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Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

OBJECTIVES: To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic. DESIGN: Systematic review. ELIGIBILITY: Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services incl...

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Autores principales: Moynihan, Ray, Sanders, Sharon, Michaleff, Zoe A, Scott, Anna Mae, Clark, Justin, To, Emma J, Jones, Mark, Kitchener, Eliza, Fox, Melissa, Johansson, Minna, Lang, Eddy, Duggan, Anne, Scott, Ian, Albarqouni, Loai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969768/
https://www.ncbi.nlm.nih.gov/pubmed/33727273
http://dx.doi.org/10.1136/bmjopen-2020-045343
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author Moynihan, Ray
Sanders, Sharon
Michaleff, Zoe A
Scott, Anna Mae
Clark, Justin
To, Emma J
Jones, Mark
Kitchener, Eliza
Fox, Melissa
Johansson, Minna
Lang, Eddy
Duggan, Anne
Scott, Ian
Albarqouni, Loai
author_facet Moynihan, Ray
Sanders, Sharon
Michaleff, Zoe A
Scott, Anna Mae
Clark, Justin
To, Emma J
Jones, Mark
Kitchener, Eliza
Fox, Melissa
Johansson, Minna
Lang, Eddy
Duggan, Anne
Scott, Ian
Albarqouni, Loai
author_sort Moynihan, Ray
collection PubMed
description OBJECTIVES: To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic. DESIGN: Systematic review. ELIGIBILITY: Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19. DATA SOURCES: PubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact. DATA ANALYSIS: Risk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis. OUTCOME MEASURES: Primary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores). RESULTS: 3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference. CONCLUSIONS: Healthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery. PROSPERO REGISTRATION NUMBER: CRD42020203729.
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spelling pubmed-79697682021-03-19 Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review Moynihan, Ray Sanders, Sharon Michaleff, Zoe A Scott, Anna Mae Clark, Justin To, Emma J Jones, Mark Kitchener, Eliza Fox, Melissa Johansson, Minna Lang, Eddy Duggan, Anne Scott, Ian Albarqouni, Loai BMJ Open Health Services Research OBJECTIVES: To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic. DESIGN: Systematic review. ELIGIBILITY: Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19. DATA SOURCES: PubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact. DATA ANALYSIS: Risk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis. OUTCOME MEASURES: Primary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores). RESULTS: 3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference. CONCLUSIONS: Healthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery. PROSPERO REGISTRATION NUMBER: CRD42020203729. BMJ Publishing Group 2021-03-16 /pmc/articles/PMC7969768/ /pubmed/33727273 http://dx.doi.org/10.1136/bmjopen-2020-045343 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Health Services Research
Moynihan, Ray
Sanders, Sharon
Michaleff, Zoe A
Scott, Anna Mae
Clark, Justin
To, Emma J
Jones, Mark
Kitchener, Eliza
Fox, Melissa
Johansson, Minna
Lang, Eddy
Duggan, Anne
Scott, Ian
Albarqouni, Loai
Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review
title Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review
title_full Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review
title_fullStr Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review
title_full_unstemmed Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review
title_short Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review
title_sort impact of covid-19 pandemic on utilisation of healthcare services: a systematic review
topic Health Services Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969768/
https://www.ncbi.nlm.nih.gov/pubmed/33727273
http://dx.doi.org/10.1136/bmjopen-2020-045343
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