Changes in primary care visits arising from the COVID-19 pandemic: an international comparative study by the International Consortium of Primary Care Big Data Researchers (INTRePID)

Abstract

IntroductionThrough the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID), we compared the pandemic impact on the volume of primary care visits and uptake of virtual care in Australia, Canada, China, Norway, Singapore, South Korea, Sweden, the UK and the USA.MethodsVisit definitions were agreed on centrally, implemented locally across the various settings in INTRePID countries, and weekly visit counts were shared centrally for analysis. We evaluated the weekly rate of primary care physician visits during 2019 and 2020. Rate ratios (RRs) of total weekly visit volume and the proportion of weekly visits that were virtual in the pandemic period in 2020 compared with the same prepandemic period in 2019 were calculated.ResultsIn 2019 and 2020, there were 80 889 386 primary care physician visits across INTRePID. During the pandemic, average weekly visit volume dropped in China, Singapore, South Korea, and the USA but was stable overall in Australia (RR 0.98 (95% CI 0.92 to 1.05, p=0.59)), Canada (RR 0.96 (95% CI 0.89 to 1.03, p=0.24)), Norway (RR 1.01 (95% CI 0.88 to 1.17, p=0.85)), Sweden (RR 0.91 (95% CI 0.79 to 1.06, p=0.22)) and the UK (RR 0.86 (95% CI 0.72 to 1.03, p=0.11)). In countries that had negligible virtual care prepandemic, the proportion of visits that were virtual were highest in Canada (77.0%) and Australia (41.8%). In Norway (RR 8.23 (95% CI 5.30 to 12.78, p<0.001), the UK (RR 2.36 (95% CI 2.24 to 2.50, p<0.001)) and Sweden (RR 1.33 (95% CI 1.17 to 1.50, p<0.001)) where virtual visits existed prepandemic, it increased significantly during the pandemic.ConclusionsThe drop in primary care in-person visits during the pandemic was a global phenomenon across INTRePID countries. In several countries, primary care shifted to virtual visits mitigating the drop in in-person visits.

Virtual family physician care during COVID-19: a mixed methods study using health administrative data and qualitative interviews

“…Virtual visit volumes increased dramatically within 2 weeks of the start of the pandemic and with the implementation by the Ontario MOH of special billing codes that reimbursed FPs for virtual care including telephone and video [ 7 ]. This rapid move to virtual care was found in other Canadian jurisdictions [ 30 ] and international jurisdictions such as Australia [ 31 , 32 ], the United States [ 32 , 33 ], and China, Norway, Singapore, South Korea, Sweden, and the United Kingdom [ 32 ].…”

Disruptions in Primary Care among People with Schizophrenia in Ontario, Canada, During the COVID-19 Pandemic

“…Billing codes were used to assess both access to care (i.e., no visit vs at least one visit) and intensity of service use (i.e., number of visits). As in previous studies using UTOPIAN EMR data, 16 , 22 visits were further classified based on format of care delivery (in-person or virtual). Four indices for quality of care were created to capture distinct services provided: (a) at least one test for hemoglobin A1c, (b) at least one test for LDL cholesterol, (c) at least one test for white blood cell count (as a measure of CBC tests), and (d) at least one blood pressure measurement.…”

Adverse events following first and second dose COVID-19 vaccination in England, October 2020 to September 2021: a national vaccine surveillance platform self-controlled case series study

“…It may represent a ‘healthy vaccinee effect’, a type of bias in which people who are unwell may avoid or delay vaccination [ 45 ]. General practice appointments dipped but then have recovered nearly back to normal following the COVID-19 pandemic, with a greater proportion of appointments taking place over the phone, which is a phenomenon that is observed both in the UK as well as globally [ 46 , 47 ]. We have seen no evidence to suggest that this would have differently affected the pre- and post-vaccination window.…”