Changes in care utilization by patients in low-income neighborhoods during two Covid-19 waves

BACKGROUND: During the COVID-19 pandemic, general practitioners’ face-to-face consultations were replaced by remote (telephone or digital) consultations. This study aims to gain insight into the impact of the COVID-19 pandemic on GP care and the suitability of remote GP care for patients living in low-income neighborhoods. METHODS: A follow-up study of GP patients in disadvantaged neighborhoods of Rotterdam, using questionnaires at T1, the outbreak of COVID-19 (N = 213) and T2, after one year with gradual easing of COVID-19 measures (N = 133). At T1 and T2, 56% and 61% respectively were female, 61% and 65% 50 years and over, 48% and 53% had low health literacy. RESULTS: The proportion of patients who used remote or other care, i.e. face-to-face care or contact with assistant (56% and 44% respectively) was at T2 similar to T1. A positive attitude toward remote care declined from T1 to T2 from 71% to 58%. At T1 use of remote care was associated with sex and age, with significantly more females using remote care (OR = 3.22, 95% C.I. 1.57 - 6.59) and less respondents 50 years and over using remote care (OR = 0.46, 95% C.I. 0.22 - 0.97). At T2, remote care use was associated with having a migration background (OR = 2.18, 95% 1.00 - 4.74), financial difficulties (OR = 0.30, 95% 0.11 - 0.81), lack of digital skills (OR = 2.73, 95% 1.19 - 6.26) and a chronic disease (OR = 0.40, 95% 0.19 - 0.87). At multivariate level, the associations of age and digital skills with remote care at both time points T1 and T2, compared to remote care only at T1 or T2 or no remote care, were confounded by chronic disease, with lower remote care use by those with a chronic disease (OR = 0.33, 95% 0.13 - 0.87). CONCLUSIONS: The COVID-19 pandemic rapidly accelerated the use of remote care in Dutch general practices. Experience after one year showed provision of GP remote care should be advised selectively for patients showing vulnerability, such as financial difficulties, low digital skills and chronic diseases. KEY MESSAGES: • At the start of the COVID-19 pandemic, patients were willing to receive GP care remotely and provision was depending on general characteristics sex and age. • Remote GP care is less suitable for vulnerable older patients, patients with financial difficulties and those with low digital skills or chronic diseases living in low-income neighborhoods.