit, Teaching Hospital Batticaloa, Batticaloa, LKA
| | - Vaithehi R Francis
- Department of Pathophysiology, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
- Microbiology, Teaching Hospital Batticaloa, Batticaloa, LKA
| | - George Rajeevan Francis
- Department of Clinical Sciences, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
- Cardiology, Teaching Hospital Batticaloa, Batticaloa, LKA
| | - Sanooz Raheem
- Department of Clinical Sciences, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
| | - Rajavarthani Sanjeev
- Department of Human Biology, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
| | - Rajeswaran Rajavarman
- Department of Human Biology, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
- Emergency Medicine, Teaching Hospital Batticaloa, Batticaloa, LKA
| | - Ramanathan Ramesh
- General Internal Medicine, Teaching Hospital Batticaloa, Batticaloa, LKA
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Hwang J, Kim WH, Heo J. An association between individual's risk perceptions and delayed or foregone healthcare services during the COVID-19 pandemic in Korea. BMC Health Serv Res 2023; 23:850. [PMID: 37568127 PMCID: PMC10422804 DOI: 10.1186/s12913-023-09807-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/11/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Existing evidence highlights that the COVID-19 pandemic is associated with a large reduction in healthcare utilization for routine and less-urgent services around the world including Korea. During the COVID-19 pandemic, delayed and foregone healthcare are driven by various factors, and risk perception, a complex psychological construct, is one of them. The aim of this study was to examine how COVID-19 risk perceptions influence delayed and foregone care during the pandemic in Korea. METHODS The Koreans' Happiness Survey (KHS) 2020 was used to analyze responses from 13,491 individuals over 19 years of age residing in Korea. To assess delayed and foregone care, self-reported delayed or foregone care after the COVID-19 outbreak was used. COVID-19 risk perceptions were analyzed in terms of fear and severity of the pandemic based on responses from the participants. Logistic regression models, stratified by gender, were used to examine the relationship between COVID-19 risk perception and delayed/foregone healthcare. RESULTS Among the total 13,491 individuals included in the study, 4.0% (n = 541) reported delayed and foregone care in 2020. The results showed that higher level of fear of COVID-19 was associated with an increased likelihood of reporting delayed and foregone care in Korean adults (OR = 1.36, 95% CI = 1.08-1.73). The gender-stratified model revealed that greater fear of COVID-19 was associated with higher odds of delayed and foregone healthcare (OR = 1.71, 95%CI = 1.23-2.39) among women while the perceived severity did not have any association. However, the perceived severity was associated with a higher likelihood of delayed and foregone care in men (OR = 1.17, 95%CI = 1.04-1.32), but no association was found between fear of COVID-19 and delayed and foregone healthcare in men. CONCLUSIONS To ensure the timely use of any needed healthcare services, it is worth considering establishing policy interventions to mitigate unnecessary fear and worries about COVID-19. This can be achieved by providing accurate information on the virus, protective measures, and treatment.
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Affiliation(s)
- Jongnam Hwang
- Division of Social Welfare & Health Administration, Wonkwang University, Iksan, Korea
| | - Woong-Han Kim
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, Seoul, Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jongho Heo
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea.
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea.
- National Assembly Futures Institute, Seoul, Korea.
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Oduro MS, Peprah P, Morgan AK, Agyemang-Duah W. Staying in or out? COVID-19-induced healthcare utilization avoidance and associated socio-demographic factors in rural India. BMC Public Health 2023; 23:1439. [PMID: 37501140 PMCID: PMC10375657 DOI: 10.1186/s12889-023-16282-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Although evidence on healthcare utilization avoidance during COVID-19 pandemic is emerging, such knowledge is limited in rural settings. An effective policy to the COVID-19 shocks and stresses in rural settings require empirical evidence to inform the design of health policies and programmes. To help overcome this evidence gap and also contribute to policy decisions, this study aimed at examining COVID-19-induced healthcare utilization avoidance and associated factors in rural India. METHODS This study used the third-round data from the COVID-19-Related Shocks in Rural India survey conducted between 20-24 September, 2020 across six states. The outcome variable considered in this study was COVID-19-induced healthcare utilization avoidance. Multivariable Binary Logistic Regression Model via Multiple Imputation was used to assess the factors influencing COVID-19-induced healthcare utilization avoidance. RESULTS Data on 4,682 respondents were used in the study. Of this, the prevalence of COVID-19-induced healthcare utilization avoidance was 15.5% in rural India across the six states. After adjusting for relevant covariates, participants from the Bihar State have significantly higher likelihood of COVID-19-induced healthcare utilization avoidance compared to those from the Andhra Pradesh. Also, participants whose educational level exceeds high school, those who use government hospital/clinic, engage in daily wage labour in agriculture have significantly higher odds of COVID-19-induced healthcare utilization avoidance compared to their counterparts. CONCLUSION Our study revealed that state of residence, type of health facility used, primary work activity and educational level were associated with COVID-19-induced healthcare utilization avoidance in rural India. The findings suggest that policy makers and public health authorities need to formulate policies and design interventions that acknowledge socioeconomic and demographic factors that influence healthcare use avoidance.
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Affiliation(s)
- Michael Safo Oduro
- Pfizer, Inc., Pharm Sci and PGS Statistics, 445 Eastern Point Rd, Groton, Connecticut, USA
| | - Prince Peprah
- Social Policy Research Center, UNSW, Sydney, Australia
- Center for Primary Health Care and Equity, UNSW, Sydney, Australia
| | - Anthony Kwame Morgan
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Williams Agyemang-Duah
- Department of Geography and Planning, Queen's University, K7L 3N6, Kingston, Ontario, Canada
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Herrera CA, Kerr AC, Dayton JM, Kakietek JJ. Healthcare service disruption in 14 Latin American and Caribbean countries during the COVID-19 pandemic: Analysis of household phone surveys, 2020-2021. J Glob Health 2023; 13:06023. [PMID: 37469284 PMCID: PMC10359759 DOI: 10.7189/jogh.13.06023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
Background The coronavirus 2019 (COVID-19 pandemic) and associated responses have significantly disrupted healthcare. We aimed to estimate the magnitude of and reasons for households reporting healthcare disruption in 14 Latin America and the Caribbean (LAC) region countries from mid-2020 to mid-2021, and its relationship with country contextual factors. Methods We used COVID-19 high-frequency phone surveys (HFPS) conducted in 14 LAC countries in three rounds in 2020 and one in 2021. We classified the reasons reported for healthcare disruption into four groups: concerns about contracting COVID-19, healthcare supply constraints, financial reasons, and public health measures (PHMs). We used bivariate and multivariate regressions to examine correlates of reported healthcare disruption with the above groups and country context as control variables. Results On average, 20% of households reported a disruption in May-June 2020 (45% to 10% at country level), dropping to 9% in June-July 2020 (31% to 3%) and July-August 2020 (26% to 3%), and declining to 3% in May-July 2021 (11% to 1%). The most common reason reported for disruption was healthcare supply constraints, followed by concerns about contracting COVID-19, PHM, and financial reasons. In multivariable regression analyses, we found that a higher incidence of new COVID-19 cases (regression coefficient (β) = 0.018, P < 0.01), stricter PHM (β = 0.002, P < 0.01), fewer hospital beds per population (β = -0.011, P < 0.01), and lower out-of-pocket health spending (β = -0.0008, P < 0.01) were associated with higher levels of disrupted care. A higher care disruption was associated with a lower gross domestic product (GDP) per person (β = -0.00001, P < 0.01) and lower population density (β = -0.056, P < 0.01). Conclusions Healthcare services for households in LAC were substantially disrupted during the COVID-19 pandemic. Findings about supply and financial constraints can inform the recovery of postponed healthcare services, while public health and contextual factors findings can inform future health system resilience efforts in LAC and elsewhere.
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Affiliation(s)
- Cristian A Herrera
- World Bank, Washington DC, District of Columbia, USA
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Amanda C Kerr
- Department of Economics, University of Maryland, College Park, Maryland, USA
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Seo SH, Cho S, Yoo SH, Keam B, Shin A. Changes in the Utilization of Health Care Services by Cancer Patients during the COVID-19 Pandemic. Yonsei Med J 2023; 64:463-470. [PMID: 37365741 DOI: 10.3349/ymj.2023.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE The first year of the COVID-19 pandemic in Korea elicited changes in healthcare service utilization. This study aimed to report changes in healthcare service utilization among cancer patients during the first year of the COVID-19 pandemic in Korea. MATERIALS AND METHODS We analyzed records from National Health Insurance Service Database and identified cancer patients as those with specific beneficiary codes ("V193" or "V194") assigned to cancer patients. We calculated percentage changes in the number of patients between 2019 and 2020 based on claims records for outpatient clinic visits, hospitalization, and emergency room visits by month, age group, residential areas, and hospital location. RESULTS The number of newly diagnosed cancer patients in 2020 decreased by 3.2%, compared to the previous year. The number of patients who visited an outpatient clinic, were hospitalized, and visited the emergency room decreased by 2.6%, 4.0%, and 3.5%, respectively, in 2020, compared to the year 2019. CONCLUSION During the first year of the COVID-19 pandemic, the number of newly diagnosed cancer patients decreased by 3.2%, compared to the previous year, and their utilization of healthcare services declined significantly after the outbreak of COVID-19.
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Affiliation(s)
- Seung Hee Seo
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Korea
| | - Sooyoung Cho
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Medical Research Center, Genomic Medicine Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Aesun Shin
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Kwon RH, Kim SH, Jung M. Behavioral predictors associated with HIV screening needs in gay Korean men during the COVID-19 pandemic. PLoS One 2023; 18:e0287061. [PMID: 37307274 DOI: 10.1371/journal.pone.0287061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/26/2023] [Indexed: 06/14/2023] Open
Abstract
During the pandemic, the capacity of medical resources focused on testing, diagnosing and treating COVID-19 has severely limited public access to health care. In particular, HIV screening, for which homosexual males in Korea received free and anonymous testing at public health centers, was completely halted. This study investigated behavioral predictors related to the HIV screening needs of Korean male homosexuals during the pandemic. Data were collected by conducting a web survey targeting members of the largest homosexual portal site in Korea with support from the National Research Foundation of Korea (n = 1,005). The key independent variables are COVID-19-related characteristics and sexual risk behavior. The moderating variable is health information search behavior, and the dependent variable is the need for HIV screening. For a statistical analysis, a hierarchical multiple logistic regression analysis was conducted while controlling for potential confounding variables. According to the results of this study, the need for HIV screening was 0.928 times lower for older people (p<0.05, 95% CI = 0.966-0.998). However, if the respondent had a primary partner, the need for HIV screening was 1.459 times higher (p<0.01, 95% CI = 1.071-1.989). In addition, the need for screening was 1.773 times higher for those who preferred anal intercourse (p<0.01, 95% CI = 1.261-2.494) and 2.034 times higher (p<0.01, 95% CI = 1.337-3.095) if there was a history of being diagnosed with an STD. Finally, health information-seeking behavior was marginally significant. This study revealed that male Korean homosexuals who were young, preferred anal sex with a primary partner, and who had a history of a sexually transmitted disease had a high need for HIV screening at public health centers. They are more likely to be susceptible to HIV infection because they are usually consistent with gay men, characterized by risky behavior. Therefore, an intervention strategy that provides health information using a communication campaign is needed.
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Affiliation(s)
- Rang Hee Kwon
- Department of Health Science, Dongduk Women's University, Seoul, South Korea
| | - So-Hyun Kim
- Department of Health Science, Dongduk Women's University, Seoul, South Korea
| | - Minsoo Jung
- Department of Health Science, Dongduk Women's University, Seoul, South Korea
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
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Angeles G, Silverstein H, Worges M, Hotchkiss DR, Wisniewski JM, Lusamba Dikassa PS, Weiss W, Ahsan KZ. Area-specific covid-19 effects on health services utilization in the Democratic Republic of the Congo using routine health information system data. BMC Health Serv Res 2023; 23:575. [PMID: 37270545 DOI: 10.1186/s12913-023-09547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/14/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Since March 2020, the COVID-19 pandemic has shocked health systems worldwide. This analysis investigated the effects of the pandemic on basic health services utilization in the Democratic Republic of the Congo (DRC) and examined the variability of COVID effects in the capital city Kinshasa, in other urban areas, and in rural areas. METHODS We estimated time trends models using national health information system data to replicate pre-COVID-19 (i.e., January 2017-February 2020) trajectories of health service utilization, and then used those models to estimate what the levels would have been in the absence of COVID-19 during the pandemic period, starting in March 2020 through March 2021. We classified the difference between the observed and predicted levels as the effect of COVID-19 on health services. We estimated 95% confidence intervals and p-values to examine if the effect of the pandemic, nationally and within specific geographies, was statistically significant. RESULTS Our results indicate that COVID-19 negatively impacted health services and subsequent recovery varied by service type and by geographical area. COVID-19 had a lasting impact on overall service utilization as well as on malaria and pneumonia-related visits among young children in the DRC. We also found that the effects of COVID-19 were even more immediate and stronger in the capital city of Kinshasa compared with the national effect. Both nationally and in Kinshasa, most affected services had slow and incomplete recovery to expected levels. Therefore, our analysis indicates that COVID-19 continued to affect health services in the DRC throughout the first year of the pandemic. CONCLUSIONS The methodology used in this article allows for examining the variability in magnitude, timing, and duration of the COVID effects within geographical areas of the DRC and nationally. This analytical procedure based on national health information system data could be applied to surveil health service disruptions and better inform rapid responses from health service managers and policymakers.
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Affiliation(s)
- Gustavo Angeles
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hannah Silverstein
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Matt Worges
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - David R Hotchkiss
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Janna M Wisniewski
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Paul Samson Lusamba Dikassa
- Tulane International LLC, Kinshasa, Democratic Republic of the Congo
- Kinshasa School of Public Health, The University of Kinshasa, DRC, Kinshasa, Democratic Republic of the Congo
| | - William Weiss
- Department of International Health, The John Hopkins University, Baltimore, MD, USA
| | - Karar Zunaid Ahsan
- Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
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Mahmoodpour-Azari M, Rezaei S, Badiee N, Hajizadeh M, Mohammadi A, Kazemi-Karyani A, Soltani S, Khezeli M. The COVID-19 pandemic and healthcare utilization in Iran: evidence from an interrupted time series analysis. Osong Public Health Res Perspect 2023; 14:180-187. [PMID: 37415435 PMCID: PMC10522821 DOI: 10.24171/j.phrp.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/08/2023] [Accepted: 04/21/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND This study aimed to examine the effect of the coronavirus disease 2019 (COVID-19) outbreak on the hospitalization rate, emergency department (ED) visits, and outpatient clinic visits in western Iran. METHODS We collected data on the monthly hospitalization rate, rate of patients referred to the ED, and rate of patients referred to outpatient clinics for a period of 40 months (23 months before and 17 months after the COVID-19 outbreak in Iran) from all 7 public hospitals in the city of Kermanshah. An interrupted time series analysis was conducted to examine the impact of COVID-19 on the outcome variables in this study. RESULTS A statistically significant decrease of 38.11 hospitalizations per 10,000 population (95% confidence interval [CI], 24.93-51.29) was observed in the first month of the COVID-19 outbreak. The corresponding reductions in ED visits and outpatient visits per 10,000 population were 191.65 (95% CI, 166.63-216.66) and 168.57 (95% CI, 126.41-210.73), respectively. After the initial reduction, significant monthly increases in the hospitalization rate (an increase of 1.81 per 10,000 population), ED visits (an increase of 2.16 per 10,000 population), and outpatient clinic visits (an increase of 5.77 per 10,000 population) were observed during the COVID-19 pandemic. CONCLUSION Our study showed that the utilization of outpatient and inpatient services in hospitals and clinics significantly declined after the COVID-19 outbreak, and use of these services did not return to pre-outbreak levels as of June 2021.
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Affiliation(s)
- Monireh Mahmoodpour-Azari
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nasim Badiee
- Institute for Studies in Medicine History, Persian and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Traditional Medicine, School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Ali Mohammadi
- Department of Health Information Technology, Paramedical School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Kazemi-Karyani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Khezeli
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Zhang B, Kang W, Xiong S, Huang X, Chen P, Huang J, Hou Y, Ma L, Xiang T. Changes in the epidemiological characteristics of prehospital emergency services before and during the COVID-19 pandemic, Chengdu, 2016-2021. Sci Rep 2023; 13:7796. [PMID: 37179377 PMCID: PMC10182747 DOI: 10.1038/s41598-023-34852-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/09/2023] [Indexed: 05/15/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) brought a healthy crisis all around the world. It's not only affected healthcare utilization, but also some disease's incidence. We collected pre-hospital emergency data in Chengdu from January 2016 to December 2021, and studied the demand for emergency medical services (EMSs), emergency response times (ERTs), and the disease spectrum in the city proper of Chengdu as a whole. A total of 1,122,294 prehospital emergency medical service (EMS) instances met the inclusion criteria. Under the influence of COVID-19, notably in 2020, the epidemiological characteristics of prehospital emergency services in Chengdu were considerably altered. However, as the pandemic was brought under control, they returned to normal or even earlier in 2021.The COVID-19 pandemic had an effect on people's medical care-seeking behavior and the performance of prehospital emergency services. Although the indicators associated with prehospital emergency services eventually recovered as the epidemic was brought under control, they remained marginally different from before the outbreak.
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Affiliation(s)
- Bihua Zhang
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, China
- Department of Emergency, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, No. 82 Qinglong Street, Chengdu, Sichuan, China
| | - Wenchao Kang
- Chengdu Medical Emergency Center, Chengdu, China
| | - Shiqiang Xiong
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, China
| | - Xia Huang
- Chengdu Medical Emergency Center, Chengdu, China
| | - Pei Chen
- Chengdu Medical Emergency Center, Chengdu, China
| | - Jinmin Huang
- Chengdu Medical Emergency Center, Chengdu, China
| | - Yufei Hou
- Chengdu Medical Emergency Center, Chengdu, China
| | - Lin Ma
- Chengdu Medical Emergency Center, Chengdu, China
| | - Tao Xiang
- Department of Emergency, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, No. 82 Qinglong Street, Chengdu, Sichuan, China.
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Du Y, Jin C, Jit M, Chantler T, Lin L, Larson HJ, Li J, Gong W, Yang F, Ren N, Cheng W, Zhou Y, Tang W, Tucker JD, Wu D. Influenza vaccine uptake among children and older adults in China: a secondary analysis of a quasi-experimental study. BMC Infect Dis 2023; 23:225. [PMID: 37055738 PMCID: PMC10098986 DOI: 10.1186/s12879-023-08145-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 03/09/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Influenza vaccination is the key to prevent influenza-related disease, especially among high-risk populations. However, influenza vaccine uptake in China is low. This secondary analysis of a quasi-experimental trial aimed to understand factors associated with influenza vaccine uptake among children and older people stratified by funding context. METHODS A total of 225 children (aged 0.5-8 years) and 225 older people (aged 60 years or above) were recruited from three clinics (rural, suburban and urban) in Guangdong Province. Participants were allocated into two groups based on funding contexts: a self-paid group (N = 150, 75 children and 75 older adults) in which participants paid full price for their vaccination; and a subsidized group (N = 300, 150 children and 150 older adults) in which varying levels of financial support was provided. Univariate and multivariable logistic regressions were conducted stratified by funding contexts. RESULTS Overall, 75.0% (225/300) of participants in the subsidized group and 36.7% (55/150) in the self-paid group got vaccinated. Older adults had lower vaccination rates than children in both funding groups, while both age groups showed much higher uptake in the subsidized group than in the self-paid group (aOR = 5.96, 95% CI: 3.77-9.42, p = 0.001). In the self-paid group, having prior influenza vaccination history of children (aOR:2.61, 95%CI: 1.06-6.42) or older people (aOR:4.76, 95%CI: 1.08-20.90) was associated with increased influenza vaccine uptake compared to those who had no prior vaccination experiences in the family. While in the subsidized group, participants who got married or lived with partners (aOR = 0.32, 0.10-0.98) had lower vaccination uptake than single ones. Trust in providers' advice (aOR = 4.95, 95%CI:1.99, 12.43), perceived effectiveness of the vaccine (aOR: 12.18, 95%CI: 5.21-28.50), and experienced influenza-like illnesses in the family in the past year (aOR = 46.52, 4.10, 533.78) were associated with higher vaccine uptake. CONCLUSIONS Older people had suboptimal vaccine uptake compared to children in both contexts and need more attention to enhance influenza vaccination. Tailoring interventions to different vaccine funding contexts may help improve influenza vaccination: In self-paid context, motivating people to accept their first ever influenza vaccination may be a promising strategy. In subsidized context, improving public confidence in vaccine effectiveness and providers' advice would be useful.
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Affiliation(s)
- Yumeng Du
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Chenqi Jin
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Dermatology Hospital of South Medical University, Guangzhou, China
| | - Mark Jit
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, New Territories, Hong Kong, China
| | - Tracey Chantler
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Leesa Lin
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, New Territories, Hong Kong, China
| | - Heidi J Larson
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jing Li
- Department of Occupational and Environmental Health, West China School of Public Health, Sichuan University, Chengdu, China
| | - Wenfeng Gong
- China Country Office, Bill & Melinda Gates Foundation, Beijing, China
| | - Fan Yang
- Institute of Population Research, Peking University, Beijing, China
| | - Nina Ren
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Weibin Cheng
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yi Zhou
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Weiming Tang
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph D Tucker
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dan Wu
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China.
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, Room 360, Keppel St, London, WC1E 7HT, UK.
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Thonprasertvat B, Roopsawang I, Aree-Ue S. Assessing the Predictive Power of Frailty and Life-Space Mobility on Patient-Reported Outcomes of Disability in Older Adults with Low Back Pain. Healthcare (Basel) 2023; 11:healthcare11071012. [PMID: 37046939 PMCID: PMC10093851 DOI: 10.3390/healthcare11071012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/28/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Background: Frailty and decreased life-space mobility are known as risk factors to develop physical limitations leading to disability in older adults with low back pain (LBP). This cross sectional study aimed to investigate the prevalence and predictive power of frailty and life-space mobility on patient-reported outcomes of disability in older adults with LBP. Methods: The sample comprised 165 older adults with LBP who visited two tertiary care hospitals between December 2021 and February 2022. The participants responded to structured standard questionnaires. Data were analyzed using descriptive statistics and robust logistic regression. Results: More than two-thirds of participants were classified as non-frail (26.67%) or pre-frail (66.67%). Mobility restrictions and minimal to severe disability were identified. Controlling other variables, frailty (OR = 1.74, 95% CI: 1.14–2.64) and restricted life-space mobility (OR = 0.42, 95% CI: 0.26–0.67) were significantly associated with disability. Integrating frailty with life-space mobility evaluations demonstrated the highest predictive power for disability-related LBP (AUC = 0.89, 95% CI: 0.84–0.93). Conclusion: Frailty and restricted life-space mobility significantly predicted disability in older adults with LBP. Healthcare professionals should recognize the critical importance of integrating patient-reported outcomes with screening for frailty and life-space mobility limitation to optimize care or tract symptom progression.
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Affiliation(s)
- Benyapa Thonprasertvat
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Inthira Roopsawang
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Suparb Aree-Ue
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Raisi-Estabragh Z, Mamas MA. Cardiovascular Health Care Implications of the COVID-19 pandemic. Heart Fail Clin 2023; 19:265-272. [PMID: 36863818 PMCID: PMC9973542 DOI: 10.1016/j.hfc.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has challenged the capacity of health care systems around the world, including substantial disruptions to cardiovascular care across key areas of health care delivery. In this narrative review, we examine the implications of the COVID-19 pandemic for cardiovascular health care, including excess cardiovascular mortality, acute and elective cardiovascular care, and disease prevention. Additionally, we consider the long-term public health consequences of disruptions to cardiovascular care across both primary and secondary care settings. Finally, we review health care inequalities and their driving factors, as highlighted by the pandemic, and consider their importance in the context of cardiovascular health care.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University, London EC1M 6BQ, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele ST5 5BG, United Kingdom; Department of Cardiology, Thomas Jefferson University, Philadelphia, PA 19107, USA; Institute of Population Health, University of Manchester, Manchester M13 9PT, United kingdom.
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Liu J, Zhai X, Yan W, Liu Q, Liu M, Liang W. Long-term impact of the COVID-19 pandemic on health services utilization in China: A nationwide longitudinal study. GLOBAL TRANSITIONS 2023; 5:21-28. [PMID: 36987499 PMCID: PMC10036308 DOI: 10.1016/j.glt.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Long-term impact of the COVID-19 pandemic on health services utilization is unknown. We aim to assess the long-term effect of the COVID-19 pandemic on health services utilization in China. METHODS Between Jan 2017 and Dec 2021, we conducted a nationwide longitudinal study using routinely collected data on health services utilization in the National Health Information System of China. We extracted national and provincial data of demographic characteristics, socio-economic characteristics, and health resources. Interrupted time-series segmented negative binominal regression models were used. RESULTS A total of 34.2 billion health facilities visits and 1.1 billion inpatients discharged were included. The largest negative impact of COVID-19 pandemic on the health services utilization was during containment period, that health facility visits were observed 32% reduction in hospitals (adjusted incidence risk ratios [aRRs] 0.68, 95%CI: 0.50-0.92), 27% reduction in community health centers (aRR 0.73, 95%CI: 0.57-0.93), and 22% reduction township centers (aRR 0.78, 95%CI: 0.67-0.91), respectively. The impact on health facility visits and inpatients discharged were reduced and eliminated over time (all p>0.05). However, the negative impact on utilization rate of beds, average length of stay, average inpatient costs, and average outpatient costs in different level of health facilities still existed two years later (all p<0.05). CONCLUSIONS The impact of the COVID-19 pandemic on health services utilization was largest during containment period and reduced over time, but it still existed two years later. There are disparities in the recovery of health services. Our findings highlighted the importance of maintaining primary healthcare services during the pandemic and strengthen resilient health system on the rapid recovery of medical services.
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Affiliation(s)
- Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, No. 5 Yiheyuan Road, Haidian, Beijing, 100871, China
| | - Xiaohui Zhai
- Medical Management Center, National Health Commission of the People's Republic of China, No. 1, Xizhimenwai South Road, Xicheng District, Beijing, 100044, China
| | - Wenxin Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Qiao Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, No. 30, Shuangqing Road, Haidian District, 100084, Beijing, China
- Institute for Healthy China, Tsinghua University, No. 30, Shuangqing Road, Haidian District, 100084, Beijing, China
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Zhang W, Wu Y, Wen B, Zhang Y, Wang Y, Yin W, Sun S, Wei X, Sun H, Zhang Z, Li S, Guo Y. Non-pharmaceutical interventions for COVID-19 reduced the incidence of infectious diseases: a controlled interrupted time-series study. Infect Dis Poverty 2023; 12:15. [PMID: 36895021 PMCID: PMC9996566 DOI: 10.1186/s40249-023-01066-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/06/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Non-pharmaceutical interventions (NPIs) have been implemented worldwide to suppress the spread of coronavirus disease 2019 (COVID-19). However, few studies have evaluated the effect of NPIs on other infectious diseases and none has assessed the avoided disease burden associated with NPIs. We aimed to assess the effect of NPIs on the incidence of infectious diseases during the COVID-19 pandemic in 2020 and evaluate the health economic benefits related to the reduction in the incidence of infectious diseases. METHODS Data on 10 notifiable infectious diseases across China during 2010-2020 were extracted from the China Information System for Disease Control and Prevention. A two-stage controlled interrupted time-series design with a quasi-Poisson regression model was used to examine the impact of NPIs on the incidence of infectious diseases. The analysis was first performed at the provincial-level administrative divisions (PLADs) level in China, then the PLAD-specific estimates were pooled using a random-effect meta-analysis. RESULTS A total of 61,393,737 cases of 10 infectious diseases were identified. The implementation of NPIs was associated with 5.13 million (95% confidence interval [CI] 3.45‒7.42) avoided cases and USD 1.77 billion (95% CI 1.18‒2.57) avoided hospital expenditures in 2020. There were 4.52 million (95% CI 3.00‒6.63) avoided cases for children and adolescents, corresponding to 88.2% of total avoided cases. The top leading cause of avoided burden attributable to NPIs was influenza [avoided percentage (AP): 89.3%; 95% CI 84.5‒92.6]. Socioeconomic status and population density were effect modifiers. CONCLUSIONS NPIs for COVID-19 could effectively control the prevalence of infectious diseases, with patterns of risk varying by socioeconomic status. These findings have important implications for informing targeted strategies to prevent infectious diseases.
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Affiliation(s)
- Wenyi Zhang
- Division of Disease Surveillance, Chinese PLA Center for Disease Control and Prevention, Beijing, 100071, China
| | - Yao Wu
- School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Bo Wen
- School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Yongming Zhang
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yong Wang
- Division of Disease Surveillance, Chinese PLA Center for Disease Control and Prevention, Beijing, 100071, China
| | - Wenwu Yin
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Shanhua Sun
- Beijing Center for Disease Prevention and Control, Beijing, 100013, China
| | - Xianyu Wei
- Division of Disease Surveillance, Chinese PLA Center for Disease Control and Prevention, Beijing, 100071, China
| | - Hailong Sun
- Division of Disease Surveillance, Chinese PLA Center for Disease Control and Prevention, Beijing, 100071, China
| | - Zhijie Zhang
- Department of Epidemiology and Health Statistics, Fudan University, Shanghai, 200032, China
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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Huang F, Liu H. The impact of the COVID-19 pandemic and related policy responses on non-COVID-19 healthcare utilization in China. HEALTH ECONOMICS 2023; 32:620-638. [PMID: 36397307 DOI: 10.1002/hec.4636] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/20/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
We investigate the impact of the COVID-19 pandemic and related policy responses on non-COVID-19 healthcare utilization (i.e., different types of outpatient care) up to October 2020 in China. Using an administrative database from a large prefecture-level city, we find that both direct exposure to the COVID-19 pandemic and the strict containment policy responses led to reductions in outpatient care utilization. The largest decline during the lockdown was observed in preventive care visits, which nevertheless recovered to pre-pandemic levels 2 months after the lockdown. The disruptions in prenatal care visits could not be offset by the recovery later on. Chronic care and emergency department visits had not returned to pre-pandemic levels as of October 2020, which may be driven by extended days' supply of prescription medication, increased use of telemedicine, and improved health-protective behaviors. In the reopening period, there were increases in visits for mental and sleep disorders, especially among children, and for medical abortion. Among health facilities at all levels, primary care facilities saw the least reductions in total outpatient visits. Our results emphasize the need for strategies to ensure access to urgent or essential care services when managing the current epidemiologic transition and future crises.
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Affiliation(s)
- Feng Huang
- School of Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Hong Liu
- School of Labor and Human Resources, Renmin University of China, Beijing, China
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Sukmanee J, Butchon R, Karunayawong P, Saeraneesopon T, Boonma C, Teerawattananon Y, Isaranuwatchai W. Pattern of OPD utilisation during the COVID-19 pandemic under the Universal Coverage Scheme in Thailand: what can 850 million records tell us? BMC Health Serv Res 2023; 23:116. [PMID: 36737787 PMCID: PMC9897880 DOI: 10.1186/s12913-023-09121-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Out-patient department (OPD) is a crucial component of the healthcare systems in low- and middle-income countries including Thailand. A considerable impact of coronavirus disease 2019 (COVID-19) pandemic and its control measures, especially the lockdown, on utilisation of OPD services was expected. This study thus aims to estimate the pattern of OPD utilisation during the COVID-19 pandemic in Thailand including overall utilisation and within each sub-groups including diagnostic group, age group, and health region. METHODS This study was a secondary data analysis of aggregated outpatient data from patients covered under the Universal Coverage Scheme (UCS) in Thailand over a 4-year period (2017-2020). Interrupted time series analyses and segmented Quasi-Poisson regression were used to examine the impact of COVID-19 on the overall OPD utilisation including the impact on each diagnostic group, age groups, health regions, and provinces. RESULTS Analysis of 845,344,946 OPD visits in this study showed a seasonal pattern and increasing trend in monthly OPD visits before the COVID-19 pandemic. A 28% (rate ratio (RR) 0.718, 95% confidence interval (CI): 0.631-0.819) and 11% (RR 0.890, 95% CI: 0.811-0.977) reduction in OPD visits was observed during the lockdown and post-lockdown periods, respectively, when compared to the pre-lockdown period. Diseases of respiratory system were most affected with a RR of 0.411 (95% CI: 0.320-0.527), while the number of visits for non-communicable diseases (ICD-10: E00-E90, I00-I99) and elderly (> 60 years) dropped slightly. The post-lockdown trend in monthly OPD visits gradually increased to the pre-pandemic levels in most groups. CONCLUSIONS Thailand's OPD utilisation rate during the COVID-19 lockdown decreased in some diseases, but the service for certain group of patients appeared to remain available. After the COVID-19 lockdown, the rate returned to the pre-pandemic level in a timely manner. Equipped with a knowledge of OPD utilisation pattern during COVID-19 based on a national real-world database could aid with a better preparation of healthcare system for future pandemics.
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Affiliation(s)
- Jarawee Sukmanee
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Rukmanee Butchon
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Picharee Karunayawong
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Thanayut Saeraneesopon
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Chulathip Boonma
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand
| | - Yot Teerawattananon
- grid.477319.f0000 0004 1784 9596Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand ,grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore ,grid.415836.d0000 0004 0576 2573Health Administration Division, Office of the Permanent Secretary of the Ministry of Public Health, Nonthaburi, Thailand
| | - Wanrudee Isaranuwatchai
- Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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Wu X, Zhou X, Chen Y, Zhai K, Sun R, Luo G, Lin YF, Li Y, Yang C, Zou H. The impact of COVID-19 lockdown on cases and deaths of AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C in China: an interrupted time series analysis. JMIR Public Health Surveill 2023; 9:e40591. [PMID: 36634257 DOI: 10.2196/40591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/07/2022] [Accepted: 01/12/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND China has implemented nationwide lockdown to contain COVID-19 from an early stage. Previous studies of the impact of COVID-19 on sexually transmitted diseases (STDs) and diseases caused by blood-borne viruses (BBVs) in China have yielded widely disparate results, and study on deaths attributable to STDs and BBVs are scarce. OBJECTIVE We aimed to elucidate the impact of COVID-19 lockdown on the cases, deaths, and case-fatality ratios of STDs and BBVs. METHODS We extracted the monthly cases and deaths data for AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C between January 2015 and December 2021 from the notifiable disease reporting database on the official website of the National Health Commission of China. We used descriptive statistics to summarize the number of cases and deaths, and calculated incidence and case-fatality ratios before and after implementing nationwide lockdown (January 2020). We used negative binominal segmented regression models to estimate the immediate and long-term impacts of lockdown on cases, deaths, and case-fatality ratios in January 2020 and December 2021, respectively. RESULTS A total of 14,800,330 cases and 127,030 deaths of AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C were reported from January 2015 to December 2021, with an incidence of 149.11/100,000 before lockdown and 151.41/100,000 after lockdown , and a case-fatality ratio of 8.21/1000 before lockdown and 9.50/1000 after lockdown . In the negative binominal model, AIDS cases (-23.4%; 0.766, 0.626-0.939) and deaths (-23.9%; 0.761, 0.647-0.896), gonorrhea cases (-34.3%; 0.657, 0.524-0.823), syphilis cases (-15.4%; 0.846, 0.763-0.937), hepatitis B cases (-17.5%; 0.825, 0.726-0.937) and hepatitis C cases (-19.6%; 0.804, 0.693-0.933) showed significant decreases in January 2020. Gonorrhea, syphilis and hepatitis C showed small increases in the number of deaths or case-fatality ratios in January 2020. By December 2021, the cases, deaths, and case-fatality ratios for each disease had either reached or remained below expected levels. CONCLUSIONS COVID-19 lockdown may have contributed to fewer reported cases of AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C, and more reported deaths or case-fatality ratios of gonorrhea, syphilis and hepatitis C in China. CLINICALTRIAL
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Affiliation(s)
- Xinsheng Wu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, P.R. China, Shenzhen, CN
| | - Xinyi Zhou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, P.R. China, Shenzhen, CN
| | - Yuanyi Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, P.R. China, Shenzhen, CN
| | - Ke Zhai
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, P.R. China, Shenzhen, CN
| | - Ruoyao Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, P.R. China, Shenzhen, CN
| | - Ganfeng Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, P.R. China, Shenzhen, CN
| | - Yi-Fan Lin
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, P.R. China, Shenzhen, CN
| | - Yuwei Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, P.R. China, Shenzhen, CN
| | - Chongguang Yang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, P.R. China, Shenzhen, CN
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China, No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, P.R. China, Shenzhen, CN
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Kinaan W, Soares P, Rocha JV, Boto P, Santana R, Lopes S. The Pandemic-Related Factors Associated with Emergency Department Visits in Portugal throughout Two Years of the Pandemic: A Retrospective Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1207. [PMID: 36673960 PMCID: PMC9858921 DOI: 10.3390/ijerph20021207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic has affected the use of emergency departments (ED) worldwide. This study identifies the pandemic-related factors associated with the number of ED visits in mainland Portugal and each of its regions. We collected data on ED visits from March 2020 to March 2022. Data on incidence, vaccination, mobility, containment index, and Google search volume were retrieved from open online sources at different time points. We fitted a quasi-Poisson generalized linear regression model, and each variable was modeled separately and adjusted for time and month. There was a positive ED trend throughout the two years of the pandemic in mainland Portugal and each of its regions. In the mainland, during months with high workplace mobility, there were 10.5% more ED visits compared to months with average mobility. ED visits decreased in months with low mobility for retail and recreation, groceries and pharmacies, and transit compared to months of medium mobility. Portugal saw a reduction in ED utilization during the pandemic period, but with a positive trend from March 2020 to March 2022. The change in the population's behavior of seeking the ED throughout the pandemic might be associated with mobility, incidence, and pandemic fatigue.
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Affiliation(s)
- Walaa Kinaan
- NOVA National School of Public Health, NOVA University Lisbon, 1600-560 Lisboa, Portugal
| | - Patrícia Soares
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), NOVA University Lisbon, 1600-560 Lisboa, Portugal
| | - João Victor Rocha
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), NOVA University Lisbon, 1600-560 Lisboa, Portugal
| | - Paulo Boto
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), NOVA University Lisbon, 1600-560 Lisboa, Portugal
| | - Rui Santana
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), NOVA University Lisbon, 1600-560 Lisboa, Portugal
| | - Sílvia Lopes
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), NOVA University Lisbon, 1600-560 Lisboa, Portugal
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Zhang X, Yin R, Zheng M, Kong D, Chen W. Impact of COVID-19 on health services utilization in mainland China and its different regions based on S-ARIMA predictions. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001044. [PMID: 36962843 PMCID: PMC10021243 DOI: 10.1371/journal.pgph.0001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/28/2022] [Indexed: 06/18/2023]
Abstract
Global health services are disrupted by the COVID-19 pandemic. We evaluated extent and duration of impacts of the pandemic on health services utilization in different economically developed regions of mainland China. Based on monthly health services utilization data in China, we used Seasonal Autoregressive Integrated Moving Average (S-ARIMA) models to predict outpatient and emergency department visits to hospitals (OEH visits) per capita without pandemic. The impacts were evaluated by three dimensions:1) absolute instant impacts were evaluated by difference between predicted and actual OEH visits per capita in February 2020 and relative instant impacts were the ratio of absolute impacts to baseline OEH visits per capita; 2) absolute and relative accumulative impacts from February 2020 to March 2021; 3) duration of impacts was estimated by time that actual OEH visits per capita returned to its predicted value. From February 2020 to March 2021, the COVID-19 pandemic reduced OEH visits by 0.4676 per capita, equivalent to 659,453,647 visits, corresponding to a decrease of 15.52% relative to the pre-pandemic average annual level in mainland China. The instant impacts in central, northeast, east and west China were 0.1279, 0.1265, 0.1215, and 0.0986 visits per capita, respectively; and corresponding relative impacts were 77.63%, 66.16%, 44.39%, and 50.57%, respectively. The accumulative impacts in northeast, east, west and central China were up to 0.5898, 0.4459, 0.3523, and 0.3324 visits per capita, respectively; and corresponding relative impacts were 23.72%, 12.53%, 13.91%, and 16.48%, respectively. The OEH visits per capita has returned back to predicted values within the first 2, 6, 9, 9 months for east, central, west and northeast China, respectively. Less economically developed areas were affected for a longer time. Safe and equitable access to health services, needs paying great attention especially for undeveloped areas.
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Affiliation(s)
- Xiangliang Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Rong Yin
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Meng Zheng
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Di Kong
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
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Wang Z, Tang Y, Cui Y, Guan H, Cui X, Liu Y, Liu Y, Kang Z, Wu Q, Hao Y, Liu C. Delay in seeking health care from community residents during a time with low prevalence of COVID-19: A cross-sectional national survey in China. Front Public Health 2023; 11:1100715. [PMID: 36895687 PMCID: PMC9989024 DOI: 10.3389/fpubh.2023.1100715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
Background The pandemic of COVID-19 has significant implications on health resources allocation and health care delivery. Patients with non-COVID illness may have to change their care seeking behaviors to mitigate the risk of infections. The research aimed to investigate potential delay of community residents in seeking health care at a time with an overall low prevalence of COVID-19 in China. Methods An online survey was conducted in March 2021 on a random sample drawn from the registered survey participants of the survey platform Wenjuanxing. The respondents who reported a need for health care over the past month (n = 1,317) were asked to report their health care experiences and concerns. Logistic regression models were established to identify predictors of the delay in seeking health care. The selection of independent variables was guided by the Andersen's service utilization model. All data analyses were performed using SPSS 23.0. A two-sided p value of <0.05 was considered as statistically significant. Key results About 31.4% of respondents reported delay in seeking health care, with fear of infection (53.5%) as a top reason. Middle (31-59 years) age (AOR = 1.535; 95% CI, 1.132 to 2.246), lower levels of perceived controllability of COVID-19 (AOR = 1.591; 95% CI 1.187 to 2.131), living with chronic conditions (AOR = 2.008; 95% CI 1.544 to 2.611), pregnancy or co-habiting with a pregnant woman (AOR = 2.115; 95% CI 1.154 to 3.874), access to Internet-based medical care (AOR = 2.529; 95% CI 1.960 to 3.265), and higher risk level of the region (AOR = 1.736; 95% CI 1.307 to 2.334) were significant predictors of the delay in seeking health care after adjustment for variations of other variables. Medical consultations (38.7%), emergency treatment (18.2%), and obtainment of medicines (16.5%) were the top three types of delayed care, while eye, nose, and throat diseases (23.2%) and cardiovascular and cerebrovascular diseases (20.8%) were the top two conditions relating to the delayed care. Self-treatment at home was the most likely coping strategy (34.9%), followed by Internet-based medical care (29.2%) and family/friend help (24.0%). Conclusions Delay in seeking health care remained at a relatively high level when the number of new COVID-19 cases was low, which may present a serious health risk to the patients, in particular those living with chronic conditions who need continuous medical care. Fear of infection is the top reason for the delay. The delay is also associated with access to Internet-based medical care, living in a high risk region, and perceived low controllability of COVID-19.
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Affiliation(s)
- Ziyu Wang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Yurong Tang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Yu Cui
- School of Health Management, Harbin Medical University, Harbin, China
| | - Hanwen Guan
- School of Health Management, Harbin Medical University, Harbin, China
| | - Xiaoqian Cui
- School of Health Management, Harbin Medical University, Harbin, China
| | - Yuan Liu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Yanni Liu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Zheng Kang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Yanhua Hao
- School of Health Management, Harbin Medical University, Harbin, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Impact of the COVID-19 pandemic lockdown on hospitalizations for cerebrovascular disease and related in-hospital mortality in China: A nationwide observational study. Arch Gerontol Geriatr 2023; 104:104832. [PMID: 36219895 PMCID: PMC9531358 DOI: 10.1016/j.archger.2022.104832] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this nationwide study was to assess the impact of the COVID-19 pandemic on cerebrovascular disease hospitalization rates, out-of-pocket rates, and in-hospital case fatality rates. METHODS All hospitalizations for cerebrovascular disease from 1599 hospitals from 2019 to 2020 were selected using the International Classification of Diseases, 10th revision, in the Hospital Quality Monitoring System (HQMS). We defined 2019 as the pre-pandemic group and 2020 as the post-pandemic group. Multivariate analyses were done to assess the association between the pandemic and patient outcomes and out-of-pocket rate with odds ratios (OR) and 95% CIs presented. RESULTS In total, 9 640 788 patients with the cerebrovascular disease were recruited (mean age was 65.7[SE.0.004] years, and 55.7% were male), and data is available for 5145358 patients in 2019 (pre-epidemic) and 4495430 patients in 2020(post-pandemic), indicating a 12.6% decrease. Out-of-pocket rate increase of 9.3% (2020 vs 2019: 34.1%% vs 31.2% [absolute difference, 2.9% {95% CI, 1.3% to 4.5%}, odd ratio {OR}, 1.1{95% CI, 1.0 to 1.1}]. The epidemic has led to an 18.0% increase in in-hospital mortality (2020 vs 2019: 1.1%% vs 0.9% [absolute difference, 0.2% {95% CI, 0.1% to 0.2%}, odd ratio {OR}, 1.1{95% CI, 1.1 to 1.2}]. The epidemic has led to significantly increased in-hospital mortality for patients with stroke but had no significant impact on other cerebrovascular diseases. CONCLUSIONS During the COVID-19 pandemic lockdown, patients hospitalized for stroke fell by 12.6%, and there were substantial increases in out-of-pocket rates (9.3%) and in-hospital case fatality rates (18.0%).
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Yang Y, Huang L, Yan H, Nicholas S, Maitland E, Bai Q, Shi X. Coping with COVID: Performance of China's hierarchical medical system during the COVID-19 pandemic. Front Public Health 2023; 11:1148847. [PMID: 37181683 PMCID: PMC10173579 DOI: 10.3389/fpubh.2023.1148847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Objective The COVID-19 pandemic has challenged the health system worldwide. This study aimed to assess how China's hierarchical medical system (HMS) coped with COVID-19 in the short-and medium-term. We mainly measured the number and distribution of hospital visits and healthcare expenditure between primary and high-level hospitals during Beijing's 2020-2021 pandemic relative to the 2017-2019 pre-COVID-19 benchmark period. Methods Hospital operational data were extracted from Municipal Health Statistics Information Platform. The COVID-19 period in Beijing was divided into five phases, corresponding to different characteristics, from January 2020 to October 2021. The main outcome measures in this study include the percentage change in inpatient and outpatient emergency visits, and surgeries, and changing distribution of patients between different hospital levels across Beijing's HMS. In addition, the corresponding health expenditure in each of the 5 phases of COVID-19 was also included. Results In the outbreak phase of the pandemic, the total visits of Beijing hospitals declined dramatically, where outpatient visits fell 44.6%, inpatients visits fell 47.9%; emergency visits fell 35.6%, and surgery inpatients fell 44.5%. Correspondingly, health expenditures declined 30.5% for outpatients and 43.0% for inpatients. The primary hospitals absorbed a 9.51% higher proportion of outpatients than the pre-COVID-19 level in phase 1. In phase 4, the number of patients, including non-local outpatients reached pre-pandemic 2017-2019 benchmark levels. The proportion of outpatients in primary hospitals was only 1.74% above pre-COVID-19 levels in phases 4 and 5. Health expenditure for both outpatients and inpatients reached the baseline level in phase 3 and increased nearly 10% above pre-COVID-19 levels in phases 4 and 5. Conclusion The HMS in Beijing coped with the COVID-19 pandemic in a relatively short time, the early stage of the pandemic reflected an enhanced role for primary hospitals in the HMS, but did not permanently change patient preferences for high-level hospitals. Relative to the pre-COVID-19 benchmark, the elevated hospital expenditure in phase 4 and phase 5 pointed to hospital over-treatment or patient excess treatment demand. We suggest improving the service capacity of primary hospitals and changing the preferences of patients through health education in the post-COVID-19 world.
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Affiliation(s)
- Yong Yang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Lieyu Huang
- Office of Policy and Planning Research, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Hao Yan
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China
- School of Economics and School of Management, Tianjin Normal University, Tianjin, China
- Newcastle Business School, University of Newcastle, Callaghan, NSW, Australia
| | - Elizabeth Maitland
- University of Liverpool Management School, University of Liverpool, Liverpool, United Kingdom
| | - Qian Bai
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, China
- National Institute of Traditional Chinese Medicine Strategy and Development, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Xuefeng Shi,
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Wu X, Wu G, Ma Y, Huang X, Yang Y, Cai Y, Luo G, Ma P, Qiao Y, Chen Y, Lin YF, Gao Y, Zhan Y, Song W, Wang Y, Wang R, Yang X, Sun L, Wei H, Li Q, Xin X, Wang L, Wang X, Xie R, Yang L, Meng X, Zhao J, Li L, Zhang T, Xu J, Fu G, Zou H. The impact of COVID-19 non-pharmaceutical interventions on HIV care continuum in China: An interrupted time series analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 29:100569. [PMID: 35966023 PMCID: PMC9365399 DOI: 10.1016/j.lanwpc.2022.100569] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND China implemented strict non-pharmaceutical interventions to contain COVID-19 at the early stage. We aimed to evaluate the impact of COVID-19 on HIV care continuum in China. METHODS Aggregated data on HIV care continuum between 1 January 2017 and 31 December 2020 were collected from centers for disease control and prevention at different levels and major infectious disease hospitals in various regions in China. We used interrupted time series analysis to characterize temporal trend in weekly numbers of HIV post-exposure prophylaxis (PEP) prescriptions, HIV tests, HIV diagnoses, median time intervals between HIV diagnosis and antiretroviral therapy (ART) initiation (time intervals, days), ART initiations, mean CD4+ T cell counts at ART initiation (CD4 counts, cells/μL), ART collections, and missed visits for ART collection, before and after the implementation of massive NPIs (23 January to 7 April 2020). We used Poisson segmented regression models to estimate the immediate and long-term impact of NPIs on these outcomes. FINDINGS A total of 16,780 PEP prescriptions, 1,101,686 HIV tests, 69,659 HIV diagnoses, 63,409 time intervals and ART initiations, 61,518 CD4 counts, 1,528,802 ART collections, and 6656 missed visits were recorded during the study period. The majority of outcomes occurred in males (55·3-87·4%), 21-50 year olds (51·7-90·5%), Southwestern China (38·2-82·0%) and heterosexual transmission (47·9-66·1%). NPIs was associated with 71·5% decrease in PEP prescriptions (IRR 0·285; 95% CI 0·192-0·423), 36·1% decrease in HIV tests (0·639, 0·497-0·822), 32·0% decrease in HIV diagnoses (0·680, 0·511-0·904), 59·3% increase in time intervals (1·593, 1·270-1·997) and 17·4% decrease in CD4 counts (0·826, 0·746-0·915) in the first week during NPIs. There was no marked change in the number of ART initiations, ART collections and missed visits during the NPIs. By the end of 2020, the number of HIV tests, HIV diagnoses, time intervals, ART initiations, and CD4 counts reached expected levels, but the number of PEP prescriptions (0·523, 0·394-0·696), ART collections (0·720, 0·595-0·872), and missed visits (0·137, 0·086-0·220) were still below expected levels. With the ease of restrictions, PEP prescriptions (slope change 1·024/week, 1·012-1·037), HIV tests (1·016/week, 1·008-1·026), and CD4 counts (1·005/week, 1·001-1·009) showed a significant increasing trend. INTERPRETATION HIV care continuum in China was affected by the COVID-19 NPIs at various levels. Preparedness and efforts to maintain the HIV care continuum during public health emergencies should leverage collaborations between stakeholders. FUNDING Natural Science Foundation of China.
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Affiliation(s)
- Xinsheng Wu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Guohui Wu
- Institute for AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, People's Republic of China
| | - Yanmin Ma
- Institute for AIDS/STD Control and Prevention, Henan Provincial Center for Disease, Zhengzhou, People's Republic of China
| | - Xiaojie Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yuecheng Yang
- Dehong Prefecture Center for Disease Control and Prevention, Dehong, People's Republic of China
| | - Yanshan Cai
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, People's Republic of China
| | - Ganfeng Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Ping Ma
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, People's Republic of China
- Tianjin Association of STD/AIDS Prevention and Control, Tianjin, People's Republic of China
| | - Ying Qiao
- No.2 Hospital of Huhhot, Huhhot, People's Republic of China
| | - Yuanyi Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Yi-Fan Lin
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Yanxiao Gao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Yuewei Zhan
- Talents and Discipline Office, Shenzhen People's Hospital, Shenzhen, People's Republic of China
| | - Wei Song
- Shenyang Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Yingying Wang
- Department of STD/AIDS Control and Prevention, Shijiazhuang Center for Disease Control and Prevention, Shijiazhuang, People's Republic of China
| | - Rugang Wang
- Dalian Public Health Clinical Center, Dalian, People's Republic of China
| | - Xuejuan Yang
- Department of Infectious Diseases, Yunnan Provincial Infectious Disease Hospital/Yunnan AIDS Care Center, Kunming, People's Republic of China
| | - Lijun Sun
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hongxia Wei
- Department of infectious disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Quanmin Li
- Infectious disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xiaoli Xin
- No.6 People's Hospital of Shenyang, Shenyang, People's Republic of China
| | - Lijing Wang
- Shijiazhuang Fifth Hospital, Shijiazhuang, People's Republic of China
| | - Xicheng Wang
- Department of Infectious Diseases, Yunnan Provincial Infectious Disease Hospital/Yunnan AIDS Care Center, Kunming, People's Republic of China
| | - Ronghui Xie
- Department of Infectious Diseases, Yunnan Provincial Infectious Disease Hospital/Yunnan AIDS Care Center, Kunming, People's Republic of China
| | - Lijuan Yang
- Department of Infectious Diseases, Yunnan Provincial Infectious Disease Hospital/Yunnan AIDS Care Center, Kunming, People's Republic of China
| | - Xiaojun Meng
- Emergency Management Office, Wuxi Municipal Center for Disease Control and Prevention, Wuxi, People's Republic of China
| | - Jin Zhao
- Shenzhen Center for Disease Control and Prevention, Shenzhen, People's Republic of China
- Corresponding authors: No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, PR China.
| | - Linghua Li
- Infectious disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China
- Corresponding authors: No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, PR China.
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
- Corresponding authors: No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, PR China.
| | - Junjie Xu
- Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, People's Republic of China
- Corresponding authors: No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, PR China.
| | - Gengfeng Fu
- Department of STD/AIDS Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, People's Republic of China
- Corresponding authors: No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, PR China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
- Corresponding authors: No. 66, Gongchang Road, Guangming District, Shenzhen, Guangdong 518107, PR China.
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Wei X, Yuan H, Sun Y, Zhang J, Wang Q, Fu Y, Wang Q, Sun L, Yang L. Health Services Utilization in China during the COVID-19 Pandemic: Results from a Large-Scale Online Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15892. [PMID: 36497964 PMCID: PMC9739892 DOI: 10.3390/ijerph192315892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Timely access to essential health services is a concern as COVID-19 continues. This study aimed to investigate health services utilization during the first wave of the pandemic in China. A cross-sectional online survey was conducted using a self-administrated questionnaire in March 2020. Descriptive statistics and logistic regression were used for data analysis. A total of 4744 respondents were included, with 52.00% reporting affected services utilization. Clinical testing (68.14%) and drug purchase (49.61%) were the most affected types. Higher education level, being married, chronic disease, frequently visiting a provincial medical institution, spending more time on pandemic-related information, perception of high-risk of infection, perception of large health impact of the pandemic, and anxiety/depression were significant predictors for reporting affected services utilization. For the 431 chronic disease respondents, 62.18% reported interruption, especially for drug purchase (58.58%). Affected health services utilization was reported during the first wave of the pandemic in China, especially for those with higher education level, chronic diseases, and COVID-19 related concerns. Enhancing primary healthcare, use of telehealth, extended prescription, and public communication were countermeasures undertaken by China during the rapid rise period. As COVID-19 progresses, the changing disease characteristics, adapted health system, along with enhanced public awareness/knowledge should be considered for the evolution of health services utilization, and further investigation is needed.
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Affiliation(s)
- Xia Wei
- School of Public Health, Peking University, Beijing 100191, China
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Haowen Yuan
- School of Public Health, Peking University, Beijing 100191, China
| | - Yan Sun
- School of Public Health, Peking University, Beijing 100191, China
| | - Jiawei Zhang
- School of Public Health, Peking University, Beijing 100191, China
| | - Qingbo Wang
- School of Public Health, Peking University, Beijing 100191, China
| | - Yaqun Fu
- School of Public Health, Peking University, Beijing 100191, China
| | - Quan Wang
- School of Public Health, Peking University, Beijing 100191, China
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Li Sun
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Li Yang
- School of Public Health, Peking University, Beijing 100191, China
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Dorjey Y, Tshomo Y, Wangchuk D, Bhandari P, Dorji C, Pradhan D, Pemo R, Wangdi P. Impact of COVID‐19 pandemic on reproductive, maternal, newborn, and child health care services in Phuentsholing General Hospital: A retrospective descriptive study. Health Sci Rep 2022; 5:e946. [PMCID: PMC9686349 DOI: 10.1002/hsr2.946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background COVID‐19 pandemic has derailed health care services. The health resources and manpower were prioritized and diverted to curb the COVID‐19 infections at the cost of routine medical services to the people. The impact of the COVID‐19 pandemic on maternal and child health is unknown. This study aimed to assess the impact of the Covid‐19 pandemic on maternal and child health care services in Phuentsholing General Hospital. Methods A descriptive retrospective study was conducted at Phuentsholing General Hospital from January 1 to June 30, 2022. The patient medical records were reviewed for the prepandemic years 2018, and 2019, and the pandemic years 2020, and 2021. The medical records of all the female patients and newborns who came to the Maternal and Child Health Unit (MCH), those who were admitted to the gynecology ward, and who underwent obstetrical and gynecological surgeries were reviewed. The data were analyzed using SPSS version 23. Descriptive statistics such as frequencies and percentages were used to describe the study variables. The line graph and bar graph were used to determine the trends and to compare the impact of COVID‐19 on MCH services between the pre‐pandemic and pandemic years. Results During the COVID‐19 pandemic, the total admission dropped by 10% to 14.4%; the total deliveries dropped by 16.1%; Cesarean section rate dropped to 12.9%; and fewer gynecological surgeries were performed (13.9% from 20.6%). There was a significant drop in antenatal and postnatal follow‐up visits (31.5% and 24.51%) respectively; Pap smear dropped by 93% and colposcopy by 52%. The overall immunization coverage has dropped drastically during the pandemic period. Conclusion The pregnant mothers and newborn babies missed antenatal and postnatal follow‐up visits, missed immunization, and women were not able to be screened for cervical cancers during the pandemic. These negative impacts of the COVID‐19 pandemic on maternal and child health care were profound.
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Platen M, Bohlken J, Hoffmann W, Kostev K, Michalowsky B. The long-term impact of the COVID-19 pandemic on primary and specialized care provision and disease recognition in Germany. Front Public Health 2022; 10:1006578. [PMID: 36466500 PMCID: PMC9712961 DOI: 10.3389/fpubh.2022.1006578] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
Background The COVID-19 pandemic and the imposed lockdowns severely affected routine care in general and specialized physician practices. Objective To describe the long-term impact of the COVID-19 pandemic on the physician services provision and disease recognition in German physician practices and perceived causes for the observed changes. Design Observational study based on medical record data and survey data of general practitioners and specialists' practices. Participants 996 general practitioners (GPs) and 798 specialist practices, who documented 6.1 million treatment cases for medical record data analyses and 645 physicians for survey data analyses. Main measures Within the medical record data, consultations, specialist referrals, hospital admissions, and documented diagnoses were extracted for the pandemic (March 2020-September 2021) and compared to corresponding pre-pandemic months in 2019. The additional online survey was used to assess changes in practice management during the COVID-19 pandemic and physicians' perceived main causes of affected primary and specialized care provision. Main results Hospital admissions (GPs: -22% vs. specialists: -16%), specialist referrals (-6 vs. -3%) and recognized diseases (-9 vs. -8%) significantly decreased over the pandemic. GPs consultations initially decreased (2020: -7%) but compensated at the end of 2021 (+3%), while specialists' consultation did not (-2%). Physicians saw changes in patient behavior, like appointment cancellation, as the main cause of the decrease. Contrary to this, they also mentioned substantial modifications of practice management, like reduced (nursing) home visits (41%) and opening hours (40%), suspended checkups (43%), and delayed consultations for high-risk patients (71%). Conclusion The pandemic left its mark on primary and specialized healthcare provision and its utilization. Both patient behavior and organizational changes in practice management may have caused decreased and non-compensation of services. Evaluating the long-term effect on patient outcomes and identifying potential improvements are vital to better prepare for future pandemic waves.
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Affiliation(s)
- Moritz Platen
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Jens Bohlken
- Institute for Social Medicine, Occupational Medicine, and Public Health (ISAP) of the Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald (UMG), Greifswald, Germany
| | | | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany,*Correspondence: Bernhard Michalowsky
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