Characterization and Identification of Variations in Types of Primary Care Visits Before and During the COVID-19 Pandemic in Catalonia: Big Data Analysis Study

Abstract

Background The COVID-19 pandemic has turned the care model of health systems around the world upside down, causing the abrupt cancellation of face-to-face visits and redirection of the model toward telemedicine. Digital transformation boosts information systems—the more robust they are, the easier it is to monitor the health care system in a highly complex state and allow for more agile and reliable analysis. Objective The purpose of this study was to analyze diagnoses from primary care visits and distinguish between those that had higher and lower variations, relative to the 2019 and 2020 periods (roughly before and during COVID-19), to identify clinical profiles that may have been most impaired from the least-used diagnostic codes for visits during the pandemic. Methods We used a database from the Primary Care Services Information Technologies Information System of Catalonia. We analyzed the register of visits (n=2,824,185) and their International Classification of Diseases (ICD-10) diagnostic codes (n=3,921,974; mean 1.38 per visit), as approximations of the reasons for consultations, at 3 different grouping levels. The data were represented by a term frequency matrix and analyzed recursively in different partitions aggregated according to date. Results The increase in non–face-to-face visits (+267%) did not counterbalance the decrease in face-to-face visits (–47%), with an overall reduction in the total number of visits of 1.36%, despite the notable increase in nursing visits (10.54%). The largest increases in 2020 were visits with diagnoses related to COVID-19 (ICD-10 codes Z20-Z29: 2.540%), along with codes related to economic and housing problems (ICD-10 codes Z55-Z65: 44.40%). Visits with most of the other diagnostic codes decreased in 2020 relative to those in 2019. The largest reductions were chronic pathologies such as arterial hypertension (ICD-10 codes I10-I16: –32.73%) or diabetes (ICD-10 codes E08-E13: –21.13%), but also obesity (E65-E68: –48.58%) and bodily injuries (ICD-10 code T14: –33.70%). Visits with mental health–related diagnostic codes decreased, but the decrease was less than the average decrease. There was a decrease in consultations—for children, adolescents, and adults—for respiratory infections (ICD-10 codes J00-J06: –40.96%). The results show large year-on-year variations (in absolute terms, an average of 12%), which is representative of the strong shock to the health system. Conclusions The disruption in the primary care model in Catalonia has led to an explosive increase in the number of non–face-to-face visits. There has been a reduction in the number of visits for diagnoses related to chronic pathologies, respiratory infections, obesity, and bodily injuries. Instead, visits for diagnoses related to socioeconomic and housing problems have increased, which emphasizes the importance of social determinants of health in the context of this pandemic. Big data analytics with routine care data yield findings that are consistent with those derived from intuition in everyday clinical practice and can help inform decision making by health planners in order to use the next few years to focus on the least-treated diseases during the COVID-19 pandemic.

Impact of the COVID-19 pandemic on diagnoses of common mental health disorders in adults in Catalonia, Spain: a population-based cohort study

“…In Catalonia, two studies have found declines in new all-cause diagnoses and primary care visits associated with diagnoses related to chronic conditions 21 22. Both studies found moderate reductions in diagnoses of mental health conditions, which were lower than the ones observed for other diagnosis groups.…”

“…For instance, while the average decline in new all-cause diagnoses in 2020 compared with 2019 was 31.1%, the decline in mental health conditions was 27.5% 21. Although reductions have been reported across diagnostic groups,21 22 reductions in mental health diagnoses are particularly concerning as the effects of the pandemic have been estimated to account for an increase of 27.6% (95% CI 25.1 to 30.3) in cases of major depressive disorders and 25.6% (23.2 to 28.0) in cases of anxiety disorders globally in 2020 14. Indeed, the increased rates of anxiety and depressive disorders observed in our study during the first trimester of 2021 might be explained by the midterm effects of the pandemic on mental health, which could be gradually appearing, and the efforts of general practitioners (GPs) to adapt to the increasing demands for care.…”

Impact of COVID-19 on Hospital Admissions and Healthcare Quality Indicators in Non-COVID Patients: A Retrospective Study of the First COVID-19 Year in a University Hospital in Spain

“…A gradual reopening started on 2 May 2020 until 21 June 2020. During the first national lockdown, face-to-face visits in both primary care and specialised care were cancelled to avoid infections and were redirected to telemedicine [ 15 ]. In our centre, elective surgeries were cancelled on 16 March, and the workforce turned to attending to the increasing number of COVID-19 patients and urgent non-COVID diseases.…”

A Cost–Benefit Analysis of COVID-19 Vaccination in Catalonia

“…Third, it would be reasonable to adjust the cost for doses that will expire without being administered: in the absence of better approximations, it is observed that 5.6% of purchased doses have not yet been administered [27]. Fourth, the cost to the healthcare system caused by the underdiagnoses arising from mandatory closures has yet to be assessed, which, according to recent studies performed in Catalonia, could be substantial [30,31].…”