ObjectivesTo determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic.DesignSystematic review.EligibilityEligible 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 sourcesPubMed, 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 analysisRisk 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 measuresPrimary 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).Results3097 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.ConclusionsHealthcare 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 numberCRD42020203729.
We all want to base our healthcare decisions on trustworthy evidence. Yet the landmark 2009 Institute of Medicine report identified widespread financial conflicts of interest across medical research, education, and practice. 1 It highlighted that extensive industry influence may be jeopardising "the integrity of scientific investigations, the objectivity of medical education, the quality of patient care, and the public's trust in medicine." 1 Problem of financial dependence Research Financial dependence on commercial companies is common within research, and in the United States almost 60% of medical research is industry funded. 9 It's been shown repeatedly that published outcomes of industry sponsored studies tend to favour sponsors' products, creating a "sponsorship bias" in the evidence base that overplays benefits and underplays harms. 10 In 2013, research by the German Institute for Quality and Efficiency in
Recovering health systems can prioritise genuine need
Cochrane Database of Systematic Reviews lasted three years; outcomes were measured at the screening clinics during this time. There was no further follow-up. The purpose of the study was to investigate whether it was possible to conduct a larger trial, which was stopped by lack of funding. The first study was funded by the National Cancer Institute (US); the second, by Queensland Cancer Fund and Queensland Health (Australia). Key results There was no information from either study on the e ects of screening on total deaths, overdiagnosis from screening, or participant quality of life. The following outcomes were also not reported: deaths from skin cancer and false-positive/-negative rates (i.e. diagnosing a skin lesion as a melanoma when it is not present/not recognising a melanoma when it is present). Thus, we do not know whether screening for malignant melanoma results in any benefit, or whether such a possible benefit would be outweighed by harms of screening. General adult population screening for malignant melanoma is not supported or refuted by evidence from well-designed trials up to May 2018 and therefore does not fulfil accepted criteria for implementing screening programmes. Reliability of the evidence We could not assess the reliability of the evidence for our primary outcomes as they were not assessed.
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