gms | German Medical Science

Background and status of (inter)national research: During the cause of the COVID-19 pandemic several studies have reported a decline in utilisation of routine healthcare services, due to regulations as lockdown, ‘voluntary’ contact restriction and limited reachability.

Objective: The objective of this study was to estimate the magnitude and time course as well as the carrier of cancelled or postponed medical in- and outpatient appointments due to COVID-19.

Method: The Hamburg City Health Study (HCHS) is a large, population-based cohort study to gain essential insights into risk and prognostic factors for a wide range of major chronic diseases. The study comprises a random sample from the general population of Hamburg at the age of 45 to 74 years. With the beginning of the COVID-19 pandemic, a specific module was integrated into the study, including questions about doctors and hospitals visits that were postponed or cancelled due to the pandemic. Information were obtained by self-completion questionnaire for the period 05/20 to 11/21.

Results: Data of 2,566 participants were available for analysis (46 % female, mean age 55 yrs). From the 2,046 participants with valid answers, 19.8% reported at least one cancelled or postponed medical appointment. 313 persons (15.3%) stated that they made this decision on their own, even though an appointment was scheduled or they had health complaints. 7.4% reported, that the practice had cancelled a scheduled appointment.

Within the group of persons with cancelled or postponed visits, the majority refers to control or check-up examinations at the specialist’s practice: 41.2% initiated by patients, 42.0% by providers. Cancellation for dental practices represented a large group among patients (42.5%) but less among dentists (20.7%). General practices were each affected by < 20% (patients 18.5%; GP 12.0%).

Cancellation of inpatient treatments or surgical interventions by hospitals accounted for 14.7%. Avoiding emergency treatments was reported by < 1.5% of the participants. The highest proportion of cancellations was seen during autumn 2020 (25.0%).

Discussion: The finding that the pandemic leads to a decrease in utilisation of medical services is consistent with results from other studies. The main strength of the data from the HCHS COVID module is that they rise from a population-based cohort. Furthermore, primary survey data instead of secondary or proxy variables are presented. However, the attribution of change in utilisation to the pandemic represents a subjective assessment by the participants. Another potential limitation is that especially in the context of the pandemic a bias due to higher participation rates of younger, healthier persons cannot be ruled out.

Practical implications: The analysis of decreased healthcare utilisation and its impact on health outcomes, costs and equity may help to disentangle missed necessary care from avoiding unnecessary care.

Appeal for practice: Careful time-trend analyses are needed to evaluate the extent and quality of ongoing changes in utilisation especially with a view to the most vulnerable groups.

Funding: Sonstige Förderung